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PubMed1977

Cholera on Guam, 1974: epidemiologic findings and isolation of non-toxinogenic strains.

In August 1974, six cases of cholera occurred on Guam. The index case had severe diarrhea and metabolic acidosis and died from pneumonia on the ninth day of illness; the other five cases had only mild to moderate diarrhea. Fish caught in Agana Bay and home-preserved was found to be the vehicle most likely responsible for the cases. Vibrio cholerae, El Tor Ogawa, was isolated from two patients, the Guam sewerage system, and a river emptying into Agana Bay. V. cholerae, El Tor Inaba, was isolated from the sewerage system, three storm drains imptying into Agana Bay, and Agana Bay. The Ogawa and Inaba isolates differed in their sucrose fermentation and hemolysis reactions, phage type and ability to produce toxin. Although this was the first reported cholera outbreak on Guam, the isolation of differentV. cholerae strains suggested that multiple introductions of V. cholerae had occurred on the island.

Cholera↗
PubMed1994

The Cu/Zn superoxide dismutase gene in ALS and parkinsonism-dementia of Guam.

Guam is one of three endemic foci whose indigenous (Chamorro) people have an unusually high incidence of fatal neurodegenerative disorders, amyotrophic lateral sclerosis (ALS) and Parkinsonism-dementia (PD). Recently, mutations in the Cu/Zn superoxide dismutase (SOD-1) gene have been identified in some familial cases of ALS. To investigate if mutations in the SOD-1 gene are also involved in the pathogenesis of ALS and PD of Guam, we analyzed the SOD-1 gene in Chamorros. No mutations were found in Chamorros with ALS or PD, indicating that mutations in the SOD-1 gene do not underlie the high-incidence neurodegenerative disorders of Guam.

Amyotrophic Lateral Sclerosis↗
PubMed1980

Studies on amyotrophic lateral sclerosis by neutron activation analysis--2. Comparative study of analytical results on Guam PD, Japanese ALS and Alzheimer disease cases.

Metal analysis of calcium, manganese, aluminum and copper in CNS tissue samples of degenerative CNS disease cases (six Japanese ALS, three Japanese Alzheimer disease, four Guam PD, one Guam ALS) using neutron activation analysis, was conducted with following results: Five of six Japanese ALS cases, two of three Japanese Alzheimer disease cases and all of four Guam PD cases showed a high content of calcium and aluminum in CNS tissue with a significant positive correlation between calcium and aluminum and/or between calcium and manganese. These findings suggest a possible process of metal-induced soft tissue calcification with interaction of other di- and/or trivalent cations such as aluminum, manganese in CNS tissue of these degenerative CNS diseases.

Adult↗
PubMedDate not supplied

Incidence of amyotrophic lateral sclerosis and of the parkinsonism-dementia complex of Guam, 1950-1989.

Studies representing the accumulated information from the first 30 years of research effort on Guam (1950-1979) have demonstrated a varying degree of decline in the incidence of amyotrophic lateral sclerosis (ALS) and the parkinsonism-dementia complex (PDC) of Guam. Analysis with more complete information for the period 1980-1989 provides more valid estimates of the later patterns in the incidence of ALS and PDC and affords a more extensive assessment of trends over a 40-year period. The annual age-adjusted incidence of ALS was 7/100,000 and the annual age-adjusted incidence of PDC was 22/100,000 in 1989. The incidence was much higher for the period 1980-1989 than suggested in previous reports. These findings provide compelling evidence that this spectrum of neurodegenerative diseases continues to have a significant impact on the health of the Chamorro people of Guam.

Adult↗
PubMed1990

Risks to infants on Guam from bites of the brown tree snake (Boiga irregularis).

The brown tree snake, Boiga irregularis, is abundant on Guam and commonly invades human habitations. Data on emergency room visits on Guam document a high frequency of snakebites on Guam. Over 50% of the emergency room visits for snakebite involved children less than 4 years old. Records exist of 4 infants, 1, 2, 5, and 10 months old, who displayed significant symptoms after being bitten, while sleeping, by snakes. Two infants developed respiratory problems within a few hours and required medical treatment for asphyxiation. Lethargy, diminished sensory perceptions, drooping eyelids, swelling, discoloration, and bleb formation were variable in occurrence in the patients.

Animals↗
PubMed1992

Was disease involved in the decimation of Guam's avifauna?

Between 1982 and 1986, 402 (290 live, 112 dead) exotic, migrant or native resident birds on Guam were surveyed for disease-causing agents to determine the role of disease in the decline of native forest bird populations on Guam. Traumatic injury, primarily from collisions with motor vehicles and predation, was the most prevalent (46%) cause of death. Thirty-eight percent of the carcasses examined were in poor body condition largely as a result of inadequate nutrition in captive native birds and poultry and adipose exhaustion in errant migrants. A variety of commensal or opportunistic bacteria, including Salmonella spp., were cultured from 220 birds, and nothing remarkable was found in 15 fecal samples. Lastly, no haematozoans, the suspected cause for the decline of the Hawaiian avifauna, were observed in blood slides examined from 260 birds. Based on the results of the survey and other lines of evidence presented in the discussion, we concluded there were no data implicating disease in the decline of Guam's avifauna.

Accidents, Aviation↗
PubMed1995

Culturally diverse management teams. Mercy International sponsors project on Guam.

In 1989 Mercy International Health Services (MIHS) sent a team of advisers to help upgrade the skills of the managers of Guam Memorial Hospital. Their experience offers lessons for U.S. healthcare organizations as they become culturally diverse. The hospital had a number of problems, including high management turnover, troubles with financial resources, political interference, and a building that did not meet codes. The advisers also planned to prepare the hospital for an accreditation survey by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). MIHS, which has a growing presence in the Pacific, does not take charge of healthcare organizations. Instead, it trains local persons to assume leadership roles. At Guam Memorial Hospital, the MIHS advisers spent their first year assessing the organization and the various cultures represented on its staff. Then the advisers devoted three years to coaching and mentoring their Guamanian counterparts. The advisers learned that the hospital had basically been run by one person. It had no management team, either formal or informal. The advisers began their coaching by forming a management team in the dietary department. When the rest of the hospital staff saw that team perform successfully, they became willing to join similar teams themselves. Guam Memorial Hospital had changed by the time the MIHS advisers left the island in 1993. It has not yet been accredited, but it does have management teams working to meet JCAHO standards. The hospital also has in place a continuous quality improvement system, with more than three years of documentation. And the hospital building now conforms to codes.

Accreditation↗
PubMed1975

Patterns of Amyotrophic Lateral Sclerosis and Parkinsonism-Dementia on Guam.

The striking concentration of amyotrophic lateral sclerosis (ALS) and parkinsonismdementia (PD) among the Chamorro people of Guam has attracted attention since the early 1950's. Extensive studies conducted over the past 20 years have not revealed the causes of these diseases and the reasons for their remarkable concentrations on Guam. Approximately 1 in 10 Guamanian deaths over age 25 is from ALS, and another 1 in 10 is from PD. ALS still occurs approximately 50 times more frequently on Guam than in the continental United States. Advances in virologic and biochemical techniques, and long years of study, appear to be leading us to a point where some of the problems will be resolved. We shall attempt to review the pertinent background information and summarize the data and observations up to the present time.

Adult↗
PubMed2003

Comparative analysis of oral health indicators among young children in Hawai'i, the Republic of Palau and Territory of Guam, 1999-2000.

Dental caries prevalence data were collected in Hawai'i, Palau and Guam and analyzed for dft, DMFT, unmet treatment needs, sealant utilization and various caries patterns. Data sets include examinations of 24,752 children ages 5 through 9 years of age in Hawai'i, 558 children in Palau and 1,518 children in Guam. Dental disease in early childhood is truly endemic throughout the Pacific basin. The findings of this report quantify in a standardized manner and contrast, basic oral health / oral disease indicators from each jurisdiction. While children from all three jurisdictions demonstrated dental disease prevalence rates which far exceed those found on the U.S. mainland, overall, children in Guam were found to be the poorest oral health indicators, followed by Palau and Hawai'i. Overall, young children at all sites exhibited excessively high caries prevalence and unmet treatment needs rates. Significant progress has been made at Palau in the past decade, however, at all three sites presented, more work is necessary if early childhood caries is to be brought under control. Findings also include an apparent negative correlation between dental sealants and DMFT rates.

Child↗
PubMed1994

Topographic investigation of brain atrophy in parkinsonism-dementia complex of Guam: a comparison with Alzheimer's disease and progressive supranuclear palsy.

The topographic distribution of brain atrophy in nine patients with parkinsonism-dementia complex of Guam (Guam PDC) was evaluated quantitatively, and compared with that in six Japanese patients with Alzheimer's disease or senile dementia of Alzheimer type (AD), five Japanese patients with progressive supranuclear palsy (PSP), and nine Japanese control subjects. Characteristic features of Guam PDC were as follows: (1) severe atrophy of the frontal and temporal cortex with relative preservation of the white matter; (2) atrophy of the tectum, tegmentum and cerebral peduncle of the midbrain, and (3) atrophy of the tegmentum and base of the upper pons. In contrast, sectional areas of the tectum and cerebral peduncle of the midbrain were relatively well preserved in PSP, while in AD there was no significant atrophy in the brain stem.

Aged↗
PubMed1997

Health status of diabetic persons in an Asian-Pacific population: evidence from Guam.

OBJECTIVE: The goal of this study was to document the sociodemographic, physical, and psychosocial health characteristics of self-reported diabetic Asian-Pacific Americans in Guam. METHODS: Data from Guam's 1991 Behavioral Risk Factor Survey were analyzed using analysis of variance. RESULTS: Diabetic men are significantly more likely than nondiabetic men to be Chamorro, not to have graduated from high school, to be unemployed, and to be impoverished. Diabetic women are also significantly more likely than nondiabetic women to be impoverished. Hypertension is more prevalent among diabetic men and women than among nondiabetic persons. Diabetic men are at greater risk than nondiabetic men for heart attack, and are significantly more likely to assess their physical health as poor. Diabetic women are more likely than nondiabetic women to suffer strokes. CONCLUSIONS: The results of this study indicate significant differences in the health status of diabetic and nondiabetic Asian-Pacific persons in Guam and extends our understanding of the health characteristics and service needs of this rapidly growing and under-studied population.

Adult↗
PubMed1997

Ophthalmomyiasis interna posterior and pigmentary retinopathy of Guam.

BACKGROUND: Ophthalmomyiasis is ocular invasion by a fly larva. In the United States, only two cases of bilateral subretinal ophthalmomyiasis have been reported in the literature. Subretinal invasion by the fly larva results in characteristic ophthalmoscopic and angiographic findings. Recently, similar subretinal changes have been associated with amyotrophic lateral sclerosis/Parkinsonism dementia complex (ALS-PDC) in the Chamorro population of Guam. This pigmentary retinopathy of Guam (PROG) is generally bilateral in presentation, whereas ophthalmomyiasis is generally unilateral. While PROG has been associated with neurologic findings, ophthalmomyiasis interna posterior (OIP) has not. CASE REPORT: A case of a 65-year-old Asian man with bilateral subretinal changes is described. Similarities and differences between ophthalmomyiasis and the pigmentary retinopathy of Guam are discussed. CONCLUSIONS: Because PROG has been associated with ALS-PDC, a neurologic evaluation should be included in the workup of patients suspected of having OIP or PROG.

Aged↗
PubMed1994

The Effects of Marriage and Being a Parent on Prenatal Physician Visits for Chamorro, Filipino, White and Other Asian and Pacific Island Women on Guam.

PURPOSE OF THE PAPER: The purpose of this study was to examine the effect of marital status, parental status, and ethnicity on the frequency of prenatal physician visitations reported by Chamorro, Filipino, White, and other Asian and Pacific Island women residing in Guam. SUMMARY OF METHODS UTILIZED: Data were extracted from birth records and analyzed using ordinary least squares multiple regression. PRINCIPAL FINDINGS: We found that ethnic effects remained even when age, education, and region of residence on Guam were held constant. Marriage had a significant and positive effect on prenatal visitations, and a number of previoius children had significant negative effect on prenatal visitations. CONCLUSIONS: We conclude that spouses encourage positive health behaviors while the expectations of parenting detract significantly from the amount of time women can devote to caring for themselves. RELEVANCE TO ASIAN AND PACIFIC ISLANDER AMERICAN POPULATIONS: Our results indicate that marital status may be more important than educational levels for understanding the health care behaviors of Chamorro, Filipina, and other Asian and Pacific Island women on Guam. KEY WORDS: Chamorro, Filipino, prenatal visitations, marital status, parental status.

Journal Article↗
PubMed1981

Neurofibrillary change on Guam.

Distribution and occurrence of neurofibrillary change (NFC) in the brain were studied in 114 Guamanians who had neither amyotrophic lateral sclerosis (ALS) nor parkinsonism dementia (PD). Comparison was made with 28 Guamanians with ALS-PD and 53 non-Guamanians without ALS-PD. Search for NFC was made in 15 dogs and cats that lived on Guam. Most of the Guamanians without ALS-PD during and after middle age had NFC similar to that of Guamanians with ALS-PD but lesser in degree and extent of involvement. It is possible that the general population of Guam had been exposed to the unknown etiologic agent of ALS-PD during some previous period.

Adolescent↗
PubMed1990

Patterns of acquiring parkinsonism-dementia complex on Guam. 1944 through 1985.

For 1944 through 1985, documented clinical descriptions compatible with a diagnosis of parkinsonism-dementia complex were found in 363 Chamorros (including mixed Chamorros) and three Filipino immigrants who had lived on Guam before onset. Downward trends in age-adjusted incidence rates and upward trends in age at onset were seen for Chamorros of both sexes. Since 1980, new cases have occurred only among persons over 50 years of age, whereas a younger age at onset had been noted in the past. Evidence suggests that the length of the latent period varied widely (up to decades) and increased with time, the risk of acquiring parkinsonism-dementia complex had declined since the late 1950s, and the critical age of exposure to an unknown factor in the environment on Guam appears to have been during adolescence or adulthood.

Adult↗
PubMed2001

TAU as a susceptibility gene for amyotropic lateral sclerosis-parkinsonism dementia complex of Guam.

BACKGROUND: A Guam variant of amyotrophic lateral sclerosis (ALS-G) and parkinsonism dementia complex (PDC-G) are found in the Chamorro people of Guam. Both disorders have overlapping neuropathologic findings, with neurofibrillary tangles in spinal cord and brain. The cause of ALS-G-PDC-G is unknown, although inheritance and environment appear important. Because neurofibrillary tangles containing tau protein are present in ALS-G-PDC-G, and because mutations in the tau gene (TAU) cause autosomal dominant frontotemporal dementia, TAU was examined as a candidate gene for ALS-G-PDC-G. METHODS: TAU was evaluated by DNA sequence analysis in subjects with ALS-G-PDC-G, by linkage analysis of TAU polymorphisms in an extended pedigree from the village of Umatac, and by evaluation of linkage disequilibrium with polymorphic markers flanking and within TAU. RESULTS: Linkage disequilibrium between ALS-G-PDC-G and the TAU polymorphism CA3662 was observed. For this 2-allele system, PDC and ALS cases were significantly less likely than Guamanian controls to have the 1 allele (4.9% and 2% vs 11.5%, respectively; Fisher exact P =.007). DNA sequence analysis of TAU coding regions did not demonstrate a mutation responsible for ALS-G-PDC-G. Analysis of TAU genotypes in an extended pedigree of subjects from Umatac showed obligate recombinants between TAU and ALS-G-PDC-G. Linkage analysis of the Umatac pedigree indicates that TAU is not the major gene for ALS-G-PDC-G. CONCLUSIONS: The genetic association between ALS-G-PDC-G implicates TAU in the genetic susceptibility to ALS-G-PDC-G. TAU may be a modifying gene increasing risk for ALS-G-PDC-G in the presence of another, as yet, unidentified gene.

Adult↗
PubMed2005

Parkinsonism-dementia complex of Guam.

On Guam and in two other Pacific locales, indigenous residents and immigrants are prone to familial neurodegeneration that manifests as atypical parkinsonism, dementia, motor neuron disease, or a combination of these three phenotypes. This progressive and fatal disease of the Mariana islands, the Kii peninsula of Japan, and the coastal plain of West New Guinea is similar and the pathological features have close affiliation with universal tauopathies, including progressive supranuclear palsy, Alzheimer's disease, and amyotrophic lateral sclerosis. The Chamorros of Guam call the disease lytico-bodig, and neuroscientists refer to it as the amyotrophic lateral sclerosis/Parkinsonism-dementia complex. During recent decades, its prevalence has declined progressively, and the age at onset has steadily increased. In 2004, motor neuron disease, once 100 times more common than elsewhere is rare, atypical parkinsonism is declining, and only dementia remains unusually common in elderly females. The cause of this obscure malady remains uncertain, despite 60 years of international research, but its ending implicates environmental influences rather than genetic predisposition.

Age of Onset↗
PubMed2001

Effects of trapping and subsequent short-term confinement stress on plasma corticosterone in the brown treesnake (Boiga irregularis) on Guam.

The effects of capture in a live trap and subsequent handling stress on plasma concentrations of corticosterone and other sex steroids were examined in wild male and female brown treesnakes (Boiga irregularis), an introduced species on Guam that has been implicated in the extirpation or decline of many of that island's vertebrate species. Males and females that spent 1 night in a trap had plasma levels of corticosterone about four and two times higher, respectively, than those of the respective free-ranging controls. Mean plasma levels of corticosterone of snakes that had spent 3 nights in a trap were intermediate between, but not significantly different from, those of snakes that had spent 1 night in a trap and free-ranging snakes, suggesting that some acclimation to capture occurred during this period. Snakes that were taken from traps and held in collecting bags for 10 min and 2 h prior to blood sampling had levels of corticosterone about two and three times higher, respectively, than those of control snakes that were taken from traps and bled immediately. Concentrations of plasma corticosterone in free-ranging females were about two times higher than those of males but were well within the range of basal levels observed in other reptiles. Few snakes of potential reproductive size were reproductive (males: 1 of 35; females: 2 of 33), and plasma concentrations of testosterone and progesterone in nonreproductive males and females, respectively, were accordingly low. The possible relationship between corticosterone and these sex steroids, therefore, could not be adequately assessed, although there was a positive relationship between plasma progesterone and corticosterone in the nonreproductive females. Nonetheless, as a prerequisite for studies on the seasonal hormonal cycles of this species on Guam, our observations raise the possibility that the stress caused by trapping could affect the levels of other sex steroids and that, therefore, such studies should use free-ranging individuals.

Animals↗