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PubMed1997

Temporal trends in maternal characteristics and pregnancy outcomes: their relevance to the provision of health services. Hawaii, 1979-1994.

This paper examines changes in maternal sociodemographic characteristics and pregnancy outcomes in Hawaii during the period 1979-1994. The more striking changes were increases of 129% in the proportion of births to women > 35 years old and of 67% in the proportion of births to unmarried mothers. The percentage of low birth weight and small-for-gestational age infants decreased while the proportion of premature births increased. Identified changes were not limited to selected population groups, but were found in various degrees in all ethnic groups. These findings are relevant to all health practitioners and will assist in the provision of appropriate care and counseling to individual women.

Adult↗
PubMed1997

Advances in ophthalmic plastic, reconstructive and orbital surgery in Hawaii.

Advances in ophthalmic plastic and reconstructive surgery continue to be made in the state of Hawaii. A new technique of dacryocystorhinostomy using the endoscope and the pulsed Holmium: YAG laser as well as a subconjunctival endoscopic assisted approach to orbital surgery for orbital decompression is described. The integrated hydroxyapatite implant replacing the enucleated eye gives excellent postoperative extraocular motility.

Adult↗
PubMed1976

Organochlorine pesticides in the Hawaii Kai Marina, 1970-74.

Sediments, water, and oysters from the receiving waters of the Hahaione Valley, a suburban development in south-easter Oahu, Hawaii, were analyzed for organochlorine pesticidal compounds. The insecticides dieldrin, alpha- and gamma- chlordane, and p,p'-DDT were found in the study site environment. Levels were in the low parts per billion range for oysters and sediments and in the low parts per trillion range for water. During the past several years dieldrin residues in the marina study site have increased, even though the only activity known to influence pesticide levels in the valley is the chronic treatment for subterranean and dry wood termites. If present trends continue, dieldrin may pose a threat to biota of the aquatic environment. Findings have shown that residue levels of dieldrin and p,p'-DDT in the sediments are within the LD50 (median lethal dose) range for estuarine fish and thus may have a deleterious effect on bottom-feeding organisms. According to present standards of the Food and Agriculture Organization/World Health Organization, pesticide residue levels within the study site do not appear to constitute a health hazard to humans.

Animals↗
PubMed1998

A review of 79 patients with malaria seen at a military hospital in Hawaii from 1979 to 1995.

The goal of our study was to determine the epidemiological and clinical features of imported malaria seen at our military hospital in Hawaii. We reviewed the records of malaria cases seen from January 1, 1979, to December 31, 1995, and compared our results with published reviews from civilian hospitals in North America. Seventy-nine patients were diagnosed with malaria by blood smears. All acquired malaria abroad, mostly in southeast Asia. Sixty-seven percent of cases were vivax malaria, 22% were falciparum malaria, and 11% were caused by undetermined species. Common symptoms were fever (100%), alternate day fever (41%), rigors (91%), headache (59%), nausea (41%), fatigue (39%), dark urine (32%), and vomiting (31%). Ninety-one percent had fever during hospitalization, but 39% were afebrile on admission. Splenomegaly was detected in 49% of cases. The white blood cell count was normal in 65%, low in 31%, and elevated in 4% of cases. Other laboratory findings were anemia (58%), thrombocytopenia (74%), and mild hyperbilirubinemia (64%). Military physicians initially considered the diagnosis of malaria in only 54% of patients. The epidemiological features of our patients differ from those described in the civilian hospitals. Most of our patients were nonimmune, U.S.-born, military personnel infected in southeast Asia, whereas patients described in reviews from U.S. civilian hospitals were usually foreign-born civilians who were infected in Africa or India. The clinical features of malaria, and the problems of initial misdiagnosis in our patients, were similar to those reported from civilian hospitals. Military physicians, like their civilian colleagues, need more training and experience in malaria.

Adult↗
PubMed1998

Seizures in east-bound visitors to Hawaii.

Anecdotal observations by emergency physicians at Straub Clinic and Hospital suggest that first-time seizures are common in Japanese tourists visiting Hawaii. Because such patients seemed to present in the evening of their day of arrival, some physicians have attributed these seizures to sleep deprivation based primarily upon clinical impressions. However, there has been no previous review of these cases to confirm the impression that these seizures have a relatively benign cause. This retrospective study aims to identify the role of sleep deprivation as a potential factor in seizures within this population.

Adolescent↗
PubMed1998

Prenatal care utilization in Hawaii: did it improve during the last 16 years?

This paper examines the utilization of prenatal care in Hawaii from 1979 to 1994 to determine if early and adequate utilization of prenatal care has changed during this period. Birth certificates of single live born infants of resident women were the source of data for the study. During the study period, the proportion of women receiving prenatal care in the first trimester increased by nearly 5 percent but was still below the national and state Year 2000 health objective of 90 percent. Notwithstanding this improvement, the percentage of women who did not receive the recommended number of visits in spite of starting care early significantly increased. The overall proportion of women with 'intensive' prenatal care use markedly increased (134.7%). The proportion of women with 'inadequate' care use declined (10.3%), although the proportion of women with 'no care' use doubled. Complete reporting of use of care through birth certificates markedly deteriorated. The findings of this study indicate the need for changes in the targeting and provision of counseling and education on the part of health care providers. Public health leaders, policy makers, health care providers, and advocacy groups need to collectively review programmatic directions with an aim toward the development of innovative approaches to address the emerging health needs of mothers and infants in the state.

Ethnicity↗
PubMed1998

The Hawaii Poison Center: what's it worth to you?

Benefits of the Hawaii Poison Center (HPC) to the public, providers, and third party payers are enumerated. Financial advantages to third party payers during 1996-7 were quantified by comparing costs for the home management of poisonings with alternative sources of care reported by callers, if the HPC were closed. The value for third party payers exceeded $2.5 million, greater than eight times the investment in operating the HPC, similar to national data. Since third party payers are the most visible beneficiary of cost savings, a case is made for their financial support of the HPC.

Costs and Cost Analysis↗
PubMed1998

Hawaii Poison Center data reveals a need for increasing hazard awareness about household products.

This study examined for the fiscal years 1995-1996 and 1996-1997, the frequency of calls to Hawaii Poison Center related to household products and pesticides poisoning, the frequency of the source of calls (professional versus layperson), and the patient's age distribution. The data was compared with the data recorded in 1989 which was reported earlier in the literature. We found the most frequent calls were from general public (6 to 8 times) and were related to household products (30% in 1996-97, 39% in 1995-96, and 39% in 1989) involving children less than 5 years of age. Results strongly suggest the need for increasing the awareness of hazards related to household products amongst the general public.

Adolescent↗
PubMed1998

The association of plasma micronutrients with the risk of cervical dysplasia in Hawaii.

Limited data from hematological studies suggest that certain nutrients, including carotenoids, tocopherols, and vitamin C, may protect against malignant change in cervical tissue. Recognizing that human papillomavirus (HPV) infection induces most neoplastic transformation of cervical tissue, the authors conducted a case-control study to examine the association of plasma micronutrient concentrations with the risk of cervical dysplasia after careful adjustment for HPV infection, using a sensitive and reliable HPV detection method. The sample included 147 multiethnic women, between 18 and 65 years of age, with biopsy-confirmed squamous intraepithelial lesions (SILs) of the cervix and 191 clinic controls identified between 1992 and 1996. Cases were identified through cytology and pathology logs in three clinics on Oahu, Hawaii. Controls were selected randomly from admission logs of the participating clinics. In-person interviews were conducted in the subjects' homes, and a fasting blood sample was drawn to measure plasma levels of lutein, lycopene, cryptoxanthin, total carotene, retinol, tocopherol, ascorbic acid, and cholesterol. The presence and type of HPV was determined in exfoliated cell samples using PCR dot blot hybridization. Mean plasma lycopene, total cryptoxanthin, and alpha-cryptoxanthin levels were lower among cases than controls. We found an inverse dose-response of alpha-cryptoxanthin, total tocopherol, and alpha-tocopherol to the odds ratios for cervical SIL after adjustment for HPV and other confounders. The odds ratio among women in the highest compared with the lowest quartile was 0.3 (95% confidence interval, 0.1-0.7) for alpha-cryptoxanthin and 0.3 (95% confidence interval, 0.1-0.8) for alpha-tocopherol. Negative trends in the odds ratios were suggested for other carotenoids and vitamin C, but these were weak, and confidence intervals were wide. Our results support existing evidence that high plasma levels of antioxidants may reduce the risk of cervical SILs independent of HPV infection. These findings are significant because diet is potentially modifiable, and nutrition education and dietary intervention might be targeted at specific high-risk groups.

Adolescent↗
PubMed1998

Admissions, length of stay, and discharge barriers at the Hawaii State Hospital.

Based on data gathered from patients, psychiatrists, and social workers at the Hawaii State Hospital, it was determined that the majority of patients had been in the hospital for more than one year, were committed for forensic reasons, and did not need continued hospitalization. An inter-agency systems approach is needed to address the issue of length of patient stay.

Adult↗
PubMed1998

Incidence of enteroviruses in Mamala Bay, Hawaii using cell culture and direct polymerase chain reaction methodologies.

The consequence of point and nonpoint pollution sources, discharged into marine waters, on public recreational beaches in Mamala Bay, Hawaii was evaluated using virus cell culture and direct reverse transcriptase-polymerase chain reaction (RT-PCR). Twelve sites, nine marine, two freshwater (one stream and one canal), and one sewage, were assessed either quarterly or monthly for 1 year to detect the presence of human enteric viruses. Water samples were concentrated from initial volumes of 400 L to final volumes of 30 mL using Filterite electronegative cartridge filters and a modified beef extract elution procedure. Cell culture was applied using the Buffalo Green Monkey kidney cell line to analyze samples for enteroviruses. Positive samples were also evaluated by RT-PCR, using enterovirus-specific primers. Levels of RT-PCR inhibition varied with each concentrated sample. Resin column purification increased PCR detection sensitivity by at least one order of magnitude in a variety of sewage outfall and recreational marine water samples but not in the freshwater canal samples. Using cell culture, viable enteroviruses were found in 50 and 17% of all outfall and canal samples, respectively. Samples were positive at beaches 8% of the time. These data illustrate the potential public health hazard associated with recreational waters. Using direct PCR, viruses were detected at the outfall but were not found in any beach or canal samples, in part, owing to substances that inhibit PCR. Therefore, conventional cell culture is the most effective means of detecting low levels of infectious enteroviruses in environmental waters, whereas direct RT-PCR is rendered less effective by inhibitory compounds and low equivalent reaction volumes.

Animals↗
PubMed1997

Divergence and conservation of the genomic RNAs of Taiwan and Hawaii strains of papaya ringspot potyvirus.

The complete nucleotide sequence of the genome of a Taiwan isolate of papaya ringspot potyvirus (PRSV YK) was determined from three overlapping cDNA clones and by direct RNA sequencing. Comparison was made with the reported Hawaii isolate of PRSV HA. Both genomes are 10,326 nucleotides long, excluding the poly(A)-tail. They encode a polyprotein of 3344 amino acids with a 5' leader of 85 nucleotides and a 3' non-translated region of 209 nucleotides. The two genomes share an overall nucleotide identity of 83.4% and an amino acid identity of 90.6%. The 3' non-translated regions show 92.3% identity. The first 23 nucleotides of the leaders are identical, while the remaining parts of the leaders only show 51.6% identity. The P1 protein genes of the two isolates are very different, with 70.9% nucleotide identity and 66.7% encoded amino acids identity. However, the other viral proteins of the two virus isolates are similar, with a 82.5-89.8% nucleotide identity of their genes and 91.2-97.6% amino acid identity, indicating that they are strains of the same potyvirus. Analysis of the ratios of nucleotide differences to the actual amino acid changes revealed that there are only 2.63 nucleotide changes for each amino acid change in the P1 protein, whereas for the other proteins 4.0-16.4 nucleotide changes are required for each amino acid replacement. The P1 protein has 58% of all the differences of polyprotein. The unusual variation in the leader sequences and the P1 proteins suggests that the two PRSV strains were derived from different evolutionary pathways in different geographic areas.

Amino Acid Sequence↗
PubMed1999

Cardiac troponin T and I, echocardiographic [correction of electrocardiographic] wall motion analyses, and ejection fractions in athletes participating in the Hawaii Ironman Triathlon.

Cardiac troponin T (cTnT) and troponin I (cTnI) are highly sensitive and specific for detecting myocardial damage even in the presence of skeletal muscle injury. In this study, we assessed whether ultraendurance exercise induced cardiomyocyte injury using plasma cTnT and cTnI measurements, quantitative echocardiographic wall-motion analysis, and ejection fraction measurement in athletes who participated in the Hawaii Ironman Triathlon. Twenty-three athletes (11 men) who completed the triathlon (3.9 km swim, 180.2 km bike, and 42.2 km run) participated in this study. Blood samples were obtained 2 days before and immediately after the triathlon for the determination of cTnT (Enzymun, Roche Diagnostics) and cTnI (Dade Behring) concentrations. Quantitative echocardiographic wall motion analysis and ejection fraction were obtained on 12 of the 23 participants before and immediately after the race. No subject had detectable cTnT or cTnI or abnormal echo score before the race. Following the race, 2 subjects (9%) had marked increases in both cTnT (0.15 and 0.33 microg/L) and cTnI (2.09 and 4.44 microg/L). Four additional subjects (17%) had moderate increases in cTnT (0.04 to 0.05 microg/L) but no detectable cTnI. Race time correlated inversely with cTnT (r = -0.65, p <0.01). Mean change in the number of abnormal echo segments after the race was 6.5 in those with a marked increase in cTnT and cTnI, 2.3 in those with a moderate increase in cTnT, and 1.7 in those with no increase. Ejection fraction decreased by an average of 24% after the race (p <0.002). Thus, ultraendurance exercise may cause myocardial damage as indicated by biochemical cardiac-specific markers and echocardiography. The cellular nature of this damage and whether it is transient or permanent is unclear at present.

Adult↗
PubMed2000

Effects of physical and biological disturbances on algal turfs in Kaneohe Bay, Hawaii.

Disturbance in coral reef environments commonly results in an algal community dominated by highly productive, small filamentous forms and cyanobacteria, collectively known as algal turf. Research on the types of disturbance responsible for this community structure has concentrated mainly on biological disturbance in the form of grazing, although physical and other forms of biological disturbances may be important in many coral reef areas. On the reef flat in Kaneohe Bay, Oahu, Hawaii, algal turfs grow primarily upon coral rubble that tumbles with passing swells. We manipulated the frequency of rubble tumbling in field experiments to mimic the effects of physical disturbance by abrasion and light reduction on algal biomass, canopy height, and community structure. Treatments approximated a gradient of disturbance intensities and durations that occur on the reef flat. Although sea urchins and herbivorous fishes are not widespread and abundant on the reef flat, biological disturbances to algal turf communities in the form of herbivory by small crabs and abrasion by tough macroalgae contributed significantly to the variation in algal turf biomass. Within all experiments increasing disturbance significantly reduced algal biomass and canopy heights and the community structure shifted to more disturbance-tolerant algal forms. This study shows that the chronic physical disturbances from water motion and biological disturbances other than grazing from large herbivores can control algal communities in coral reef environments.

Journal Article↗
PubMed2000

Metal phase associations in soils from an urban watershed, Honolulu, Hawaii.

Soils of Manoa watershed, Hawaii, have received varying inputs of anthropogenic trace metals, with roadside soils primarily influenced by automobile contributions. A four-stage sequential extraction procedure was used to fractionate 13 topsoil (0-2.5 cm) and 13 subsoil (7.5-10.0 cm) samples into: (i) an adsorbed, exchangeable and carbonate (AEC) phase; (ii) a reducible phase; (iii) an oxidizable phase; and (iv) a residual phase. Phases (i)-(iii) were considered 'labile', with the residual fraction 'non-labile' under normal circumstances. An examination of eight elements (Al, Co, Cu, Fe, Mn, Ni, Pb and Zn) indicated that Pb was the trace metal most impacted by anthropogenic inputs. Roadside soil Pb enrichment was apparent with data from a 0.5 M HCI leach exhibiting a maximum concentration of 1000 mg/kg compared with a median background value of 12 mg/kg. Sequential extraction results indicated the following order with respect to phase dominance for Pb: reducible > residual > oxidizable > AEC. The identification of the reducible phase as the primary pool of available Pb supports previous work from temperate roadside soil environments. The reducible phase is characterized by hydrous Fe and Mn oxides and mobilization of fixed elements can occur with decreases in pH and redox potential. Iron was the least labile of the elements examined with only 5-6% of total Fe removed by the first three steps of the extraction procedure. Lead had the highest labile percentage with average values between 74 and 81%. Therefore, results from this study support earlier research in this watershed which identified Pb as the primary trace metal of concern from a contamination perspective.

Humans↗
PubMed2003

In vitro and in vivo antiviral properties of sulfated galactomannans against yellow fever virus (BeH111 strain) and dengue 1 virus (Hawaii strain).

Two galactomannans, one extracted from seeds of Mimosa scabrella, having a mannose to galactose ratio of 1.1, and another with a 1.4 ratio from seeds of Leucaena leucocephala, were sulfated. The products from M. scabrella (BRS) and L. leucocephala (LLS) had a degree of sulfation of 0.62 and 0.50, and an average molecular weight of 620x10(3) and 574x10(3) gmol(-1), respectively. Their activities against yellow fever virus (YFV; BeH111 strain) and dengue 1 virus (DEN-1; Hawaii strain) were evaluated. This was carried out in young mice following intraperitoneal infection with YFV. At a dose of 49 mgkg(-1), BRS and LLS gave protection against death in 87.7 and 96.5% of the mice, respectively. When challenged with 37.5 LD50 of YFV, mice previously inoculated with BRS+virus or LLS+virus, showed 93.3 and 100% resistance, respectively, with neutralization titers similar to mice injected with 25 LD50 of formaldehyde-inactivated YFV. In vitro experiments with YFV and DEN-1 in C6/36 cell culture assays in 24-well microplates showed that concentrations that produced a 100-fold decrease in virus titer of YFV were 586 and 385 mgl(-1) for BRS and LLS, respectively. For DEN-1 they were 347 and 37 mgl(-1), respectively. Sulfated galactomannans, thus demonstrate in vitro and in vivo activity against flaviviruses.

Animals↗
PubMed2003

Suppression of the release of type-1 plasminogen activator inhibitor from human vascular endothelial cells by Hawaii deep sea water.

The effect of deep sea water on the fibrinolytic properties of human vascular endothelial cells was investigated. There was no difference in the growth ratio between human umbilical vein endothelial cells (HUVECs) cultured with growth medium (RPMI-1640 containing 20% fetal calf serum) prepared with Hawaii deep sea water (HDSW medium) and those with medium prepared with normal distilled water (control medium). The secretion of type 1 plasminogen activator inhibitor (PAI-1) from HUVECs was significantly reduced by about twofold. However, the levels of PAI-1 mRNA in HUVECs cultured with HDSW medium did not change when compared with those cultured with control medium. Though HDSW medium also reduced the secretion of tissue-type plasminogen activator, the suppressive effect was more prominent for PAI-1. Thus, the balance of fibrinolytic activity was turned toward anti-thrombotic in HUVECs. This was evidenced by the lysis of 125I-fibrin clot in the presence of plasminogen. That is, HUVECs cultured with HDSW medium degraded 125I-fibrin more efficiently than HUVECs with control medium. Such enhanced clot lysis was maintained as long as HDSW medium was present. The accelerated effect of HDSW medium on clot lysis disappeared after the exchange of HDSW medium to control medium. These findings suggest that HDSW may specifically and predominantly affect the process of molecular transfer of PAI-1 after its transcription, resulting in an enhanced fibrinolytic activity of HUVECs. Since HDSW reduces the thrombotic potential of cultured HUVECs, it is speculated that the materials contained in HDSW may prevent the incidence of thrombotic disorders.

Journal Article↗