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PubMed1994

Cardiac transplantation in Hawaii.

Clinical cardiac transplantation was successfully introduced 26 years ago, and from an initial experimental status, it has moved forward to become an accepted and well-established treatment modality for end-stage cardiac disease. The first cardiac transplant operation in Hawaii was performed in March 1987; the patient lived for 1 year. A total of 20 heart transplant operations have been performed in 19 patients at St. Francis Medical Center in Honolulu. There has been only one hospital death, and our current one-year survival is 77%, which is similar to national statistics. Our longest survivor is now more than 6 years following transplantation. The incidence of rejection episodes and infectious complications is comparable to other studies.

Adult↗
PubMed1994

The need for organ donation in Hawaii.

Donor organ availability is the primary limiting factor in organ transplantation. The number of patients on the national organ waitlist has increased to more than 32,000, while the number of donors has remained fairly constant at approximately 4,500 per year. In Hawaii, there are 98 patients awaiting organ transplants, and for the past 5 years, the average number of donors per year was 15. The criteria for organ donation, brain death, approaches to donation request, and the management of the multiple organ donor are discussed.

Adolescent↗
PubMed1994

Decreased susceptibility of Neisseria gonorrhoeae to fluoroquinolones--Ohio and Hawaii, 1992-1994.

Until 1992, virtually all strains of N. gonorrhoeae tested were susceptible to fluoroquinolones, including ciprofloxacin (minimal inhibitory concentrations [MICs] of < or = 0.06 microgram/mL). However, gonococcal strains with decreased susceptibilities to ciprofloxacin (MICs of 0.13-0.25 micrograms/mL) have been isolated sporadically from patients in the United States through the Gonococcal Isolate Surveillance Project (GISP), which measures antimicrobial susceptibilities of urethral isolates from men each month. This report describes findings from Ohio and Hawaii that suggest the emergence of fluoroquinolone resistance in N. gonorrhoeae.

Anti-Infective Agents↗
PubMedDate not supplied

Epstein-Barr virus-associated gastric adenocarcinoma among Japanese Americans in Hawaii.

This study confirms the observation that some gastric adenocarcinomas contain Epstein-Barr viral (EBV) sequences in their carcinoma cells. EBV sequences were detected by polymerase chain reaction and in situ hybridization in the tumors of 19 of 187 (10.2%) Japanese-American men and women living in Hawaii. The EBV-associated gastric cancers were more frequently present in men than in women: 14 of 99 (14.3%) men versus 5 of 88 (5.7%) women (P = 0.046). EBV type A was found in 17 of the 19 EBV-associated cancers, a finding consistent with the type A predominance in Japanese populations. Intestinal and diffuse-type tumors were both EBV-positive, and moderate to marked inflammation was usually present. The virus was not found in adjacent normal nonneoplastic mucosal cells or in mucosa showing intestinal metaplasia. EBV-associated tumors were found at stages 1 or 2 in 53% of cases, compared with 36% of the EBV-negative cancers (P = 0.13). The presence of EBV did not appear to influence survival. The relatively high incidence of gastric cancer compared to other EBV-associated tumors makes EBV-associated gastric cancer potentially one of the most common EBV-related tumors in the United States.

Adenocarcinoma↗
PubMed1993

Keratoacanthoma in Kauai, Hawaii. The first documented incidence in a defined population.

BACKGROUND AND DESIGN: A prospective 5-year population-based incidence study was conducted on the island of Kauai, Hawaii, from 1983 through 1987 to investigate the frequency of keratoacanthoma in white residents. RESULTS: A total of 53 residents, 36 men and 17 women, were identified with an initial episode of keratoacanthoma during the 5-year study. The average annual incidence rate per 100,000 Kauai residents, standardized to the US white population, was 144 for men and 73 for women, with a combined rate of 104. The average patient age was 63.5 years. The limbs, particularly the hands and arms, were the most common anatomic site, with the trunk second. Only one patient developed a new subsequent keratoacanthoma, and no recurrent lesions were observed. Three patients had two keratoacanthomas when they first presented, and 13 patients had concurrent skin cancer. Sixty percent (32) of our patients developed skin cancer at one time or another. CONCLUSIONS: We report the first population-based keratoacanthoma incidence rates documented in the United States, which are almost equal to those of squamous cell carcinoma. Keratoacanthoma also shares many common epidemiological features with squamous cell carcinoma, such as increasing incidence in progressively older age groups.

Adult↗
PubMed1993

Strongyloides infection in Hawaii: an imported case.

Tropical diseases may present anywhere in the world. A case of strongyloidiasis in Hawaii, identified by a characteristic manifestation, larva currens, is described. Strongyloides infection may persist long after leaving an endemic area through the mechanism of autoinfection and, especially under circumstances of immunosuppression, may become overwhelming (the hyperinfection syndrome), with a likelihood of being fatal. Each case of Strongyloides infection should be treated aggressively in order to prevent this dangerous outcome; in addition, the parasite should be eliminated before immunosuppressive therapy is begun.

Animals↗
PubMed1993

A rare case of cholera in Hawaii.

Cholera is the most fatal of the infectious diarrheas but only rarely encountered in Hawaii. Two cases previously have been documented in the Islands. We describe an elderly patient, without obvious risk factors, who contracted cholera. Early consideration of cholera as a diagnostic possibility is recommended in patients with unexplained, profuse diarrhea. The unique features of this case are discussed in this report.

Aged↗
PubMed1995

Hepatic cryosurgery: early experience in Hawaii.

Liver cancer, both primary and metastatic, is often deemed hopeless and patients with advanced disease cannot be offered a treatment that is completely effective. Surgical resection is the treatment of choice, but less than 20% of patients are candidates for this treatment. Hepatic cryosurgery is a relatively new procedure in which the tumor is localized intraoperatively with ultrasound guidance and exposed to liquid nitrogen at -196 degrees C. Nine cases have been performed in Hawaii, and we present the first four cases here. Of these cases, there were no mortalities and only one patient required blood transfusion. All patients currently are alive with up to 11-month follow-up. Long-term studies will be necessary to assess the effectiveness of this modality.

Aged↗
PubMed1995

Plantation medicine in Hawaii 1840 to 1964: a patient's perspective.

The first contract laborers arrived from China in 1852, but little attention was paid to their medical needs. In 1886 a physician from Japan arrived to minister to the health and medical needs of the Japanese immigrants. After 1900 most physicians caring for immigrant plantation workers were Western trained from the Mainland. Many advances in medicine were started on plantations such as the second x-ray machine in Hawaii. The 1950s brought rapid changes in plantation medicine with the closing of plantation facilities on Oahu. The author describes her personal experience as a patient in the plantation medical system.

Agriculture↗
PubMed1995

How open heart surgery came to Hawaii.

The evolution of open heart surgery had its beginnings in 1938 with the closing of a patent ductus arteriosus. In 1954 Hawaii began to perform right heart catheterizations and a bubble oxygenator was made locally out of plastic food tubing and a Sigmamotor double head pump. The first open heart surgery was successfully performed at Queen's Hospital in December 1959 on a woman from Hilo with a large interatrial septal defect (IASD).

Animals↗
PubMed1996

Characteristics of naturally acquired Plasmodium relictum capistranoae infections in naive Hawaiian crows (Corvus hawaiiensis) in Hawaii.

Indigenous to Hawaii, the Hawaiian crow (Corvus hawaiiensis) is the world's most severely endangered species with only 3 reproductively active pairs remaining in the wild. Seven captive-reared, avian malaria-naive C. hawaiiensis were exposed in an outdoor aviary and hematologically and serologically monitored for 9 wk. Three birds showed Plasmodium relictum capistranoae parasitemia (6.35%, 2.15%, and 0.60%). All birds were seroconverted for malaria on week 7 as determined by enzyme-linked immunosorbent assay (ELISA). Malaria IgG levels of exposed parasitemic birds did not differ from those of exposed nonparasitemic C. hawaiiensis and were not significantly correlated with the level of parasitemia. Four of 9 hematological parameters, e.g., white blood cell count (WBC), relative and absolute lymphocytosis, and total solids (TS), showed significant increases related to ELISA-determined malarial infection. The sensitivity, specificity, and the positive predictive values of these 4 parameters for malarial infections in C. hawaiiensis were higher than 66%, with the WBC and TS sensitivity reaching 100%. The reference range of 9 hematological parameters was established based on uninfected, clinically healthy C. hawaiiensis. Seven birds were successfully treated and released, increasing the total wild C. hawaiiensis world population by approximately 50%.

Animals↗
PubMed1995

Competencies of new registered nurses: a survey of deans and health care agencies in the state of Hawaii.

In Hawaii, a survey of schools of nursing and health care agencies revealed significant differences in the perceived competencies of new registered nurse graduates. When directors of nursing were asked if new graduates meet expectations, more than 42% said no. This survey identifies that numerous discrepancies exist between agency expectations and what is actually practiced in the clinical setting. Suggestions for achieving competencies in both academic and agency settings are offered.

Clinical Competence↗
PubMed1995

[Health care and social services provided for the elderly in Hawaii: a study of the activities of Alzheimer's Disease and Related Diseases Association in Honolulu].

The purpose of this study is to develop helpful strategies to serve the elderly and their families in Japan. We conducted the study by spending three months at the Honolulu Chapter of the Alzheimer's Association, participating in various programs of the Association, conducting a literature search and interviewing various health and social services available to the caregivers and persons with Alzheimer's disease in Hawaii. From the study we make the following recommendations, which we feel would be very helpful if applied to the Japanese context; 1) The supply of information through educational videos and leaflets in caregiver support center and so on. 2) Active efforts to make widely known the social services in public place. 3) The promotion and development of the voluntary activities to increase services and resources for Japanese. 4) The promotion of caregiver support groups in the health care system of each Japanese community. 5) QOL (Quality of Life) programs for dementia patients among elderly such as reminiscence and life review therapy. 6) The development of the organization with the help of professionals and scholars of related fields.

Aged↗
PubMed1996

Prevalence of dementia in older Japanese-American men in Hawaii: The Honolulu-Asia Aging Study.

OBJECTIVE: To determine prevalence of dementia and its subtypes in Japanese-American men and compare these findings with rates reported for populations in Japan and elsewhere. DESIGN AND SETTING: The Honolulu Heart Program is a prospective population-based study of cardiovascular disease established in 1965. Prevalence estimates were computed from cases identified at the 1991 to 1993 examination. Cognitive performance was assessed using standardized methods, instruments, and diagnostic criteria. PARTICIPANTS: Subjects were 3734 Japanese-American men (80% of surviving cohort) aged 71 through 93 years, living in the community or in institutions. MAIN OUTCOME MEASURES: Age-specific, age-standardized, and cohort prevalence estimates were computed for dementia (all cause) defined by 2 sets of diagnostic criteria and 4 levels of severity. Prevalence levels for Alzheimer disease and vascular dementia were also estimated. RESULTS: Dementia prevalence by Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised ranged from 2.1% in men aged 71 through 74 years to 33.4% in men aged 85 through 93 years. Age-standardized prevalence was 7.6%. Prevalence estimates for the cohort were 9.3% for dementia (all cause), 5.4% for Alzheimer disease (primary or contributing), and 4.2% for vascular dementia (primary or contributing). More than 1 possible cause was found in 26% of cases. The Alzheimer disease/vascular dementia ratio was 1.5 for cases attributed primarily to Alzheimer disease or vascular dementia. CONCLUSIONS: Prevalence of Alzheimer disease in older Japanese-American men in Hawaii appears to be higher than in Japan but similar to European-ancestry populations. Prevalence of vascular dementia appears to be slightly lower than in Japan, but higher than in European-ancestry populations. Further cross-national research with emphasis on standardized diagnostic methods is needed.

Age Distribution↗
PubMed1996

PTSD among women survivors of domestic violence in Hawaii.

Empirical evidence suggests that between 33% and 83% of Hawaii women receiving services from programs that serve battered women meet diagnostic criteria for posttraumatic stress disorder (PTSD). In addition, PTSD symptom severity is associated with depression severity, lowered self-esteem, and diminished quality of life. Combined with evidence that domestic violence often goes on for years, these findings provide additional compelling reasons why domestic violence screening should be conducted routinely in medical settings.

Adult↗
PubMed1996

Incidence of non-insulin-dependent diabetes mellitus and its risk factors in Japanese-Americans living in Hawaii and Los Angeles.

UNLABELLED: The incidence of non-insulin-dependent diabetes mellitus (NIDDM) and its risk factors were analysed from data of a follow-up study conducted on Japanese-Americans living in Hawaii and Los Angeles areas known to have a high prevalence of NIDDM. There were 1144 Japanese-Americans aged 40 years or more (mean (+/- SD) age: 60.7 +/- 10.1) available for follow-up, and who were non-diabetic based on glucose tolerance test (GTT) results conducted at the time of the initial examination. During the study period (6.3 +/- 3.2 yr), 124 cases of NIDDM occurred with an incidence rate as high as 10.8% or 17.2 persons per 1000 person-years. The incidence of NIDDM was 1.25 times higher in males than in females, and the rate increased with age. The incidence in obese people (body mass index: BMI > or = 25) was approximately twice that in the non-obese, the rate increasing with the level of obesity. Using Cox's proportional hazards model, the risk factors for NIDDM were analysed after adjusting for sex and age. Significant risk factors were the serum glucose (SG) level (fasting, 1-h, 2-h), the serum immuno-reactive insulin (IRI) level (1-h, 2-h) during GTT, BMI, serum triglycerides, high density lipoprotein (HDL)-cholesterol, serum uric acid, diastolic blood pressure, systolic blood pressure, serum total protein, and delta IRI/delta SG (0-30 min) level. In particular the hyperinsulinaemia was a significant risk factor even after adjusting for sex, age, and obesity. The incidence of NIDDM in the sub-group whose delta IRI/delta SG (0-30 min) level was under 0.3 was higher than that of the over 0.8 sub-group by a factor of approximately 12. Likewise, after dividing the subjects into five sub-groups according to the fasting or 2 h IRI level, the incidence of NIDDM was higher in the highest quintile than in the lowest quintile sub-group by a factor of approximately 3 and 7, respectively. The results of the GTT of the subjects who developed NIDDM during the follow-up period were analysed longitudinally and compared with the results obtained 8 years before occurrence of NIDDM. An increase in the 2-h serum IRI was observed initially, followed by an increase in the 2-h serum glucose level, preceding the appearance of NIDDM. IN CONCLUSION: 1. A high incidence of NIDDM is clearly observed in the population of Japanese-Americans, who are genetically indistinguishable from native Japanese; causes of this increase, from the survey results, are suspected to include westernization of lifestyle, particularly the reduction in the level of physical activity, conversion to a diet containing markedly more animal fat, simple carbohydrates, and less complex carbohydrates. 2. In the Japanese-Americans, diminished early insulin release to an oral glucose challenge and increased insulin resistance characterized by hyperinsulinaemia are suspected to be some of the important risk factors for NIDDM. Consequently, this study strongly suggested the possibility that the development of NIDDM in Japanese persons may be influenced by environmental factors.

Adult↗
PubMed1996

Life and death in Hawaii: ethnic variations in life expectancy and mortality, 1980 and 1990.

Life expectancy in Hawaii is among the highest in the nation. Past research, however, found significant ethnic differences in longevity. This study presents life expectancy estimations for 1980 and 1990, along with ethnic differences in mortality rates for specific causes of death. The findings suggest that ethnic differences continue, with Chinese and Japanese having the longest life expectancy and Native Hawaiians having the shortest.

Asian↗
PubMed1996

How Hawaii's doctors feel about physician-assisted suicide and euthanasia: an overview.

We polled, by questionnaire, all doctors and medical trainees in Hawaii (n = 3,017) to determine their attitudes towards physician-assisted suicide, euthanasia and other end-of-life medical issues. One thousand and twenty-eight (34.1%) responded. Medical trainees did not differ significantly from practicing physicians. Only a minority of respondents (15.6%) were willing to assist a terminally-ill patient to commit suicide. An even smaller number (9.8) would perform active euthanasia. On the other hand, an overwhelming majority would withhold (97.6%) or withdraw (78.6%) life-support upon request. Most doctors (88.0%) were also willing to administer high doses of narcotics for pain relief, even if such therapy hastened death. About half the doctors felt that physician-assisted suicide and active euthanasia may be justified under some circumstances, although most were unwilling to personally carry out these acts. Catholic, Filipino and Hawaiian/Polynesian doctors were statistically less likely to approve of or perform physician-assisted suicide or active euthanasia.

Attitude of Health Personnel↗