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Department of Family Medicine and Rural Health

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Mobile Health Unit for Obesity Education
Mobile Health Unit for Obesity Education
Objective: Poverty is a risk factor for obesity. Using homelessness as a marker for poverty, we examined the prevalence of obesity in Leon County, Florida's homeless population to determine their attitudes and perceptions towards the disease. Methods: Our medical team equipped a mobile health unit with educational material before visiting homeless shelters, health fairs and shopping areas in Northwest Florida. Participants at these sites completed a short survey and our staff calculated Body Mass Index (BMI). The team also distributed lifestyle modification and obesity patient education. BMI and survey responses were compared and analyzed using statistical software. Results: Subjects were assigned to one of two groups: the homeless group or the "all others" group. The homeless group's responses and BMIs were compared to the "all others" group. Weight status in the homeless group was distributed as follows: normal weight (48.3%), overweight (39.7%) and obese (12.1%). The distribution among all other participants was: normal weight (34.8%), overweight (25.8%), and obese (39.3%). Homeless participants overestimated their BMI category as often as all others, were less likely to participate in weight loss interventions, and less likely to recognize overweight and obesity as a problem. Conclusion: Medical practitioners need to recognize the role of patients' attitudes about weight loss and clarify definitions of exercise. Obesity is less prevalent among the homeless; however, the same obesity trends exist. In addition, we learned that the homeless are eager to learn about obesity and healthy lifestyles, but may not be as willing to attempt interventions that have worked in other populations. Mobile health units can be used to reach out to them., Keywords: obesity, homeless, BMI, body mass index, poverty, Note: Originally published in The Bariatrician 1099-4521, Citation: Soberon, A. M., Brown, L. S., & Rodríguez, J. E. (2009). Mobile health unit for obesity education: Attitudes and perceptions among local homeless residents. The Bariatrician, 24 (1), 29-33.
Optimal management of type 2 diabetes in patients with increased risk of          hypoglycemia
Optimal management of type 2 diabetes in patients with increased risk of hypoglycemia
With the number of individuals diagnosed with type 2 diabetes on the rise, it has become more important to ensure these patients are effectively treated. The Centers for Disease Control and Prevention estimated that 8.3% of all Americans were diagnosed with diabetes in 2011 and this number will likely continue to rise. With lifestyle interventions, such as proper diet and exercise, continuing to be an essential component of diabetes treatment, more patients are requiring medication therapy to help them reach their therapeutic goals. It is important for the clinician, when determining the treatment strategy for these individuals, to find a balance between reaching treatment goals and limiting the adverse effects of the treatments themselves. Of all the adverse events associated with treatment of diabetes, the risk of hypoglycemia is one that most therapies have in common. This risk is often a limiting factor when attempting to aggressively treat diabetic patients. This manuscript will review how hypoglycemia is defined and categorized, as well as discuss the prevalence of hypoglycemia among the many different treatment options., Keywords: diabetes, type 2, treatment, therapy, hypoglycemia, complications, Note: Originally published in Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, Citation: Anderson M, Powell J, Campbell KM, Taylor JR. (2014). Optimal management of type 2 diabetes in patients with increased risk of hypoglycemia. Diabetes Metab Syndr Obes, 7:85-94.
Pockets of progress amidst persistent racial disparities in low birthweight rates.
Pockets of progress amidst persistent racial disparities in low birthweight rates.
Racial disparities persist in adverse perinatal outcomes such as preterm birth, low birthweight (LBW), and infant mortality across the U.S. Although pervasive, these disparities are not universal. Some communities have experienced significant improvements in black (or African American) birth outcomes, both in absolute rates and in rate ratios relative to whites. This study assessed county-level progress on trends in black and white LBW rates as an indicator of progress toward more equal birth outcomes for black infants. County-level LBW data were obtained from the 2003 to 2013 U.S. Natality files. Black LBW rates, black-white rate ratios and percent differences over time were calculated. Trend lines were first assessed for significant differences in slope (i.e., converging, diverging, or parallel trend lines). For counties with parallel trend lines, intercepts were tested for statistically significant differences (sustained equality vs. persistent disparities). To assess progress, black LBW rates were compared to white LBW rates, and the trend lines were tested for significant decline. Each county's progress toward black-white equality was ultimately categorized into five possible trend patterns (n = 408): (1) converging LBW rates with reductions in the black LBW rate (decreasing disparities, n = 4, 1%); (2) converging LBW rates due to worsening white LBW rates (n = 5, 1%); (3) diverging LBW rates (increasing disparities, n = 9, 2%); (4) parallel LBW rates (persistent disparities, n = 373, 91%); and (5) overlapping trend lines (sustained equality, n = 18, 4%). Only four counties demonstrated improvement toward equality with decreasing black LBW rates. There is significant county-level variation in progress toward racial equality in adverse birth outcomes such as low birthweight. Still, some communities are demonstrating that more equitable outcomes are possible. Further research is needed in these positive exemplar communities to identify what works in accelerating progress toward more equal birth outcomes., Publication Note: This NIH-funded author manuscript originally appeared in PubMed Central at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6067759.
Racial Disparity in the Associations of Microalbuminuria and Macroalbuminuria with Odds          of Hypertension
Racial Disparity in the Associations of Microalbuminuria and Macroalbuminuria with Odds of Hypertension
Background. Limited information is available on whether the associations of microalbuminuria and macroalbuminuria with the odds of hypertension differ among non-Hispanic Whites, non-Hispanic Blacks, and Hispanics. Methods. Cross-sectional data of 24,949 participants aged ≥18 years were collected from the National Health and Nutrition Examination Survey (NHANES) 1999–2008. Odds ratios of hypertension for microalbuminuria and macroalbuminuria were estimated by conducting weighted multiple logistic regression models. Results. After adjustment for extensive confounding factors, microalbuminuria is 1.45 (95% confidence interval (CI) [1.17, 1.80]), 2.07 (95% CI [1.52, 2.83]) and 2.81 (95% CI [2.06, 3.84]) times more likely to be associated with hypertension, and macroalbuminuria is 4.08 (95% CI [1.98, 8.38]), 8.62 (95% CI [3.84, 19.35]), and 4.43 (95% CI [2.13, 9.21]) times in non-Hispanic Whites, non-Hispanic Blacks, and Hispanics, respectively. The odds of hypertension for microalbuminuria (versus normalbuminuria) were 52% higher in non-Hispanic Blacks and 98% higher in Hispanics than in non-Hispanic Whites; the odds of hypertension for macroalbuminuria (versus normalbuminuria) did not differ among racial groups. Conclusion. Racial differences in the relation between microalbuminuria and hypertension are prevalent among non-Hispanic Whites, non-Hispanic Blacks, and Hispanics. More screening efforts should be encouraged in normotensive non-Hispanic Blacks and Hispanics with microalbuminuria., Keywords: microalbuminuria, macroalbuminuria, hypertension, racial disparities, Note: Originally published in ISRN Hypertension., Citation: Xuefeng Liu, Yali Liu, Dennis Tsilimingras, and Kendall M. Campbell, "Racial Disparity in the Associations of Microalbuminuria and Macroalbuminuria with Odds of Hypertension: Results from the NHANES Study in the United States," ISRN Hypertension, vol. 2013, Article ID 390109, 8 pages, 2013. doi:10.5402/2013/390109
Should Coenzyme Q10 Be Used to Lower Blood Pressure in Asymptomatic Patients?
Should Coenzyme Q10 Be Used to Lower Blood Pressure in Asymptomatic Patients?
Coenzyme Q10 (CoQ10) may lower systolic and diastolic blood pressures in patients with primary hypertension, but is not recommended as an antihypertensive treatment (SOR: C, systematic review of low-quality RCTs using disease-oriented outcomes)., Keywords: primary hypertension, antihypertensive agent, Note: Originally published in Evidence Based Practice., Citation: Barker D. & Rodriguez JE. (2013). Should coenzyme Q10 be used to lower blood pressure in asymptomatic patients? Evidence Based Practice, 16(2): 7-8.
State-Level Progress in Reducing the Black-White Infant Mortality Gap, United States, 1999-2013.
State-Level Progress in Reducing the Black-White Infant Mortality Gap, United States, 1999-2013.
To assess state-level progress on eliminating racial disparities in infant mortality. Using linked infant birth-death files from 1999 to 2013, we calculated state-level 3-year rolling average infant mortality rates (IMRs) and Black-White IMR ratios. We also calculated percentage improvement and a projected year for achieving equality if current trend lines are sustained. We found substantial state-level variation in Black IMRs (range = 6.6-13.8) and Black-White rate ratios (1.5-2.7), and also in percentage relative improvement in IMR (range = 2.7% to 36.5% improvement) and in Black-White rate ratios (from 11.7% relative worsening to 24.0% improvement). Thirteen states achieved statistically significant reductions in Black-White IMR disparities. Eliminating the Black-White IMR gap would have saved 64 876 babies during these 15 years. Eighteen states would achieve IMR racial equality by the year 2050 if current trends are sustained. States are achieving varying levels of progress in reducing Black infant mortality and Black-White IMR disparities. Public Health Implications. Racial equality in infant survival is achievable, but will require shifting our focus to determinants of progress and strategies for success., Grant Number: R13 MD011260, Publication Note: This NIH-funded author manuscript originally appeared in PubMed Central at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5388953.
Status of underrepresented minority and female faculty at medical schools located within Historically Black Colleges and in Puerto Rico
Status of underrepresented minority and female faculty at medical schools located within Historically Black Colleges and in Puerto Rico
Background and objectives: To assess the impact of medical school location in Historically Black Colleges and Universities (HBCU) and Puerto Rico (PR) on the proportion of under represented minorities in medicine (URMM) and women hired in faculty and leadership positions at academic medical institutions. Method: AAMC 2013 faculty roster data for allopathic medical schools were used to compare the racial/ethnic and gender composition of faculty and chair positions at medical schools located within HBCU and PR to that of other medical schools in the United States. Data were compared using independent sample t-tests. Results: Women were more highly represented in HBCU faculty (mean HBCU 43.5% vs. non-HBCU 36.5%, p = 0.024) and chair (mean HBCU 30.1% vs. non-HBCU 15.6%, p = 0.005) positions and in PR chair positions (mean PR 38.23% vs. non-PR 15.38%, p = 0.016) compared with other allopathic institutions. HBCU were associated with increased African American representation in faculty (mean HBCU 59.5% vs. non-HBCU 2.6%, p = 0.011) and chair (mean HBCU 73.1% vs. non-HBCU 2.2%, p <= 0.001) positions. PR designation was associated with increased faculty (mean PR 75.40% vs. non-PR 3.72%, p <= 0.001) and chair (mean PR 75.00% vs. non-PR 3.54%, p <= 0.001) positions filled by Latinos/Hispanics. Conclusions: Women and African Americans are better represented in faculty and leadership positions at HBCU, and women and Latino/Hispanics at PR medical schools, than they are at allopathic peer institutions., Keywords: academic medicine, academic medicine, care, Discrimination, diversity, diversity climate, experiences, health-professions, medical faculty, perceptions, programs, underrepresented minority, women, workforce, Publication Note: The publisher’s version of record is available at http://www.dx.doi.org/10.3402/meo.v21.29535
Status of underrepresented minority and female faculty at medical schools located within Historically Black Colleges and in Puerto Rico.
Status of underrepresented minority and female faculty at medical schools located within Historically Black Colleges and in Puerto Rico.
To assess the impact of medical school location in Historically Black Colleges and Universities (HBCU) and Puerto Rico (PR) on the proportion of underrepresented minorities in medicine (URMM) and women hired in faculty and leadership positions at academic medical institutions. AAMC 2013 faculty roster data for allopathic medical schools were used to compare the racial/ethnic and gender composition of faculty and chair positions at medical schools located within HBCU and PR to that of other medical schools in the United States. Data were compared using independent sample t-tests. Women were more highly represented in HBCU faculty (mean HBCU 43.5% vs. non-HBCU 36.5%, p=0.024) and chair (mean HBCU 30.1% vs. non-HBCU 15.6%, p=0.005) positions and in PR chair positions (mean PR 38.23% vs. non-PR 15.38%, p=0.016) compared with other allopathic institutions. HBCU were associated with increased African American representation in faculty (mean HBCU 59.5% vs. non-HBCU 2.6%, p=0.011) and chair (mean HBCU 73.1% vs. non-HBCU 2.2%, p≤0.001) positions. PR designation was associated with increased faculty (mean PR 75.40% vs. non-PR 3.72%, p≤0.001) and chair (mean PR 75.00% vs. non-PR 3.54%, p≤0.001) positions filled by Latinos/Hispanics. Women and African Americans are better represented in faculty and leadership positions at HBCU, and women and Latino/Hispanics at PR medical schools, than they are at allopathic peer institutions., Keywords: Academic medicine, Diversity, Medical faculty, Underrepresented minority, Women, Grant Number: D54HP23297, Publication Note: This NIH-funded author manuscript originally appeared in PubMed Central at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4788771.
Students' Perceptions of the Impact a Creative Arts Journal Has on Their Medical          Education
Students' Perceptions of the Impact a Creative Arts Journal Has on Their Medical Education
BACKGROUND AND OBJECTIVES: Student-produced creative arts journals now exist in several medical schools. The Florida State University College of Medicine (FSUCOM) has created HEAL: Humanism Evolving through Arts and Literature. This study sought to determine what influence, if any, HEAL publications may have on medical students. METHODS: A survey utilizing Likert scale questions was sent to Florida State University medical students. Student responses were tabulated and analyzed using SAS 9.2 and MS Excel. A total of 241 (49.5%) students responded to the survey. RESULTS: About 81% of the respondents enjoyed reading HEAL. Many respondents agreed that HEAL promoted patient-centered care (55.9%) and could prevent burnout (61.8%). Sixty-four percent thought that HEAL helped them to understand their colleagues and classmates. CONCLUSIONS: This survey found that the medical students perceive HEAL as having positive value., Keywords: creative arts, literature, student journal, health, HEAL, medical education, humanities, medicine, poetry, art, Note: Originally Published in Family Medicine., Citation: Rodriguez JE, Welch TJ, Saunders C, Edwards JC. (2013). Students' perceptions of the impact a creative arts journal has on their medical education. Fam Med, 45(8):569-71.
Substance Abusing Patients in the Primary Care Setting
Substance Abusing Patients in the Primary Care Setting
The world of primary care can be complex and challenging. With an ever increasing body of medical knowledge, primary care physicians must make it a priority to think outside the box when diagnosing patients. This is especially true when it comes to the consideration of substance abuse as a diagnosis. Managing common medical problems such as hypertension and diabetes are familiarities of care, but substance abuse can be easily dismissed or overlooked. It is proposed that 20% of patients encountered for a primary care visit have a problem with substance abuse. Primary care providers should add substance abuse to differential diagnosis, treat when trained and refer when appropriate. Automatically discharging patients who are found to carry this diagnosis is inappropriate, as this patient population deserves and needs to be treated as much as any other patient population. This article will provide tips for the primary care physician to aid in the diagnosis of substance abuse and provide recommendations by which these patients can receive treatment., Keywords: substance abuse, primary care, Note: Originally published in The Journal of Global Drug Policy and Practice and available at http://www.globaldrugpolicy.org/, Citation: Campbell KM. (2008). Substance abusing patients in the primary care setting: They deserve treatment too. Journal of Global Drug Policy and Practice, vol. 2 (3).
Successful Reorganization of an Interdisciplinary Underserved Practice
Successful Reorganization of an Interdisciplinary Underserved Practice
Caring for underserved patients presents great challenges for community practices. This report discusses an interdisciplinary underserved practice that was reorganized in 2008 allowing for practice improvement and greater community presence. Current practice structure is discussed and a model provided that can enhance productivity, revenue, and community outreach., Keywords: community health services, community-institutional relations, cooperative behavior, efficiency, organizational, Florida, health services accessibility, interprofessional relations, medically underserved area, models, organizational, patient care team, patient-centered care, Uncontrolled subjects: Community Health Services, Community-Institutional Relations, Cooperative Behavior, Efficiency, Organizational, Florida, Health Services Accessibility, Humans, Interprofessional Relations, Medically Underserved Area, Models, Organizational, Patient Care Team, Patient-Centered Care, Note: Copyright © 2011 Meharry Medical College. This article first appeared in Journal of Health Care for the Poor and Underserved, vol. 22, (2011), 225-230. Reprinted with permission by The Johns Hopkins University Press., Citation: Campbell K, Hayes D, Wielgos C, Theoktisto K, & Taylor J. (2011). Successful reorganization of an interdisciplinary underserved practice. Journal of Health Care for the Poor and Underserved, 22 (2011): 225-230.
Training Medical Students to Recognize and Address Health Disparities
Training Medical Students to Recognize and Address Health Disparities
As the U.S. population grows more diverse, it is becoming more and more important for medical schools to address health disparities, underserved populations and cultural competency. The growing population places increasing demands on our health care system and requires our medical schools to produce more culturally competent, health disparity-minded physicians. The 16th Report of the Council on Graduate Medical Education suggests that the demand for physicians after 2015 will be greater than the supply. The persons most impacted will be those who are underserved., Keywords: medical education, underserved, minorities, medical students, family medicine, Note: Originally published in Florida Family Physician at http://www.fafp.org/news/Journal., Citation: Campbell KM. Training students to recognize and address health disparities. Florida Family Physician, Winter 2009, Vol. 58: Issue 2:28-29.
Underrepresented Minority Faculty in Academic Medicine
Underrepresented Minority Faculty in Academic Medicine
BACKGROUND AND OBJECTIVES: Retention and recruitment of minority faculty members continues to be a concern of medical schools because there is higher attrition and talent loss among this group. While much has been written, there has not been a systematic review published on this topic. This is the first study to use evidence-based medicine (EBM) criteria and apply it to this issue. METHODS: We searched MEDLINE, Web of Knowledge, ProQuest, and Google Scholar for papers relating to the recruitment and retention of minority faculty. We then graded the evidence using the EBM criteria as defined by the American Academy of Family Physicians. The same criteria were applied to extract evidence-based observations of problems in recruitment and retention for minority faculty. RESULTS: Of the 548 studies identified and reviewed, 11 met inclusion criteria for this literature review. This article presents the data from the reviewed papers that described or evaluated minority faculty development programs. Faculty development programs in 15 different institutions showed mentoring and faculty development for minority faculty could increase retention, academic productivity, and promotion rates for this group. ConclusionS: For medical schools to be successful in retention and recruitment of minority medical school faculty, specific programs need to be in place. Overall evidence is strong that faculty development programs and mentoring programs increase retention, productivity, and promotion for this group of medical faculty. This paper is a call to action for more faculty development and mentorship programs to reduce the disparities that exist between minority faculty and all other faculty members., Keywords: underrepresented, minority faculty, retention, recruitment, academic medicine, medical education, minority groups, faculty, Note: Originally published in Family Medicine., Citation: Rodríguez JE, Campbell KM, Fogarty JP, Williams RL. Underrepresented minority faculty in academic medicine: A systematic review of URM faculty development. Fam Med 2014;46(2):100-104.
University of Florida's Commitment to Recruit Family Physicians
University of Florida's Commitment to Recruit Family Physicians
At the University of Florida, we enthusiastically educate and encourage students about family medicine. Communities in which family physicians practice are healthier, and relationships patients have with their family physicians are some of the most rewarding. We demonstrate this to UF students in a variety of settings and interactions with our faculty throughout their entire four-year medical education. Paramount to our efforts are personal interactions with core faculty members enthusiastic about family medicine and teaching. Students participate in a wide range of clinical settings, providing the full complement of family medicine. They encounter faculty members whose focus is hospital medicine, procedures, sports medicine, women's health, student health, ambulatory care, urgent care, academic medicine and underserved care. The diversity of our faculty provides students insight into the many opportunities available in family medicine. Targeted student activities throughout medical school help spark and maintain student interest in family medicine., Keywords: family medicine, medical students, primary care, medical education, Note: Originally published in Florida Family Physician at http://www.fafp.org/news/Journal., Citation: Cotter SJ, Campbell KM, & Curry RW. The University of Florida's Commitment to Recruit Family Physicians. Florida Family Physician. Spring 2009, Vol. 57: Issue 3:26-27.
What Are Effective Treatments for Painful Varicose Veins?
What Are Effective Treatments for Painful Varicose Veins?
Several ablative therapies are effective. However, endovenous laser ablation (EVLA) has a higher 5-year success rate than surgical stripping, ultrasound-guided foam sclerotherapy (UGFS), and radiofre-quency ablation (RFA). EVLA is also associated with less postoperative pain, and results a faster improvement in health-related quality of life when compared with surgery. (SOR A, based on a meta-analysis.) Compression stockings are not as effective as ablative therapy. (SOR A, based on a meta-analysis.), Keywords: varicose veins, treatment, endovenous laser ablation, Note: Originally published in Evidence Based Practice, Citation: Gonzalez, D., & Rodríguez, J. E. (2010). What are effective treatments for painful varicose veins? Evidence Based Practice, 13(7): 8-9.
What Are the Best Nonpharmacologic Treatments for Urinary Incontinence in          Women?
What Are the Best Nonpharmacologic Treatments for Urinary Incontinence in Women?
Pelvic floor muscle training (PFMT) is superior to no treatment or inactive controls, and is effective in nonpregnant, pregnant, and postpartum women. (SOR A, based on meta-analyses.) The clinical value of habit retraining, timed voiding, or mechanical devices for treatment of urinary incontinence is unknown., Keywords: urinary incontinence, treatment, pelvic floor muscle training, Note: Originally published in Evidence Based Practice, Citation: Rojas, C., & Rodríguez, J. E. (2009). What are the best nonpharmacologic treatments for urinary incontinence in women? Evidence Based Practice, 12(9): 12.
What Are the Best Treatments for Reducing Pain Due to Compression Fractures?
What Are the Best Treatments for Reducing Pain Due to Compression Fractures?
The answer remains unclear. Nasal salmon calcitonin is effective for analgesia of vertebral compression fractures (SOR A, based on a systematic review of randomized controlled trials [RCTs]). Although percutaneous vertebroplasty is slightly more effective than balloon kyphoplasty for reducing pain, it also has a higher refracture rate (SOR A, based on a meta-analysis). Isometric back-extensor muscle strengthening and proprioceptive postural retraining is more effective for prolonging time between refractures if there has not been a vertebroplasty (SOR B, based on a case series)., Keywords: compression fractures, treatment, pain, vertebroplasty, balloon kyphoplasty, Note: Originally published in Evidence Based Practice, Citation: Bada, A. M., & Rodríguez, J. E. (2009). What are the best treatments for reducing pain due to compression fractures? Evidence Based Practice, 12(1): 4-5.
What Are the Causes of Systolic Murmurs in Young Children?
What Are the Causes of Systolic Murmurs in Young Children?
Innocent or functional murmurs are the most common, present at some point in 50% to 90% of children, typically between 2 and 7 years of age. (SOR B, based on a cohort study.) Systolic murmurs due to systemic diseases or infections are the next most common, with anemia being the most frequent cause. (SOR C, based on a narrative review.) Congenital heart disease is the least common cause of a systolic murmur, occurring in less than 1% of the general population. (SOR B, based on a systematic review of cohort studies.), Keywords: systolic murmurs, functional murmurs, innocent murmurs, anemia, congenital heart disease, Note: Originally published in Evidence Based Practice, Citation: Goodwin, M., Dexter, N., & Rodríguez, J. E. (2010). What are the causes of systolic murmurs in young children? Evidence Based Practice, 13(1): 11-12.
What Are the Most Effective Methods for Managing General Psychosocial Stress?
What Are the Most Effective Methods for Managing General Psychosocial Stress?
Mindfulness-based stress reduction (MBSR), cognitive-behavioral stress reduction (CBSR), and somatic relaxation are all effective therapies for psychosocial stress. Exercise also reduces stress and improves mental health (SOR B, based on small randomized controlled trials [RCTs]). Anxiolytic agents and antidepressants may be used in refractory cases. (SOR C, expert opinion.), Keywords: stress reduction, mindfulness, cognitive-behavioral, somatic relaxation, psychosocial stress, Note: Originally published in Evidence Based Practice, Citation: Rodby, K., & Rodríguez, J. E. (2009). What are the most effective methods for managing general psychosocial stress? Evidence Based Practice, 12(8): 5.

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