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PubMed1991

Retraining faculty for the problem-based curriculum at the University of Hawaii, 1989-1991.

The problem-based learning (PBL) curriculum, adopted by an increasing number of medical schools, requires retraining faculty for new roles as tutors with small groups of medical students. This study describes the procedures and results of four PBL training workshops (1989-1991) given at the University of Hawaii John A. Burns School of Medicine. Eighty-eight faculty volunteers each answered a 20-item multiple-choice questionnaire testing their knowledge of PBL both before and after they participated in a workshop. The posttest results were used to identify deficiencies in the tutors' knowledge and practice of both their role and their function. The authors conclude that these deficiencies, now identified, will be addressed in a systematic fashion in subsequent workshops.

Curriculum↗
PubMed1993

The triple-jump examination as an assessment tool in the problem-based medical curriculum at the University of Hawaii.

BACKGROUND: The three-step triple jump (TJ) examination aims to assess students' clinical problem-solving processes predominantly by means of subjective assessments administered by faculty. But training TJ administrators to ensure interrater reliability is both time- and cost-intensive, and difficult at best--hence the desire to test a more objective system of scoring students' TJ performances. METHOD: The sample was the 58 first-year students of the class of 1995, who in March 1992 were finishing the second 13-week unit in the problem-based curriculum at the University of Hawaii John A. Burns School of Medicine. To determine how well the school had succeeded in standardizing and objectifying its TJ examination (used for all units in the first two years), scores were correlated for various objective examinations independent of the TJ, the TJ administrators' subjective assessments, and the TJ objective assessments (regarding number of problem-based hypotheses generated and number of hypothesis-testing clinical database items elicited). The statistical methods used were linear regression, Student's unpaired t-test, chi-square, and the z-test. RESULTS: The TJ scores and independent objective examinations did not correlate significantly (suggesting that they assess different aspects of student achievement), but the TJ subjective and objective scores did correlate significantly. There were large standard deviations on the TJ objective scores, largely because one problem was significantly more difficult than the others (each student works on only one of several problems). However, the administrators' subjective scores for all problems were comparable. CONCLUSION: Because problems vary in difficulty, objective scores cannot be used across problems as a major component of all students' grades; but when a student has received an unsatisfactory score, an external reviewer can evaluate the appropriateness of the subjective score by comparing the student's objective performance with those of students who had the same problem and received higher subjective scores. That the administrators' subjective assessments for all problems were comparable not only suggests that the administrators were able to adjust for problem variability but also reinforces the appropriateness of using subjective assessments for the TJ examination.

Educational Measurement↗
PubMed1984

Distribution of fallout cesium-137 in Hawaii.

The concentration of 137Cs was determined by gamma spectrometry in soils and surface-deposited volcanic sublimates from various climatic locations on the islands of Hawaii, Oahu and Maui. A distinct pattern of higher concentrations on the wetter windward sides of the islands and a correlation between 137Cs concentration and amount of rainfall were observed, which confirm the source of the 137Cs as atmospheric fallout. In the soils, the concentrations measured (to 1.93 pCi/g) are within the range reported for the continental United States and other mid-latitude locations in the northern hemisphere. In the basaltic lavas, the concentration of 137Cs was found to be variable but was overall very low, and is apparently controlled by the porosity and permeability of the lavas in addition to rainfall.

Cesium Radioisotopes↗
PubMed1979

The competitive response of Blue Cross and Blue Shield to the health maintenance organization in Northern California and Hawaii.

The health maintenance organization (HMO) can provide an alternative to the predominant form of health care delivery in the United States, fee-for-service. Although market penetration of the HMO is relatively low in most parts of the country, the HMO has achieved a significant market share in a number of states. This paper examines the competitive response of Blue Cross and Blue Shield to the introduction of the HMO in two geographic regions with significant HMO activity, northern California and Hawaii. The evidence obtained from extensive interviews indicates that Blue Cross and Blue Shield plans have responded to HMO competitive pressure by establishing their own HMOs and by altering traditional procedures. HMO competition has stimulated Blue Cross and Blue Shield to make greater cost control efforts and to offer larger benefit packages. These results can have important policy implications for the role that HMOs are to play in cost containment.

Blue Cross Blue Shield Insurance Plans↗
PubMed1985

Survey of childhood burns in Hawaii.

A review of 247 pediatric emergency charts and 80 pediatric impatient charts was performed over a three-year period at a tertiary care children's hospital in Honolulu. The purpose of this review was to examine the causes of childhood burns in Hawaii in order to develop guidelines for anticipatory guidance regarding burn prevention. Most burns occurred in the 0.8- to 3.0-year age group. Over one half of these burns were caused by tap water. Medicaid patients were more likely to be admitted to the hospital than nonMedicaid patients. Severe burns were mainly the result of scalds, fire, or contact with heating appliances. Burn severity and the causes of burns did not vary significantly with sex or ethnic or economic status. A burn prevention program which adequately addresses the unique cultural and climatic differences of this community, based on the data obtained, is described.

Accidents, Home↗
PubMed1994

Exposure to biogenic silica fibers and respiratory health in Hawaii sugarcane workers.

We conducted a cross-sectional environmental and medical survey of 355 male sugarcane workers in Hawaii to determine whether exposure to biogenic silica fibers (BSF) affected their respiratory health. Exposures to BSF ranged from nondetectable to more than 0.700 BSF/mL and varied by job and department. Respiratory symptoms, chest radiograph findings, and pulmonary function were not associated with BSF exposures. Cigarette smoking was associated with respiratory symptoms and pulmonary obstruction. Fifteen workers had pleural thickening or pleural plaques and 3 of these workers were exposed to BSF for more than 10 years. BSF exposure does not appear to influence the respiratory health of sugarcane workers; however, further study is warranted.

Agriculture↗
PubMedDate not supplied

Occupational differences in job strain and physiological stress: female nurses and school teachers in Hawaii.

OBJECTIVES: The two objectives are to test the hypothesis that women in a profession with low decision latitude will have greater catecholamine excretion and higher blood pressure than women in a profession with greater decision latitude, and to assess the influence of ethnicity on the occupational comparison. METHODS: Premenopausal women who were either full-time teachers in public schools (teachers; N = 92) or nurses or nurse's aides (nurses; N = 55) in East Hawaii who were not currently taking antihypertensive medication had ambulatory blood pressure (BP) and urinary catecholamine excretion measured over an approximate 4-hour period at work and home and over an approximate 8-hour period overnight. The women also filled out the Job Content Questionnaire (JCQ). RESULTS: The nurses had significantly lower scores on the "decision latitude" subscale of the JCQ. After controlling for the effects of ethnicity, age, body mass index, JCQ subscale scores, smoking habits, and menopausal status in regression analyses, the nurses also had significantly higher mean systolic and diastolic BP both in work and home settings and higher mean rates of both norepinephrine and epinephrine excretion in all daily settings (p < .05). There were no significant ethnic differences in scores on the JCQ subscales, but Asian-Americans had significantly higher systolic BP in all daily settings and higher diastolic BP overnight (p < .05) than Euro-Americans. CONCLUSIONS: These results suggest that among professional women, physiological stress responses are significantly greater when occupation-related decision latitude is low (nurses) than when it is high (teachers). The physiological response to stress is carried over into the home and overnight settings when occupation-related decision latitude is low (nurses). Individual scores on the JCQ were not significantly related to physiological measures in this study, however. Inclusion of contrasting occupations may be necessary to properly evaluate the relationships between individually reported job strain and heightened physiological stress responses in studies of working women.

Asian↗
PubMed2006

Insulin resistance is associated with cognition among HIV-1-infected patients: the Hawaii Aging With HIV cohort.

OBJECTIVE: To determine if insulin resistance (IR) is associated with lower cognitive performance among HIV-1-infected adults and to determine if advanced age magnifies risk. DESIGN: Cross-sectional analysis within the Hawaii Aging With HIV Cohort. METHODS: We calculated the homeostasis model assessment of insulin resistance (HOMA-IR) among 145 cohort participants. Values were compared to concurrent neuropsychological test performance and cognitive diagnoses. RESULTS: Hypertension, body mass index (BMI), and non-Caucasian self-identity were directly related to insulin resistance (IR); however, age, CD4 lymphocyte count, and rates of treatment with HAART were not. In logistic regression analyses and stratifying cognition status on a 3-tiered scale (normal, minor cognitive motor disorder (MCMD), and HIV-associated dementia (HAD)), we identified an increased risk of meeting a higher diagnostic category as HOMA-IR increased (OR, 1.12; 95% CI: 1.003 to 1.242 per unit of HOMA-IR, P = 0.044). In linear regression models and among nondiabetic participants, an increasing degree of IR was associated with lower performance on neuropsychological summary scores. CONCLUSIONS: IR is associated with cognitive dysfunction in this contemporary HIV-1 cohort enriched with older individuals. Metabolic dysfunction may contribute to the multifactorial pathogenesis of cognitive impairment in the era of HAART.

AIDS Dementia Complex↗
PubMed1991

Ciliated gastric cells among Japanese living in Hawaii.

A total of 129 consecutive gastrectomy specimens from Japanese (99), Philippinos (11), Hawaiians (8), Koreans (5), Chinese (4) and Caucasians born in Hawaii (2) were examined under high-power light microscopy (1000 x) for the presence of ciliated gastric cells. Fifty-two of the 129 gastrectomy specimens (40.3%) contained ciliated cells. Ciliated cells were found in the basal segments of antral glands (usually cystically dilated) whose superficial segments had undergone intestinal metaplasia. The presence of ciliated cells in the gastric mucosa was influenced by the age of the patient and by the degree of intestinal metaplasia: the older the patient, the greater the degree of intestinal metaplasia and the greater the frequency of specimens with ciliated cells. The presence of ciliated cells was also influenced by the type of lesion in the specimen. Although the highest frequency (47.2%) was found in stomachs removed for adenocarcinoma, a substantial number of stomachs removed for gastric ulcer also showed that change (36%). The data suggest that increasing age and advanced atrophic gastritis, especially of the antrum, provide the necessary conditions that lead to the development of cilia, not only in Japanese subjects, but in other Hawaiian ethnic groups as well.

Adult↗
PubMed2004

Descriptive epidemiology of selected congenital heart defects, Hawaii, 1986-1999.

Congenital heart defects are the most common type of birth defect and contribute the most to infant mortality due to birth defects. This study examined the relationship between several demographic factors and selected congenital heart defects among the unique multiethnic population in Hawaii during 1986-99, using data from a population-based birth defects registry. Rates were significantly higher in 1993-99 than in 1986-92 for transposition of the great arteries and Ebstein's anomaly, and significantly lower for tetralogy of Fallot. Significantly elevated rates were found with maternal age of > or =35 years for ventricular septal defect, atrial septal defect, endocardial cushion defect, and hypoplastic left heart syndrome. When cases with a known chromosomal abnormality were excluded, elevated rates among the older maternal age group remained for ventricular septal defect, atrial septal defect, and hypoplastic left heart syndrome. Whites had significantly higher rates than one or more of the other racial/ethnic groups for Ebstein's anomaly and coarctation of aorta, and significantly lower rates for tetralogy of Fallot, atrial septal defect, pulmonary valve atresia/stenosis, tricuspid valve atresia/stenosis, and anomalous pulmonary venous return. Significantly higher rates were found among males for transposition of great arteries, aortic valve stenosis, and interrupted aortic arch and, among females, for ventricular septal defect, endocardial cushion defect, and anomalous pulmonary venous return. Some of these differences were consistent with the literature while others were not.

Adult↗
PubMed1985

The dermatology of Kauai, Hawaii, 1981-1982.

The distribution of skin disease within a population can be used as the basis for research as well as planning for the delivery of health services. In this prospective study, the cutaneous diagnoses and demographic data on all patients seen in the only dermatology clinic on Kauai, Hawaii, were recorded from March 1981 to February 1982. Kauai is relatively unique in that the population is comprised of four racial groups with roughly equal representation; these groups live under similar conditions. A total of 3,277 patients were seen and 4,106 diagnoses were made. Three hundred twenty-four separate diagnoses were rendered: acne vulgaris, contact dermatitis, verrucae, and dermatophytosis were the most common. Various diseases were not equally divided among the racial groups. These data are compared to similar previous studies.

Adolescent↗
PubMed1987

Scabies epidemiology, Kauai, Hawaii, 1981-1985.

The demography of scabies was studied in the sole dermatology practice on the island of Kauai, Hawaii, over a 50-month period. Scabies was observed far more frequently in whites and Hawaiians than in Japanese and Filipinos. Within the white ethnic group, scabies was most frequently diagnosed in persons between 15 and 44 years old, while in Hawaiians, the disease was most common in the 0-14-year age group. It is possible that learned or acquired behavior patterns may play a significant role in contracting the disease.

Adolescent↗
PubMed1995

Keratoacanthoma in Japanese Hawaiians in Kauai, Hawaii.

BACKGROUND: This is the first incidence report of keratoacanthoma (KA) in a Japanese ethnic population. METHODS: The study was designed as a 5-year prospective incidence study using an island-wide survey of Japanese residents in Kauai, Hawaii, during the years 1983 through 1987. RESULTS: Eleven Japanese residents of Kauai, three men and eight women, had KA. The crude incidence is 22.1 per 100,000 Japanese Kauaiian population. Two thirds of the lesions were on the extremities. No recurrence was noted, but a nonmelanoma skin cancer developed in some patients. CONCLUSIONS: The incidence of KA in a Japanese ethnic population is not low. Ultraviolet light exposure must, in part, contribute to the development of KA. This is supported by fact that the incidence of KA in Japanese residents in Kauai is much higher than in Japan and that most of the KAS appear on exposed skin.

Aged↗
PubMedDate not supplied

Liver transplant in Hawaii: the survival of a small centre.

Although many report the importance of case volume in complex cases, liver transplantation (LT) can be carried out successfully in a small centre. During a 11.5-yr period, 88 patients underwent LT in a single transplant centre in Hawaii. Indications for LT were primarily hepatitis C (n = 49) and hepatitis B (n = 13) and 22 patients (25%) had hepatocellular cancer (HCC) on explanted liver. There was no primary graft nonfunction, one retransplant for recurrent hepatitis C and two late hepatic artery thromboses, which did not require a retransplant. One patient developed partial portal vein thrombosis related to a hypercoagulable state and was rescued with anticoagulation. Of the 22 patients with HCC, 18 are alive, two died from recurrent disease (253 and 1428 d post-LT, respectively), one died because of a ruptured hepatic artery aneurysm (151 d) and one from complications caused by noncompliance (723 d). One-, 3- and 5-yr survival rates were 89%, 82% and 71%, respectively. Mean survival was 3034.9 d. During this time period, 142 liver resections, 77 pancreatic resections and 43 splenorenal shunts were performed by this group of surgeons. Because of the recent explosion of information on case volumes and centres of excellence, LT can be performed successfully at a small centre. Other major hepatobiliary/transplant procedures can help the surgeons maintain their operative skills. A smaller LT program may require a longer period of evolution, but it can provide a service for a geographically isolated population that would otherwise have limited opportunity for LT.

Adolescent↗
PubMed1998

Culture, law and psychiatry in Hawaii.

Hawaii is a set of islands with a broad mix of cultures. The law is American, but it was predominantly derived from English Common Law. Thus, the law is derived from a very distant culture. Theoretically, this 'transplanted' law could cause difficulties for people from Pacific cultures. Indeed, it appears to create difficulties for individuals with mental illness. A substantial number of these people are arrested for disobedience of a law that is not sensible for their culture. This problem is an example of the need for cultural knowledge when a psychiatrist conducts an examination for the legal system. An individual may appear legally guilty or medically insane when acting within cultural norms.

Adult↗
PubMed2006

Population and service characteristics of youth with schizophrenia-spectrum diagnoses in the Hawaii system of care.

BACKGROUND: Population and service characteristics were compared for youth (age 0-18 years) with and without schizophrenia-spectrum disorders, who received public mental health services in Hawaii's comprehensive system of care between July 1, 2000 and June 30, 2001. METHODS: Electronic records of youth with a diagnosis in the schizophrenia-spectrum (n=71) were compared to all other youth (n=13,904) who received services with respect to age, gender, ethnicity, comorbidity, type of service, and service cost. RESULTS: The schizophrenia-spectrum group had higher Asian representation, greater comorbidity, and was more likely to receive restrictive services for a higher average annual expense. When restrictive services were provided, they were of similar duration and intensity across groups. Almost all youth received less intensive services, but the schizophrenia-spectrum group received a higher frequency or longer duration of such services. CONCLUSIONS: Although youth with schizophrenia-spectrum disorders were uncommon, collectively they represented a distinct population with above average service consumption. Future monitoring of interventions and outcomes may help develop systematic and effective treatment strategies for youth with schizophrenia-spectrum disorders.

Adjustment Disorders↗
PubMed1998

Strength, physical activity, and body mass index: relationship to performance-based measures and activities of daily living among older Japanese women in Hawaii.

OBJECTIVES: Remaining strong, lean, and physically active may contribute to successful aging, both by maintaining function and by enabling more independent living. The study objective was to investigate this hypothesis among a long-lived population of older Japanese women. DESIGN: A cross-sectional study. SETTING: The island of Oahu, Hawaii. PARTICIPANTS: A total of 705 community-dwelling women (mean age, 74; range, 55-93). MEASUREMENTS: As outcomes, 7 physical performance measures including walking speed, the Get Up and Go test, chair stands, functional reach, and hand and foot reaction times, and 8 questions regarding activities of daily living (ADL). As possible predictors, physical activity, body mass index, and quadriceps, grip, and triceps strength. RESULTS: In multivariable models, one or more of the strength tests was associated positively with six of the seven performance-based measures. Among the significant associations, 1-SD increases in strength were associated with 2 to 4% increases in performance compared with the sample mean. Physical activity was independently, and positively associated with the most complex of the tests, the Get Up and Go test. Body mass index (BMI), in contrast to strength and physical activity, was negatively associated with five of the seven performance tests. Among the significant associations, 1-SD increases in BMI were associated with 3 to 8% reductions in performance. In multivariable models strength was also associated positively with seven of the eight ADLs. In the same models, physical activity was positively associated with five and BMI was negatively associated with six of the ADLs. CONCLUSION: The results suggest that remaining strong, lean, and physically active provided wide-ranging benefits for this population of older Japanese women.

Activities of Daily Living↗
PubMed1999

Risk factors for falls and for serious injuries on falling among older Japanese women in Hawaii.

OBJECTIVES: To evaluate if similar constellations of factors underlie the risks of falls and injuries on falling for Japanese women as reported for predominately white populations. DESIGN: A prospective cohort study SETTING: The island of Oahu PARTICIPANTS: The older Japanese women who participated in the Hawaii Osteoporosis Study (mean age = 74 +/- 5 (SD) years). MEASUREMENTS: As outcomes: falls and serious injuries on falling. As predictors: anthropometric measurements, measurements of neuromuscular performance, activities of daily living (ADLs), past falls, and other suspected risk factors for falls and serious injuries. RESULTS: In multivariable models, four subject characteristics were positively associated with having a fall (having a fall in the past year (RR = 2.0 (95% CI, 1.5-2.8)), slow chair stands (RR = 1.4 (95% CI, 1.0-1.9), a short height (RR = 1.5 (95% CI, 1.1-2.1)), difficulties with five or more ADLs (RR = 1.5 (95% CI, 1.1-2.1))). Two subject characteristics were negatively associated with having a fall (ability to perform a full tandem balance with eyes closed (RR = .7 (95% CI, .5-1.0)) and having a long functional reach (RR = .7 (95% CI, .5-1.0))). The RRs represent as nearly as possible comparisons of the upper (or lower) quartile and the remaining quartiles. In multivariable models, long times for chair stands (odds ratio (OR) = 3.0 (95% CI, 1.5-6.1)) and a low BMI (OR = 3.1 (95% CI, 1.5-6.4)) were positively associated with having a serious injury among women who had a fall. Among the same women, taking part in an activity they did frequently (OR = .3 (95% CI, .1-.8)) and slow foot reaction times (OR = .3 (95% CI, .1-.8)) were associated negatively with having a serious injury. CONCLUSIONS: The results from this Japanese cohort support the conclusion that women at high risk of falling and serious fall injuries can be identified using a questionnaire and simple, performance-based tests of neuromuscular function. The risk factors for falling overlapped, but were distinct from, those for suffering a serious injury once a fall had occurred.

Accidental Falls↗