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PubMed1992

Glucose-6-phosphate dehydrogenase variants in Hawaii.

Sequence analysis has been performed on the DNA of 13 glucose-6-phosphate dehydrogenase (G6PD) deficient males from Hawaii, 6 of Filipino, 6 of Laotian, and 1 of Chinese extraction. Four different mutations were found: A-->T at cDNA nt 835, G-->A at nt 871, C-->T at nt 1360, and G-->A at nt 1388. The mutations at nt 835 and nt 1360 have not been described previously, and the latter, in particular, appears to be relatively common. The nt 1360 mutation changes the same codon as is altered in a previously described mutation, G6PD Andalus.

China↗
PubMedDate not supplied

Biological and dietary correlates of plasma lipids and lipoproteins among elderly Japanese men in Hawaii.

The relationships of plasma total cholesterol (total-C), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), and triglyceride (TG) to a variety of personal attributes were investigated cross-sectionally in a random sample of approximately 1360 elderly Japanese men, aged 60-81 years, in Hawaii. In multivariate analyses, total-C was positively related to hematocrit (p less than 0.01); LDL-C was positively related to hematocrit (p less than 0.0001), and inversely related to alcohol consumption (p less than 0.0001); HDL-C was positively related to alcohol consumption (p less than 0.0001) and physical activity index (p less than 0.05), and inversely related to body mass index (p less than 0.0001) and antihypertensive medication (p less than 0.05); and LogTG was positively related to body mass index (p less than 0.0001), alcohol consumption (p less than 0.0001), antihypertensive medication (p less than 0.0001), and diastolic blood pressure (p less than 0.01), and inversely related to physical activity index (p less than 0.01). Body mass index and alcohol consumption were the most important correlates of plasma lipids and lipoproteins. Several dietary variables were significantly related to each lipid or lipoprotein fraction after controlling for nondietary variables, but their independent contributions were generally quite modest.

Aged↗
PubMedDate not supplied

Biological and social correlates of blood pressure among Japanese men in Hawaii.

A cohort of more than 8,000 Japanese men living in Hawaii was studied for factors associated with blood pressure levels, with an emphasis on biological and sociocultural variables. Bivariate and multivariate analyses of more than 50 variables indicated that obesity, age, hematocrit, heart rate, forced vital capacity, serum triglyceride, serum uric acid, cigarette consumption, and family history of hypertension were independently associated with both cross-sectional levels and longitudinal changes in blood pressure. Serum glucose and alcohol consumption were associated with cross-sectional levels only. There was little evidence of association for specific dietary items, type of diet, diet changes, or use of salt. Furthermore, there was no support for the psychosocial hypotheses of elevated blood pressure from the stress of migration, acculturation, or status incongruity.

Acculturation↗
PubMedDate not supplied

Autopsy study of cerebrovascular disease in Japanese men who lived in Hiroshima, Japan, and Honolulu, Hawaii.

Evidence of cerebrovascular disease at autopsy was compared in 2 groups of men: 186 long-time residents of Hiroshima, Japan, and 253 men of Japanese ancestry long resident in Honolulu, Hawaii. They were 45 to 71 years-of-age at death. Atherosclerosis of the circle of Willis and its major branches, sclerosis of the intraparenchymal arteries and the frequency of cerebral hemorrhage and cerebral infarct were compared in the 2 populations. The Honolulu subjects had significantly more atherosclerosis of the circle of Willis, but less intraparenchymal artery sclerosis and less cerebral infarction. Cerebral hemorrhage was equally frequent in the 2 cities. It was concluded that cerebral infarction is more frequent in Japanese men in Hiroshima than Honolulu, and that men of Japanese ancestry in Honolulu are spared an appreciable risk of cerebral infarction through decreased frequency of intraparenchymal arterial sclerosis despite higher levels of atherosclerosis of large intracranial arteries.

Aged↗
PubMedDate not supplied

Factors related to stroke incidence in Hawaii Japanese men. The Honolulu Heart Study.

As part of an ongoing longitudinal study of coronary heart disease and stroke among Japanese men in Hawaii, 8,006 men of Japanese ancestry living on the island of Oahu and aged 45-68 at entry examination have been followed by reexamination and surveillance. One hundred and eleven were found to have evidence of prior stroke at the time of the initial examination. During a six-year follow up period of the remaining 7,895 men, 94 developed definite thromboembolic stroke, 33 definite intracranial hemorrhage, and 6 developed stroke of unknown type. The principal risk factors for thromboembolic stroke were: elevated blood pressure, glucose intolerance, age, and electrocardiography evidence of left ventricular hypertrophy or strain. Attributes associated with increased risk of intracranial hemorrhage were elevated blood pressure, electrocardiographic evidence of left ventricular hypertrophy or strain, and alcohol intake. Serum cholesterol level was negatively associated with risk of intracranial hemorrhage.

Age Factors↗
PubMedDate not supplied

Patterns of cerebrovascular disease in Japanese and other population groups in Hawaii: an angiographical study.

Angiograms of the carotid system were analyzed for incidence and type of intracranial and extracranial lesions in 296 patients with a final diagnosis of non-hemorrhagic stroke. These patients represent all the major ethnic groups in Hawaii. A significant difference was found between the ratio of frequency of involvement of the extracranial and intracranial vessels in Caucasian and that in the Hawaiian-born Japanese populations, similar to that reported by others in native Japanese. The Filipino, Chinese, Hawaiian and part-Hawaiian populations showed no such significant difference.

Adult↗
PubMed1996

Tuberculosis screening for immigrants and refugees. Diagnostic outcomes in the state of Hawaii.

The effectiveness of the required overseas tuberculosis (TB) screening for immigrants and refugees to the United States has not been evaluated since new guidelines were introduced in 1991. Using data from the Hawaii State TB register for 1992-1993, patient records, and data from the U.S. government notifications of suspect TB among aliens, we determined the percentage of persons either classified as having active TB (B1), inactive TB (B2), or considered "normal" overseas, who were evaluated and subsequently diagnosed with active TB within 1 yr of arrival in the United States. Of the 124 TB cases among immigrants and refugees evaluated within 1 yr of arrival, 78 (63%) had been classified overseas as B1, 17 (14%) as B2, and 29 (23%) as "normal." The proportion of TB cases diagnosed after arrival in the United States was 14.0% for B1s and 2.1% for B2s. This proportion decreased with increasing age. A positive skin test was a strong predictor (OR: 10.7; 95% CI: 1.4-80.1) of culture-confirmed TB. These data document that immigrants and refugees with B1 and B2 TB status have a high prevalence of active TB. They should be promptly evaluated after arrival in the United States to determine the need for curative or preventive therapy.

Adolescent↗
PubMed1985

Family interaction patterns among Japanese-American and Caucasian families in Hawaii.

The authors compared the family interaction patterns of Japanese-American and Caucasian families in Hawaii by rating videotapes of structured family interactions. There were significant differences between the two groups in many aspects of family interaction, such as power, coalition, closeness, negotiation, clarity of self-disclosure, responsibility, invasiveness, affect, and empathy. The differences in family interaction could be explained by the cultural differences between the two groups and indicate that profiles of healthy families differ between distinct cultures, and there is a need to establish a culturally relevant family interaction profile; otherwise normal interactions in families outside the mainstream could be misinterpreted as pathological.

Adolescent↗
PubMed1978

Cultural aspects of psychiatric clinic utilization a cross-cultural study in Hawaii.

Data was obtained by ethnic status from 411 outpatients at a psychiatric clinic in Honolulu, Hawaii, and were then analyzed according to demographic variables, welfare status, source of referral, primary compliants or symptoms, diagnosis, and duration of treatment received. Clinic utilization was highly related to ethnicity, with Caucasians highly over-represented in proportion to the population, and other groups, especially Japanese, being greatly under-represented. The Caucasians were more likely to be self-referred, to have subjective symptoms of anxiety and depression, and to receive a neurotic diagnosis. The Japanese, and to some extent all other groups, were more often referred after a crisis or severe mental illness, displayed more socially disruptive symptoms, and had a higher percentage of schizophrenic diagnoses. Ethnicity was thus highly related to utilization of mental health services; however, once entry into the system was made, review of therapist case loads and analysis of duration of treatment revealed no ethnic difference in the clinic's response to patients.

Adolescent↗
PubMed1989

Cost estimate of health care coverage for the medically indigent in Hawaii.

The objective of the study was to estimate the cost of health insurance coverage of the medically indigent in Hawaii. The number of uninsured was estimated deductively from the coverages of those insurance companies doing business in the state, with an additional factor for persons with more than one policy coverage. Age and sex breakdowns of the uninsured were entered into actuarial tables and fee-for-service and HMO plan costs were obtained for the most prevalent health plan in the state. Annual coverage is estimated at US$46.090866 million and US$58.040700 million for fee-for-service and HMO plans, respectively. Seven potential sources of financing and five recommendations for further research are given.

Actuarial Analysis↗
PubMed1989

Hawaii Asian-American response to the Staying Healthy After Fifty program.

A nationwide project conducted by the American Association of Retired Persons, the American Red Cross, and the Dartmouth Institute for Better Health to disseminate a health promotion program for older adults included a study to test its ability to serve different ethnic minorities. This article reports how the Staying Healthy After Fifty Program, designed for the general United States population, was introduced into the State of Hawaii, how it was adapted for use with two Asian-American groups, the Japanese and Filipinos, and on the benefits reported by participants. To determine the appropriateness and effectiveness of the adapted SHAF program, a quasi-experimental design, involving a test group and a comparison group whose members completed questionnaires at three points in time, was used. The results of the data collected from the Hawaiian population were consistent with the results of the general U.S. population skills, health activities, and health care cost skills areas. Participants were very pleased with the course and its quality, as noted in the high ratings of course satisfaction.

Aged↗
PubMed2003

Time dependent ethnic convergence in colorectal cancer survival in Hawaii.

BACKGROUND: Although colorectal cancer death rates have been declining, this trend is not consistent across all ethnic groups. Biological, environmental, behavioral and socioeconomic explanations exist, but the reason for this discrepancy remains inconclusive. We examined the hypothesis that improved cancer screening across all ethnic groups will reduce ethnic differences in colorectal cancer survival. METHODS: Through the Hawaii Tumor Registry 16,424 patients diagnosed with colorectal cancer were identified during the years 1960-2000. Cox regression analyses were performed for each of three cohorts stratified by ethnicity (Caucasian, Japanese, Hawaiian, Filipino, and Chinese). The models included stage of diagnosis, year of diagnosis, age, and sex as predictors of survival. RESULTS: Mortality rates improved significantly for all ethnic groups. Moreover, with the exception of Hawaiians, rates for all ethnic groups converged over time. Persistently lower survival for Hawaiians appeared linked with more cancer treatment. CONCLUSION: Ethnic disparities in colorectal cancer mortality rates appear primarily the result of differential utilization of health care. If modern screening procedures can be provided equally to all ethnic groups, ethnic outcome differences can be virtually eliminated.

Adult↗
PubMed2001

An investigation of soy intake and mammographic characteristics in Hawaii.

This cross-sectional investigation in Hawaii explored the relation between soy foods and mammographic characteristics using two food frequency questionnaires and a computer-assisted density assessment method. Japanese and Chinese women reported significantly greater soy food intake than Caucasian women. Whereas soy intake and the size of the dense areas were not related, soy intake and percent mammographic densities were positively associated. The size of the entire breast and the nondense area (ie the fatty part of the breast) were inversely related to soy intake. These results suggest the hypothesis that soy foods by themselves or as part of an Asian dietary pattern may affect the growth of the female breast before adulthood, but the possible mechanisms of action have to be explored in future studies.

Breast Neoplasms↗
PubMed2004

Higher frequency of dementia in older HIV-1 individuals: the Hawaii Aging with HIV-1 Cohort.

BACKGROUND: Antiretroviral therapy has improved survival for HIV-1-infected individuals. The neuroepidemiologic implications of HIV-1 in an aging population are not well known, particularly the prevalence of HIV-associated dementia (HAD). METHODS: The authors report a baseline cross-sectional analysis of 202 HIV-1-seropositive individuals enrolled into one of two groups of the Hawaii Aging with HIV Cohort: older (50 or more years old, n = 106) and younger (20 to 39 years old, n = 96). Neuropsychological, neurologic, medical, and laboratory data were obtained at enrollment. Participant cognitive status was classified (research case definitions) using American Academy of Neurology (1991) criteria in a consensus conference of physicians and neuropsychologists. RESULTS: HAD was more frequent in older (25.2%) compared to younger (13.7%) individuals (p = 0.041) corresponding to an OR of 2.13 (95% CI: 1.02 to 4.44) for the older compared to the younger group. After adjusting for education, race, substance dependence, antiretroviral medication status, viral load, CD4 lymphocyte count, and Beck Depression Inventory score, the odds of having HAD among individuals in the older group was 3.26 (1.32 to 8.07) times that of the younger group. CONCLUSIONS: Older age is associated with increased HAD in this HIV-1 cohort. Underlying mechanisms are unclear but do not appear related to duration of HIV-1 infection.

AIDS Dementia Complex↗
PubMed1986

The competitive effects of health maintenance organizations: another look at the evidence from Hawaii, Rochester, and Minneapolis/St. Paul.

There has been much discussion about the potential cost-containing impact of HMOs upon the local medical care market. Three areas have been identified by various observers as experiencing such beneficial effects: Hawaii, after the development of Kaiser in the late 1950s; Rochester, New York, which experienced rapid HMO growth and declining Blue Cross hospital use in the late 1970s; and Minneapolis/St. Paul, which has been the focus of vigorous HMO competition in the last decade. While comprehensive data on health care expenditures are not available, bits of evidence can be pieced together to develop case studies of each area. Careful review of the available data often identifies internal inconsistencies and contradictions, but in none of the three sites is there a reduction in hospital use that is most plausibly attributed to HMO competition. Instead, the reported reductions are in each case attributable to other factors--including biases in data, long-term trends predating HMOs, indirect effects of other policy changes, and other forms of competition.

Blue Cross Blue Shield Insurance Plans↗
PubMed2001

Leisure-time physical activity and other factors in relation to blood pressure in Japanese-Americans in Hawaii, USA.

To examine physical activity at work and during leisure-time as well as other factors related to blood pressure (BP) in Japanese-Americans living in Hilo, Hawaii, USA, we performed a population-based cross-sectional study with a sample of 238 participants aged 42-64 years old. This survey was carried out between 19 February and 1 March 2000 in Hilo. All participants were invited to Hilo Medical Center for a free physical examination and experimental tests including an examination of blood and urine samples. A self-administered health questionnaire was used that included items related to demographics, smoking, alcohol consumption, and habitual physical activity at work and during leisure-time. A summary score of physical activity (PA) was calculated. BP was measured using an automated BP measurement system (Khi machine, VINE Co., Ltd., Kyoto, Japan). The results showed the following. 1) Mean (SD) PA scores at work (WPA) and during leisure-time (LTPA) were 2.9 (0.5) and 2.5 (0.5) in men, and 3.0 (0.5) and 2.4 (0.3) in women, respectively; 2) Pearson correlation analyses (adjustment for age) indicated that WPA and LTPA in men show significant negative associations with SBP and DBP (p<0.05 and p<0.01), while LTPA shows significant negative associations with SBP and DBP in women (p<0.05 and p<0.01). After further adjustment for education, occupation, smoking, and alcohol consumption status, LTPA continued to show significant and negative associations with both SBP and DBP in men (p<0.01) and with DBP alone in women (p <0.01). 3) Hypertensive subjects had significantly lower mean LTPA scores than normotensive men (2.39 vs. 2.61, p<0.05) and women (2.32 vs. 2.45, p<0.05). 4) Body mass index and the ratio of sodium to potassium excretion showed significant and positive associations with SBP and DBP in multiple linear regression analyses. In conclusion, the results further emphasize that the health benefits of LTPA, control of body weight, and reduction in salt intake should continually receive strong attention in population-based high BP control.

Adult↗
PubMed2001

Association of apolipoprotein E phenotype with hypertension in Japanese-Americans: data from the Hawaii-Los Angeles-Hiroshima Study.

We evaluated the association between the phenotypes or alleles of apolipoprotein E and hypertension in Japanese-Americans living in Hawaii or Los Angeles. The study consisted of 932 nondiabetic participants aged 40-79 years. Of these participants, 315 were hypertensive, while the remainder were normotensive. The prevalence of hypertension was higher in subjects with the e2 allele than in those without. Using a multivariable prediction model that included age, serum glucose, insulin, lipids, and body mass index, we found the epsilon2 allele to be associated with hypertension in men (odds ratio (OR), 1.53; 95% confidence interval (CI), 1.05-2.24) and for both sexes combined (OR, 1.35; 95% CI, 1.05-1.73). In a follow-up study, 37 of the 352 (11%) normotensive subjects had developed hypertension 4 years after the baseline examination. The frequencies of the apolipoprotein E phenotype E3/2 and the epsilon2 allele were higher in the subjects who became hypertensive than in those who remained normotensive. The E3/2 phenotype was associated with incidence of hypertension after adjustment for age, sex, baseline body mass index, and systolic blood pressure (OR, 1.75; 95% CI, 1.01-2.90). When serum lipids, glucose, and insulin were included in this analysis, the E3/2 phenotype tended to be associated with the incidence of hypertension. In conclusion, the epsilon2 allele of apolipoprotein E was associated with hypertension in Japanese-Americans. This association may be mediated via high levels of serum triglycerides that in turn are mediated in part by the epsilon2 allele. Nonlipid mechanisms may also be responsible for the effect of the epsilon2 allele on hypertension.

Aged↗
PubMed2001

Hyperinsulinemia for the development of hypertension: data from the Hawaii-Los Angeles-Hiroshima Study.

The present study was to assess the association of metabolic factors including hyperinsulinemia, with the development of hypertension in Japanese-Americans. One hundred forty normotensive (<140/90 mmHg) subjects aged 40 to 69 years old from the Hawaii-Los Angeles-Hiroshima study were followed for 15 years. Patients with cardiovascular disease were excluded. Body mass index (BMI), blood pressure (BP), serum total cholesterol (TC), triglycerides (TG), uric acid (UA), and glucose and insulin responses at baseline, 1 h, and 2 h after a glucose load were analyzed. Seventeen subjects became hypertensive (systolic BP > or = 160 mmHg, diastolic BP > or = 95 mmHg, or received drug treatment) during follow-up. Age- and sex-adjusted BMI, BP, serum UA, TG, insulin, and changes in fasting glucose during follow-up were higher in subjects who later became hypertensive than in those who did not. There was no difference in the change in BMI. Age- and sex-adjusted relative risks for the development of hypertension by quartiles of BMI, serum UA, TG, and the sum of insulin values (sigmainsulin) during a glucose load were highest in highest quartile of the distribution. When age, sex, systolic BP, BMI, serum UA, TC, TG, fasting glucose, sigmainsulin, and the change in BMI were used in a proportional hazard analysis, hyperinsulinemia, hyperuricemia, and systolic BP were found to be significant risk factors for hypertension. In conclusion, hyperinsulinemia, as well as obesity, hyperuricemia, and hypertriglyceridemia were associated with hypertension in Japanese-Americans. Hyperinsulinemia and hyperuricemia were independent predictors of the development of hypertension.

Blood Glucose↗