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Leprosy in Hawaii dates back to about 1840. The first recorded ocular leprosy is from the 1880s. Robert Louis Stevenson and Jack London both wrote descriptions of the ocular signs of leprosy. Pinkerton in 1927 and Van Poole in 1934 reported large series of patients with ocular leprosy. In 1973 there were about 2,168 cases of leprosy in the 50 states. Most ophthalmologists practice in areas where there are leprosy patients.
Questions on end-of-life preferences were included in two statewide, random-sample telephone surveys. Findings suggest that Hawaii residents are similar to mainlanders on their rates of advance directive completion, their preference for dying at home, their desire for hospice care when dying, and their support for legalization of aid in dying. Physicians are encouraged to ask these questions directly of their patients as a first step to improving end-of-life care.
A history of leptospirosis research in Hawaii is presented, beginning with the first published work in 1937. This account traces the leading researchers who described the organism and the disease, the diagnostic tests developed and used, the reservoir animals identified, methods of disease transmission discovered, prevention programs developed in the state, and research into more effective disease detection and prevention.
With the advent of The Final Rule, the state of Hawaii should have potential organ donor identification and referral rates of 100%. However, a retrospective chart review of 4,697 deaths in 1999 and 4,730 deaths in 2000, revealed identification rates of 80% and 84%, and referral rates of 53% and 71%, respectively. Proper recognition and referral of all potential donors is essential to bridging the enormous gap between the supply of organs and its demand.
This article describes the importance of early identification of hearing loss in newborns, the current status of newborn hearing screening in the United States, and the leadership that Hawaii has contributed to that effort. Described are events that may help the nation reach the Year 2010 Health Goals for newborn hearing screening, identification, and intervention.
The vision of Hawaii's HIPAA Readiness Collaborative (HRC) effort is to realize the positive potential of HIPAA through a collaborative process that engages the entire healthcare delivery system. Goals include reducing the cost of healthcare through streamlining, reducing the cost of HIPAA implementation for HRC participants, and improving the interoperability between facilities through use of standard technologies.
Laparoscopic donor nephrectomy for transplant is a minimally invasive, effective, and safe operation that also provides less post-operative pain and earlier return to pre-donation activity. In review of the first 10 cases, no major complications occurred and mean hospital stay was 3.7 days. All recipients of these kidneys displayed excellent allograft function (mean creatinine--1.5 mg/dL) and no ureteral problems. Successful use of this procedure has also resulted in a steady increase in the number of living transplants performed in Hawaii and perhaps this will impact the 330 patients currently awaiting renal transplant.
Neisseria gonorrhoeae is a major cause of pelvic inflammatory disease, ectopic pregnancy, and infertility, and it can facilitate human immunodeficiency virus (HIV) transmission. Gonorrhea is the second most frequently reported communicable disease in the United States, with 361,705 reported cases in 2001. During the 1980s, gonococcal resistance to penicillin and tetracycline became widespread; as a result, CDC recommended using cephalosporins as first-line treatment for gonorrhea. Since 1993, CDC also has recommended using fluoroquinolones (i.e., ciprofloxacin, ofloxacin, or levofloxacin) for gonorrhea treatment. Fluoroquinolone therapy is used widely because it is a relatively inexpensive, oral, and single-dose therapy. However, fluoroquinolone-resistant N. gonorrhoeae (QRNG) is being identified more frequently. This report summarizes investigations of increases in QRNG in Hawaii and California in 2001 and provides data to support the recommendation that cephalosporins (i.e., ceftriaxone or cefixime) be used instead of fluoroquinolones as first-line treatment for gonorrhea acquired in these two states. The increases in QRNG highlight the importance of monitoring gonococcal resistance throughout the United States to guide local treatment decisions.
Details of female choice of mate in Drosophila silvestris of Hawaii strikingly parallels epigamic behavioral systems in many other animals and may be common in other species of Drosophilidae. Females respond selectively to male circling, wing displays, songs and tactile stimulation with foreleg cilia, a quantitative character that is highly variable in some populations. I hypothesize that the female can exert choice based on these cues from individual males that differ genetically by quantitative trait loci. Laboratory tests show that one third of courting males are repeatedly rejected in favor of a minority of 'alpha' males. This result imposes non-random mating at the local population level. Past multiple-choice lab tests, widely used to measure 'isolation' between pairs of populations or species of Drosophila may be flawed, since random mating has been assumed in the interpretation of results. Pre-mating sexual selection is clearly a powerful intrapopulation force in population biology. This view creates difficulties for discerning any proposed simultaneous interpopulation selective events in the presence of strong female choice. The long-held theory assuming that there is significant selection for pre-mating isolation between groups is questionable.
This paper describes the progressive changes in cancer incidence that have been observed among Japanese after their migration to Hawaii. It reviews descriptive and analytic epidemiologic data suggesting a role for genetic susceptibilities in explaining the high risk of Japanese for colon cancer and their low risk for lung cancer, when compared to Caucasians. Differences in certain pharmacogenetic polymorphisms may explain these risk patterns. This research may lead to a better characterization of cancer risk at the individual level and, consequently, to improved methods of prevention.
A case-control study of the association of dietary fat and animal protein consumption with breast cancer was conducted between 1975 and 1980 on Oahu, Hawaii. Data from this study were used to explore the relation of selected foods and the interaction of nutrients and foods with other factors, such as body size, age at menopause, and ethnicity on the risk for breast cancer. The sample included 272 postmenopausal breast cancer cases and 296 neighborhood controls. Study participants included Japanese and Caucasian women, aged 45 to 74, who were residents of Oahu. There was a suggestion of a positive-dose response relation (P < 0.01) between sausage consumption and the odds ratio for breast cancer. Significant odds ratios for breast cancer were also found for higher intakes (above the 50th percentile) of diary items, sausage, and all meats combined. The dose-response relation for nutrients and foods tended to be stronger among women with a high Benn's index (kg/cm1.5182) compared to women with a low Benn's index. In general, subjects with high dietary intakes of fat and animal protein who were in the upper 50th percentile of body size were at the greatest risk for breast cancer. However, there was no evidence for an interaction between the dietary variables and body size, ethnic group, age at menarche, age at menopause, or age at first birth that would affect the odds ratio for breast cancer. These data suggest that women with both a high intake of foods rich in fat and animal protein and with a large body size are at increased risk for breast cancer.
We examine the relationship between ethnicity and income as determinants of mammography use over a span of four years as a means of assessing community intervention impacts. The sample consisted of 1,447 women older than 34 years, living in Hawaii, who participated in the Behavioral Risk Factor Surveillance System (BRFSS). The percentage of women in the sample reporting a screening mammogram within the past two years was 31.4% in 1987, 54.1% in 1989, and 51.6% in 1990. Women of Hawaiian ancestry had the lowest percentage of mammogram use in the past two years (38.7%), while Japanese women had the highest percentage (49.8%). Results of logistic regression analysis indicate a significant increase in mammography use from 1987 to 1989 and no difference from 1989 to 1990. Findings also showed an association between age, income, and ethnicity with use in the past two years. Greater age, higher income, and Japanese origin, compared to Hawaiian, were all independently associated with increased odds of having had a mammogram in the past two years. We discuss results in terms of program evaluation and future research implications for community health surveys.
A study of racial/ethnic-specific mean infant birth-weights reported on 1968 to 1972 live birth-weight certificates for Oahu, Hawaii is reviewed here. The 1983 to 1986 data confirm those earlier results: (a) The Hawaiian group is significantly heavier in mean birth-weights than other cohorts during the preterm period (33 to 36 weeks gestational age); (b) statistically significant differences also were present in mean birth-weights for the term and post-term periods (37 to 45 weeks gestational age); and (c) the ranking of cohorts from heaviest to lightest in mean birth-weights is Caucasian, Hawaiian, Japanese and Filipino respectively. The data raises 2 questions: (1) Which birth-weight standards are most applicable for Asian and Pacific Islanders; and (2) what are the implications of the race/ethnic-specific mean birth-weight differences relative to mortality, morbidity and developmental outcome?
The relationship between limb reduction deformities and clinical and demographic factors in Hawaii during 1986-2000 were examined using population-based birth defects program data. The limb defect rate was highest with maternal age less than 20 years, and the defect was more common among males. Among racial/ethnic groups, Pacific Islanders and Filipinos had higher rates than whites and Far East Asians.
The presence of Paramecium dodecaurelia (three strains) was recorded in Hawaii.
An international telehealth symposium was conducted between healthcare institutions in Hawaii and Thailand using a combination of Asynchronous Transfer Mode, and Internet2 connectivity. Military and civilian experts exchanged information on the acute and rehabilitative care of landmine victims in Southeast Asia. Videoconferencing can promote civil-military cooperation in healthcare fields that have multiple international stakeholders.
Even as officials in Hawaii prepare to market to congressional legislators their universal access health care plan as a model for the nation, small-business owners on the mainland are battling against mandates in place in the state's unique health care program. Meanwhile, Hawaiian officials continue to make ongoing improvements in their system.
OBJECTIVE: The National Cholesterol Education Program Adult Treatment Panel III diagnostic criteria for metabolic syndrome (MS) provide a standard for comparing various populations. Using these criteria, the Third National Health and Nutrition Examination Survey reported an overall US prevalence of 21.8%. With these same criteria, we estimated the prevalence of MS among a multiethnic population in rural Hawaii. DESIGN: These data are from a cross-sectional survey from 1997-2000. SETTING: The survey was conducted in the rural community of North Kohala. PARTICIPANTS: More than 1,450 adult residents from five ethnic categories were included: Caucasian, Japanese, Filipino, Hawaiian/part-Hawaiian, Other/mixed non-Hawaiian. Ethnic ancestry was determined by self-report. Ethnic differences were compared by using logistic regression. MAIN OUTCOMES: Blood pressure, height, weight, and waist circumference, fasting and two-hour post-oral glucose challenge plasma was obtained for lipid and glucose determinations. RESULTS: Overall prevalence was 33.4%. Prevalence was significantly higher among all ethnic groups when compared to Caucasians. Despite significant differences in the prevalence of overweight and abdominal obesity, the prevalence of MS was similar in all non-Caucasian ethnic groups. Filipinos had the highest adjusted odds for prevalent MS (prevalence OR=4.2; 95% CI=2.4-7.3). CONCLUSION: Metabolic syndrome (MS) prevalence was high in Asian ethnic groups previously reported to have low cardiovascular disease (CVD) mortality. These findings suggest either a differential effect of CVD risk factors on mortality among some ethnic groups, or more likely, that future mortality rates will increase among those ethnic groups that currently enjoy low mortality rates.