Front Cover
 Table of Contents
 Post it
 Patient safety
 Emerging pathogens
 HIV's evolution
 New hope for hurt hearts
 Aging well
 Chili for a cause
 Learning from a legend
 Serving the underserved
 SCHIP woes
 Lost in translation
 Eye implant
 HIV/AIDS clinical trials
 Community nurse
 Back Cover


The Post
Full Citation
Permanent Link: http://ufdc.ufl.edu/UF00073869/00035
 Material Information
Title: The Post
Uniform Title: Post (Gainesville, Fla. 2001)
Physical Description: v. : ill. ; 28 cm.
Language: English
Creator: University of Florida -- Health Science Center
University of Florida -- Health Science Center. -- Office of Public Information
Publisher: HSC Office of Public Information
Place of Publication: Gainesville Fla
Creation Date: November 2007
Publication Date: 2001-
Frequency: biweekly
Subjects / Keywords: Health occupations schools -- Periodicals -- Florida   ( lcsh )
Genre: government publication (state, provincial, terriorial, dependent)   ( marcgt )
periodical   ( marcgt )
serial   ( sobekcm )
Statement of Responsibility: The University of Florida Health Science Center.
Dates or Sequential Designation: July 27, 2001-
General Note: Title from caption.
 Record Information
Source Institution: University of Florida
Rights Management: All rights reserved by the source institution and holding location.
Resource Identifier: oclc - 47826372
lccn - 2001229452
System ID: UF00073869:00035
 Related Items
Preceded by: Friday evening post (1989)


This item has the following downloads:

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Table of Contents
    Front Cover
        Page 1
    Table of Contents
        Page 2
    Post it
        Page 3
    Patient safety
        Page 4
        Page 5
    Emerging pathogens
        Page 6
    HIV's evolution
        Page 7
    New hope for hurt hearts
        Page 8
    Aging well
        Page 9
    Chili for a cause
        Page 10
    Learning from a legend
        Page 11
    Serving the underserved
        Page 12
        Page 13
        Page 14
        Page 15
    SCHIP woes
        Page 16
    Lost in translation
        Page 17
    Eye implant
        Page 18
    HIV/AIDS clinical trials
        Page 19
        Page 20
        Page 21
        Page 22
    Community nurse
        Page 23
    Back Cover
        Page 24
Full Text

Why UF is a safety
net for many in need

On the Cover

Nearly 47 million Americans lack health coverage and
even more lack access to regular health care. UF
students and faculty are trying to break down some of
the barriers that prevent people from getting the care
they need, though. UF nursing student Nikki Hughes
and her classmates visit the St. Francis House in
Gainesville every week to provide free screenings and
health information to people there.

Table of Contents

Administration: Patient safety
Research: Emerging pathogens
Research: HIV's evolution
Five questions: Aging well
Community: Chili for a cause
Education: Learning from a legend
Cover Story: Serving the underserved
Research: SCHIP woes
Jacksonville: Eye implant
Jacksonville: HIV/AIDS clinical trials
Grants: Putting minds together
Profile: Community nurse


College celebrates

nursing clinic's new digs
since its 2001 opening in a small historic house in Archer, Archer Family Health
Care has played a significant role in the community's health. Faculty and clinical
staff in the nurse-managed clinic handle more than 3,000 patient visits each year
and provide quality care to underserved adults, children and families in Alachua County
and surrounding areas.
On Oct. 12, the UF College of Nursing celebrated the clinic's recent move from that
tiny brick house to an expanded facility in downtown Archer that triples its space for
patient care. After a dedication and ribbon-cutting ceremony, visitors were offered tours.
Eighty-five percent of patients who come to Archer Family Health Care have a
household income 200 percent below the federal poverty level, and more than 50 percent
have no health insurance coverage. Tracy Brown Wright

The UF College of Nursing celebrated the Archer Family Health Care clinic's
recent move from a tiny brick house to an expanded facility in downtown Archer
last month. Barbara Frazier, a family nurse practitioner at the clinic, shows off one
of the new patient rooms to a community member.

Visit us online @ http://news.health.ufl.edu/ for the latest news and HSC events.

- -

2 Lfe IB




r T )f

Gators take Manhattan?
Christy Lemak Ph.D.. the Michael 0. and Barara Bice term
professor in the College of Pubhic Health and Health Professions
department ol health services resear: h. management and poli: v.
was visiting flew Tork City rer ently with her l-year-old
daughter. Maggie. when they spotted a restaurant that reminded
them ot hiume. The Mediterranean restdiurant in the SoHO
neighborhood was closed when they passed by so the pair was
unable to investigate it the restaurant had any UF connect tion. but
Leniak snapped this photo.

Promised land
On Oct 30, UF leader I Jlole 1 c l on the nl' Cog
Denti flJplt Ch[iilipn t Clini te notI Colleci n
othei C:ollege allrinsin l ns D a l~J iin Te l 0h lal n
Chili~e n and EldutclCon Founilialon utt 'hol e ioi P I e th Io
(celeb r e th c ,:i, I1 ot I n1, it
C'ini th SIai 1 O1 C ons 1tiiCn on the 20 000. -itti- .lool
C;lini on the cmptous ol Ellison College Thpe clinl i lt fnde
by o Sn5 65 ,i llion- l r mat.ie b the f.l. Ch:liip n ,intI-
E ul catiii oin Founialion, %'hC'h 1 h ec, oil 4 S- Million in c:litI
machinhyg luntit

2020, a Nurse Odyssey
i ,,S '36.3 ,n ,111,1 1114t n si t. c ll, Ai 5 blj3 s-: ill Jy 11. O 6 I ,vOlv ud n11111, 1 ng -
i n e t. Ti, tin d Do, oil, f./ Sir,,tl, i ii Siii' Le Adti slii. Cctilt, i nti. e ,III l held
S 17-18 it 1, UF Ht iiil, Pi ,tssicis il i P Ii ri, I CcIpie '.. T te conference

tcdu i ,L I I -I 36 I ut I I tit i Lt Iid Li u, I'.u'- uluttt551 t 6.i Ov It, rnL t -ilt t t LI/the year
2020. I,0 ded n l Ot, ti L t t ii t ill L i, d, sst I'o i it IL I it st d iti iti; t entds
I clattd to I ii t si' slin i1t iii si',] jtd t ilL iiid lie u1 i t ii iii tof patient
care. Also planned is a panel discussion on nurse work environments and strategies
to improve patient outcomes. To register for the conference, visit www.conferences.
ufl.edu/nur. For more information, call 352-273-6421.

Are you usually the first one to chime in when someone sings "Winter
Wonderland?" Do you know what note to hit during the "Five gold rings!"
part of "The Twelve Days of Christmas"? Then keep reading. Health Science
Center faculty, staff and students are invited to join the UF&Shands Singers,
who will perform a Shands Arts in Medicine-sponsored concert of holiday
songs at noon Dec. 7 in the Shands Atrium. Rehearsals will be held at 5 p.m.
on Tuesday beginning Nov. 13. For more information, e-mail Gail Ellison at



DTT: "

1 _77-'__1 11

Protecting patients

UF implements new patient quality

care and safety initiatives

By Melanie Fridl Ross

When Bruce C. Kone, M.D., became dean of the UF

College of Medicine in May, it was only a matter
of weeks before he issued "a call to action" for
new standards in performance across the board.

His vision? To build on existing excellence and to branch out with new initiatives as well,
many of them aimed at improving how UF teaches and trains students and residents,
enhancing faculty diversity, ensuring quality patient care and safety, and bolstering the
institution's research efforts.
Before arriving at UF, Kone already had an established track record of focusing on patient
care, including as care management medical director for a large teaching hospital, medical
director of three dialysis units in Houston and as a member of the National Quality Forum,
a public-private partnership created to develop and implement a national strategy for
health-care quality measurement and reporting.
So it was no surprise when he announced the UF College of Medicine would collaborate
with its hospital partners at Shands at UF, Shands AGH and the Malcom Randall Veterans
Affairs Medical Center to launch new programs aimed at cultivating a "culture of quality"
across the spectrum of patient care steps he hopes will position the organizations as
national leaders in this area.
Now, the recent death of a 3-year-old boy from a medication overdose has accelerated these
"I want us to practice unsurpassed health-care quality and safety and be leaders in
educating about and investigating new models for safer, more effective and more accessible
patient care," Kone said.
Earlier this year, Blue Cross and Blue Shield of Florida established a $3.5 million
endowment at UF to open the BCBSF Center for Health Care Access, Patient Safety and
Quality Outcomes, a gift that rose to $6.7 million with state matching funds. The center is
housed in the colleges of Nursing and Public Health and Health Professions and is working
to improve the health of Florida's citizens, uniting experts from a variety of disciplines,
including health services administration, nursing, health policy, medicine, pharmacy and
Together they will design and evaluate improved approaches to health-care access and
delivery and will pursue evidence-based research on topics such as attracting and retaining
well-prepared nurses to maximize patient safety and quality care outcomes, and financing
and delivering health care in a fiscally responsible manner to people who are underserved.
These steps, and others, can help to prevent patient deaths and reduce suffering while also
saving hundreds of thousands of dollars in unnecessary health-care costs.
As for Kone, he's committed to establishing the "UF System for Innovation in Patient
Safety, Education and Research," a clinical, educational and research "system" in quality
and patient safety based on lean-thinking principles, interdisciplinary teams, the continuum
of care from outpatient to inpatient, vertical integration of education from students to
faculty, information and simulation technologies, and facility modeling.
"This system would not only be an engine for innovation here, but would be an exportable
model that could be used in academic health centers nationally," Kone said.
In addition, plans include hiring a chief patient safety officer to help achieve the goal of
unsurpassed access, quality and safety of patient care in all patient-care settings, he said, and

Safety comes first
Last month one of our patients, a 3-year-old
child, died from a medication error. (See news.
health.ufl.edu for a complete account.) We
have chosen to work in health care to help our
patients, so the death of any one of them as the result
of an avoidable accident is a tragedy that torments all
of us at the University of Florida Health Science
Center and Shands HealthCare. This error, like most
medical errors, can be attributed to poorly designed
or insufficient safety systems. It is our responsibility
to put effective systems in place, to improve them
where they are wanting and to adhere to them once
established. Even as we do that, we must move
forward in our daily work, because there are many
other patients who depend on us for their care.
In response to this tragic death, the UF Physicians
group practice and Shands HealthCare have taken a
series of immediate and forceful steps to better ensure
patient safety in the outpatient setting going forward.
These steps can also be viewed on our Web site. But
other, more broad-based efforts are also under way,
and I wanted to bring your attention to them.
In the February 2007 issue of the POST, we told
you about a $3.5 million endowment provided by
Blue Cross and Blue Shield of Florida to create the
BCBSF Center for Health Care Access, Patient Safety
and Quality Outcomes in our colleges of Nursing
and Public Health and Health Professions. This
center will bring together experts from a variety of
disciplines to evaluate and improve the way we
deliver health care with an eye on safety.
In the article that accompanies this one, we
outline the plans of College of Medicine Dean Bruce
Kone a vision he expressed during his
recruitment last spring to introduce a rigorous
and innovative quality improvement initiative to
cultivate a culture of quality across our missions.
At some level, ensuring the safety of all our
patients is a responsibility each of us bears, which is
why it grieves us so when we fall short. We must all
do all that we can to prevent tragedies like the one
we just experienced from ever happening again.

Douglas Barrett M.D.
Senior vice president, health affairs

Visit us online @ http://news.health.ufl.edu/ for the latest news and HSC events.

I4 1e .iBm

- -


to ensure communication on these issues is integrated.
"Quality is no longer a self-proclaimed attribute of a health-care
organization. Today, health-care quality is numerically measured using
performance metrics, with comparisons made both at the organizational
and the individual physician level," said Michael Good, M.D., senior
associate dean for clinical affairs at UF's College of Medicine. "We are a
bit behind our peers in terms of numerically measured quality
performance, but Dean Kone brings to us the knowledge, personal
understanding and leadership vision to help us reshape our clinical care
processes such that they reliably deliver optimal, high-quality, evidence-
based care to each of our UF and Shands patients."
Efforts also include seeking ways to improve how medical students and
health-care practitioners are taught about and updated on preferred
practices. Developing groundbreaking research projects focused on quality
care and patient safety for both inpatients and outpatients also is a priority.
"With education I think it's important for trainees to learn about the
systems approach to how patient safety is best handled, how errors can be
measured and predicted and how continuous quality improvements are
pursued in the hospital and clinics, so they understand the methodology
and tools available," Kone said. "More importantly, though, we plan to use


the recent medication error tragedy as a highly visible and painfully
memorable example to teach our students and trainees the human
elements involved in medical errors and their aftermath, and to motivate
them to improve systems to eliminate such errors."
The notion dovetails with UF's longstanding commitment to the
development and use of simulation in medical education. Keeping patients
out of harm's way is a key driver of the growing interest in simulation.
Seven years ago, the Institute of Medicine produced its seminal report,
"To Err is Human," sounding the alarm on medical errors in health care.
But to really reduce errors, UF health administrators believe, it's
necessary to go upstream and provide better training to health
professionals in basic skills and, just as important, to assess how well those
skills have been learned. Major advances in computing, virtual reality and
microengineering are making that possible.
Nursing students start IVs on "trainer" arms. Plastic heads, their
mouths agape, await the probes and drills of dental students. Emergency
medicine and anesthesia residents sharpen their critical thinking and
resuscitation skills on the Human Patient Simulator, pioneered by UF

anesthesia faculty including Good in the mid-1980s. The lifelike
mannequin is programmed to mimic an array of illnesses, including
emphysema, heart failure and abnormal heart rhythms, and respond to
injected medications, changes in ventilation and other interventions.
Among its many benefits, simulation helps students learn how to
function as part of multidisciplinary teams and exposes them to enough
patients with the breadth of problems they will need to master before
entering practice.
Growing evidence also suggests that simulator-based interdisciplinary team
training may improve the quality of patient care, Good said. For example, a
European study of newborns published last year reported a significant
reduction in low Apgar scores and in brain injury caused by lack of oxygen
coinciding with the institution of structured, mandatory, simulator-based
team training for the entire interdisciplinary obstetrical team.
"Many UF COM faculty are already involved in education and research
projects involving patient simulation," Good said. "Dean Kone has made a
modern, state-of-the-art simulation learning center a priority for the
proposed health education building. Such a facility and the simulator-
based programs contained within will enable important advances in the
quality of both our clinical care and our educational programs."
To accomplish his objectives, Kone has reached out to faculty in
individual college departments as well as members of the UF Faculty Group
Practice, the UF College of Medicine Executive Committee, the UF and
Shands Medical Quality and Operations Committee, the College of
Medicine Alumni Board, members of the entering medical school Class of
2011, and Dean's Office employees and departmental administrative staff.
He has appointed a cadre of departmental physician quality and safety
officers to coordinate departmental and institutional quality improvement
activities. In addition, faculty members' annual evaluations will include a
quality and safety component, and financial incentives will be linked to
the provision of quality patient care.
"Rapid Cycle Teams" have been formed at Shands at UF to attack
clinical quality problems in real-time. The first two initiatives have sought
to eliminate ventilator-associated pneumonias and central venous line
infections. In addition, new processes for approving, implementing and
tracking intravenous infusions have been introduced in the outpatient
clinics to reduce the possibility of medication errors.
The Faculty Group Practice has also approved funding for installation of
an electronic medical record system in UF's ambulatory patient-care clinics.
"We want to try to develop innovative ways of using the electronic
medical record to prevent medical errors," Kone said.
On the research front, a poster session will be added to the college's
Research Day program. Dr. Eric Thomas, one of this year's recipients of
the John M. Eisenberg Patient Safety and Quality Awards from the
National Quality Forum and the Joint Commission on Quality and Patient
Safety, also has accepted an invitation to be the session's plenary speaker
and to review the college's goals, plans and procedures. The college has
begun funding intramural Clinical Quality Education Grants, promoting
faculty research in approaches to improve care.
Kone has also initiated a "Dean's Lecture Series on Advances in
Healthcare Access, Quality and Safety" that will feature lectures by
international experts in these areas. Dr. Garth Graham, deputy assistant
secretary for minority health in the Office of Minority Health at the
Department of Health and Human Services, has accepted the invitation to
launch the series in January.
"I am extremely grateful for, and proud of, the tireless efforts of the
leadership and faculty and house staff of the College of Medicine and our
partners in Shands HealthCare and the VA Medical Center in designing
and implementing these initiatives," Kone said. "We won't be satisfied
until we achieve our goals." O

Visit us online @ http://news.health.ufl.edu/ for the latest news and HSC events. 5





New director explains why studying pathogens

is still an important part of public health

ByJill Pease

As a youngster, J. Glenn Morris Jr.,
M.D., M.P.H., director of UF's new
Emerging Pathogens Institute, lived
in Bangkok, Thailand. It was the early 1960s
and the seventh pandemic of cholera was
moving rapidly through the city.

Dr. J. Glenn Morris discussed the importance of studying emerging
pathogens during a Sept. 28 lecture.

That experience watching the impact of a deadly waterborne
disease shut down a major city led to his career in emerging
pathogens research, said Morris, who later studied India's 1992
cholera epidemic and discovered the infection was a new strain, a
genetic recombination of earlier cholera disease.
In a lecture at the College of Public Health and Health
Professions on Sept. 28, Morris outlined public health's historical
and ongoing role in emerging pathogens.
"For me, public health is the key element of emerging pathogens
- it is the core," said Morris, who most recently served as interim
dean of the University of Maryland-Baltimore School of Public
"Public health, as a discipline, really arose because of emerging
pathogens," said Morris, adding that the nation's first health
department was established in Philadelphia in 1794 when the city
was in the throes of a yellow fever epidemic.
"The nature of mortality in the United States has changed over
the last 100 years," Morris said. "Now most deaths are caused by
non-infectious, chronic conditions. But the spike in infectious
disease caused by the influenza pandemic in 1918 leaves us with
this warning: While the major focus of public health prevention
needs to remain on chronic conditions, we cannot forget emerging
pathogens. They can have a major impact on the health of a
As Emerging Pathogens Institute director, Morris will oversee
the construction of the institute's 100,000-square-foot research
building and plans to bring together researchers from across the
university to develop the institute's research program.
"My goal is to bring faculty together to build a strong
interdisciplinary spirit and to play on each other's strengths,"
Morris said. "If you put them all together in one room and close
the door, it is amazing what can happen." 0



Ebola virus
Legionella pneumophila
Borrelia burgdorferi
HIV-1, HIV-2
Escherichia coli 0157:H7
Helicobacter pylori
Hepatitis C virus
Vibrio cholerae 0139:H7
Bartonella henselae
Sin nombre virus
Human herpesvirus-8
Influenza A (H5N1)
West Nile-like virus
SARS coronavirus

Major cause of infantile diarrhea
Ebola hemorrhagic fever
Legionnaires' disease
Lyme disease
Cause of AIDS
Toxic strain of E. coli
Major cause of peptic ulcers, gastric cancer
Bloodborne virus, causes hepatitis
New strain associated with epidemic cholera
Cat scratch fever
Hantavirus pulmonary syndrome
Kaposi's sarcoma
Bird flu
Severe acute respiratory syndrome

Source: The Journal of Infection

Visit us online @ http://news.health.ufl.edu/ for the latest news and HSC events.

- -

S6 'LIX~~C


The evolution

of a killer

Tracking HIV's genetic evolution

from birth to death

By Ann Griswold
U F scientists have discovered how HIV evolves over the course of a
person's lifetime into a more deadly form that heralds the onset of
full-blown AIDS. The findings could pave the way for new therapeutic
agents that target the virus earlier in the disease process, before it takes a
lethal turn, researchers say.

"We were very interested in understanding how the
virus mutates from the beginning of the infection until the
end," said Marco Salemi, Ph.D., an assistant professor of
pathology, immunology and laboratory medicine in the UF
College of Medicine and lead author on the study, which
appeared in an online issue of the journal PLoS ONE in
September. "Previously, the only thing known was that
somehow the HIV population mutates. And as soon as that
happens, patients start developing AIDS. But no one knew
how and where the population evolved over time."
To find out, UF researchers began tracking four children
born with HIV, studying blood samples taken at birth,
throughout life and just after death, when tissues samples
were also taken. Using a high-resolution computational
technique, they monitored mutations in a protein that
helps HIV attach to human cells and then categorized the
virus into two groups, R5 and X4. The R5 population is
usually present in high numbers during the early stages of
infection. But the X4 population enters the scene later, just
before HIV gives way to full-blown AIDS. The researchers
tracked the viruses in each patient to find out when and
where the telltale X4 population first appeared.
"The general dogma has always been that the X4 viruses
are more pathogenic than the R5 viruses. And that really
isn't true. People die from the R5 viruses," said Maureen
Goodenow, Ph.D., senior author of the paper and the
Stephany W. Holloway university chair for AIDS research
in the UF College of Medicine. "But certainly evolution of
these X4 viruses is not a good prognostic indicator. So if we
could understand the selective pressures that push viruses
to develop like that, and the steps involved in the
conversion of viruses, then we might be able to set up new
targets for drug development."
Previous studies have relied on cell culture or animal
models to follow the virus's mutations over time. The UF

researchers are among the first groups to study the
progression of HIV in human patients.
The origin of the X4 viruses has puzzled scientists for
years. The UF research reveals that the X4 viruses are not
present in the body all along, as some scientists had
speculated, but rather, that they evolve directly from the
R5 population just before the onset of AIDS. The
researchers also found that HIV followed a similar path in
each child, regardless of variations in the patients'
medical histories.
"We're starting to see what looks like a program of virus
development over time. And it doesn't matter who the
person is. And it doesn't matter what the time scale is,"
Goodenow said. "It's raising the possibility that, in fact,
the evolutionary track of the virus is not totally random.
There could be a real developmental program that the
virus goes through."
Eight years ago, when the National Institutes of Health-
funded study began, pregnant women infected with HIV
had few therapeutic options. Recent advances in prenatal
drug therapies have substantially decreased the rates of
mother-to-child transmission. The Centers for Disease
Control and Prevention estimates that less than 2 percent
of American mothers currently infected with HIV/AIDS
will transmit the viruses to their babies during birth.
Without the drugs, about 40 percent of infected mothers
would give birth to babies with HIV.
Those therapies may help future children, but they came
too late for the subjects enrolled in the study. The children
received minimal medication and all developed full-blown
AIDS by their first birthdays.
UF researchers hope their findings will pave the way for
new drugs that interfere with the virus' ability to evolve.
The next step, Goodenow said, will be to track the
evolution of HIV in adults before and after treatment. O

Visit us online @ http://news.health.ufl.edu/ for the latest news and HSC events.

11.d 7

-- ---



UF reseaichers test stem cell theiap\ in heart patients

By Melanie Fridl Ross

UF doctors on Oct. 3 treated their first

patient enrolled in a new study designed

to test whether injecting stem cells into

the heart helps restore blood flow to the organ by

prompting new blood vessels to grow.

UF researchers plan to test the
experimental therapy in people with severe
coronary artery disease and daily chest pain
who have not responded to traditional
medications or surgical procedures designed
to restore blood flow, such as angioplasty or
bypass surgery.
"The general idea is that by providing these
cells of blood vessel origin, we hope to either
generate new blood vessels from the growth of
these implanted cells or stimulate the heart to
regenerate new blood vessels from the cells
that reside in it," said study investigator Carl CARL J. PEPINE, M.D.
J. Pepine, M.D., chief of cardiovascular medicine
at UF's College of Medicine. "It's not completely clear whether it's the actual
cell itself that would do this or whether it's just the milieu and the chemical
signals that occur from the cells that would result in this."
Each year, nearly half a million Americans with heart disease experience
severe chest pain because coronary arteries and the smaller vessels that
supply oxygen-rich blood to the heart muscle become narrowed or blocked by
plaque deposits or clots. These blockages can trigger mini-heart attacks that,
while too small to be noticed as they occur, over time irreversibly damage the
heart, leading to disability, progressive heart failure or even death.
In the prospective, double-blind, placebo-controlled study, known as the
Autologous Cellular Therapy CD34-Chronic Myocardial Ischemia Trial, UF
researchers will study 15 Shands at UF medical center patients to determine
whether a person's own stem cells can be used to effectively and safely treat
chronic reductions in blood flow to the heart, improving symptoms and
long-term outcomes. They also will evaluate whether participants report

improved quality of life and exercise tolerance, and whether the heart
functions better.
Participants will undergo screening tests and then receive a series of
injections of a protein that releases stem cells from the bone marrow into the
bloodstream. The cells, known as CD34+ stem cells, help spur blood vessel
growth and are harvested from the patient during a procedure called
apheresis, said Chris Cogle, M.D., an assistant professor of medicine at the
UF's College of Medicine Program in Stem Cell Biology and Regenerative
Participants will then be randomly assigned to receive one of two dosing
levels of the cells, or a placebo.
"Physicians will use a catheter-based electrical mapping system to find
muscle they think is still viable but not functioning," said R. David
Anderson, M.D., an associate professor of medicine at UF and director of
interventional cardiology. "The cells are injected into viable sites in the
heart, which have poor blood flow, in the cardiac catheterization laboratory at
Shands at UF medical center."
Patients will be periodically evaluated by echocardiography and magnetic
resonance imaging over the course of a year after the procedure. Although to
date study subjects have tolerated this procedure well, potential risks include
infection, allergic reactions, bleeding, blood clots and damage to the heart or
its vessels.
UF is one of 20 research sites participating in the national study, which is
evaluating a total of 150 patients and is sponsored by the Cellular Therapies
business unit of Baxter Healthcare Corp. and led by principal investigator
Douglas Losordo, M.D., of Northwestern University's Feinberg School of
Medicine. Baxter makes the cell-sorting equipment used to isolate the cells
from the blood.
Douglas E. Vaughan, M.D., chief of the division of cardiovascular
medicine at Vanderbilt University Medical Center, said the study is
important and targets a challenging group of patients who need new options.
"There's a lot of enthusiasm in the cardiovascular community about the
potential of cell-based therapies for the treatment of cardiovascular diseases,"
Vaughan said, "and there is increasing experience around the world in using
bone marrow-derived stem cells in patients with cardiovascular disease.
There is growing confidence this is going to be a safe form of therapy, but
there are continuing questions about how effective it will be and what its
impact will be in individual patients." 0

Visit us online @ http://news.health.ufl.edu/ for the latest news and HSC events.




S8 1 ~~~ C

The secrets to

aging well?

Fewer calories,

more smiling


By Ann Griswold

Some things get better with age. The human
body isn't one of them. But it doesn't have to be
that way, says Christiaan Leeuwenburgh, Ph.D.,
chief of the division of biology of aging in UF's
Institute on Aging. Leeuwenburgh investigates
the problem of age-related muscle loss, or
sarcopenia, in a quest to find new solutions
to an old problem. An avid surfer, cyclist and
a former All-American pole vault champion,
Leeuwenburgh can't help but take his findings
seriously his future depends on it. Here's what
he has to say about health, longevity and the art
of aging gracefully.

Aubrey de Grey, a Cambridge University geneticist,
has predicted that the first person to live past age
1,000 is alive right now. Do you think that's possible?
(Laughs) Yeah, we know de Grey; we know what he said. He has some good aspects, but
he's a little extreme. I always say we need those extremes, but we also need basic scientists
to balance them out. People are making huge progress in the science of aging, but I think de
Grey's theory is a little far-fetched.

What do you consider the secret to longevity?
Dieting? Exercise? A positive attitude?
I think those three key concepts have been helpful in increasing health span. That's more
important than increasing the maximum life span, which is what Aubrey de Grey is trying to
do. Health span is more relevant. If you take the French lady, Jeanne Calment, she was 122
when she died. She obviously had a very positive attitude; you could see it from her smile in
her pictures. She was modestly active, she exercised past the age of 100 and she was very
independent. And she looked like she had a good French diet and enjoyed a nice glass of wine.

Your research shows low-calorie diets extend life by
reducing waste in older cells. But American diets are
expanding and our life spans continue to increase.
How long do you suppose we can go on like this?
You're right on the money. We can't keep doing this. Eventually, it's going to catch up.
People love food. I love food. But their intake is probably 50 to 60 percent above calorie
requirements for that day. All of the studies on longevity show you need to restrict the diets of
animals anywhere from 10 to 40 percent in a very controlled environment and then you see
an extension to longevity.
So the answer is yes, people are living longer, but people are also getting more obese. Some
people predict there's going to be a decrease in longevity. This might also impact future
generations, when children will have similar habits and live very indoor lifestyles. People need to
enjoy nature and interact with the outdoors. That is disappearing, and that's the saddest aspect.

Your findings suggest that oxidation within our
cells exacerbates the aging process. Does that
mean we should start eating more antioxidant-
laden foods, such as dark chocolate?
There are two ways to think about it. One is to boost your system with antioxidants and try
to alleviate the oxidative stress and apoptosis that accumulates. But I think it's much more
efficient to think in the other direction (by preventing the problem before it starts). It's kind of
like you have a fire in your cells. You can't just splash a couple drops of water on it and expect
to extinguish it. You really need to attack that internal fire. It comes down to people making
the right choices. Have a piece of fruit and go for periods of fasting a few times a week. If
you start doing that to begin with, then yes, some additional chocolate and herbs will be

What steps have you taken to extend
the span of your own life?
I enjoy a lot of outdoor activities, like mountain biking and running. And it's important to be
consistent in your nutritional intake. Again, you're getting fooled because every meal has
50 percent too many calories. So you've got to modify that. You've got to be strong, and
sometimes you've simply got to skip a meal and substitute a piece of fruit or juice for the
hunger you're experiencing. O

Visit us online @ http://news.health.ufl.edu/ for the latest news and HSC events. o 9


Recipe for a cure

UF, Harley-Davidson pair chili and motorcycles
to raise money for Parkinson's disease


Don't blame the turkey
oddling away from the table with a turkey-stuffed tummy on
Thanksgiving usually means one thing: Naptime is near.
Most of us link the post-Thanksgiving penchant for dozing off on
the couch to tryptophan, a sleep-inducing amino acid found in turkey. But
this "turkey coma" so many of us face after a big holiday meal actually has
more to do with everything else on your plate than the tryptophan in
Tryptophan can cause drowsiness, but it works best on an empty
stomach. The Thanksgiving tummy is anything but. Eaten alone, the
tryptophan in turkey can cause sleepiness, but the chemical doesn't fare
well when it shares stomach space with amino acids from other foods.
That's why experts believe Thanksgiving drowsiness is probably less a
turkey coma and more a "cranberry sauce, sweet potato, green bean
casserole, two pieces of pumpkin pie and turkey coma."
An overstuffed tummy has been shown to lead to increased drowsiness,
as does the wine that often accompanies a holiday meal. And a long day
spent cooking or traveling could also be part of what prompts the post-
meal nap.
Turkey isn't the only food with tryptophan that most of us eat regularly,
either. Beef and chicken contain just as much of the amino acid, and no
one ever complains of falling into a hamburger coma.
You may still need to snooze after a big Thanksgiving meal, but don't
blame it on the turkey when you curl up on the couch. 0
This first appeared on the UF-produced radio program Health in a Heartbeat.

a~t hewt be at

Health in a Heartbeat is a daily radio series that features
consumer health information and the latest news on medical
research, patient-care breakthroughs and health-care industry
trends. A production of our staff and WUFT FM Classic 89
and WJUF-FM Nature Coast 90, Health in a Heartbeat airs on
public radio stations in more than 55 markets in 18 states and
Washington, D.C. If you have a script idea, comments or would
like to subscribe to the Health in a Heartbeat weekly E-News,
e-mail smithkimOi ifl edll

By Lauren Edwards
J ust call it chili for a cause.
Scott Higginbotham wanted to find a way to aid in the fight against
Parkinson's disease, and he ended up with quite a tasty answer.
The owner of Capital City Harley-Davidson in Tallahassee, Higginbotham
helped create "Hawg Wild for a Cure," a fund through the UF Foundation.
Supporting Parkinson's disease research and education, Hawg Wild for a
Cure will be a major ingredient in the Harley-
Davidson Sixth Annual Chili Cookoff in
Gainesville Nov. 17.
Along with Frank Skidmore, M.D., a UF
assistant professor of neurology and director of
the Parkinson's Disease and Movement
Disorders Center at the Malcom Randall
Veterans Affairs Medical Center, Higginbotham
wants to help the 6 million people worldwide
who are living with Parkinson's, a progressive
neurological disease.
Money raised at the event will support
medical doctoral fellows and research. FRANK SKIDMORE, M.I
Organizers also hope to raise awareness about
the disease and encourage students to study it.
"I think that people have a sense that they would like to do something (to
help), and we would like to tap into that," Skidmore said.
Although most people are familiar with the motor symptoms of
Parkinson's such as stiffness, slowness and tremor lesser-known
non-motor effects such as depression, anxiety and sleep disorders are
common and can greatly impact patients' lives, too.
"Concentration, motivation, ability to manage stress and moods ... these
circuits are significantly affected," says Skidmore.
Higginbotham has funded a charter bus to bring Parkinson's patients from
The Villages, a large retirement community in Central Florida, to the
cookoff. A group of Harley riders will escort the bus.
The cookoff will take place from noon to 4 p.m. at Gainesville Harley-
Davidson & Buell and will benefit Hawg Wild for a Cure. There will be live
music, a raffle for a Harley-Davidson motorcycle and of course chili.
For more information, visit www.hawgwildcure.com. O

Visit us online @ http://news.health.ufl.edu/ for the latest news and HSC events.

101 er"iI

- -


From a .

William Enneking still draws a

crowd for annual seminar

By April Frawley Birdwell

William Enneking, M.D., hands over
a stack of pages, stapled together,
and leans back in his chair in the
suite of rooms named after him and William
Anspach, M.D., in the Medical Science
Building. The packet details the history of a
seminar he started for residents in 1963, back
when a pipe usually dangled from his lips.

"Fifteen years ago a student came up and said, 'My father took this
course in 1966,'" Enneking said. "We have had 14 second-generation
The course, a tutorial in tumor pathology, was designed in the days
when there were few orthopedics residency programs across the
Southeast and each of them generally had different strengths. Leaders
from these programs developed a system to send residents to other
schools to learn skills they lacked from those who specialized in them.
Enneking taught his specialty musculoskeletal pathology. This
allowed residents to learn pathology the science of studying changes
associated with disease from an orthopedics perspective. The
seminar was so successful that even after the need for the collaboration
between the residency programs dissolved in 1968, the seminar kept
going, with residents coming to UF from all across the country for the
weeklong course.
Last month, Enneking handed out his stapled history packet on the
course to students once again during the 44th Seminar on
Musculoskeletal Pathology.
The pipe is gone and Enneking is now a professor emeritus of
orthopaedics in the College of Medicine. But the seminar goes on,
though it has changed over the years. Residents now use computers
instead of microscopes and slides. Faculty members change the
material to keep the course fresh. And it's now held in the UF
Orthopaedics and Sports Medicine Institute.
"It may be the longest-running educational seminar in orthopedics,
mostly because of his influence," said Mark Scarborough, M.D., a UF
professor and division chief of orthopedic oncology in the College of

Dr. William Enneking started the Seminar in Musculoskeletal
Pathology for orthopedic residents 44 years ago.

Medicine who took the seminar as a medical student and again as a
resident. "He's an outstanding teacher."
Since its inception, 4,465 students and residents have taken the
semi-annual course. And Enneking actually presents much of the
material he covers at medical schools across the globe.
"I'll go anywhere there's good fishing," Enneking said, the corners of
his mouth curling into a smile.
He's only half joking.
"He's fished all over the world," said Scarborough, who is also
married to one of Enneking's daughters.
After serving in Korea, Enneking completed his medical residency
in orthopedics at the University of Chicago. Afterward, while working
at the University of Mississippi, he got a letter from another surgeon
who'd been a resident with him in Chicago. As the first head of surgery
for the new UF College of Medicine, Edward Woodward was trying to
recruit surgeons to the new program. Enneking and a few other former
University of Chicago residents bit.
"All the people from the University of Chicago were scattered around
different places so we thought let's get together and work down in
Florida," Enneking said.
At UF, Enneking became a legend in his field and among the
students and residents he taught. He developed a revolutionary
treatment to save limbs when surgeons are forced to cut away bone and
support tissue to remove tumors. He also developed a staging system
doctors use to classify the severity of bone and soft-tissue tumors.
Enneking also served as a UF team physician during the 1960s, as an
Alachua County School Board member and as a chair of dozens of
groups and committees.
Now, aside from the seminar and his talks across the globe, he still
teaches a small group of students and residents every Monday on
campus. And of course, he still fishes.
"I enjoy working with young people. I enjoy teaching," Enneking
said. "If I didn't like it, I'd quit. It's as simple as that." Q

Visit us online @ http://news.health.ufl.edu/ for the latest news and HSC events. o 11

n. Ca

Tax re.urnme;


Millions lack health
oy at insurance and access to care.
yve. The problems are many, but
S.F. UF faculty and students are
String to break down some
of these barriers.


Story by Amelia Beck
Photos by Sarah Kiewel
t was five minutes until 6 p.m. and nearly two
dozen people had lined up outside the
downtown building. Some limped, using
canes to steady themselves. Others cooed at
infants tucked in their arms.
"Sorry guys, we can only take 15 tonight,"
a man called from inside the doorway of the
UF Equal Access Clinic, a free student-run
clinic medical students and faculty hold every week.
Tammy Gunn stood 15th in line.
"Take my place, please," she said, offering her spot to a
mother waiting with her preteen daughter. "No ma'am," the
woman replied. "My daughter's healthy. You go ahead."
In the packed waiting room, Gunn beamed as she talked
about her wedding plans. The newly engaged 48-year-old
plans to sew her own dress and hopes her sons can come
from Wisconsin.
But as she shifted in her chair, her smile turned to a
grimace. She's been in pain for a week since slipping down
the stairs of her sister's backyard deck. It's the latest
addition to a list of ailments Gunn faces. She had to quit


Attn: I


K. ..-.. : :.:..
Tammy Gunn, a patient at the Equal Access Clinic, suffers from
chronic health problems that forced her to quit her job. She
subsequently lost her health coverage.

Visit us online @ http://news.health.ufl.edu/ for the latest news and HSC events.

S121 Be

- -


her job at the Family Dollar in 2002 because of her health and
subsequently lost her health insurance. She has been awaiting
approval for Social Security disability since March.
"It is scary," Gunn said of living without health insurance. "It took
me almost a year to find this place."
She is not alone.
For a variety of reasons economical, social, geographical,
cultural the United States, one of the world's most prosperous,
service-driven nations, is home to millions who don't have access to
regular health care.
In 2006, nearly 47 million Americans lacked health insurance,
according to a U.S. Census Bureau report. Florida ranks third in the
number of uninsured by state. Only New Mexico and Texas had more
uninsured residents in 2006.
"All of these numbers are awful," said Paul Duncan, Ph.D., director
of the Florida Center for Medicaid and the Uninsured at UF. "Health
insurance is a key financial ticket to accessing health care. Most
people who are uninsured are not getting the health care they need."
The problem is vast but faculty members and students from UF's
Health Science Center are working to break down these access-to-
care barriers. Teaming education with community outreach, UF has
established a number of safety-net resources for the uninsured and
underserved population in Gainesville and surrounding areas.
Nursing students educate the homeless about their health at the St.
Francis House. Medical students run the Equal Access Clinic. HSC
faculty and students volunteer in rural clinics across the area. Nurse
practitioners care almost exclusively for the underserved at a nurse-
managed clinic in Archer. There are so many programs for the
underserved that few HSC students leave UF without a firsthand
grasp of the issues.

Run by medical students under the supervision of UF College of
Medicine faculty, the Equal Access Clinic provides free health care to
Gainesville's poor and uninsured.

Alex Nguyen, a UF student working at the Equal Access clinic, checks
Tammy Gunn's blood pressure. Gunn, who does not have health coverage,
discovered the clinic about a year ago.

rlhc Barrier icr

) ising premiums, co-pay ents and deductibles have priced health
L insurance way beyond wh t many Americans can afford.
In the past, most workers : J on their employers for coverage. But
now employers, pressed to cove rising health insurance costs, are shifting
the burden to their employes or dropping coverage altogether. The
number of Americans :- i' irng L-.verage from government programs also
declined in 2006, the (Cnru, r!,p.". t states.
Lack of health insurance isn't the only barrier to health care, either.
People in rural areas face a shortage of providers, lack of public
transportation and long commutes to and from clinics. Those who do not
speak English face language barriers.
But if access to health care is bad, access to dental care is worse. A 2006
Centers for Disease Control and Prevention report shows for every one
adult without health insurance, there are three without dental insurance.
"Dental insurance is not universally available," said Micaela Gibbs,
D.D.S., an associate professor of community dentistry and director of
community-based programs in UF's College of Dentistry.
If dental insurance is not offered through an employer-based benefits
package, Americans are left to pay out of pocket for care, which can be
extremely costly, Gibbs said. Though Medicaid provides comprehensive
dental coverage for America's poorest children, it offers only minimal
coverage for adults.
And of the 9,464 practicing dentists in Florida, only 912 are active
Medicaid providers, according to a 2007 Florida Department of Health
Public Dental Health Program report. Some Florida counties don't have
dentists at all, Gibbs said.
"Unfortunately, dental care is just not considered a basic necessity,"
Gibbs said.

Visit us online @ http://news.health.ufl.edu/ for the latest news and HSC events. 13



G oing without proper medical and
dental care can mean risky business
for many A rr, ic n r
"If they J!. lucky, the basic consequences
are -.ihinril," said Duncan, also a professor
and chair of health services research,
management and policy in the College of
Public Health and Health Professions. "The
real issue arises when something bad
happens, and they have nowhere to go."
The uninsured are less likely to seek
preventive care and if certain conditions go
untreated, the consequences are serious.
"Health care can be miraculous," Duncan
said. "But if you don't have access to it, the
consequences can be deadly."
Periodontal disease has been linked to
heart disease, and, in the worst-case
scenario, an abscessed tooth can lead to
death, Gibbs said. Other consequences of
dental disease include missed work,
unemployment and low self-esteem.
Children often fare the worst, she added.
"Kids can't learn in school if dental pain
eclipses everything else," Gibbs said. "All of
our educators' work is undermined from
the start."

'lihe SafietN Nets,

n Thursday evenings, the Fa ily
P ctice Medical Group transfo ms
into th Equal Access Clinic, an enti ely
1luJLni-i un clinic that provides free hJIih
care to Gainesville's poor and uninsured.
UnirJ i I, u LI. iui.' n. fUF d.~ .I mrnJ iLJI
students assess and treat patients who come.
"This place is perfect for learning your
skills and refining your skills," said Logan
Schneider, a fourth-year medical student
and former co-director of the clinic. "Plus,
it kind of defines health care for me. To be
able to fulfill people's right to health care is
pretty awesome."
Hidden along a highway near Brooker,
the Alachua County Organization for Rural
Needs Clinic provides medical, dental and
psychological care to patients in need. Many
of the folks who come here live at or below
the federal poverty level. Getting to a bigger
city for care generally isn't an option. So far
in 2007, UF faculty and students from the
colleges of Medicine, Nursing, Dentistry

and Pharmacy have volunteered nearly
8,000 hours at the clinic, care valued at
more than $922,000.
"ACORN Clinic would not be the facility
it is today without the assistance of and the
collaboration with the University of
Florida," said Amy J. Davis, M.D., the
clinic's managing director. "Without them,
it would not exist."
Much of the HSC's service efforts would
not be possible without UF's Area Health
Education Centers Network, which funds
initiatives for HSC faculty and students to
volunteer in underserved areas. The
program also operates offices that provide
continuing education and training for
health-care providers in underserved areas.
"The efforts of UF and AHEC are trying
to fill a huge gap, and I think we have been
highly successful in getting resources out to
the underserved communities," said Larry
G. Rooks, M.D., a UF associate professor of
medicine and AHEC's medical director.
"Sometimes the attitude is 'they should to
come to us,' but I think sometimes it's up to
us to go to them."
In the past 25 years, nurse practitioners
have emerged as a driving force in filling
the nation's access-to-care void. UF College
of Nursing students and faculty are no
The Archer Family Health Care clinic, a
UF nurse-managed clinic, now provides
more than 3,000 patient visits each year.
About 85 percent of the clinic's patient
population earns below 200 percent of the
federal poverty level, and more than half do
not have health insurance, said Dee
Williams, Ph.D., the associate dean for
clinical affairs in the College of Nursing.
Established in a tiny brick building in 2001,
the clinic is now a nationally recognized
model for nurse-managed care.
The clinic also serves as a clinical
teaching site for more than 75 nursing and
pharmacy students each year.
"We hope that more of our students will
choose careers working in rural areas or
with the indigent," Williams said.

To see more photos from the Equal Access Clinic
and the..St Francis House, check out the back page.
~i~~i8~i~i~,~ R rLC CV* ILI~I4

Matthew Harris, 14, waits in the lobby of the Equal Access Clinic with his mother. The teen needed a
physical for school.

141 ol1 i

Visit us online @ http://news.health.ufl.edu/ for the latest news and HSC events.




fax re.,ume.

New clinic helps

gay youth in
A w. Jacksonville

.~~~;r* ..

UF nursing students visit the St. Francis House in Gainesville once
a week to provide health education and free screenings. Lauren
Williams, a senior nursing student, takes a man's blood pressure
during a recent visit.

As the need for dental -ji. grows and the number of
dentists who accept .AlJ i IJ lags, many Americans,
especially the poorer ones, are 'lI uigglirn to find affordable
dental care. But through its local and state clinics, UF's
College of Dentistry provides 10 percent of care to the state's
neediest patients.
"For a small dental school such as UF to provide 10 percent
is pretty huge," said Gibbs.
The College's Statewide Network for Community Oral
Health was established in 1997 to provide oral health services
to low-income and low-access populations in Florida. The
network, with facilities staffed by UF faculty, boasts clinics
in Jacksonville, St. Petersburg, Miami and soon, Naples.
The College also partners with six safety-net providers
across the state who allow UF dental students to volunteer in
their clinics for 20-day stints.
Between its UF at Shands and Eastside clinics, the College
of Dentistry's department of pediatrics also is the largest
Medicaid provider in North Central Florida, said Marcio
Guelmann, D.D.S., a UF associate professor and chair of
pediatric dentistry.
Guelmann said he encourages students to be sensitive to
the needs of the underserved.
"We encourage them to be Medicaid providers," he said.
"We don't train them just to be private-pay practitioners. We
train them to be aware of the situation and make space for
the underserved population."

WIThile some hope for a fundamental policy change
that would grant all Ame icans access to health
i ., in the meantime UF exp rts are committed to
Researching the source of the pik mhr
That's why UF researchers .!i leading The Florida
Health Insurance Study, whicAi will identify major
problem areas in hopes (.1 implmn ni ri a set of
programs to meet the needs of the uninsured.
In a separate study, UF researchers have been
contracted by the state Agency for Health Care
Administration to evaluate the effectiveness of
Medicaid reform in Florida over five years.
"Figuring out who the uninsured are and what their
characteristics are helps us understand how to design
programs to meet their needs," said Duncan, the study's
principal investigator. "Until we, as a nation, get a hold
of what we want to do, these efforts to find small,
incremental solutions to specific problems will remain
the direction we are headed. And they will always be
less than what is really needed."

Her visit to the Equal Access Clinic almost over, Gunn is relieved to learn her back is healing fine. Her
clinic visit was just the second time Gunn was able to get out of bed that week, so she says she's eager
to get back into the swing of things.
Most experts agree relying on safety-net providers isn't an ideal health-care system for patients. But for
the time being, it's all Gunn has.
"I'm just glad this place is here to help me out," she said with a smile. "And I don't mind being here for
the students to learn."






The boy is 16, gay and struggling to stay
safe in his neighborhood and
school. He has had several
boyfriends, a few scares and lots of questions.
One Friday afternoon he stopped by the
Jacksonville Area Sexual Minority Youth
Network clinic before hanging out with his
friends at the JASMYN house. There he talked
with the clinic's staff nurse and doctor and
discovered several things he could talk
openly about his questions and sexual behavior
without being judged or made to feel bad, and
he could find out if he had an infection. When
he found out he had gonorrhea, he could get
the medicine to treat it right away without
telling his mom and without having any
money to pay for it.
As the only youth service organization in
Northeast Florida for lesbian, gay, bisexual
and transgender youth, JASMYN's mission is
to build a safe space for LGBT youths ages
13-23, nurture their health and well-being, and
enhance their pride and self-esteem.
The UF College of Medicine-Jacksonville,
in partnership with the Duval County Health
Department, provides health services for these
youth. Under the direction of Steve Matson,
M.D., chief of adolescent medicine in the
department of pediatrics, UF helped open the
JASMYN clinic in May.
"Jacksonville has a very high rate of sexually
transmitted infections, with almost 5,000 teen
cases of chlamydia and gonorrhea each year,"
Matson said. "Many LGBT youth are not
accessing health services or are not accurately
sharing their sexual behavior with health
professionals because they're afraid of the
stigma or being harassed."
LGBT youth have traditionally been wary of
accessing health care, Matson said.
"Now they have a place that they know will
treat them with respect and provide much-
needed services in the Jacksonville
community," he said.
Since May, the clinic, which offers general
medical care and testing for HIV and other
sexually transmitted infections to Jacksonville
youth, has treated more than 30 patients.

Visit us online @ http://news.health.ufl.edu/ for the latest news and HSC events. o 15


The price of care

E\en minol cost changes affej SCHIP families

Dr. Sarosh Batlivala, a UF pediatrics resident, and other doctors at Shands AGH protested a presidential veto of a bill to expand the State Children's Health
Insurance Program last month during a 15-minute lunch hour "stand-up". UF researchers have found that even slight changes in the cost of the program can
affect families who rely on this insurance.

By April Frawley Birdwell

Raising monthly premiums by just $5 was

enough to push many low-income families out

of Florida's State Health Insurance Program in

2003, placing thousands of children at risk for being

uninsured, a new UF study shows.

Although slight, the premium increase reduced the amount of time the poorest
SCHIP-covered families stayed in the program by 61 percent, UF researchers report
in the October issue of the journal Health Services Research. The fluctuation in cost
also seemed to have a lasting effect on poorer families, who remained more likely to
drop out of the program even after the premium was restored to its original level.
"One of the things we found, in the time frame we looked at, is that it's difficult to
undo the effects of a premium increase," said Jill Boylston Herndon, Ph.D., a UF
health economist and the lead author of the research. "So it is very important to
weigh the different options for making program modifications against the potential
impact on enrollment."
SCHIP is often the only insurance option for children whose families do not
qualify for Medicaid and cannot afford private coverage. The program made
headlines in October when President Bush vetoed a bill to reauthorize and expand
the program. Lawmakers are now working on a revised version of the bill. Depending
on how much money is earmarked for the program, some states may raise premiums
or co-payments to compensate for budget deficits, Herndon said.
"What often happens when states face shortfalls is they look at ways to reduce
program costs, and one strategy may be to increase family cost-sharing," said
Herndon, a research associate professor with the Institute of Child Health Policy and
the department of epidemiology and health policy research in UF's College of
Medicine. "What this (research) demonstrates is if family cost-sharing were
increased, then we face children falling off the rolls and being at greater risk for being

U.S. lawmakers enacted the program in 1997 as a way to reduce the number of
uninsured children. For several years the number of children lacking health
insurance dropped, but shifted course in 2005 and has been increasing since then,
according to the U.S. Census Bureau. In 2005, 11 percent of children, about 8 million,
lacked coverage. Last year, 12 percent of children, or about 9 million, were uninsured.
To study how slight changes in cost would affect the program in Florida, UF
researchers examined enrollment data from more than 150,000 children who were
insured through the program in 2003 when the subsidized monthly premium was
raised from $15 to $20 per family. Herndon collaborated with UF researchers W.
Bruce Vogel, Ph.D., Richard Bucciarelli, M.D., and Elizabeth Shenkman, Ph.D., on
the study.
The researchers divided the children into two groups based on income. Families in
the lower-income group, whose household incomes ranged from $18,000 to $27,000
for a family of four, were most affected by the change. Prior to the increase, children
in these families were enrolled in the program for an average of 53 months. The
premium hike reduced that by 61 percent to about 21 months immediately after the
change. Families with slightly higher incomes, between $27,000 and $37,000 for a
family of four, were affected too. The average enrollment length among these families
dropped 55 percent, from 61 months to 27 months.
"What was striking is how rapid the changes in enrollment were in response to
changes in policy," said E. Richard Brown, Ph.D., the director of the University of
California-Los Angeles Center for Health Policy Research. "It shows we need to be
very careful with these policies. We need to be thinking about the families and
children affected.
"If we increase the cost and kids are dropped, we're really missing the important
goal of why we developed SCHIP in the first place, which is to ensure children have
health coverage and access to care."
Research from other institutions has shown that many children who drop SCHIP
often remain uninsured, Herndon added.
"They may stay uninsured for significant periods of time, which means they're
going to have reduced access to care," she said. "They're more likely to not get care,
have delays in care and have unmet health-care needs." Q

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S16 1 IX ~

Lost in


Regional, language differences affect

Hispanics' health-care experiences

ByJill Pease

H ispanics face multiple barriers to health care,
but their experiences in the health-care
system can vary widely by language and

new UF study.

In the study of Hispanics enrolled in Medicare-
managed care programs, Spanish-speaking patients
reported more negative experiences with care than
did English-speaking Hispanic patients. However,
Spanish speakers in Florida were more satisfied
with their health-care experiences than their peers
in California and the New York/New Jersey region
- a finding that could be attributed to the "Miami
effect." The results appeared in the October issue of
the journal Health Services Research.
"Eighty-six percent of the Spanish-speaking
survey respondents from Florida live in the Miami
area, the U.S. city with the highest proportion of ROBERTWEECH-MALDONADO, Ph.E
Hispanic residents," said lead investigator Robert
Weech-Maldonado, Ph.D., an associate professor in the department of health
services research, management and policy at the College of Public Health and
Health Professions. "Spanish is one of the primary languages in Miami and there
is an excellent network of Spanish-speaking health providers."
The study is the first to examine health-care experiences of Hispanics a
population vulnerable to health disparities by regional and language
The Medicare-managed care program, known as Medicare Advantage, was
designed to give beneficiaries the option of enrolling in a variety of private plans,
including health maintenance organizations, or HMOs, and preferred provider
organizations, or PPOs. Patients' out-of-pocket costs associated with the Medicare
Advantage plans are relatively lower than those associated with traditional
Medicare. Although most Medicare recipients use the traditional fee-for-service
program, about 5 million Medicare beneficiaries were enrolled in the managed
care program in 2004, according to the Kaiser Family Foundation. More than 50
percent of enrollees were Hispanic.
UF researchers analyzed data from the Consumer Assessments of Healthcare
Providers and Systems Medicare managed care survey, conducted in 2002. The
survey focused on five aspects of care: timeliness of care, provider communication,
office staff helpfulness, getting needed care and health plan customer service. Of
the more than 125,000 Medicare-managed care recipients who completed the
survey, 7 percent, or 8,463, identified themselves as Hispanic. The survey was
available in English and Spanish.

Hispanic English speakers reported more negative experiences than whites for
all aspects of care except provider communication. Hispanic Spanish speakers
had more negative experiences than whites with timeliness of care, office staff
helpfulness and provider communication, suggesting language barriers in the
clinical setting.
However, the researchers were surprised to find that Hispanic Spanish speakers
reported more positive experiences with getting needed care than their English-
speaking counterparts.
"This was an unexpected result; we haven't found this in other studies," Weech-
Maldonado said. "We speculate that Spanish-speaking Hispanics, who may be
less acculturated, could be more tolerant of the managed care practices because
they are less familiar with the U.S. health-care system."
Overall, the UF study demonstrates that differences in Hispanics' health-care
experiences exist and there is room for improvement, especially given the regional
differences, Weech-Maldonado said.
"Our study suggests that managed care companies should implement quality
improvement programs to reduce disparities in patient experiences with care, and
one area they can target is interpreter services," he said, adding that the Hispanic
Spanish speakers in the survey were more likely than English speakers to rate
their health as fair or poor. "Managed care health plans cover a well-diversified
population, so it is important for them to look at disparities in care." Q

Visit us online @ http://news.health.ufl.edu/ for the latest news and HSC events. 17

geographical area, according to a


rare eye disease

By Patricia Bates McGhee

Most people have never heard of retinitis pigmentosa, a rare hereditary disease

that affects fewer than 200,000 people in the United States. But for families who
are affected by this condition, the prognosis is devastating: RP steals sight and
there's no treatment or cure.

Not yet, anyway. Sandeep Grover, M.D., an assistant
professor of ophthalmology in the UF College of
... Medicine-Jacksonville, is one of three state researchers
i h ..i.t w testing an implant packed with a type of growth factor to
see if it will keep cells in the eye from deteriorating
during RP. UF is one of only 12 centers participating in
the national clinical trial, which Neurotech USA is
Grover describes RP's complex course in simple terms.
"In the eye, the retina is like film in a camera, and the
two types of cells in the retina that help us to see are the
rods and cones," he said. "The rods help us see at night,
and the cones help us see in daylight and identify colors.
Sa"The rods and cones are like antennas on old TV sets,
and if these antennas are broken, you don't get a good
picture on the TV," he explained. "So if enough rods and
cones degenerate, then vision quality and center vision
Goes down.
S/ "For those who inherit RP, cell death is pre-
programmed and starts the day they're born. How fast it
progresses differs in different people, but slowly these
.,I rods and cones degenerate," Grover added. "These
c patients start having problems with night vision first, then
their peripheral vision, and finally their center vision. A
majority of them are legally blind by age 40."
.. Researchers are looking at different ways to save these
photoreceptor cells, Grover said.
Dr. Sandeep Grover is one of three state researchers testing an eye implant that One way to save the cells is to replenish the eye with
could help patients with retinitis pigmentosa, a rare hereditary disease, naturally occurring proteins called growth factors, which
scientists think may help rods and cones to survive or
maybe, even improve, Grover said.
"That is something we don't know yet, but for at least
two decades we have known about a certain kind of growth factor called CNTF or ciliary neurotrophic factor that is probably one of
the best growth factors for the rods and the cones," he said. "But the problem was how to get it into the eye.
"Injecting it into the blood doesn't work because the blood-retina barrier prevents anything from getting into the retina; and, directly
injecting it in the eye may be toxic to the rods and cones, and then you've lost the game," Grover explained. "So you've got to give a
sustained release of a known concentration of CNTF somehow, and that's what took all this time."
Neurotech USA, a biotechnology company based in Lincoln, R.I., developed a sustained delivery method called encapsulated cell
technology. The ECT implant is a very small hollow tube just 6 millimeters long, like the tip of a pencil with pores in it and live cells
inside the tube. These cells secrete CNTF at a constant rate that diffuses through these pores into the eye.
As part of the phase 2 study, Grover is studying the implant for its efficacy in patients. The implant will be in place for one year and then
removed, but patients will be followed for an additional six months to ensure problems don't occur.
Every month, Tom Harcz's wife, Deborah, drives him more than 400 miles from their home in Holly Springs, N.C., to Jacksonville so he
can participate in the study.
"It gives us hope and it gives hope to our family members who could develop the disease, too," he said. "I feel like I'm losing my vision
quickly at this point, but with this study maybe I'm not and that's exciting."
Grover is hopeful, too. "We are hoping for the best because this is the first treatment trial ever for this almost blinding disease," he said.
"It makes sense to do it, and with this new ECT technology we are all cautiously optimistic about it." 0

S181 ol in

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Grant to support HIV/AIDS clinical trials

By Patricia Bates McGhee

Jacksonville recently received $5 million from the National Institutes of
he chief of pediatric infectious diseases at the UF College of Medicine-
Health to fund an international group focused on studying HIV/AIDS.
The money will go toward the International Maternal Pediatric Adolescent
AIDS Clinical Trials network, a cooperative group of institutions, investigators
and other collaborators organized to evaluate potential therapies for HIV
infection and the various medical conditions it can cause in infants, children,
adolescents and pregnant women, said Mobeen Rathore, M.D.
"What's really exciting is that we're participating in such a huge international -
effort, all under the auspices of the NIH," Rathore said. "We'll have direct .
access to a network that is probably the only 'place' for international t -i
collaboration that includes not only the U.S. but also Asia, Africa, the MOBEEN RATHORE, M.D.
Caribbean, North America and South America."
Researchers at these institutions will conduct various clinical trials for HIV-infected children,
adolescents and women, said Rathore, a principal investigator for Jacksonville's part of the study. The goal
of the multiple studies is to understand various aspects of pediatric, adolescent and perinatal HIV/AIDS.
"Directives will come from the National Institutes of Health, which will develop a road map for the
studies from which we, as a cooperative group of various international institutions and programs, will
develop research initiatives," he said. "We could study various and sundry things about HIV/AIDS new
drugs, new vaccines, complications, mental health, drug side effects, how to deal with the complications
those living with the disease experience."
The network's international emphasis and mission is a first in the study of HIV/AIDS.
Rathore hopes these studies will shed light on how HIV/AIDS affects adolescents.
"There's a lot of work to be done on adolescents because their issues are different," he said. "They're
getting pregnant and being infected behaviorally issues that the new grant will allow us investigate and
learn more about." Q

Around the city

in four days

Fifty-three community leaders from Wichita, Kan.,
spent four days in Jacksonville in September as part
of a region-to-region program to observe how other
metropolitan areas develop and implement
.. comprehensive growth plans.
Because the Wichita visitors were particularly
interested in Jacksonville's medical industry, they
spent a day on the Jacksonville campus meeting
with UF College of Medicine-Jacksonville and
Shands Jacksonville administrators. The campus visit
also included tours of the Florida Proton Therapy
Institute and the Center for Simulation Education &
Safety Research.

Visit us online @ http://news.health.ufl.edu/ for the latest news and HSC events. a o 19



associate director of UF's
Orthopaedics and Sports
Medicine Institute, received
the annual "Early Careerist"
award at the 2007 American
College of Healthcare Executives
conference in Orlando. The
award is presented each year Leslie Jebson
to a health-care professional
who demonstrates outstanding leadership abilities
and innovative management skills at the state and
community levels.

a professor of neuroscience,
has been appointed to the
National Institutes of Health
Center for Scientific Review's
Clinical Neuroplasticity and
Neurotransmitters Study Section.
Mandel and his fellow section
members will review and make Ronald J. Mandel
recommendations on grant
applications submitted to the National Institutes
of Health and survey the status of research in their
fields of science.


former Appleton Professor of
Equine Studies and retired
director of the Island Whirl
Equine Colic Research
Laboratory at the University of
Florida College of Veterinary
Medicine, has received
the Florida Association of Alfred Merritt
Equine Practitioners' lifetime
achievement award.
FAEP members honored Merritt, a UF faculty
member from 1978 until his retirement in 2003, in
September during the group's annual meeting in
the Bahamas.
Merritt's primary research interests were
the function and malfunction of the equine
gastrointestinal system. Merritt served as editor or
co-editor of four books and has written 20 book

chapters. Two of his books are widely used in
veterinary courses throughout the world.
While at UF, Merritt was recognized with
several teaching awards, including the Norden
Distinguished Teacher Award, which is bestowed
by college faculty. Veterinary students chose Merritt
three times as Large Animal Clinician of the Year.

D.V.M., Ph.D., a professor of
ophthalmology, was named
a Continuing Educator of the
Year in the category of equine
medicine and surgery during
the 2007 Western Veterinary
Conference in Las Vegas.
Brooks has not only personally Dennis E. Brooks
saved sight for many animals, his
research has changed the standard of care other
veterinarians provide for equine eye problems.


PSYCHOLOGY is one of two national recipients
of the American Psychological Association's
Departmental Award for Culture of Service in
the Psychological Sciences. The UF department
was honored for exhibiting a pattern of support
for service from faculty at all levels, including a
demonstration that service to the discipline is an
integral part of training and mentoring and is
rewarded in faculty tenure and promotion. The
$5,000 award will be used to support student travel
to conferences or meetings in which they perform
service to scientific organizations.


associate professor in the
department of medicine's division
of cardiology in the College
of Medicine-Jacksonville,
received the 2007 Rear Admiral
Paul Kaufman Award at the
September meeting of the Duval
County Medical Society.

UF administrator named president

of Florida Nurses Association

D.S.N., R.N., a UF
A associate professor of
nursing and director
of the College of
Nursing's Jacksonville
campus, has been
elected president of
the Florida Nurses
The Florida Nurses
Association is a constituent of the
American Nurses Association and
the only organization representing
more than 200,000 nurses in Florida
regardless of specialty or practice
Gregg, who has practiced as a
registered nurse for 35 years both
in clinical and administrative roles,
has served as an elected officer
on numerous professional and
community boards, including the
Florida Nurses Foundation, the
Florida League for Nursing and
the Child Guidance Center. She is
the past chairwoman of the Florida
Center for Nursing and continues to
sit on the center's board of directors.
She has worked closely with other
state organizations to lobby the
legislature for increased funding
for nursing workforce solutions and
nursing education.
Gregg was appointed director of
the college's Jacksonville campus in
1995. She has worked collaboratively
to establish and maintain a distance-
learning program, enabling graduate
nurses to attend classes and complete
courses in Jacksonville.


Each year Naval Hospital Jacksonville presents the
award to a network provider who selflessly supports
the Naval Hospital and the care of its patients.

New grant helps train scholars in rehabilitation research

ByJill Pease

UF and the University of Texas Medical Branch
have received a $5 million National Institutes
of Health grant to train future rehabilitation
The Rehabilitation Research Career Development
Program will recruit and train 12 occupational and
physical therapy scholars from across the nation to
become independent investigators and scientific
leaders in rehabilitation.
"If you look at the field of rehabilitation, we don't
have a strong history of research and there are not
enough faculty with this kind of research experience,"
said the program's deputy director Krista
Vandenborne, Ph.D., P.T., chair of the department of
physical therapy at the UF College of Public Health

and Health Professions. "This program will allow us
to train the next generation of rehabilitation
The grant, the first of its kind devoted to scholar
training in rehabilitation research, is funded by the
National Center for Medical Rehabilitation Research
in the National Institutes of Child Health and Human
Development and by the National Institute for
Neurological Disorders and Stroke. William Mann,
Ph.D., O.T.R., chair of the department of occupational
therapy, will serve as the program's associate director.
UF and UTMB's grant is one of two awarded
nationally, the other going to a consortium of
Washington University in St. Louis, the University of
Delaware and the University of Pittsburgh.

The career development program will provide five
years of support for six scholars who will train at UF
and six who will train at UTMB. Trainees will choose
which mentor they want to work with in one of several
areas: neurological and cognitive rehabilitation;
neuromuscular disease; assistive technology;
respiratory physiology and rehabilitation; aging and
geriatric rehabilitation; muscle biology and
rehabilitation; and functional outcomes.
"The senior faculty members involved in this
program come from all over campus," Vandenborne
said. "We've invested a lot in transdisciplinary work
at UF and we have a depth of resources and a great
critical mass of faculty focused on rehabilitation,
more than any other campus in the nation."

201 Ieu i-

Visit us online @ http://news.health.ufl.edu/ for the latest news and HSC events.

- -



perfect pairs

Projects bring together faculty

from public health and health

professions disciplines

PHHP faculty David Janicke and Ellen Lopez are among the recipients of
Public Health-Health Professions Model Program project grants. They will
develop a healthy lifestyle program for children ages 6 to 12 and their
parents. The program merges Janicke's clinical expertise in behavioral
weight management programs with Lopez's skills in community assessment
and community participation.

ByJill Pease

childhood obesity, older driving errors, head
and neck cancer and gynecological cancer
are all topics of new College of Public
Health and Health Professions research projects
that combine the talents of faculty in the college's
traditional health disciplines with those in the public
health disciplines.

"We believe that what we learn in individual patient care from those in the
health professions can tell us a great deal about the importance of disease
prevention and community approaches to health promotion," said Michael G.
Perri, Ph.D., the college's interim dean. "And the population perspective
inherent to public health helps us determine what problems need to be targeted
for intervention at the individual level.
"The two groups public health faculty and health professions faculty -
working together can produce more than either one working alone," he added.
The four projects are supported by $20,000 grants from the college and the
UF Area Health Education Centers program.
In the child weight management project, David Janicke, Ph.D., of the
department of clinical and health psychology, and Ellen Lopez, Ph.D., of the
department of behavioral science and community health, will offer a healthy
lifestyle program that emphasizes good nutrition and physical activity for
children ages 6 to 12 and their parents. The program will be offered in Bradford
and Levy counties, two of the most medically underserved counties in North
Central Florida.
Occupational therapy faculty members Orit Shechtman, Ph.D., and

Sherrilene Classen, Ph.D., have teamed up with Yongsung Joo, Ph.D., of the
department of epidemiology and biostatistics, to examine the validity of current
on-road driving assessments for people age 65 and older. Along with Kezia
Awadzi, Ph.D., a postdoctoral associate in occupational therapy, the group will
analyze the 2005 Florida Traffic Crash Records Database to determine which
driving errors are predictive of crashes among older drivers. They will then
compare the data to actual driving errors of older drivers performing an on-road
test in order to make recommendations for improving standard driving
After radiation or surgery, patients with head and neck cancer often
experience disabling conditions such as decreased ability to eat or swallow,
limited mobility in the mouth and neck and shoulder pain. To identify unmet
rehabilitation needs of these patients, Gwenda Creel, M.H.S., P.T., of the
department of physical therapy, and Giselle Mann, Ph.D., a speech pathologist
and faculty member in the department of behavioral science and community
health, will survey patients and community stakeholders, such as family
members and health providers. Along with physical therapy faculty Genn6
McDonald, P.T., and Mary Thigpen, Ph.D., P.T., the research team will review
current clinical practice guidelines and with the knowledge gained from the
patients and community members, they will develop a model of optimal service
delivery for patients with head and neck cancer.
Psychologists Deidre Pereira, Ph.D., and Michelle Bishop, Ph.D., will work
with Lopez to investigate quality of life issues for women with gynecological
cancer and their caregivers. The study will employ an innovative research
method, known as Photovoice, which provides cameras to participants so they
can record, discuss and relate the reality of their lives. The researchers hope
that giving women with gynecological cancer the opportunity to express
themselves in this manner will improve their quality of life and at the same
time, give health providers a better understanding of the physical and emotional
well-being of the women and their caregivers. Q

Visit us online @ http://news.health.ufl.edu/ for the latest news and HSC events. o 21




Nov. 14, 11 a.m.
Diversity Dialogue with keynote speaker Martha Barnett, J.D.
McKnight Brain Institute, Room LG-101A. For more information,
call the HSC Office of Equity and Diversity at 352-273-5310.

Nov. 15, 11:30a.m.
IHi-. IIII I.j i l il- :li-l':It H Tlh I
l i-.: i : l ih : 11.: 11 -i 1: 11-111i: l : l TIi l

IF ltV: 'l4.I I :, :I l I ll 11 _'l II 1

I H tc ili, o lc ue

Nov. 17, noon
The Harley-Davidson Annual Chili
Cookoff benefiting Hawg Wild for a
Cure, a fund supporting Parkinson's
disease research and education.
Gainesville Harley-Davidson & Buell,
4125 N.W. 97th Blvd, Gainesville. For
more information, visit www.

Stop An hea holda sounds

Nov. 25, 4p.m.
Stop! Children's Cancer presents
Holiday Traditions, holiday music
by local choirs. Curtis M. Phillips
Center for the Performing Arts,
315 Hull Road, Gainesville. For
more information, visit www.
performingarts.ufl.edu or call
352-392-1900 ext. 324.

ADNov. 16, 10 a.m.
.11111 h :, il WWII i: 1 i, l- I In I- :, I 1 ,

; 1111 di- Ft, 1 II, I l. -, II. 11.j l
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Dec. 7, noon

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[ I l h:lf TI/ '.1 t1 -,l _lF 0l,.nl
F,, m :/p ti:,m :h,, ,p m :1 .

Disoe you origin

Dec. 13, 10 a.m.
The Emerging Pathogens Institute
presents its Fall Research Retreat,
featuring a poster session,
luncheon and guest speakers. Open
to all faculty and students
interested in emerging pathogens.
HPNP Reception Area. Formore
information e-mail Lisa Lindsey at

Dec. 13, 7p.m.
EL.biil a jl l\ ltl [ ublli Lbululb6 b6Ilb6 plb olil
F I-I: i : i:r n. I.i : H ii .11.i ,1 liil.ilii. i F'I l jects from the Am ericas
.in l N1 III -i 1n:.1i I 111i i- I[ l]ul, i Ph.D. The W hitney
I _. ii i),I in, r i 1. 1 i- E:i, :I- : iIn:- I -i ter for M marine Studies,
' I.il, i ll .3 h uh.l', :1 F I ,I 1 4-u_..1 n:ii For more information,
v/ 111 -/. J4-A /. J ,-/ ::a ,.i 4- hitney.ufl.edu.

For additional information and more HSC events, visit the HSC News calendar of events: www.news.health.ufl.edu/calendar.asp. To contribute to the calendar, e-mail Anney Doucette at anneyd@ufl.edu, or call 352-273-5772.



0000or i


I Intereste in emergin pathogens




Community comes first

for nursing professor and

her students

By Katie Phelan
Community health nursing professor
Joan Castleman, M.S., R.N., has a pretty
extensive bag of tricks. On any given
day, her students may be surprised to find what
comes out of this bag to help teach disease
prevention and promotion in her community
health nursing classes.
There's the alligator with a full set of teeth for teaching children about
proper oral care, the piece of yellow plastic for showing what a pound of fat
looks like, a straw diagram to illustrate how smoking affects lung strength
and an interactive food pyramid for teaching proper nutrition. She's
collected these learning aids over the years to help students work with
patients in the community.
Castleman believes visual learning helps teach nursing students how to
communicate about disease prevention and promotion while at the same
time educating patients about improving their health.
As a community health nursing professor, Castleman's goal is for students
to understand the multiple factors that affect a person's health.
"Students need to listen to people's stories and recognize the social and
physical barriers to health that many vulnerable populations face,"
Castleman said. "Students are usually assigned a community group, such as
a school or housing project, with whom they will work throughout the
semester. They must assess their assigned community and develop
appropriate health promotion or disease prevention activities."
These activities could range from organizing a wellness program, for
older adults and people with disabilities at a subsidized living facility to
visiting the St. Francis House for the homeless to provide health care
screenings and health education. In 2006 alone, community health nursing
students provided more than 15,000 hours of service to the local community.
"We spend a great deal of time developing and maintaining relationships
with community partners," Castleman said. "We are guests in these
communities. There is always a tendency for outside professionals to tell
communities what is wrong and offer solutions. Our goal is for students to
learn how to partner nonjudgmentally with community members and
jointly identify community strengths, weaknesses and possible solutions."
Castleman's typical week includes organizing her students in daily
community outreach programs, teaching lecture courses for both
undergraduate and master's level nursing students and being both an active
member on the Health Science Center tobacco training program and the
faculty adviser for the UF nursing student association.
After receiving her bachelor's degree in nursing from the University of
Michigan, Castleman worked as a nurse in a neonatal intensive care unit in
Michigan and often cared for low birthweight and sick infants whose
conditions could have been prevented with proper prenatal care. This
experience inspired her to pursue her master's degree in community health



With her nursing students, Joan Castleman emphasizes the importance of
offering patients nonjudgmental health care.

nursing at the University of Rochester. She joined the UF College of
Nursing faculty in 1992.
Another focus for Castleman is tobacco use prevention. She has been
involved with the UF Area Health Education Centers' Tobacco Training
and Cessation program for the past 10 years. She was one of the founding
team members and continues to play an active role in the program today.
The educational interdisciplinary program includes first-year medical and

"We spend a great deal of time

developing and maintaining

relationships with community partners.

We are guests in these communities."

-Joan Castleman, M.S., R.N.

dental students and fourth-year nursing and pharmacy students. Each
semester, these students work together to review case studies dealing with
tobacco and other substance abuse within a community in order to examine
their own behaviors as healthy role models and explore interventions for
tobacco cessation with patients. They then visit local middle schools to
apply what they have learned and educate children about the dangers of
tobacco use.
"The challenge of decreasing the use of tobacco is a problem that requires
interdisciplinary collaboration," Castleman said. "It is especially significant
for nurses because we emphasize that this profession is not just about
treating disease but also preventing disease."
Castleman's passion to educate extends beyond the classroom, and after
32 years in the field of community health, she still values the importance of
health promotion and disease prevention within our society.
"It is a privilege to be able to work with the people in the community and
I continue to learn every day from the people I see," Castleman said. O

Visit us online @ http://news.health.ufl.edu/ for the latest news and HSC events. o 23


The Equal Access Clinic, run by UF medical
students under the guidance of College of
Medicine faculty, was established to help
uninsured and medically underserved patients.
Dr. David Feller (below, left) advises medical
students working in the Equal Access Clinic.

UF nursing students visit the St.
Francis House in Gainesville every
week to provide health education
and free screenings. Lauren
Williams, a senior nursing student
takes a man's blood pressure
during a recent visit.

Published by
UF Health Science Center
Office of News & Communications
Senior Vice President,
Health Affairs
Douglas J. Barrett, M.D.
Director, News &
Tom Fortner
April Frawley Birdwell

Senior Editors
Melanie Fridl Ross, John Pastor
Mickey Cuthbertson
Staff Writers
April Frawley Birdwell, Tracy Brown,
Sarah Carey, Anney Doucette, Ann
Griswold, Linda Homewood, Lindy
McCollum-Brounley, Patricia Bates
McGhee, John Pastor, Jill Pease,
Melanie Fridl Ross

Contributing Writers
Amelia Beck, Lauren Edwards,
Katie Phelan

Sarah Kiewel
Support Staff
Cassandra Jackson, Beth Powers,
Kim Smith

The POST is the monthly internal
newsletter for the University of
Florida Health Science Center, the
most comprehensive academic

health center in the Southeast,
with campuses in Gainesville
and Jacksonville and affiliations
throughout Florida. Articles feature
news of interest for and about HSC
faculty, staff and students. Content
may be reprinted with appropriate
credit. Ideas for stories are welcome.
The deadline for submitting items to
be considered for each month's issue
is the 15th of the previous month.
Submit to the editor at afrawley@ufl.
edu or deliver to the Office of News &
Communications in the Communicore
Building, Room C3-025.

F Health Science Center