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PubMed1989

Helminth parasites of intermingling axis deer, wild swine and domestic cattle from the island of Molokai, Hawaii.

Helminth infections of axis deer (Cervus axis), wild swine (Sus scrofa) and domestic cattle (Bos taurus) were studied among intermingling herds on the Puu-O-Hoku Ranch, Molokai, Hawaii. Twenty-four species of helminths were collected from the 10 deer, 10 swine and 10 cattle. Capillaria bovis, Cooperia punctata, Haemonchus contortus and Trichostrongylus axei infected both axis deer and cattle, whereas Gongylonema pulchrum infected both axis deer and wild swine. None of the species of helminths occurred in both wild swine and cattle nor was any species found in all three hosts. Wild swine and domestic cattle supported separate and distinct helminth communities. In contrast, the helminth community of axis deer appeared to be derived from the helminth communities of cattle and wild swine and consisted only of those species capable of parasitizing either a broad range of ruminants or many mammalian taxa.

Animals↗

PubMed1995

Fusarium solani fungal infection of the lateral line canal system in captive scalloped hammerhead sharks (Sphyrna lewini) in Hawaii.

Two of five scalloped hammerhead sharks (Sphyrna lewini) captured May 1987 in Hawaii (USA) developed granulomatous exudative mycotic dermatitis localized in the lateral line canal system. The lesion initially was noted in the cephalic canals, but over a period of months extended into the lateral canal. Fusarium solani and Vibrio spp. were isolated from the canal exudate of both sharks. Bacterial colonies were not observed in the canal walls or surrounding tissues. Fusarium solani infection resulted in a chronic physical and behavioral deterioration of the two sharks; one shark was euthanized in September 1988 and the other in July 1989. This is the first report of Fusarium solani infection in the lateral line canal system and the third account in hammerhead sharks.

Animals↗

PubMed1999

Mass stranding of wedge-tailed shearwater chicks in Hawaii.

Unusual numbers of wedge-tailed shearwater (Puffinus pacificus) chicks stranded on Oahu (Hawaii, USA) in 1994. Compared to healthy wedge-tailed shearwater (WTSW) chicks, stranded chicks were underweight, dehydrated, leukopenic, lymphopenic, eosinopenic, and heterophilic; some birds were toxemic and septic. Stranded chicks also were hypoglycemic and had elevated aspartate amino transferase levels. Most chicks apparently died from emaciation, dehydration, or bacteremia. Because many birds with bacteremia also had severe necrosis of the gastrointestinal (GI) mucosa associated with bacteria, we suspect the GI tract to be the source of disseminated bacterial infection. The identity of the bacteria was not confirmed. The daily number of chicks stranded was significantly related to average wind speeds, and the mortality coincided with the fledging period for WTSW. Strong southeasterly winds were a distinguishing meteorologic factor in 1994 and contributed to the distribution of stranded chicks on Oahu. More objective data on WTSW demographics would enhance future efforts to determine predisposing causes of WTSW wrecks and their effects on seabird colonies.

Animals↗

PubMed1999

Relating tumor score to hematology in green turtles with fibropapillomatosis in Hawaii.

The relationship between hematologic status and severity of tumor affliction in green turtles (Chelonia mydas) with fibropapillomatosis (FP) was examined. During 1 wk periods in July 1997 and July 1998, we bled 108 free-ranging green turtles from Pala'au (Molokai, Hawaii, USA) where FP is endemic. Blood was analyzed for hematocrit, estimated total solids, total white blood cell (WBC) count and differential WBC count. Each turtle was assigned a subjective tumor score ranging from 0 (no visible external tumors) to 3 (heavily tumored) that indicated the severity of FP. There was a progressive increase in monocytes and a decrease in all other hematologic parameters except heterophils and total numbers of white blood cells as tumor score increased. These data indicate that tumor score can relate to physiologic status of green turtles afflicted with FP, and that tumor score is a useful field monitor of severity of FP in this species.

Animals↗

PubMed2001

Epidermoptid mange in Laysan albatross fledglings in Hawaii.

Mange caused by the epidermoptid mite Myialges nudus (Acari: Epidermoptidae) is described in 31 dead fledgling Laysan albatrosses (Phoebastria immutabilis) from Midway Atoll (Hawaii, USA) sampled from 18 June to 10 July 1990 and from 21 June to 22 July 1991. This is the first record for this parasite from this host. Mites were collected from the skin; were located primarily in the stratum corneum; and were associated with mild to severe granulomatous inflammation, hyperkeratosis, dermal edema, ballooning degeneration of keratinocytes, neovascularization, and subdermal fibrosis. The severity of inflammation in some birds suggested that dermatitis due to M. nudus could be a significant cause of morbidity, or even mortality, in these birds.

Animals↗

PubMed1991

Life after mandatory insurance: Hawaii providers tide a new wave.

While the nation looks to universal access laws as a solution to hospitals' rising costs of caring for the uninsured, laws covering all workers are standard operating procedure in Hawaii. The state's mandatory insurance law was meant to reduce hospitals' indigent-care losses, but losses have continued to mount at some facilities. Despite the overall benefits of the law, Hawaiian hospitals struggle just like their mainland counterparts to survive.

Evaluation Studies as Topic↗

PubMed1995

State perspectives on health care reform: Oregon, Hawaii, Tennessee, and Rhode Island.

The general consensus among States which have had their section 1115 demonstration projects approved is that there is no one best way to implement State health care reform. The Health Care Financing Administration (HCFA), however, wished to discern how States were accomplishing the task of implementing the demonstrations, and solicited responses from State representatives whose section 1115 demonstration waivers had been approved. The resulting article gives an overview of this implementation process from four State perspectives. Written by representatives from Oregon, Hawaii, Tennessee, and Rhode Island, the ideas presented here are indicative of the complex undertaking of State health care reform.

Centers for Medicare and Medicaid Services, U.S.↗

PubMed1995

Cross-cultural caring. Positive outcomes in Hawaii.

Cultural diversity in Hawaii affects all aspects of health, illness, and death and dying. Effective home care requires sensitivity to each patient's culture and a knowledge of how cultural differences can affect client outcomes.

Attitude to Death↗

PubMed1999

Prenatal diagnosis and elective termination of Down syndrome in a racially mixed population in Hawaii, 1987-1996.

The impact of demographic factors on the prenatal diagnosis and elective termination of Down syndrome in Hawaii between 1987 and 1996 were examined. Data were obtained from a population-based birth defects registry and included 306 Down syndrome cases. 131 (43 per cent) of the cases were prenatally diagnosed. Of the prenatally diagnosed cases, 110(84 per cent) were electively terminated. Advanced maternal age or having a maternal serum alpha-fetoprotein screen performed increased the probability of having an affected pregnancy prenatally diagnosed and electively terminated. Far East Asians were substantially more likely to have an affected pregnancy prenatally diagnosed and electively terminated. Pacific Islanders and Filipinos were less likely to have cases prenatally diagnosed and electively terminated. Prenatally diagnosed and electively terminated Down syndrome cases had disproportionately fewer additional birth defects than live births or fetal demises, suggesting that for many of the electively terminated cases additional birth defects may not have been identified. This implies that the elective termination of Down syndrome-affected pregnancies may influence not only the Down syndrome prevalence but also that of other birth defects.

Abortion, Induced↗

PubMed1999

Genetic and dietary predictors of CYP2E1 activity: a phenotyping study in Hawaii Japanese using chlorzoxazone.

Cytochrome P4502E1 (CYP2E1) is considered to play an important role in the metabolic activation of procarcinogens such as N-nitrosoamines and low molecular weight organic compounds. An RsaI polymorphism is present in the 5'-flanking region of the CYP2E1 gene, which could possibly affect its transcription. However, the relationship between genotype and the phenotypic catalytic activity of the enzyme has not been defined. Also, the effects in humans of specific dietary factors, other than ethanol, which have been shown in animal and in vitro studies to modulate CYP2E1 activity, are unknown. Accordingly, the CYP2E1-mediated metabolism of chlorzoxazone to its 6-hydroxy metabolite was investigated in 50 healthy Japanese of both sexes in Hawaii. The oral clearance of the in vivo probe, the trait measure of CYP2E1 activity, was smaller than that reported in European-Americans. Significantly, after adjustment for age and sex, the oral clearance of chlorzoxazone decreased with the number of variant c2 alleles, and its mean in the c2/c2 genotype (147 ml/min) was statistically lower (P < or = 0.05) than that for either the homozygous wild-type (238 ml/min) or the heterozygote (201 ml/min) genotypes. Stepwise multiple regression analysis indicated that body weight was a major contributor to the interindividual variability in the oral clearance of chlorzoxazone, accounting for 43% of the variance. Consumption of lettuce, broccoli, and black tea explained additional components of the variability (7, 5, and 6%, respectively), as did medication use (3%), age (4%), and CYP2E1 genotype (5%). Overall, 73% of the variance could be accounted for by these variables. Body weight, lettuce, and use of medications were associated with increased CYP2E1 activity, and the other covariates were associated with reduced enzyme function. Because of the role that CYP2E1 plays in procarcinogen activation, especially of N-nitrosamines involved in lung cancer, the identified factors may account in part for observed differences in individual susceptibility to disease and may also have implications for cancer prevention.

Adult↗

PubMed1999

Cluster of leprosy cases in Kona, Hawaii; impact of the Compact of Free Association.

International travel and migration will continue to contribute to the changing patterns of Hansen's disease (HD) in the United States. The majority of cases will be immigrants and refugees entering the country from leprosy-endemic regions. The Compact of Free Association, through its provision of free travel between the Freely Associated States and the United States without need for health screening, has created new public health issues. This cluster of HD cases in Kona, Hawaii, U.S.A., highlights the difficulties in detecting and monitoring the spread of disease in immigrant populations. This is a growing problem only likely to worsen in the coming years. In groups with cultural, language or other socioeconomic barriers, special and creative methods may be needed to tackle the problems of detection, treatment and education. Clinicians must remain mindful of the diagnosis of HD in high-risk groups.

Adolescent↗

PubMed1999

A review of male violence against women in Hawaii.

This review attempts to emphasize the urgency in addressing issues of violence against women in Hawaii. It demonstrates that violence against women is a significant, challenging, and often overwhelming and overlooked public health problem. While attention to this problem has dramatically increased, more needs to be done to end violence against women and improve the well-being of women and our society as a whole.

Female↗

PubMed1999

Frequently asked questions (and answers) about Hawaii's new Uniform Health Care Decisions Act (Modified).

The Hawaii Uniform Health Care Decisions Act (Modified) became law, effective July 1, 1999. The Act makes major changes the law pertaining to Advance Directives and surrogate decision-making. While some of the changes seem to be confusing, most practitioners should find the new law helpful in attempting to assure that the rights of their patients to self-determination and autonomy are preserved and their wishes are followed. Using a question and answer format, this article will provide a basic guide to the new law. The "frequently asked questions" and the answers follow a brief overview of the Uniform Health Care Decisions Act. For busy practitioners, a conclusion summarizes key points.

Advance Directives↗

PubMed2000

Hawaii's healthy start program of home visiting for at-risk families: evaluation of family identification, family engagement, and service delivery.

OBJECTIVE: To describe family identification, family engagement, and service delivery in a statewide home visiting program for at-risk families of newborns. SETTING: Six target communities of Hawaii's Healthy Start Program (HSP), which incorporates 1) early identification of at-risk families of newborns via population-based screening and assessment, and 2) paraprofessional home visiting to improve family functioning, promote child health and development, and prevent child maltreatment. DESIGN: Cross-sectional study: describes early identification process and family characteristics associated with initial enrollment. Longitudinal study: describes home visiting process and characteristics associated with continued participation. SUBJECTS: Cross-sectional study: civilian births in 6 communities (n = 6553). Longitudinal study: at-risk families in the intervention group of a randomized trial of the HSP (n = 373). MEASURES PROCESS: completeness and timeliness of early identification and home visiting activities; family characteristics: sociodemographics, child abuse risk factors, infant biologic risk. RESULTS: Early identification staff determined risk status for 84% of target families. Families with higher risk scores, young mothers with limited schooling, and families with infants at biologic risk were more likely to enroll in home visiting. Half of those who enrolled were active at 1 year with an average of 22 visits. Families where the father had multiple risk factors and where the mother was substance abusing were more likely to have >/=12 visits; mothers who were unilaterally violent toward the father were less likely. Most families were linked with a medical home; linkage rates for other community resources varied widely by type of service. Half of families overall, but >/=80% of those active at 1 year, received core home visiting services. Performance varied by program site. CONCLUSIONS: It is challenging to engage and retain at-risk families in home visiting. Service monitoring must be an integral part of operations.

Child↗

PubMed1999

Trends across two time periods in the diagnosis of substance abuse comorbidity at the Hawaii State Hospital.

This study investigates the changes from the late 1980s to early 1990s of comorbidity (mental illness plus substance abuse) at the Hawaii State Hospital. For the 1990s, a prevalence rate ranging from 14.2% to 30% was estimated, with the latter figure based on a closer review of the records. A higher proportion of comorbid clients were single, and compared to the non-abusers (i.e., patients diagnosed with only schizophrenia or affective disorder), a higher percentage were male and had an educational level less than high school. There was an increase in the percent of non-abusers and substance abusers, but a decrease in the dual diagnosed. The implications of these findings are discussed.

Adult↗

PubMedDate not supplied

Skin cancer prevention in outdoor recreation settings: effects of the Hawaii SunSmart Program.

CONTEXT: Skin cancer is the most common form of cancer in the United States, and it is one of the most preventable. Interventions for young children and their parents can help prevent future cases of skin cancer. OBJECTIVE: To determine whether a skin cancer prevention program implemented at outdoor recreation sites improved children's sun-protection behaviors and site sun-protection policies. DESIGN: Randomized trial of 14 outdoor recreation sites on the island of Oahu, Hawaii. The trial had three arms: control, education only, and education/environment. INTERVENTION: The education arm included staff training, on-site activities, take-home booklets, behavior-monitoring boards, and incentives. The education/environment arm included all education components plus provision of sunscreen and promotion of sun-safe environments. PARTICIPANTS: Children 6 to 8 years of age and their parents. OUTCOME MEASURES: Reports from parents of children's sun-protection behaviors and the sun-protection policies of recreation sites. The cohort for analysis from baseline to 6 weeks after testing had 383 participants; the cohort from 6 weeks after testing to 3 months of follow-up had 285 participants. RESULTS: Program implementation was high in the education only and the education/environment sites. Compared with control sites, children's sun-protection behaviors and, in particular, the use of sunscreen improved significantly at sites where the two interventions were implemented. In addition, sun-protection policies of recreation sites were markedly higher at intervention arm sites. The education/environment intervention was not superior to education alone. Changes were partly maintained at 3 months of follow-up. CONCLUSION: A creative, engaging, multicomponent skin cancer prevention program in outdoor recreation settings can lead to modest improvements in children's sun-protection behaviors.

Adult↗

PubMed2000

Epidemiology of neural tube defects, Hawaii, 1986-1997.

Neural tube defects (NTDs) in Hawaii between 1986 and 1997 were examined using data from a statewide birth defects surveillance system. The prevalence increased significantly over the twelve-year period. NTD prevalence did not appear to vary by place of residence. The relationship of type of defect, maternal age, and infant/fetus sex was similar to that reported in the literature.

Adolescent↗

PubMed2000

Fluoroquinolone-resistance in Neisseria gonorrhoeae, Hawaii, 1999, and decreased susceptibility to azithromycin in N. gonorrhoeae, Missouri, 1999.

In 1999, 360,076 cases of gonorrhea were reported in the United States (1). Gonorrhea is a major cause of pelvic inflammatory disease, often leading to ectopic pregnancy and infertility, and it can facilitate human immunodeficiency virus (HIV) transmission (2). During the 1980s, resistance to penicillin and tetracycline among gonococcal isolates became widespread; as a result, CDC recommended that other antimicrobial agents be used to treat gonorrhea. This report summarizes investigations of an increase in fluoroquinolone-resistant Neisseria gonorrhoeae in Hawaii and of a cluster of N. gonorrhoeae infections with decreased susceptibility to azithromycin in Missouri.

Anti-Bacterial Agents↗