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Human anisakiasis, an increasing medical problem in Japan, was recently identified in 7 people in Hawaii. We report an 8th case occurring in an individual who had consumed a large amount of raw squid sushi at a restaurant. The diagnosis of anisakiasis in this patient was made after the parasite was identified by X-ray. To our knowledge, radiographic demonstration of the anisakiasis parasite has not been reported in Hawaii previously.
On January 2, 1991, 12 of 24 persons who attended one or more of three New Year's celebrations in Honolulu, Hawaii, had onset of gastrointestinal illness. An investigation by the Epidemiology Branch of the Hawaii Department of Health (HDOH) determined that the only common foods shared by participants were oysters and clams provided by one distributor.
As a prelude to continuing surveillance in Hawaii, a 2-year retrospective study (1987-1989) was conducted by the Pacific Basin Rehabilitation Research & Training Center (PBRRTC) and the Rehabilitation Hospital of the Pacific (REHAB) in order to examine the frequency and causes of traumatic spinal cord injury (SCI) at REHAB; determine similarities and differences when compared to national statistics and make recommendations for future study. Data were abstracted from patient records at REHAB. During the period of study, 59 persons were treated for SCI. Similar to the national database, 85% were males and 70% were teenagers and young adults. Motor Vehicle Accidents (MVAs) contributed to 38% of the injuries followed by falls (28%), sports (19%) and violence (16%); however, etiology differed according to age. Sixty-two percent of the lesions were cervical. Almost 50% were neurologically complete. Sixty-six percent were in wheelchairs. Over 50% were independent in mobility and feeding and nearly 40% were independent in bathing and dressing. Eighty-eight percent returned to their homes. In general, the case at REHAB did not differ from the national database. Because reporting has not been mandatory, actual SCI incidence in Hawaii is most likely higher. Information derived from a mandatory reporting system would lead to identification of high risk groups, development and evaluation of prevention programs, identification of patients requiring early intervention and rehabilitation, and better planning of health care services.
The commercial milk supply on Oahu was contaminated by heptachlor epoxide for as long as 15 months during 1981-82 at levels possibly as high as 1.2 ug/g, fat basis. Following the contamination, several investigators attempted to evaluate potential adverse health outcomes, especially among infants and young children. However, results of the initial investigations are inconclusive due to lack of reliable measures of heptachlor exposure, use of non-random sampling techniques, and lack of definitive health outcomes attributable to heptachlor epoxide. The design of a current study to assess the body concentrations of heptachlor epoxide and related pesticides in Hawaii is presented. The study is designed (1) to relate these concentrations to prior exposure via the milk contamination, and (2) to assess the reliability of breast milk and serum pesticide concentrations as objective biological markers of body burden. No attempt is made to relate these data to health outcomes; instead, the findings may provide the foundation for future health studies or surveillance of environmental exposure to pesticides in Hawaii.
Tropical spastic paraparesis or human T-lymphotropic virus type I (HTLV-I)-associated myelopathy is a degenerative encephalomyelopathy with pyramidal tract dysfunction affecting the lower extremities. It is associated with HTLV-I infection and found primarily in the Caribbean region and in southwestern Japan. Five cases of tropical spastic paraparesis (or HTLV-I-associated myelopathy) in Hawaii are reported. All five patients were born in Hawaii; four are women. Each of the patients has parents who were from HTLV-I-endemic areas of Japan. Two of these patients had serum antibodies to HTLV-I. Five of six of the spouses and children of the seropositive patients were also seropositive. Viral cultures of lymphocytes from both seropositive patients and two of the three seropositive children were positive for HTLV-I. None of the five patients had a history of antecedent blood transfusion, multiple sexual partners, or intravenous drug use. There is no evidence of adult T-cell leukemia or lymphoma in any of the patients or their families. Given the increasing seroprevalence of HTLV-I in the United States, clinicians need to be alert to new cases of this disorder.
The island of Hawaii, like other locations in a marine environment, has low levels of atmospheric 222Rn. The low concentrations of 222Rn and its decay products result from a low average flux density of 9.8 mBq m-2 s-1, the mixing of marine air from the Pacific having a 222Rn concentration of only 0.04 Bq m-3 with air from over the island, and the decay of 222Rn as it is transported in air masses across the Pacific primarily from the Asian continent. The overall mean concentration over the Island The overall mean concentration over the Island was found to be 0.44 Bq m-3 compared with a figure of about 8 Bq m-3 for air over continents. A consideration of the island as a source of 222Rn must take into account the relatively low average flux density associated with the lava fields and accompanying thin soils. The 222Rn formed from the U and 226Ra present in the lava cannot escape to the atmosphere. The deep agricultural soils, on the other hand, provide relatively high flux densities. When the areas of the soil types are taken into account, the exhalation for the lava fields, thin organic soils, and deep agricultural soils were 0.25, 1.7, and 32 MBq s-1, respectively. Measurements of indoor 222Rn on the island indicate levels of approximately 25 Bq m-3 which is appreciably lower than 40 Bq m-3 taken as an average for indoor levels on the mainland. Based on an assumed indoor occupancy level of 0.8, the effective dose equivalent for inhaled 222Rn and its decay products on Hawaii is 1.2 mSv y-1. This is only a little more than one-half of that for a resident of the continental United States who is estimated to receive an effective dose equivalent of 2 mSv y-1. The relatively low effective dose equivalent for the population on the island may have interesting effects in comparison with people living in areas where the inhaled dose from 222Rn is much higher.
U.S. mainland studies reveal an alarming rise of progressive disability reported by long-term polio survivors. To determine if polio survivors residing in Hawaii were experiencing similar problems, this study of 100 volunteers was undertaken. Extensive interviews and physical examinations were performed. Results indicate that many patients were complaining of new or greater disability due to late complications of polio or medical conditions unrelated to polio. Twenty percent appeared at greater risk for having post-polio syndrome (PPS). Over half described mobility that was less than fully independent. Subjects voiced a clear need for specialized health, social and rehabilitative services. Consistent with Mainland reports, polio survivors in Hawaii are demonstrating changes in disability that challenge the traditional notion that polio is a static, permanently stable neurologic condition.
A study of the acquired immunodeficiency syndrome in Hawaii indicates the presence of an estimated 334 patients, 49 (14.7) of them females, between 1985 and mid-1988. Regression analysis yielded an expected count of 1200 patients by 1991, with a total cost of $50 million for care. The cost per patient was $37,053. These findings suggest that the cost of AIDS may not be as high as previously thought and that Hawaii has a relatively small share of the epidemic. An investigation of the reasons for termination of health insurance suggests that many AIDS patients resort to Medicaid for subsequent coverage. Almost half of the patients who terminated their health care coverage expired within 3 months of diagnosis. Inpatient data were obtained and compared in cities and overall nationally. These findings and their implications are discussed.
The concept of the "medical home" was adopted by the Hawaii Medical Association and the Hawaii Chapter of the American Academy of Pediatrics in the Child Health Plan over 10 years ago. The medical home is an integrated system of services that focuses on the well-being of the child, within the context of the family. Primary health care under the medical home would be continuous and comprehensive, addressing the needs of the whole child. It would provide coordinated care that is family-centered, community-based. Several recent publications have emphasized the importance of the medical home in providing access to a continuum of medical and health services to enable young children to develop and maintain a state of optimal health.
Recently, Hawaii's mental health care system has been in the news because of its alleged infamy as one of the poorest systems in the United States of America today. Hawaii has not always been considered a state with a conspicuously poor commitment to mental health. The Department of Health (DOH), the oldest department of health in the United States of America, was formed in 1850 by King Kamehameha III. In fact, Kamehameha III, recognizing the importance of developing programs in mental health, was one of the earliest political leaders in history to support government-sponsored mental health services.
The Hawaii State Hospital (HSH) is one element within the total Hawaii mental health system that defines its role and functions according to its relationship with other elements of the system. As the only public psychiatric inpatient facility, the State Hospital's unique role is to provide inpatient care and treatment to patients who are not eligible for hospitalization in the private sector.
American Samoans are one in a number of Pacific Basin groups for which the U.S. Government provides health care assistance and one in a large number of recent immigrant groups to the United States. Although these groups often have health care beliefs inconsistent with Western primary care, their compliance with basic provider expectations (such as appointment keeping and appropriate emergency room use) remains largely unstudied. In the case of Samoans in Hawaii, concern is often expressed that a group much in need of health care (pediatric hospitalization and acute illness visit rates are high) often seems "out-of-sync" with Western health care. Four measures of noncompliance were studied in the Hawaii pediatric primary care residency training program. Enrolled Samoan patients were compared with an aggregation of more established ethnic groups. Four matched case-control studies controlled for socioeconomic status and the presence or absence of medical insurance and a home telephone. Samoans were more likely than the comparison group to miss health maintenance appointments, to drop in without an appointment, and to use the emergency room for nonurgent problems when a same-day-notice clinic visit would have usually sufficed.
This is the first report of travellers' skin diseases from the Hawaiian archipelago. The diagnoses of all tourists who presented to a dermatology practice on Kauai, Hawaii, were recorded over six years. The cutaneous disorders tabulated in visitors differed significantly from those observed in the local population. In visitors, over one-third of the diagnoses were of light-induced disorders. The most common disease observed was the papulovesicular variant of polymorphous light eruption. This report should serve as a guide to the skin diseases that travellers to Hawaii frequently experience.
Because large numbers of persons were employed in United States shipyards during World War II, the long-term risks for cancer associated with asbestos exposure in this setting are of great concern. We report here on the mortality findings after up to 29 years of follow-up on a retrospective cohort of 7971 male Pearl Harbor Naval Shipyard workers, which included more than 3000 men whose employment period spanned the World War II years. Compared with the general population of Hawaii, workers in the shipyard cohort had no increase in total mortality or in total cancer mortality irrespective of the duration of their exposure. However, the risk ratio for lung cancer among workers with at least 15 years of asbestos exposure was 1.4 overall (95% confidence interval, 1.0 to 2.0) and 1.7 for those with a latency interval of 30 or more years (95% confidence interval, 1.0 to 2.5). In addition, seven mesotheliomas occurred between 1977 and 1982 in a subset of the cohort, consisting of 7029 Hawaii residents who are being followed prospectively for cancer incidence. This represented an incidence of 67.3 per million men per year, compared with a rate of 5.8 for the state as a whole. These results suggest that the long-term relative increase in risk for mesothelioma may be even greater than that for bronchogenic carcinoma in this and other cohorts of United States shipyard workers exposed to asbestos.
Since 1910 the District of Hamakua, Island of Hawaii, has been considered an endemic plague area. To obtain indirect evidence of plague infection in rodents and in the mongoose, serological surveys of the small mammal populations were undertaken. The passive microhaemagglutination test demonstrated the presence of positive reactors (titres of 1:16 and higher) in the sera of 2641 rodents and 385 mongooses tested. Positive percentages were: Rattus exulans, 1.5%; R. norvegicus, 1.9%; R. rattus, 0.6%; Mus musculus, 1.1%; and Herpestes auropunctatus, 12.5%. This study has proved the continued presence of a permanent reservoir of plague in indigenous rodent and mongoose populations after a period of 65 years since the introduction of plague into Hawaii and has demonstrated that the mongoose is an excellent indicator of plague infection.
We examined ethnic differences in smoking and drinking habits among the five major ethnic groups in Hawaii (Caucasians, Japanese, Chinese, Filipinos, and Hawaiians) by means of questionnnaire data obtained from a representative sample of 8,636 Hawaii residents. For men, lifetime cigarette use was greatest among Caucasians and lowest among Chinese and Filipinos. For women, smoking cigarettes was highest among Caucasians and lowest among Chinese. Although overall smoking patterns showed some relationship to lung cancer incidence, the observed rates could not be fully explained. Beer consumption was greatest among Hawaiians of both sexes and least among the Chinese; most consumers of spirits (hard liquor) were Caucasian. Total alcohol consumption was similar among Hawaiians and Caucasians and was considerably greater than among the other 3 ethnic groups. Alcohol consumption patterns among men did not correlate well with esophageal cancer incidence, even when the analyses were restricted to smokers; among women, however, the correlation was high. For these sex- and ethnic-specific groups whose alcohol consumption was generally low, there was a negative association of amount consumed with mean annual family income. For the groups with higher proportions of drinkers, mean annual family income was higher among those who drank moderately (less than 5 ounces/wk) than among those who either drank more heavily or not at all.
Simultaneous outbreaks of Guillain-Barré syndrome (GBS) and Bell's palsy occurred among residents of Hawaii during the three-month period June through August 1981. The outbreak of GBS (six cases) involved children, while the outbreak of Bell's palsy (22 cases) involved primarily adults. Four of the six patients with GBS had serological evidence of recent infection with cytomegalovirus (CMV) v none of 24 control subjects; no such association with CMV infection could be demonstrated for patients with Bell's palsy. The patients with GBS and Bell's palsy lived in widely scattered areas within the population centers of Hawaii, and no common exposures to specific places or events were identified. Testing for antibodies to respiratory pathogens suggested that a variety of antecedent viral infections, in addition to CMV infection, may have been associated with this unusual simultaneous cluster of illnesses.
There was a decrease in the recorded number of cases and in the incidence rate of Down's syndrome in Hawaii between 1963-1969 and 1971-1977. Independent of all other factors, induced abortion accounted for 43 percent of the decline in the number of cases, based on the assumption that a substantial number of clandestine abortions were being performed in Hawaii before the 1970 legalization of abortion. However, if we assume that very few illegal abortions were performed prior to 1970, there would have been an actual 3.5 percent increase in the number of cases of Down's syndrome in the absence of legal abortion. Declining pregnancy rates and decreasing age-specific incidence rates of Down's syndrome also contributed to the drop in the number of cases between 1963-1969 and 1971-1977.