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The types of callers and calls received by the Hawaii Poison Center's telephone triage service during the last fiscal year (July 1, 1996 through June 30, 1997) are described. A comparison to national data for human toxic exposures is provided. Methods included a review of Hawaii Poison Center statistics, the American Association of Poison Control Centers annual report, and retrospective recall of cases.
Congenital diaphragmatic hernias (CDHs) in Hawaii between 1987 and 1996 were examined with data from a birth defects surveillance system. There were 51 cases of CDH (prevalence 2.45 per 10,000 births). Forty-nine percent of livebirths survived, an increase over the rate reported in Hawaii in 1975-1982. These results are similar to those reported by other population-based studies.
Anecdotal reports from Hawaii's Neuropsychology Services reveal severe brain impaired clients have significant improvement in functions suggesting considerable recovery is possible, and contradicting the "irreversibility" of brain injury. Hawaii's Neurotraining program uses assessment techniques to map brain functions targeting deficits, evaluation to determine specific strategies to regain impaired functions, and stimulation exercises to retrain the brain with the basic cognitive skills necessary to learn.
In view of a previous report on significant antigenic and biophysical differences between the purified soluble complement-fixing antigens of dengue-1 virus strains Hawaii and TH-Sman, the NS 1 genes of both virus isolates were cloned, sequenced, and compared in an attempt to define the genetic basis for the observed differences. Sequence comparison revealed ten encoded amino acid differences between the NS 1 genes of both viruses. Three of these amino acid differences, which are associated with a change in charge distribution, are clustered within the major antigenic region previously defined by studies of recombinant dengue-1 NS 1 protein expressed in E. coli. In parallel, the NS 1 sequences of both Hawaii and TH-Sman isolates were also aligned and compared with two other published dengue-1 NS 1 protein sequences to determine the intratypic variation of dengue-1 NS 1 antigen. Pairwise comparisons between the encoded amino acid sequences revealed a variability of 1.1% to 3.1% difference in the NS 1 protein among dengue-1 strains, which is comparable to that reported for dengue-1 envelope protein (0.2% to 3.6% difference) but less than that of dengue-2 NS 1 protein (0.6% to 7.4% difference).
Road-deposited sediment (RDS) and its associated contaminant load play a critical role in degrading receiving water bodies. Few quantitative multi-element RDS studies exist, and there are none from Hawaii. This lack of baseline data combined with concerns with high concentrations of Pb and Cu in fish and enrichment of Cu, Pb and Zn in bed sediments from Manoa Stream, Hawaii, lead to a detailed characterization of RDSs in Manoa basin. Data for a total analysis of 23 elements using inductively coupled plasma atomic-emission spectrometry and instrumental neutron activation analysis and 16 elements using a 0.5 M HCl partial leach are presented for RDSs and background soils. Concentration data, comparisons with environmental guidelines, and concentration enrichment ratios (CERs) all indicate that RDS in Manoa has a significant degree of anthropogenic pollution. The most environmentally important elements were Pb, Sb and Zn. Concentrations of these elements, primarily vehicle contributed, compare favorably with those from other studies of RDS. The high mean concentration of Pb (151 mg/kg) compared to background soils (13 mg/kg) indicates remobilization of Pb previously stored in soils and transported to road surfaces by water erosion processes. The higher Pb CER(Total) in RDSs compared to bed sediments from Manoa Stream suggests a potential link via ubiquitous storm drains and subsequent dilution with less contaminated fluvial sediments. Data from the HCl leach also support Pb and Zn as having significant anthropogenic signals, and Cu having a moderate signal. These data indicate that RDSs in Manoa basin are generally contaminated with certain potentially toxic elements and the legacy of past use of leaded gasoline is still a concern in this urban drainage system.
Preliminary analysis of dietary data collected from 188 male subjects with lung cancer and 294 controls, in an ongoing population-based case-control study in Hawaii, indicate that dietary cholesterol is positively and significantly associated with lung cancer risk after statistically adjusting for age, ethnicity, pack-years of cigarette smoking, and occupational exposure to lung carcinogens. The increased lung cancer risk associated with high dietary cholesterol appears to be consistent in all five major ethnic groups in Hawaii.
OBJECTIVE: To compare awake-sleep ambulatory blood pressure variation between Japanese-American and Caucasian women in Hawaii, specifically determining whether Japanese-Americans have reduced dipping of blood pressure during sleep, as is found in comparisons of Japanese and US samples. METHODS: Normotensive school teachers from East Hawaii who were either of Japanese-American (n = 70) or Caucasian (n = 48) ethnicity were recruited. They wore an ambulatory blood pressure monitor (Spacelabs 90207) that took measurements every 15 min during waking hours and every 30 min during sleep for a 24-h period on a normal workday. All subjects provided demographic information and underwent a series of anthropometric measurements the day before monitoring. Japanese-American subjects also answered questionnaires relating to cultural identity and migration history. RESULTS: The Japanese-American women had significantly higher mean diastolic (P < 0.01) blood pressure during sleep. These ethnic differences in sleep blood pressure persisted when analyses controlled for age, body mass index, and the waist-hip circumference ratio. There were also significant differences in the proportion by which blood pressure dipped from waking to sleeping, with the Japanese-American women dipping significantly less than the Caucasian women (P < 0.05 systolic, P < 0.001 diastolic). CONCLUSIONS: Normotensive Japanese-American women have higher sleep pressure, and a smaller awake-sleep dip, in pressure than Caucasian women. The relative elevation of blood pressure in Japanese-American women during sleep, but not at other times of the day, is similar to the pattern seen among Japanese women in Japan.
Background: Hepatitis A is the most frequent vaccine-preventable infection in travelers to developing countries. Hepatitis A vaccine and immune serum globulin (IG) offer safe, effective protection against hepatitis A. Some travelers are already immune, however, and it is useful to try to identify subgroups with an anticipated high prevalence of antibody to hepatitis A (anti-HAV). Screening for antibody in these groups would often be a cost-effective alternative to routine use of hepatitis A vaccine or IG prior to travel. Methods: Prospective travelers to developing countries from Hawaii (n = 476) were tested for anti-HAV. Total antibody was measured by an enzyme immunoassay. Age, sex, birthplace, previous travel experience, and past history of hepatitis or jaundice were recorded for each traveler. Results: Overall prevalence of anti-HAV was 35.3%. Antibody prevalence increased progressively with age and varied significantly with birthplace and travel experience. Antibody prevalence was particularly high in travelers with a history of hepatitis or jaundice. Conclusions: Screening for preexisting immunity to hepatitis A is often worthwhile in extended stay or repeat travelers. This study suggests that screening may also be a cost-effective alternative to routine use of hepatitis A vaccine or IG in those travelers (i) born in the United States (including Hawaii) before 1930; (ii) born in Europe, Australasia, or Japan before 1950, (iii) born in developing countries; (iv) with increased travel experience; and (v) with a history of hepatitis or jaundice.
BACKGROUND: Arterial stiffness measurements, generally from pulse wave velocity (PWV), are widely used with little knowledge of their relationship to long-term cardiovascular mortality in general populations. METHODS AND RESULTS: We studied a cohort of 492 Japanese-Americans living in Hawaii (mean age: 63.7 +/-8.8 years) to assess the relationship between PWV and cardiovascular disease mortality and all-cause mortality. During the 10-year follow-up, 43 patients died (14 from cardiovascular events). The cohort was divided into 2 groups by the cut-off value of PWV (9.9 m/s) represented in the receiver operating characteristic curve. The risk ratio for PWV values >9.9 m/s to all-cause mortality was 1.28 [95% confidence interval (CI): 1.14-1.42], and adjusted for other risk factors this ratio was 1.42 (95% CI: 0.96-2.11). The corresponding risk ratios for cardiovascular mortality was 4.46 (95% CI: 1.61-12.32) and 4.24 (95% CI: 1.39-12.96), respectively. CONCLUSIONS: The present study demonstrated that an increased PWV value is associated with future cardiovascular disease death in Japanese-Americans living in Hawaii.
Spinosad was evaluated in Hawaii as a replacement for organophosphate insecticides (naled, dichlorvos [DDVP], and malathion) in methyl eugenol and cue-lure bucket traps to attract and kill oriental fruit fly, Bactrocera dorsalis Hendel, and melon fly, B. cucurbitae Coquillett, respectively. In the first and second methyl eugenol trials with B. dorsalis, naled was in the highest rated group for all evaluation periods (at 5, 10, 15, and 20 wk). Spinosad was equal to naled at 5 and 10 wk during both trials 1 and 2, and compared favorably with malathion during trial 2. During the first cue-lure trial with B. cucurbitae, naled and malathion were in the top rated group at 5, 10, 15, and 20 wk. Spinosad was equal to naled at 5 wk. During the second cue-lure trial, spinosad and naled were both in the top rated group at 10, 15, and 20 wk. Use of male lure traps with methyl eugenol or cue-lure had no effect on attraction of females into test areas. Our results suggest that spinosad, although not as persistent as naled or malathion, is safer to handle and a more environmentally friendly substitute for organophosphate insecticides in methyl eugenol and cue-lure traps for use in B. dorsalis and B. cucurbitae areawide integrated pest management programs in Hawaii.
Bovine sera from northeastern states (Connecticut, Delaware, Maine, Maryland, Massachusetts, New York, Pennsylvania, Vermont, and West Virginia), north central states (Indiana, Illinois, Iowa, Kentucky, Michigan, Minnesota, North Dakota, Ohio, South Dakota, and Wisconsin), Virginia, Alaska, and Hawaii were examined for the presence of neutralizing antibodies to Cache Valley (CV), Lokern (LK), Main Drain (MD), Northway (NW), and Tensaw (TS) viruses. Microneutralization tests were performed using Vero cells. Ninety percent inhibition of the virus at a 1:10 serum dilution was considered positive for the presence of specific antibody. Sera having antibody to more than one virus were titrated from 1:10 to 1:640. The results indicated that 4-28% of the cattle per region had specific antibodies to CV virus. Neutralizing antibodies to NW, LK, and TS viruses were also detected, indicating possible exposure to these Bunyamwera serogroup viruses along with CV virus. Antibody titers measured against NW virus were very similar to those against CV virus. Antibodies to MD virus were present in low levels in bovine sera from Illinois, Maryland, and Ohio. Cattle from Alaska had only antibodies to NW virus. Antibodies to Bunyamwera serogroup viruses were not observed in sera from Hawaii.
The Hawaii State Asthma Control Program, as a part of state planning, disseminated and collected an asthma needs questionnaire aimed at answering this question: "In your opinion, what asthma-related issues need to be better addressed in Hawaii?" The top five areas of need identified by asthma stakeholders were (1) education, (2) disease management, (3) prevention, (4) healthcare, and (5) support.
Over the last ten years, faculty at the John A. Burns School of Medicine (JABSOM) and the University of Hawaii (UH) have been actively engaged in ongoing efforts to increase the quantity and improve the quality of biomedical research in the State of Hawaii. JABSOM's Clinical Research Center (CRC), funded in 1995 by the National Center for Research Resources (NCRR) and the Research Centers in Minority Institutions (RCMI) of the National Institutes of Health, has provided research infrastructure that has been essential to these efforts. The CRC and other JABSOM departments and affiliated programs have collaborated with public and private entities within the community, particularly in the area of health, related to diverse racial and ethnic populations. This paper sets forth a number of the significant indicators of research progress, as illustrated primarily through CRC support for various research activities conducted at JABSOM.
In March 1992, a survey to assess motivational preference was sent to all certified athletic trainers who were practicing in the State of Hawaii and all noncertified student athletic trainers who were enrolled in the athletic training curriculum at the University of Hawaii. The return rate was 80% for certified athletic trainers and 100% for student athletic trainers. The findings of the study indicated that a motivational discrepancy exists for the following motivational stems: freedom on the job, job growth, benefits and wages, being appreciated, helping the organization obtain goals, receiving raises, being an integral part of the work team, job security, and feedback on job performance (p <.05). Further, the study indicated differences in rating the importance of motivators between the certified and the student athletic trainers concerning freedom on the job, opportunity for advancement, benefits and wages, and job security (p <.05). The differences in motivational factors between the two groups indicated that the students are more concerned with intrinsic types of motivators and less concerned with extrinsic rewards. Further investigation needs to include mainland populations and students in approved/accredited curriculums.
The evaluation of an enzyme immunoassay using recombinant Hawaii virus-like particles (rHV-LPs) with a panel of sera which had been screened previously for antibodies to Norwalk virus (NV) and Mexico virus (MxV) is described. The assay was also applied to study the epidemiology of Hawaii virus. Adult volunteers challenged with the prototype (genogroup II, human calicivirus) HV developed significant IgG responses (16-32 fold rises) following challenge whereas adults challenged or naturally infected with NV (genogroup I) did not. Lesser antibody responses (4-8 fold rises) were demonstrated in volunteers challenged with Snow Mountain agent (SMA) and patients infected by SRSV 'UK3' and 'UK4' strains, indicating a degree of antigenic relatedness among viruses within genogroup II. Comparison of the seroprevalence of IgG antibodies to rHV, rMxV and rNV in 338 children in London showed that infections with genogroup II viruses are prevalent and occur earlier in life than NV. Many young children had antibodies to MxV but not HV indicating that genogroup II viruses have both conserved and antigenically distinct epitopes. A serological study on 566 Canadians aged between 9 and 79 years showed that the prevalence of antibodies to rHV rose with age from 65-100% and from 53-100% for NV. Measurement of antibody response in a heart transplant patient infected with an MxV-like virus showed significant responses to both rMxV and rHV. Continuous monitoring of the patient over two years showed that antibody levels declined rapidly to prechallenge levels after a year.
Eighteen patients with pyomyositis were seen at a large hospital in Hawaii. Most were healthy young men or boys, and eight had never traveled abroad. Fever, muscle pain and swelling, and leukocytosis were common, but only seven had erythema or fluctuance. A single large muscle was infected in 14, and two to three muscles were infected in the others. Pyomyositis mimicked cellulitis, muscle hematoma, thrombophlebitis, appendicitis, and neoplasm. Staphylococcus aureus was found in 13, and Streptococcus pyogenes was found in two. Bacteremia occurred in 29% (5/17). Drainage and antimicrobial agents were usually effective therapy, but one patient died and another had CNS damage. The pathogenesis is uncertain, but 12 had nonpenetrating muscle injury and 13 had pyoderma, suggesting that bacteria invade injured muscle via the bloodstream or lymphatic system.
Penicillin remains the drug of choice for the treatment of streptococcal pharyngitis, with erythromycin as an alternative drug for individuals who cannot take penicillin. Two areas of concern in the management of streptococcal pharyngitis are (1) the prevalence of penicillin-tolerant group A beta-hemolytic streptococci reported in recent studies and (2) the high prevalence of erythromycin resistance in some geographic areas. We tested 305 isolates of group A beta-hemolytic streptococci from Hawaii and the Philippines for penicillin minimum inhibitory concentrations and minimum bactericidal concentrations and erythromycin minimum inhibitory concentrations. There was no evidence of penicillin resistance or tolerance. The prevalence of erythromycin-resistant and moderately susceptible isolates was 3.6% and 2.3%, respectively. There was a trend toward greater erythromycin resistance levels among Hawaiian isolates, but this was not statistically significant.
The various types of abdominal wall defects are considered to differ in their etiologies, a hypothesis suggested by differences in their epidemiologies. This study examined the impact of selected demographic factors on abdominal wall defects (omphalocele, gastroschisis, and body stalk anomaly) included in a birth defects registry in Hawaii from 1986-1997. The total prevalence for the various defects were: omphalocele (2.76 per 10,000 births, 95% confidence interval (CI), 2.14-3.50), gastroschisis (3.01, 95% CI, 2. 36-3.77), and body stalk anomalies (0.32, 95% CI, 0.14-0.64). The prevalence increased over the 12-year period for both omphalocele (P = 0.052) and gastroschisis (P = 0.008). Women less than age 20 were at increased risk for a gastroschisis-affected pregnancy, while those age 40 and over were disproportionately more likely to have an omphalocele-affected pregnancy. Pacific Islanders had the lowest risk for omphalocele, whereas Far East Asians were least likely to have gastroschisis. Omphalocele rates were lower outside metropolitan Honolulu, while place of residence did not significantly impact gastroschisis risk. The 1-year survival rate was higher for gastroschisis than for omphalocele (88.5% and 70.7%, respectively), while none of the infants with body stalk anomalies was live-born. The results of this study tend to support the hypothesis of differing etiologies for the studied abdominal wall defects.