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PubMedDate not supplied

Investigating increased incidence of events in the islands: a Hawaii department of health perspective.

Despite the relatively clean environment on the islands of Hawaii, residents have been concerned about clusters of disease due to environmental exposures. Close to 40 inquiries related to perceived increases in health conditions have been examined during the last three years. The standardized incidence ratio approach was the preferred strategy to evaluate occurrence of disease. Three examples of cluster investigation are presented. Even though all investigations except one showed results within the expected range, cluster investigations appear to be useful in allaying fears, in particular about cancer, by providing comparative numbers and factual information on carcinogenesis.

Attitude to Health↗
PubMed1977

Stomach carcinoma among Hawaiians and Caucasians in Hawaii.

A review of Caucasian and Hawaiian patients with stomach carcinoma in Honolulu reinforces observations in other racial groups that the Lauren diffuse histopathological type of gastric cancer is more frequent in females and younger patients, while the so-called intestinal type is more common in older patients and men; that the intestinal form has a better prognosis; and that there are more long-term survivors among women than men with diffuse carcinoma. Prognosis and the level of cancer risk are not associated in Hawaii, since Hawaiians share high risk with Japanese and poor prognosis with Caucasians. There is no apparent association of cancer risk with the ratio of intestinal to diffuse forms among Hawaiians, Caucasians, and Japanese. In addition to the known high risk of stomach carcinoma in Hawaiians and Japanese, this study has identified a high risk among people of Portuguese ancestry.

Age Factors↗
PubMed1978

Survivorship from large bowel cancer among Caucasians and Japanese in Hawaii.

From 1960 through 1973, the Hawaii Tumor Registry identified 781 Caucasian and 1073 Japanese cases of large bowel cancer. Survivorship analysis revealed that Japanese patients had a 32% higher 5-year relative survival rate than Caucasians. Further analyses showed that colon cancer cases did better than rectal cases, and patients diagnosed before 65 years of age fared better than cases diagnosed at an older age. As expected, patients with localized disease lived much longer than those who had more advanced disease. Men and women were similar in their survival from large bowel cancer. Histologic grade of the lesion, socioeconomic variables, behavioral practices and other factors which may affect survivorship by race could not be included in this study. Until such factors are also incoporated in the analyses, the observed results are only suggestive of a racial difference in survivorship.

Age Factors↗
PubMed1981

Racial survival patterns for lung cancer in Hawaii.

From 1960 through 1974, the Hawaii Tumor Registry identified 1895 cases of lung cancer with either small cell or non-small cell carcinoma among the five main racial groups in the islands. There were 650 Caucasians, 549 Japanese, 362 Hawaiian, 173 Filipino and 161 Chinese patients. Analysis revealed that Caucasians with non-small cell carcinoma had a significantly poorer five-year survival rate than Chinese, Filipino, or Japanese patients after simultaneous adjustment for differences in sex, age at diagnosis, stage, and socioeconomic status. Men, older patients, patients with regional or distant disease, and patients in a middle or low socioeconomic status also did worse than the others. When the 170 patients with small cell carcinoma were compared with 1725 patients with non-small cell carcinoma, patients with small cell carcinoma had significantly poorer survival rates after five years.

Age Factors↗
PubMed1984

The effects of role preparation for psychotherapy on immigrant clients seeking mental health services in Hawaii.

The present study sought to examine the effects of a standard role induction (role preparation) procedure on immigrant patients having their first therapy experience. Thirty immigrant clients who met selection criteria and were seeking treatment at a community mental health center in Hawaii were assigned to either role induction (therapy preparation intervention) or a placebo intervention prior to receiving therapy offered by 10 professional therapists. The effects of the role-induction or placebo manipulation were assessed by a measure of expectancy, satisfaction ratings, and data on premature termination and attendance. Results indicated that the patients who received the role preparation procedure as well as placebo patients had changed their expectations in appropriate ways by the end of therapy. The role-prepared patients, however, became less dependent on their therapist for support, advice, and direction. In addition, the role-prepared patients were more satisfied with therapy, rated themselves as more changed, and dropped out of treatment at significantly lower rates. The implications of the results for service delivery to immigrant patients were examined.

Community Mental Health Centers↗
PubMedDate not supplied

Effects of age, ethnicity and menopause on ambulatory blood pressure: Japanese-American and Caucasian school teachers in Hawaii.

Ambulatory blood pressure (BP) measurements of 120 female teachers of Japanese-American or Caucasian ethnicity working in public schools located in Hilo, Hawaii, were recorded. BP was measured at 15-min intervals during waking hours and 30-min intervals during sleep over a 24-hr period that included a full work day. These measurements were averaged during three daily settings: at work, at home while awake ("home"), and during sleep. ANCOVAs using ethnicity as a predictor variable of BP, with age and the body mass index (BMI) as covariates, show a significant interaction effect between age and ethnicity in some daily settings. Among Japanese-Americans partial correlations between age and systolic BP controlling for the BMI are significant in these settings, while among Caucasians none of the correlations are significant. Menopausal status is not significantly related to BP when age is controlled in analyses. There was no significant ethnic difference in number of symptoms reported, including frequency of "hot flushes/flashes," within the past two weeks. Those who reported hot flushes had significantly elevated BP in waking settings but not during sleep. The greater increase in BP with age in Japanese-Americans may be related to their elevated risk for development of hypertension. The lack of a significant relationship between menopausal status and BP may be due to the high rate of usage of hormonal replacement therapy in this sample, as well as an unusually high rate of hysterectomy.

Adult↗
PubMed2003

Pregnancy outcome and prenatal diagnosis of sex chromosome abnormalities in Hawaii, 1986-1999.

Sex chromosome abnormalities such as Turner syndrome, Klinefelter syndrome, triple X syndrome, and 47,XYY can be prenatally diagnosed and electively terminated. This investigation examined the pattern of pregnancy outcome of prenatally and postnatally diagnosed sex chromosome abnormalities in Hawaii during 1986-1999 and calculated prenatal diagnosis and subsequent elective termination rates for various factors. Data were obtained from a statewide population-based birth defects registry. The study included 205 detected sex chromosome abnormality cases of which 93 (45%) were live births, 18 (9%) late fetal deaths, 37 (18%) early fetal deaths, and 57 (28%) elective terminations. Pregnancy outcome distribution varied by type of sex chromosome abnormality. Prenatal diagnosis was reported for 132 (64%) of the cases, of which 46 (35%) were subsequently electively terminated. Eleven cases were elective terminations where the sex chromosome abnormality was diagnosed after delivery. Elective termination rates subsequent to prenatal diagnosis differed by sex chromosome abnormality, being highest for 45,X (54%), followed by 47,XXY (46%), 47,XYY (29%), and 47,XXX (17%). Although prenatal diagnosis rates increased significantly over the time period (P = 0.006), the subsequent elective termination rate declined slightly, albeit the trend was not statistically significant (P = 0.440). The prenatal diagnosis rate was highest for the 35-39-year maternal age group, although this age group did not have subsequent elective termination rates higher than other maternal age groups. Pregnancy outcome distribution and prenatal diagnosis and subsequent elective termination of sex chromosome abnormalities appeared to depend on the type of sex chromosome abnormality, year of delivery, and maternal age.

Abortion, Legal↗
PubMed2004

Impact of excluding cases with known chromosomal abnormalities on the prevalence of structural birth defects, Hawaii, 1986-1999.

Chromosomal abnormalities are more common in the presence of structural birth defects. However, much of the literature have only provided chromosomal abnormality rates for one or a few structural birth defects at a time. This study calculated the chromosomal abnormality rates for a number of structural birth defects using data from the Hawaii Birth Defects Program (HBDP) for deliveries during 1986-1999 and evaluated the impact of exclusion of cases with chromosomal abnormalities when calculating birth prevalence. The chromosomal abnormality rates were highest for endocardial cushion defect (40%) and omphalocele (27%), while no chromosomal abnormalities were reported for pyloric stenosis, persistent cloaca, and deficiency of lower limbs. The majority of chromosomal abnormality rates fell within a certain range, with 32 (63%) of the birth defect categories having chromosomal abnormality rates of 5-15%. The chromosomal abnormality rates also tended to be higher for multiple than for isolated cases. For three of the structural birth defects (ventricular septal defect, atrial septal defect, endocardial cushion defect), the birth prevalence of the defect, when cases with a chromosomal abnormality were excluded, was significantly lower than the birth prevalence that included those cases. Chromosomal abnormality rates varied by type of structural birth defect and presence of other major structural birth defects. For at least several structural birth defects, exclusion of cases with chromosomal abnormalities significantly underestimated the birth prevalence. This underestimation may be important, depending on the purpose of the analysis.

Chromosome Aberrations↗
PubMed2003

Prevalence of birth defects among infants of Gulf War veterans in Arkansas, Arizona, California, Georgia, Hawaii, and Iowa, 1989-1993.

BACKGROUND: Epidemiologic studies of birth defects among infants of Gulf War veterans (GWV) have been limited to military hospitals, anomalies diagnosed among newborns, or self-reported data. This study was conducted to measure the prevalence of birth defects among infants of GWVs and nondeployed veterans (NDV) in states that conducted active case ascertainment of birth defects between 1989-93. METHODS: Military records of 684,645 GWVs and 1,587,102 NDVs were electronically linked with 2,314,908 birth certficates from Arizona, Hawaii, Iowa, and selected counties of Arkansas, California, and Georgia; 11,961 GWV infants and 33,052 NDV infants were identified. Of these, 450 infants had mothers who served in the Gulf War, and 3966 had NDV mothers. RESULTS: Infants conceived postwar to male GWVs had significantly higher prevalence of tricuspid valve insufficicieny (relative risk [RR], 2.7; 95% confidence interval [CI], 1.1-6.6; p = 0.039) and aortic valve stenosis (RR, 6.0; 95% CI, 1.2-31.0; p = 0.026) compared to infants conceived postwar to NDV males. Among infants of male GWVs, aortic valve stenosis (RR, 163; 95% CI, 0.09-294; p = 0.011) and renal agenesis or hypoplasia (RR, 16.3; 95% CI, 0.09-294; p = 0.011) were significantly higher among infants conceived postwar than prewar. Hypospadias was significantly higher among infant sons conceived postwar to GWV women compared to NDV women (RR, 6.3; 95% CI, 1.5-26.3; p = 0.015). CONCLUSION: We observed a higher prevalence of tricuspid valve insufficiency, aortic valve stenosis, and renal agenesis or hypoplasia among infants conceived postwar to GWV men, and a higher prevalence of hypospadias among infants conceived postwar to female GWVs. We did not have the ability to determine if the excess was caused by inherited or environmental factors, or was due to chance because of myriad reasons, including multiple comparisons. Although the statistical power was sufficient to compare the combined birth defects prevalence, larger sample sizes were needed for less frequent individual component defects.

Adult↗
PubMed2003

Maternal age-specific Down syndrome rates by maternal race/ethnicity, Hawaii, 1986-2000.

BACKGROUND: Published maternal age-specific rates for Down syndrome are based mostly on populations of predominately European origin. Down syndrome rates have been reported to vary by race/ethnicity. The objective of this study was to calculate maternal age-specific Down syndrome rates for various racial/ethnic groups and to compare the rates between the racial/ethnic groups. METHODS: Data were obtained from a population-based birth defects registry and included all Down syndrome cases delivered in Hawaii during 1986-2000 with maternal race/ethnicity of white, Far East Asian, Pacific Islander, or Filipino. Maternal age-specific Down syndrome rates were calculated for each race/ethnicity, and the rates were compared. RESULTS: The pattern of maternal age-specific Down syndrome rates among Far East Asians and Filipinos was similar to that among whites--Down syndrome rates increased with maternal age, with the increase in rate being most obvious for maternal age groups of 35 years or greater. However, for maternal age of 35 years or greater, the Down syndrome rate was lower for Pacific Islanders than whites, with the difference between the two racial/ethnic groups being significant for maternal age of 40 years or greater (rate ratio 0.13, 95% confidence interval 0.02-0.48). CONCLUSIONS: All racial/ethnic groups do not appear to demonstrate the same maternal age pattern of Down syndrome rates as whites. This is important because maternal age-specific Down syndrome rates are used to calculate expected Down syndrome rates in a population and to estimate a woman's risk of having an infant with Down syndrome given her age.

Asian People↗
PubMed2004

Descriptive epidemiology of lipomyelomeningocele, Hawaii, 1986-2001.

BACKGROUND: The epidemiology of neural tube defects (NTDs) may depend on the type of the defect and its location. There is little epidemiologic information on lipomyelomeningocele, a type of NTD. The objective of this investigation was to describe the epidemiology of lipomyelomeningocele. METHODS: Cases were obtained from a Hawaii birth defect registry and consisted of all infants delivered during 1986-2001 with lipomyelomeningocele. Lipomyelomeningocele rates per 10,000 births were calculated for various factors. RESULTS: A total of 17 cases of lipomyelomeningocele were identified, for a total rate of 0.57. When the lipomyelomeningocele rate was examined with respect to the time period of folic acid fortification of cereal grains in the United States, the rate was 0.57 during 1986-1996 (prefortification), 0.57 during 1997-1998 (voluntary fortification), and 0.58 during 1999-2001 (mandatory fortification). A total of 11 (64.7%) of the cases were female. Lipomyelomeningocele rates were higher among infants born to mothers in younger and older age groups. The rate was highest among Pacific Islanders, followed by Filipinos and Far East Asians, and lowest among whites. Rates were greater with lower birth weight and gestational age and among multiple births. CONCLUSIONS: Lipomyelomeningocele rates were not found to be affected by folic acid fortification. The majority of cases were female. Other demographic and clinical factors appear to be associated with lipomyelomeningocele risk. None of the differences in rates between the various subgroups were statistically significant, and due to the small number of cases, the 95% confidence interval (CI) ranges were wide. However, the findings suggest possible patterns of occurrence. Additional studies involving larger numbers of cases are recommended.

Adult↗
PubMed1987

A genetic analysis of clubfoot in Hawaii.

The roles of major genes and multifactorial inheritance in the etiology of clubfoot (talipes equinovarus) were investigated based on 365 nuclear families consisting of three major racial groups of Hawaiians, Caucasians, and Orientals in Hawaii. Complex segregation analysis was employed using the mixed model with four parameters: major gene displacement (t), degree of dominance (d), gene frequency (q), and heritability (H). Heterogeneity was evident among the racial groups in the pattern of segregation of clubfoot. The most plausible genetic model is the presence of major gene effects with the multifactorial component for the Hawaiian and Caucasian groups, whereas no major gene action is evident for the Oriental group.

Asian People↗
PubMed1987

Genetic epidemiology of cleft lip with or without cleft palate in the population of Hawaii.

Orientals consisting of Japanese, Chinese, Koreans, and Filipinos are clearly at higher risk for cleft lip with or without cleft palate [CL(P)] than whites, Puerto Ricans, and Hawaiians/part-Hawaiians in Hawaii. Using the model of diallele cross, CL(P) incidences in incrosses and outcrosses involving 564,002 live births distributed among 669 mating types were analyzed to study the extent of major gene involvement in the difference in the two groups and to investigate maternal effect in the etiology of CL(P). CL(P) cases excluding syndrome cases were classified into two types: all CL(P) cases and CL(P) cases without additional malformations. For either type there was no evidence to suggest that simple major gene plays a dominant role in accounting for racial differences as measured by deviations from additivity in the hybrids. For CL(P) cases without additional defects, a negative "maternal effect" was detected in Filipinos such that higher risk for this racial group depends on when the father is Filipino. Implications of the findings are discussed.

Cleft Lip↗
PubMed1983

Dietary cholesterol and lung cancer risk in a multiethnic population in Hawaii.

We interviewed 364 subjects with lung cancer and 627 age- and sex-matched controls among the multiethnic population of Hawaii. Quantitative estimates of dietary cholesterol and vitamin A intakes were obtained, as well as smoking and occupational histories. Using multiple logistic regression analysis to control for potential confounding variables, we found a monotonic positive dose-response relationship between dietary cholesterol and lung cancer risk in all subjects, in smoking subjects, and in men. In each of these groups, subjects in the highest quartile of dietary cholesterol were at significantly increased risk of lung cancer (lower 95% confidence limit greater than 1.0). Among females, however, no clear association of dietary cholesterol with lung cancer risk was apparent.

Cholesterol, Dietary↗
PubMed1996

Contributions of vertebral fractures to stature loss among elderly Japanese-American women in Hawaii.

Loss of stature is a typical feature of osteoporosis and associated vertebral fractures. However, there have been few prospective population-based studies to estimate the magnitude of this association. Further, the separate contributions of different types of vertebral fractures to stature loss have not been evaluated using prospective data. In this study we investigated the extent to which stature loss could be explained by the number of different types of vertebral fractures (wedge, endplate, and crush fractures) after adjusting for other covariates. Longitudinal data on stature loss and vertebral fractures were collected among 504 postmenopausal Japanese-American women living in Hawaii with mean age 73.4 (SD 4.9) years. During an average of 7.7 years of follow-up, women with at least one incident vertebral fracture had an average of 2.1 cm of stature loss while the average stature loss among those without incident fractures was only 0.4 cm. The mean rate of stature loss was very slight (< 1 mm/year) for those without incident vertebral fractures even after age 80. Our analyses suggest that both the number of wedge and the number of crush fractures are strong predictors of stature loss. After adjusting for age and total height loss in the anterior dimension over T3-L5, the estimated stature loss resulting from each wedge and crush fracture was 0.86 and 1.08 cm, respectively. Endplate fractures did not show significant contributions to stature loss.

Adult↗
PubMed1993

A survey of ciguatera: assessment of Puako, Hawaii, associated with ciguatera toxin epidemics in humans.

A survey for the assessment of the ciguatera problem has been determined in Puako, South Kohala, on the Island of Hawaii. This is in the area of persistent ciguateric outbreaks during the months of January through March, caused by a specific species of fish (Cheilinus rhodochrous, red rose wrasse, or po'ou). Analyses of algae, Gambierdiscus toxicus, and various species of fish, including herbivores and carnivores, gave positive indications of Puako as a potential ciguateric area. Algae associated with Gambierdiscus toxicus blooms and the dinoflagellate itself were found in transects A and D. Transects A and D showed 291 G. toxicus per gram of Tolycarpidia glomurata and 9 G. toxicus per gram of Turbinaria sp. with epiphytic Jania sp., respectively. No G. toxicus was found in transects B and C. This may be attributed to the low salinity from intrusion of freshwater in this vicinity. Examinations of the fish, kole, manini, Hawaiian kole, roi, and po'ou by the solid-phase immunoassay showed 89% of fish in the borderline and positive categories from all transects. Extracts of viscera and flesh showed high levels of toxicity in mouse (13 of 23 deaths), particularly in the viscera (gut) of both herbivores and carnivores. The guinea pig atrial analysis generally showed a few ciguatoxin-like, but most were nonciguateric type responses. The data presented in this Puako survey showed evidence of toxic fish associated with ciguatoxin-like and most probably other toxins, either polyethers or non-polyethers as yet unidentified.

Animals↗
PubMed2002

Pregnancy outcome distribution and prenatal diagnosis of autosomal abnormalities, Hawaii, 1986-1999.

BACKGROUND: Approximately 10% of birth defects result from chromosomal abnormalities. This study investigated the pregnancy outcome distribution of autosomal abnormalities and impact of prenatal diagnosis on autosomal abnormalities. METHODS: Data were obtained from a population-based birth defects registry and included all autosomal abnormalities delivered in Hawaii during 1986-1999. RESULTS: There were 1,015 autosomal abnormality cases, consisting of 523 (52%) live births, 38 (4%) late fetal deaths, 187 (18%) early fetal deaths, 265 (26%) elective terminations, and 2 unknown pregnancy outcome. Live births comprised the majority of translocations (81%), inversions (93%), and deletions (84%) but a smaller proportion of trisomies (42%). Autosomal abnormalities were prenatally diagnosed in 489 (48%) of the cases, of which 243 (50%) were subsequently electively terminated. By type of autosomal abnormality, prenatal diagnosis rates were trisomy (44%), translocation (68%), inversion (91%), deletion (29%), and subsequent elective termination rates were trisomy (73%), translocation (11%), inversion (4%), deletion (50%). The prenatal diagnosis rate was higher for maternal age 35 years or greater than for maternal age less than 35 years (relative risk (RR) 1.8, 95% confidence interval (CI) 1.6-2.0), as was the elective termination rate (RR 1.3, 95% CI 1.1-1.6). The prenatal diagnosis rate was higher in 1993-1999 than in 1986-1992 (RR 1.2, 95% CI 1.1-1.4), although there was no statistically significant difference between the two time periods for subsequent elective termination rate (RR 0.9, 95% CI 0.8-1.1). CONCLUSIONS: Pregnancy outcome distribution, prenatal diagnosis rates, and subsequent elective terminations rates vary by type of autosomal abnormality.

Abortion, Legal↗
PubMed1995

Immunohistochemical detection of binding of CryIA crystal proteins of Bacillus thuringiensis in highly resistant strains of Plutella xylostella (L.) from Hawaii.

We detected binding of insecticidal crystal proteins from Bacillus thuringiensis in one susceptible strain and six resistant strains of diamondback moth, Plutella xylostella, from Hawaii. Immunohistochemical tests with tissue sections from larval midguts showed specific binding of CryIA(a), CryIA(b), and CryIA(c) to brush border membranes. CryIE, which is not toxic to P. xylostella, did not bind to midgut tissues. Larvae from one of the resistant strains ingested extremely high concentrations of a commercial formulation containing the three CryIA proteins without suffering midgut cell damage or mortality. This same resistant strain had previously been found to have greatly reduced binding of radioactively-labeled CryIA(c) to vesicles prepared from brush border membranes. The finding that binding as detected in immunohistochemical tests was not sufficient for toxicity suggests that low levels of binding can occur without harmful effects; the tests did not reflect in vivo binding, or post-binding factors contribute to resistance. Comparison with resistant strains from Florida and the Philippines, which did not bind CryIA(b) in previously reported immunohistochemical tests, suggests that more than one mechanism of resistance to B. thuringiensis may occur within a single species.

Animals↗