Obesity is a widespread national issue that affects the health and well-being of millions of people; particular attention has been focused on the burden among children. The National Survey of Children's Health data from 2007 was used to examine the relationship of child health status and unhealthy weight (overweight/obese defined as body mass index in ≥ 85 th percentile) among 874 children aged 10 to 17 years of age in Hawai'i. In particular, the parentally reported child's general health status was assessed comparing those with a poorer health status (defined as "good/fair/poor") to those with a better one (defined as "excellent/very good"). Descriptive analysis and multiple logistic regression analysis examined risk for overweight/obese with child's general health status, accounting for gender, race, and socioeconomic factors. More children with a poorer health status (46.5%; 95%CI=33.2-60.2) were overweight/obese compared to those of better health status (25.8%; 95%CI=21.9-30.2). Estimates of overweight/obese were high in Native Hawaiian/Pacific Islander (38.6%; 95%CI: 28.9-49.4), multiracial (30.9%; 95%CI=24.2-38.6) children, and children whose parents had less than 12 years education (56.8%; 95%CI=32.8-78.0). Multivariate logistic regression modeling showed a 2.92 (95%CI=1.52-5.61) greater odds for overweight/obese status in children with a poorer health status compared to those of better health status after accounting for age, race, gender, and parental education. Gender, race, and parental education were also significant factors associated with overweight/obese in the final adjusted model. It is important that children that are overweight or obese receive appropriate health screenings including assessments of general health status. Children in high risk socioeconomic groups should be a particular focus of prevention efforts to promote health equity and provide opportunities for children to reach their potential.
INTRODUCTION There are hundreds of millions of cases of malaria each year worldwide resulting in a million deaths. These deaths are mostly due to Plasmodium falciparum. The only Federal Drug Administration approved treatment for severe malaria is intravenous quinidine gluconate. Intravenous quinidine is increasingly unavailable in the United States. In 2007, the Center for Disease Control and Prevention implemented an investigational new drug protocol to allow the use of intravenous artesunate for cases of severe malaria in the United States. The authors present such a case treated under this protocol at Tripler Army Medical Center, Hawai'i. CASE REPORT A 49-year-old man presented to Tripler Army Medical Center, Hawai'i in February 2009 with a one-month history of fever, chills, and weight loss. He recently travelled to multiple malaria endemic areas. Physical examination was significant for fever and prostration. Laboratory studies revealed anemia, thrombocytopenia, and a high parasite load of Plasmodium falciparum. A strategic network was activated to obtain and administer intravenous artesunate. His condition rapidly improved as his parasitemia cleared. He was discharged after six days with no adverse medication effects and full recovery upon six-month follow-up. DISCUSSION Our patient met the criteria for severe Plasmodium falciparum malaria. He was immediately treated with intravenous artesunate and manifested a quick and durable response to therapy. At present, intravenous artesunate is awaiting Federal Drug Administration approval but available via a strategic network controlled by the Centers for Disease Control and Prevention. This case highlights a common delay in diagnosis, importance of optimal prophylaxis, and attention to travel history as they relate to the development of severe malaria.
The elderly consume a disproportionate amount of health care resources, and the recent trend in obesity will only escalate costs. EnhanceFitness® (EF) is an exercise program designed to increase the strength, flexibility, and balance of older adults. A comprehensive controlled study in Washington state of an elderly population has shown that participants who attend at least one EF class per week reduce healthcare costs by 20% per year. The present study reports the costs and potential benefits of replicating EF on Kaua'i. For Kaua'i the annual cost of an EF pilot program for 132 clients would be $204,735. Attendance records of the Kaua'i program showed that 96 (73%) of those enrolled attended at least weekly. Based on national reports of healthcare costs for the elderly, averting 20% of the costs for these 96 elderly would save $344,256 per year. The expected investment to return ratio, I-R ratio, for EF on Kaua'i is about 1-1.8. On economic grounds, a case can be made to support and expand these types of programs. In these times of budget cuts, cost-benefit analysis provides a common economic "language" to prioritize among different programs.
To present prevalence rates of adolescents in Hawai'i at-risk weight (85 percentile or higher = overweight or obese) and the relationship with comorbidities.
Suspected cases of acute appendicitis in pregnancy are considered surgical emergencies due to the potentially devastating outcomes for both mother and unborn child if the appendix perforates. Acute appendicitis is also the number one cause of non-traumatic acute abdomen in pregnancy, as well as the number one cause of fetal death. We present a case report with a typical presentation of suspected acute appendicitis in a pregnant woman. The work up and diagnostic tools available are discussed at length, as well as the finer points in treatment of this population.
OBJECTIVES:The objective of this study is to identify university faculty, community physician, and resident perceptions of how a schedule that employs overnight call in addition to a traditional weekday schedule affects medical student education, well being, and patient care during the third year obstetrics and gynecology clerkship.METHODS:In July 2007, a descriptive study was performed by distributing surveys to community teaching physicians, current residents, and faculty in the University of Hawai'i Department of Obstetrics and Gynecology. A total of 114 surveys were distributed to all current residents, clinical faculty and full-time faculty in the University of Hawai'i Department of Obstetrics and Gynecology. The survey included questions regarding the effect of the student call/work hour restrictions.RESULTS:A response rate of 45.6% was obtained (52/114). Results demonstrate that 84.6% (44/52) of residents, faculty, and community attendings agree that third year medical students should take call during their obstetrics and gynecology clerkship. Data was analyzed utilizing Spearman correlation and Cochran-Mantel-Haenszel statistics. No statistical difference was detected in terms of age or physician type (resident vs faculty vs community attending).CONCLUSION:Most physician-educators believe that medical students benefit from taking overnight call during their obstetrics and gynecology clerkship. Careful consideration should be given prior to elimination of overnight call in the obstetrics and gynecology clerkship.
BACKGROUND:Culturally competent health care providers are needed to eliminate healthcare disparities. In the State of Hawai'i, Native Hawaiians suffer some of the worst health disparities. Prior to implementing a cultural competency curriculum to address these disparities, the John A. Burns School of Medicine's Department of Native Hawaiian Health Cultural Competency Curriculum Development team asked Native Hawaiian patients about their experiences and recommendations.METHODS:We conducted four focus groups of Native Hawaiians to obtain recommendations on physician training, to be incorporated into the curriculum. Participants came from both rural and urban areas. Classical qualitative analysis of data identified recurrent themes.RESULTS:Five primary themes, arising in all four groups, were: (1) customer service; (2) respect for the patient; (3) inter-personal skills; (4) thoroughness of care; and (5) costs of medical care. Secondary themes, occurring in three of the four groups, were: (1) cultural competency training; (2) the training of medical office staff; (3) continuity of care; and (4) the role of the patient. Participants specifically requested that medical students receive cultural competency training about the host culture, its history, values, and traditional and alternative healing practices.DISCUSSION:The emphasis participants placed on the need for cultural competency training of physicians supports the need to address the role of culture in medical education. Although most of the issues raised are not unique to Hawai'i, participants' recommendations to teach students about the host culture and traditional healing practices identify important themes not usually found in medical school curricula.
To meet the needs of a more diverse population, a culturally sensitive approach to end-of-life communication is critical. This paper describes a unique communication workshop that introduces future physicians to the delivery of culturally responsive care for patients in palliative and end-of-life treatment. The workshop is embedded within the required fourth year medical student rotation in Geriatrics and Palliative Care. Using case-vignettes, role playing, and small group discussions, content areas include: breaking bad news, discussing advanced directives, and decisions regarding withdrawal or withholding of treatment. Post workshop student evaluations reveal an overwhelmingly favorable response to the curriculum, with high scores for overall quality of the workshop, practical value, and appropriateness for level of training. This workshop meets the goal for all graduating medical students to engage in culturally competent palliative and end of life patient care.
With Koch's announcement in 1882 of his work with the tubercle bacillus, his famous postulates launched the rational world of infectious disease and an abrupt social change--strict patient isolation. The postulates, so successful at their inception, soon began to show some problems, particularly with cholera, which clearly violated some of Koch's requirements. Subsequent studies of other diseases and the discovery of entirely new ones have so altered and expanded the original postulates that they now are little but a precious touch of history. The present additions and replacements of the original concepts are skillful changes that several authors have devised to introduce new order into understanding complex viral and prion diseases. In 1988, this knowledge, with the totally rational response of the British population and its cattle industry, was critical in promptly blocking the threatened epidemic of human prion disease. In contrast, the recent upsurge of tuberculosis (TB) in the worldwide AIDS epidemic in developing countries, and the sudden increase in metabolic syndrome in wealthy ones, suggests the need for focused sociobiologic research seeking ways to affect the damaging lifestyle behavior of many less educated populations in both settings. The world awaits an equivalent of Koch's Postulates in sociobiology to explain and possibly avert large self-destructive behaviors.
BACKGROUND:Death remains one of the most important and significant activities in Yap, an event that involves the entire island. A death of a Yapese not only unites the family, it initiates a complex series of reaffirmed kinship ties, rituals and exchanges that refocus the entire community and create new social identities for the participants. How these ties, exchanges, and identities are changing due to new economic challenges and new social pressures were the focus of this preliminary study, which sought to document the resiliency or fragility of traditional structures, measured in the efforts around death and dying in Yap and to identify ways that the health care system can intervene to improve palliative care.METHODS:226 persons (49 on Wa'ab--Yap Proper--and 177 on the Outer Islands) participated in 16 focus groups, of which eight were on Wa'ab and eight on four Outer Islands: Fais, Falalop, Fetherai, and Mogmog. We additionally conducted 6 semi-structured open-ended key informant interviews, added to capture more of Yap's enormous sociocultural diversity.RESULTS:The islands of Yap, particularly the Outer Islands, continue to support one of the world's best traditional palliative care involving the immediate family, more distant relatives and in many cases the entire community. However, participants showed considerable concern for ways that this system is weakening and offered numerous suggestions for improving and strengthening palliative care in Yap.DISCUSSION:Although caution must be exercised not to undermine the existing system, six recommendations on how the health system can intervene can be identified. These involve identifying a key resource person on each island; supplying small, practical "comfort care" kits; making more pain medication available; conducting regular home visits; improving patient-physician and physician-family communication; designing a suicide intervention strategy; and documenting existing variations of how the dying are cared for on the other Outer Islands of Yap.
BACKGROUNDWhile there are many reasons people choose not to donate blood, pain sustained during the venipuncture portion of the blood donation process is likely one deterrent to volunteer donation. The purpose of this study was to survey the improvement in likelihood of donation if participants were given the option of a topical anesthetic cream prior to venipuncture.STUDY DESIGN AND METHODSOver a three month period 316 adults (convenience sample) completed a one page survey consisting of twelve questions pertaining to blood donation. Participants were asked about their likelihood of donating blood in the near future (No Possibility, Possible, Likely, Certain). They were then informed of the possibility of using a topical anesthetic cream prior to donation. Subsequently, their likelihood of donating blood was reassessed.RESULTSFifty (16%) subjects reported an increased likelihood of donating blood if offered a topical anesthetic (p〈0.0001). Of these respondents reporting an increase in donation likelihood, eleven improved by 2 or more likelihood categories. Amongst the 169 participants who never donated blood, 34 (20%) reported an increased likelihood of donation after being told about the topical anesthetic cream, compared to 16 (10%) of the 147 subjects who had previously donated blood (p=0.02).CONCLUSIONThe findings of this study suggest that providing a topical anesthetic had a positive effect on the study participants' likelihood of donating blood. This improvement was greater amongst those who have never donated blood.
In the past 20-30 years, the number of overweight children in the United States has doubled.1 Overweight children are acquiring conditions such as hypertension, type II diabetes, hypercholesterolemia, sleep apnea, and orthopedic problems. The purpose of this study was to explore the prevalence of and factors associated with at risk and overweight in children 2-10 years of age in a Health Maintenance Organization (HMO) in Hawai'i. This quantitative, retrospective cross-sectional study included a stratified random sample of 554 children ages 2-10 years who received a well child health care exam at a HMO in 2003. The prevalence of at risk and overweight were examined including the relationship between ethnicity, socioeconomic status, place of residence, and a child being overweight. Thirteen percent were at risk for overweight (BMI 85-95%) and 19% (BMI >95%) were overweight. In the 6-10 year age group, 42 % were overweight or at risk for being overweight. Boys had a higher incidence of being overweight (54%) than the girls (46%). Pacific Islanders had the highest incidence of overweight (40%), followed by the Hawaiian/Part Hawaiians (19%) and Filipinos (19%). Ethnicity and place of residence were significantly associated with being at risk or overweight. Pacific Islanders were 4 times more likely to be overweight/at risk for overweight and those residing in the West O'ahu, Honolulu, and Central O'ahu/North Shore areas were 2-3 times more likely to be at risk for overweight when compared to children living in the Windward side. With increased age, the prevalence of overweight increased. Findings suggest that targeted obesity prevention strategies need to be initiated early in life and geared for ethnically and geographically diverse children and their families.
OBJECTIVE:To present prevalence rates of adolescents in Hawai'i at-risk weight (85 percentile or higher = overweight or obese) and the relationship with comorbidities. METHODS:The Hawai'i Youth Risk Behavior Survey aggregated for 2005, 2007, and 2009 was analyzed addressing at-risk weight prevalence by sex, race/ethnicity, and grade. Comorbidities were related to at-risk weight using regression. RESULTS:Over 1/4 of Hawai'i adolescents were at-risk weight. There were no differences by grade, but boys had higher prevalence (31.0%) than girls (22.4%). Overall, Other Pacific Islanders and Hawaiians had the highest prevalence (43.9% and 37.4%, respectively), followed by multi-race (27.1%), Filipino (25.7%), and Whites with the lowest (16.1%). Most associations between at-risk weight and various co-morbidities (including sexual behavior, nutrition, physical activity, mental health, bullying, alcohol, and other drug use) were not significant (p>.05). However, girls and boys trying to lose weight; and boys with 3+ hours of screen time (TV, video, or computer games) each day were at increased odds of at-risk weight (p<.05). CONCLUSION:Adolescent gender and ethnic disparities exist such that a single intervention approach (one size fits all) may be counterproductive. More research is required on the determinants and mechanisms to guide weight management interventions.
The elderly consume a disproportionate amount of health care resources, and the recent trend in obesity will only escalate costs. EnhanceFitness® (EF) is an exercise program designed to increase the strength, flexibility, and balance of older adults. A comprehensive controlled study in Washington state of an elderly population has shown that participants who attend at least one EF class per week reduce healthcare costs by 20% per year. The present study reports the costs and potential benefits of replicating EF on Kaua'i. For Kaua'i the annual cost of an EF pilot program for 132 clients would be $204,735. Attendance records of the Kaua'i program showed that 96 (73%) of those enrolled attended at least weekly. Based on national reports of healthcare costs for the elderly, averting 20% of the costs for these 96 elderly would save $344,256 per year. The expected investment to return ratio, I-R ratio, for EF on Kaua'i is about 1-1.8. On economic grounds, a case can be made to support and expand these types of programs. In these times of budget cuts, cost-benefit analysis provides a common economic "language" to prioritize among different programs.
Race and ethnicity are commonly used predictor variables in medical and public health research. Including these variables has helped researchers to describe the etiology of certain disease states. Including race and ethnicity in research has been hypothesis generating in terms of the relationship between genetic and environmental factors in the development of disease. Eliminating health disparities among different racial and ethnic groups has become a national priority. However, incorporating race and ethnicity into health research is complex because these variables are difficult to define and individuals often identify with more than one race or ethnicity. As a "minority-majority", multiethnic, multiracial state, Hawai'i faces unique challenges in incorporating race and ethnicity into research. As the demographics of the United States continue to evolve, many of the challenges faced in Hawai'i will apply to the United States as a whole.
In accordance with the sociocultural model, race/ethnicity is considered a major influence on factors associated with body image and body dissatisfaction, and eating disorders are often characterized as problems that are primarily limited to young White women from Western cultures. The purpose of this study was to determine whether there are differences that exist by race in desired body weight; the importance placed on those ideals; and dieting strategies among White, Asian American, Native Hawaiian/Pacific Islanders, and other mixed-race young women in Hawai'i. A total of 144 female college students 18-20 years of age were surveyed about body weight as well as eating and exercise habits. Results demonstrated that all the young women wanted to lose weight. However, there were no differences in desired body weight or desired weight change by race after controlling for body mass index suggesting that current weight rather than race/ethnicity is the predominant influence on weight-related concerns. Young White women placed the greatest level of importance on achieving a lower body weight, which corresponded with a greater likelihood to be attempting weight loss (dieting) and greater endorsement of behaviors consistent with weight loss compared to their counterparts. Findings imply that, for young women, race/ethnicity may not have as significant an impact on factors associated with body weight ideals as previously believed. Rather, differences in the value placed on achieving a desired body weight, as it relates to disordered eating, should be further explored among race/ethnic groups.
