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PubMed1985

Medicaid program; treatment of social security cost of living increases for individuals who lose SSI eligibility--HCFA. Proposed rule.

This proposal would revise current Medicaid rules for determining financial eligibility for an individual who is no longer eligible for benefits under title XVI of the Social Security Act, the Supplemental Security Income (SSI) Program, due to receipt of cost of living increases (COLAs) under section 215(i) of the Social Security Act. This change would affect categorically needy eligibility in all States by requiring that any individual who would still be entitled to benefits under the SSI program but for receipt of a section 215(i) COLA after April 1977 must be treated as if he or she were still receiving those SSI benefits. This proposal would not apply in Puerto Rico, Guam, the Virgin Islands, and American Samoa, where the SSI program is not in effect. This proposed revision is made pursuant to a decision of the United States District Court for the Northern District of California. That decision invalidated the existing provision of the Medicaid regulations under which individuals who were no longer eligible for SSI benefits qualified for Medicaid only when a section 215(i) COLA was the specific cause of the loss of SSI benefits.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2000

Vaccination coverage among children enrolled in Head Start programs or day care facilities or entering school.

PROBLEM/CONDITION: Undervaccinated children enrolled in day care centers and schools are vulnerable to outbreaks of vaccine-preventable diseases. A Healthy People 2000 objective is to increase to > or = 95% vaccination coverage among children attending licensed day care facilities and kindergarten through postsecondary school (objective 20.11). REPORTING PERIOD COVERED: September 1997-June 1998. DESCRIPTION OF SYSTEM: CDC's National Immunization Program administers grants to support 64 vaccination programs. These programs are in all 50 states, eight territories or jurisdictions (American Samoa, Republic of Marshall Islands, Federated States of Micronesia, Guam, Commonwealth of Northern Mariana Islands, Puerto Rico, Republic of Palau, and the U.S. Virgin Islands), five cities (Chicago, Houston, San Antonio, New York City, and Philadelphia), and the District of Columbia. Grant guidelines require annual school vaccination surveys and biennial surveys of Head Start programs and licensed day care facilities. This system constitutes the only source of nationally representative vaccination coverage estimates for these populations. RESULTS: Head Start Programs: Of the 64 reporting areas, 33 (51.6%) submitted coverage levels for children enrolled in Head Start programs. Of these, all 33 programs reported coverage levels for diphtheria and tetanus toxoids and pertussis vaccine (DTP), diphtheria and tetanus toxoids (DT), or tetanus toxoids (Td), poliovirus vaccine, and measles vaccine; and 32 reported coverage levels for mumps and rubella vaccines. Four programs reported coverage levels for the combined measles, mumps, and rubella vaccine (MMR). The mean vaccination coverage levels for the 1997-98 school year among the reporting vaccination programs were 97.8% for poliovirus vaccine (range: 80.0%-100.0%), 97.0% for DTP/DT/Td (range: 87.7%-100.0%), 93.3% for measles vaccine (range: 91.4%-100.0%), and 93.2% for mumps and rubella vaccines (range: 91.4%-100.0%). Licensed Day Care Facilities: Of the 63 reporting areas with licensed day care facilities, 38 (60.3%) submitted coverage levels for enrolled children. Of these, all 38 programs reported coverage levels for poliovirus vaccine and DTP/DT/Td, 37 reported coverage levels for measles vaccine, and 36 reported coverage levels for mumps and rubella vaccines. Four programs reported coverage levels for the combined MMR. The mean vaccination coverage levels among the reporting areas were 95.8% for poliovirus vaccine (range: 85.1%-99.8%), 95.7% for DTP/DT/Td (range: 77.6%-99.9%), 89.1% for measles vaccine (range: 78.0%-99.9%), and 89.1% for mumps and rubella vaccines (range: 78.0%-99.9%). Kindergarten/First Grade: Of the 64 reporting areas, 43 (67.2%) submitted coverage levels for children enrolled in kindergarten and first grade. Of these 43 programs, 42 reported coverage levels for poliovirus vaccine and DTP/DT/Td, and 43 reported coverage levels for measles, mumps, and rubella vaccines. Four of the 43 programs reported coverage levels for the combined MMR. The mean vaccination coverage levels among the reporting areas were 96.7% for poliovirus vaccine (range: 82.8%-99.9%), 96.7% for DTP/DT/Td (range: 82.8%-99.8%), 96.0% for measles vaccine (range: 82.8%-99.9%), and 96.5% for mumps and rubella vaccines (range: 82.8%-99.9%). INTERPRETATION: High levels of vaccination coverage among children entering school most likely result from the successful implementation of state-specific school vaccination laws, which have applied to children entering school in all states and the District of Columbia since at least 1990. All states, territories, and the District of Columbia have additional laws that require vaccination of children in licensed day care facilities. However, because a high proportion of states and territories did not submit vaccination coverage reports to CDC, these estimated means may not reflect levels for all children in the United States.

Child↗
PubMed2000

Telehealth in the Pacific Islands: a perspective and update from the Fiji School of Medicine.

The Fiji School of Medicine (FSM) has increased participation with telehealth/telemedicine in general, and specifically with the Pacific Public Health Surveillance Network (PPHSN) and the Western Pacific HealthNet(WPHNet), through the establishment of a WPHNet Centralised Triaging Service (CTS). The FSM Telehealth/Telemedicine Unit (FSMTU) will oversee the development of the CTS which is being closely coordinated with existing clinical consultation services provided through Project Aamai and the Tripler Regional Medical Center (TRMC). While the WPHNet CTS will initially be concerned with distance clinical consultation, the FSM mission encompasses community health and professional health education in a wide range of disciplines. Currently, WPHNet only serves the jurisdictions of the US-associated Pacific islands but with WPHNet CTS there will be an opportunity to include new member jurisdictions that do not have political affiliation with the USA. (e.g. Cook Is, Kiribati, Niue, Samoa, Solomon Is, Tonga, Vanuatu etc). In addition, although Internet technology is expanding rapidly in the region, the capacity for outside communication throughout the Pacific is quite varied. Very remote areas may currently only be able to communicate by using short wave radio. Others have telephone and/or fax while some have E-mail but not full internet capacity. The FSMTU will implement mechanisms to field requests through any of these communication avenues and so the WPHNet CTS will serve as a proxy for regional healthcare providers that do not have internet access.

Fiji↗
PubMed2002

Acute gastroenteritis associated with seafood privately imported from the Pacific Islands.

AIMS: To investigate a potential link between consumption of food privately imported from the Pacific Islands and presentation with acute gastroenteritis to Middlemore Hospital Emergency Department. METHODS: This was a three month prospective observational case study that included patients aged greater than fifteen years presenting with acute gastroenteritis and a history of food privately imported from the Pacific Islands. Data included case demographics, symptoms, island of food origin and food type. Stool and blood samples were collected and analysed. RESULTS: Of 358 patients who presented to Middlemore Emergency Department during the study period with gastroenteritis, 34 (9.4%) had a history of consumption of food privately imported from the Pacific Islands. The seafood came from Tonga (23 cases), Samoa (10 cases) or Niue (1 case). The implicated seafood was shellfish (28 cases), jellyfish (2 cases), fish intestine (2 cases), seaweed or seaslug (1 case each). Fourteen patients (41%) provided stool samples; all were culture positive for Vibrio parahaemolyticus (VPH). CONCLUSIONS: This case series confirms a link between acute VPH gastroenteritis and consumption of seafood privately imported from the Pacific Islands. A number of public health initiatives to reduce the burden of VPH gastroenteritis among Auckland's Pacific Islanders have commenced. The Ministries of Health, Agriculture and Forestry are considering tighter controls or banning food privately imported from the Pacific Islands.

Adolescent↗
PubMed2001

Imi Ho'ola post-baccalaureate program: recruitment, retention, and graduation of Asian American and Pacific Islander students in medicine.

Imi Ho'ola has been a successful model for training underrepresented minorities and disadvantaged individuals in medicine at the University of Hawai'i. This program has 28 years of experience assisting students to prepare for, qualify for, and complete the M.D. program, thereby producing medical doctors and other health professionals for Hawai'i, Guam, American Samoa, the U.S. Associated Pacific Islands (USAPI), and the continental U.S. Recently, Imi Ho'ola has expanded its outreach efforts to create an educational pathway for local high school and college students encouraging them to pursue higher education and health careers. A description of the Imi Ho'ola is presented with emphasis on its post-baccalaureate curriculum begun in 1995.

Asian↗
PubMed2002

Assessing physicians' continuing medical education (CME) needs in the U.S.-associated Pacific jurisdictions.

OBJECTIVE: To assess the self-perceived continuing medical education (CME) needs of physicians in American Samoa, Commonwealth of the Northern Mariana Islands, Guam, Federated States of Micronesia, Republic of the Marshall Islands, and the Republic of Palau. METHODS: Questionnaire-based survey of all physicians. RESULTS: Responses obtained from a total of 143 physicians in the region provided information on training backgrounds, previous experiences with CME, local access to regular CME sessions, perceived priority educational needs and preferred methods of CME delivery. CONCLUSIONS: Overall 64% of respondents had attended a formal CME event in 1999 or 2000, and 71% had access to local weekly or biweekly CME. However the perceived usefulness of these events varied by region. Priority learning needs were identified by physicians including non-communicable diseases such as diabetes, hypertension, cardiac disease; communicable diseases such as tuberculosis, HIV/AIDS and tropical diseases; as well as skills such as EKG and X-ray interpretation, trauma management and cardiac life support. Information on the most pressing educational needs and desired methods of delivery will be crucial in planning CME in this region.

Attitude of Health Personnel↗
PubMed1992

HTLV-I infection in selected populations in Australia and the western Pacific region.

The prevalence of infection with human T lymphotropic virus type I (HTLV-I) in 19,975 blood samples from Australia and the western Pacific was determined by measuring the presence of specific antibody (anti-HTLV-I) by enzyme-linked immunosorbent assay (ELISA) with confirmation by western blot and/or radioimmunoprecipitation techniques. In Australia no evidence of HTLV-I infection was found in injecting drug users, patients with the acquired immunodeficiency syndrome (AIDS), subjects attending a sexually transmitted diseases clinic, female prostitutes, or transfusion recipients. A low prevalence of infection was detected in people with haemophilia (0.5%) and in male homosexuals (0.5%-1%). No antibody was detected in sera from Vanuatu, Kiribati, American Samoa, the Cook Islands, New Caledonia, the Federated States of Micronesia, French Polynesia and Fiji, but a low frequency of anti-HTLV-I was detected in sera from the Solomon Islands (1.2%) and Nauru (0.6%).

Acquired Immunodeficiency Syndrome↗
PubMed2003

Empowerment through community building: Diabetes Today in the Pacific.

The goal of Diabetes Today, a program of the Centers for Disease Control and Prevention (CDC), is to develop coalitions and train coalition members in assessment, planning, and evaluation to address diabetes in their communities. CDC established the Pacific Diabetes Today Resource Center (PDTRC) in 1998 to tailor the program for Pacific Islander communities in Hawaii, American Samoa, Guam, the Commonwealth of the Northern Marianas Islands, the Federated States of Micronesia, the Republic of the Marshall Islands, and Palau. PDTRC's work is guided by the principles of community building and the goal of empowering coalitions to take action around diabetes. Culturally appropriate strategies are used to gain access to the community, transfer knowledge and skills, build coalitions, and provide technical assistance. Evidence of empowerment is seen in increased individual competence, enhanced community capacity, reduced barriers, and improved supports to address diabetes. To maintain the gains of community building in the Pacific, three factors appear critical: an engaged leader, a host agency for the coalition, and continuing access to technical assistance and funds.

Centers for Disease Control and Prevention, U.S.↗
PubMed2002

Listening to the community: a first step in adapting Diabetes Today to the Pacific.

Diabetes is a growing problem among Pacific Islanders, but few community-based groups in the Pacific are actively working on diabetes prevention and control. The Pacific Diabetes Today Resource Center (PDTRC) was established in 1998 to adapt the Diabetes Today (DT) curriculum for Pacific Island communities in Hawai'i, American Samoa, and Micronesia. To gather data to guide the development of the Pacific Diabetes Today (PDT) curriculum, a year was spent listening to Pacific communities. First, data were gathered from health professionals on how the DT curriculum should be modified. Second, health and community leaders in 11 sites were trained and supported to conduct discussion groups with people affected by diabetes. Third, site coordinators evaluated the discussion group process. A Pacific-wide Advisory Council (AC) was established to guide the project, and the AC used findings from the first year to generate guidelines for staff to follow in adapting the DT curriculum to the Pacific. These guidelines directed staff to: a) realize that Pacific communities need to build awareness about diabetes; b) train and support local community leaders as co-facilitators in the PDT curriculum, using a learn-by-doing approach, with the goal of developing them as independent trainers; c) encourage the involvement of a broad range of community members in PDT training, including the involvement of local physicians to counter medical misconceptions about diabetes; d) give the PDT curriculum a Pacific "look" and "feel;" and e) keep the training logistically flexible to accommodate differences in communities across the region. Other programs and agencies that want to develop training programs in the Pacific may find these listening strategies and guidelines helpful.

Advisory Committees↗
PubMed2004

Shriners Hospitals for Children, Honolulu's experience with telemedicine: program implementation, maintenance, growth, and lessons learned.

Shriners Hospitals for Children, Honolulu Telemedicine Program conducts real-time video consultations with remotes sites in Hawaii, Guam, Saipan, American Samoa, the Federated States of Micronesia, and the Republic of the Marshall Islands. The program began in 1999 and has provided over 240 consultations. This report is a summary of the Shriners Hospitals experience and lessons learned regarding program implementation and maintenance.

Child↗
PubMed2005

Hirschsprung disease in the U.S. associated Pacific Islands: more common than expected.

INTRODUCTION: Tripler Army Medical Center (TAMC) in Honolulu, Hawaii, is uniquely situated to serve patients from the United States Associated Pacific Islands (USAPIs) through the congressionally funded Pacific Island Health Care Project (PIHCP). Because of time differences and distance, a web-based store-and-forward consultation and referral network was established using the internet to more efficiently and economically facilitate patient care. Using both electronic and hard copy records, we sought to establish the incidence of Hirschsprung Disease (HD) in children from the USAPI and contrast it to that of the developed world. METHODS: PIHCP website records as well as all the inpatient and outpatient medical records of patients referred to TAMC fortreatment of HD from 1994 to 2002 were reviewed. A diagnosis of HD was confirmed in all cases with full thickness biopsy. Incidence figures for HD are based on this review and on the birth rates for these islands from the International Data Base of the U.S. Bureau of the Census. RESULTS: There were 14 cases of short-segment HD referred over a nine year study period. Nine patients came from the Federated States of Micronesia (FSM) with an average annual incidence of 1:3190, which is 1.5 to 2 times the reported incidence in Western nations. Remarkably, seven of these nine were from Pohnpei State, capital of the FSM (annual incidence of 1:1370 or3-5 times that in the West). Three patients came from the Republic of the Marshall Islands (RMI), and two came from American Samoa (AS). There were no reported consanguineous marriages, associated syndromes, or complications of surgery. CONCLUSION: HD was found to be up to 2-3 times more common among people from the FSM than has been reported in the developed world. Given the limitations of providing care and obtaining data from all the USAPls with a population that is spread over a massive expanse of ocean larger than the continental United States, this incidence is likely an underestimation of HD among Pacific Islanders. A secure web-based referral network developed in 1998 has been invaluable in collecting epidemiologic data from these islands as well as in providing health care workers in the USAPI with an efficient and inexpensive means to seek consultation from specialists and sub-specialists at a major tertiary care medical facility.

Hirschsprung Disease↗
PubMed2004

Cancer in the US Associated Pacific Islands (UASPI): history and participatory development.

The US-associated Pacific Island jurisdictions (USAPI) have great disparities in health care and comprehensive cancer care compared to the United States. Cancer mortality ranks first or second among the leading causes of death in most of these island nations. The USAPI has formed the Cancer Council of the Pacific Islands (CCPI), an indigenous council to identify and address the cancer health disparities of the region. The CCPI efforts were formally launched in 2002 with the support of the Center to Reduce Cancer Health Disparities, a Center of the National Cancer Institute (CRCHD-NCI) and the National Center for Minority Health Disparities, a Center of the National Institutes of Health (NCMHD-NIH). Facilitating partners are the Department of Family Medicine and Community Health, University of Hawai'i and 'Imi Hale - Native Hawaiian Cancer Network, a program of Papa Ola Lokahi. The objectives of this initiative are to describe and address the cancer health disparities in the USAPI. Over the past 2 years there has been considerable progress in identifying and prioritizing cancer prevention and control needs; launching cancer prevention and control efforts in each of the jurisdictions; and leveraging additional funding to support ongoing activities. The support from the Center to Reduce Cancer Health Disparities in fostering a participatory model of development has been landmark in the establishment and implementation of this initiative. This manuscript provides a historical background on cancer in the USAPI and prefaces 9 cancer assessments in this journal from the Commonwealth of the Northern Mariana Islands, Guam, American Samoa, Republic of the Marshall Islands, Republic of Belau, and the four states (Yap, Pohnpei, Kosrae and Chuuk) of the Federated States of Micronesia.

Attitude to Health↗
PubMed2004

The Pacific Island Health Care Project: easing the cancer burden in the United States associated Pacific Islands.

Cancer is a serious and ever increasing problem in the United States Associated Pacific Islands (USAPIs). Nearly 30% of all consultations and referrals are for cancer. Depending on the type of cancer, the prognosis for long-term survival is often poor and the cost of caring for such patients is considerable. Tripler Army Medical Center (TAMC) provides tertiary medical care to patients from the USAPIs in support of Graduate Medical Education (GME) at no cost to the patient or jurisdiction. Continuing its tradition of leading telemedicine initiatives in the Pacific, TAMC has developed a web-based electronic consultation and referral network, the Pacific Island Health Care Project (PIHCP). Ten sites in Micronesia and one in American Samoa were provided with computer equipment. Local clinicians request consultation from TAMC specialists through the internet, attaching supporting imagery. The consults are posted on a secure web page, where they are viewed, evaluated, forwarded, and commented on by the consultants. Experience with more than 2,100 cases indicates that the Internet can be easily used as a store-and-forward consultation format and offers a cost effective means for distance consultation, referral, and learning. This format has provided for a more rational evaluation of all patients but especially patients with cancer. Patients who are terminally ill, have widely metastasized disease, and/or have inoperable tumors or recurrences are excluded so that limited resources can be used for those most likely to benefit. There has been overwhelming enthusiasm for such Internet consultations between referring physicians and consultants. Many Pacific Islander patients have received state-of-the-art medical care through this program. At the same time, the training of TAMC physicians and residents has been enhanced by their opportunity to care for these remarkable and deserving patients from the Pacific.

Education, Medical, Continuing↗
PubMed1991

National Electronic Telecommunications System for Surveillance--United States, 1990-1991.

The National Electronic Telecommunications System for Surveillance (NETSS) was developed by CDC and the Council of State and Territorial Epidemiologists (CSTE) for collecting, transmitting, analyzing, and publishing weekly reports of notifiable diseases and injuries from the 50 states, New York City, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and Commonwealth of the Northern Mariana Islands. Operation of NETSS is facilitated by CDC/CSTE agreements on reportable conditions, protocols for formatting and transmitting data, standard case definitions, and designated staff members in each participating agency who provide and prepare the data for weekly publication in MMWR. This report describes the development and operation of NETSS and presents tabulations of national surveillance data for 1990 (tables on pages 505-510).

Centers for Disease Control and Prevention, U.S.↗
PubMed1987

Red cell enzyme and serum protein gene markers in Fijians.

A total of 332 persons from three localities in the Fiji Islands have been tested for genetic variation in 24 red cell enzyme systems and 4 serum protein systems. Polymorphic variation was present at 7 red cell enzyme loci and 1 serum protein locus. The remaining systems were invariant except for a single individual with a slow variant at the GOT1 locus and another individual with a D variant at the TF locus. The series from Nandi differed significantly from the Lau Islands for gene frequencies in GPT, ACP and ESD, Koro Island differed from the other localities at the PGD locus and from Nandi for ESD. Genetic distance analysis reveals that Lau Islands cluster with Western Samoa, Koro Island with New Caledonia (Vanuatu), with Nandi being separate.

Blood Proteins↗
PubMed1988

Prevalence of anti-delta antibodies in pregnant women in Bandung, Indonesia.

Knowledge of the epidemiology of hepatitis D virus (HDV)-infection is very scarce in many parts of the world. The endemicity of delta-infection is believed to be maintained and spread through the network of hepatitis B surface antigen (HBsAg) carriers in the community. In the Far East and the Pacific area, the prevalence of chronic HBsAg carriers is mostly high. Markers of HDV infection are very frequent in some regions (e.g. parts of China, Fiji Isles, Samoa), in other regions they are almost absent (e.g. Taiwan, Thailand, parts of China). In the Bandung region (West Java, Indonesia) we found 26 (2.8%) HBsAg carriers among 926 pregnant women. Most of them are chronic carriers (anti hepatitis B core (HBc) IgM negative). Although HBsAg is frequent in this Indonesian population, we could not find any anti-HD positive. This data warrants the conclusion that HDV infection has not yet been introduced in that densely populated area of Indonesia.

Carrier State↗
PubMed1985

Cancer incidence in the islands of the Pacific.

The South Pacific Commission Cancer Registry has been operational since 1977, and reasonably complete cancer incidence rates are available for New Caledonia, Fiji, Micronesia, the Cook Islands, and Niue. In addition, less complete reporting is available from American Samoa, Papua New Guinea, and French Polynesia. Cancers of the lung, oral cavity, esophagus, liver, and cervix are potentially preventable but prevalent in many Pacific island countries. Unusually low rates of many cancers were observed in Fiji, the most notable being lung and colon-rectum. Thyroid cancer rates are elevated in some but not all female populations. These and other variations in cancer by site are important areas for further research.

Demography↗
PubMed1971

A review of the filariasis control programme in Tahiti from November 1967 to January 1968.

District filariasis surveys in Tahiti in the years after the Second World War yielded the highest microfilaria rates in the South Pacific area, ranging from 25% to 44%; the mean elephantiasis rate was 5% and microfilaria densities (MfD(50)) ranged from 18 to 31. A co-operative filariasis research programme was begun and a control programme was inaugurated in 1953, using diethylcarbamazine therapy supported by mosquito larvae control measures. By 1959 fifteen districts had received mass treatment. Re-examination after 12 months showed that the mean microfilaria rate had dropped from 31% to 3% and the MfD(50) from 23 to 4. Subsequently, only positives were re-treated and by 1964 the microfilaria rate had risen to 6.8%. The increase caused concern and the significance of this reservoir of infection was investigated.Administration of diethylcarbamazine in periodic mass treatments only in American Samoa began in 1963 and was accompanied by a drop in the microfilaria rate to less than 1%, leading to interruption of transmission in some areas.

Diethylcarbamazine↗