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PubMed1993

In pursuit of excellence: a model of collaboration for nurses at Hawaii State Hospital.

In 1989 the Hawaii Medical Journal devoted an issue to the status of mental health in Hawaii and mental health leaders in the State criticized the lack of involvement by the University of Hawaii. This paper is written in response to the challenge and will discuss a dynamic model based on collaboration between the Hawaii State Hospital (HSH) and the School of Nursing of the University of Hawaii (SoN), that was implemented in September 1990. Since the publication of Magnet Hospitals. Attraction and Retention of Professional Nurses there has been much interest by service organizations in defining the factors that build excellence.

Education, Nursing, Continuing↗
PubMed1998

Substance Abuse in Hawaii: Perspectives of Key Local Human Service Organizations.

Available evidence suggests that substance abuse in Hawaii is a substantial problem. The three major objectives of this study were to determine qualitatively Hawaii's human service organizations' perspective regarding (1) the magnitude of the statewide substance abuse problem, (2) the unmet needs of the state's substance abuse treatment system, and (3) the features of the problem unique to Hawaii's many ethnic and other subgroups. The study targeted those human service organizations most burdened by the substance abuse problem. Respondents from 55 human service organizations were interviewed using a series of 21 open-ended questions. Respondents perceived the magnitude of the Hawaii substance abuse problem to be at least comparable to that of the mainland United States. Although most respondents viewed the problem using a medical model, the problem was generally thought to be exacerbated by a community context in which substance abuse is accepted, excused, or denied. Increasing use of crystal methamphetamine and heroin were cited as the most worrisome trends. Systems issues identified were unstable funding, insufficient detoxification services, and limited availability of residential treatment and supportive services following treatment, such as housing and aftercare. Service delivery problems frequently associated with rural areas were identified, such as transportation, staff development, outreach, and difficulty providing a full range of services, particularly on neighbor islands. Cultural alienation, exacerbated by the state's prevailing multiculturalism, was thought to contribute to the substance abuse problem among all ethnic groups, but especially among Native Hawaiians. Cultural factors were thought to have a major impact on seeking care and subsequent acceptance of such care. Further study is needed to understand better the content of care, therapeutic elements, and efficacy of culturally specific treatment and prevention programs. To initiate change, concerted efforts are needed to inform Hawaii residents about the statewide substance abuse problem and local treatment system needs. Future studies should compare human service organization perceptions to those of individuals abusing substances and using these services.

Journal Article↗
PubMed1997

Expression and self-assembly of recombinant capsid protein from the antigenically distinct Hawaii human calicivirus.

The Norwalk and Hawaii viruses are antigenically distinct members of the family Caliciviridae and are considered to be important etiologic agents of epidemic gastroenteritis, with most studies focusing on the role of Norwalk virus. To further investigate the importance of Hawaii virus, Hawaii virus-like particles (VLPs) were produced by expression of its capsid protein in the baculovirus system and these VLPs were used as the antigen in an enzyme-linked immunosorbent assay that was efficient in the detection of a serologic response to Hawaii virus. The ready availability of Hawaii VLPs should enable larger-scale epidemiological studies to further elucidate the importance of this agent.

Antigens, Viral↗
PubMed2001

Comparison of performance-based measures among native Japanese, Japanese-Americans in Hawaii and Caucasian women in the United States, ages 65 years and over: a cross-sectional study.

BACKGROUND: Japanese (both in Japan and Hawaii) have a lower incidence of falls and of hip fracture than North American and European Caucasians, but the reasons for these differences are not clear. SUBJECTS AND METHODS: A cross-sectional study. We compared neuromuscular risk factors for falls using performance-based measures (chair stand time, usual and rapid walking speed, and grip strength) among 163 Japanese women in Japan, 681 Japanese-American women in Hawaii and 9403 Caucasian women in the United States aged 65 years and over. RESULTS: After adjusting for age, the Caucasian women required about 40% more time to complete 5 chair stands than either group of Japanese. Walking speed was about 10% slower among Caucasians than native Japanese, whereas Japanese-American women in Hawaii walked about 11% faster than native Japanese. Grip strength was greatest in Japan, which may reflect the rural farming district that this sample was drawn from. Additional adjustment for height, weight or body mass index increased the adjusted means of chair stand time and grip strength among Japanese, but the differences remained significant. CONCLUSIONS: Both native Japanese and Japanese-American women in Hawaii performed better than Caucasians on chair stand time and walking speed tests, and native Japanese had greater grip strength than Japanese in Hawaii and Caucasians. The biological implications of these differences in performance are uncertain, but may be useful in planning future comparisons between populations.

Journal Article↗
PubMed2002

Comparison of mammographic densities and their determinants in women from Japan and Hawaii.

Breast cancer incidence increases considerably in women who migrate from Japan to the United States. Based on the hypothesis that mammographic density in healthy mammograms reflects differences in breast cancer risk, we compared mammographic density in 3 groups of women at different levels of risk: Caucasian and Japanese women in Hawaii and Japanese women in Japan. In a cross-sectional design, pre- and postmenopausal women without a history of breast cancer and with a mammogram free of suspicious lesions were recruited in mammography clinics and completed a self-administered questionnaire. Cranio-caudal mammograms were scanned into a computer and the densities measured using a computer-assisted method. Statistical analyses included ANOVA and multiple linear regression. Breast size among women of Japanese ancestry was similar in Hawaii and Japan but 50% smaller than that among Caucasian women. Dense areas were smallest among women in Japan, intermediate among Japanese women in Hawaii and largest among Caucasian women. Percent densities were greater in Japanese women than Caucasian women because of the larger breast sizes in Caucasians. However, percent densities were significantly higher among Japanese women in Hawaii than in Japan. These results indicate that the size of the total breast differs primarily by ethnicity and the size of the dense areas differs mainly by place of residence. Therefore, when comparing ethnic groups with distinct physical proportions, the absolute size of the dense areas appears to be a better measure of breast cancer risk than the relative density.

Adult↗
PubMed1991

Breast cancer in multi-ethnic populations: the Hawaii perspective.

The five major ethnic groups in Hawaii's population of 1.1 million are the Japanese, comprising 23%; Caucasians, 23%; ethnic Hawaiians, 19.9%; Filipinos, 11.3%; and Chinese, 4.8%. Only 14% of the population is foreign born. Breast cancer incidences are 29.2 per 100,000 among Filipinos, 51.3 for Japanese, 64.1 for Chinese, 104.3 for Hawaiian, and 105.6 for Caucasian women. The Caucasian incidence is similar to mainland US rates, but the incidence among Hawaii's Japanese is more than twice the rate in Japan. Japanese in Hawaii have less postmenopausal breast cancer than Caucasians, fewer axillary lymph node metastases, and a greater proportion of non-invasive tumors. Late stage at diagnosis is common among Filipino and ethnic Hawaiian woman, and their risk of death is 1.5-1.7 times that of Caucasian, Chinese, and Japanese women with the disease, even after adjustment for age, extent of disease, and socio-economic status. In the BCDDP screening study, only 20% of breast cancers detected in ethnic Hawaiians were not yet palpable and were found by mammography alone. Comparative studies of diet and estrogen levels in the ethnic groups of Hawaii and the parental populations in Japan and the West do not account for the degree of variation observed in breast cancer incidence and tumor pathology. Future research directions are suggested with a view to accounting for these differences.

Breast Neoplasms↗
PubMed2000

Hip fracture incidence among Caucasians in Hawaii is similar to Japanese. A population-based study.

Age-specific hip fracture incidence has been increasing in some parts of the world. The incidence of hip fractures among Japanese on the island of Oahu, Hawaii in 1979-1981 was approximately half that of Caucasians in North America, but similar to the incidence in Japan. We surveyed the incidence on Oahu again in 1991-1995 for all races to compare the incidence among Japanese to the earlier rates, and to other populations, including Caucasians on Oahu. The incidence of hip fracture among Japanese in Hawaii between 1991-1995 had not changed appreciably (compared to 1979-1981), and was similar to that among Caucasians on Oahu. The incidence among Hawaii Japanese and Caucasians was similar to, or lower than Japan overall, and much lower (one-third to one-half) than that reported for Caucasians in North America and Northern Europe, suggesting that the prevalence of certain risk factors may be lower in Hawaii. These findings confirm other studies suggesting that nongenetic factors may be responsible for much of the observed differences in hip fracture incidence between countries, and between races.

Age Distribution↗
PubMed2005

Relation of long chain n-3 polyunsaturated fatty acid intake to serum high density lipoprotein cholesterol among Japanese men in Japan and Japanese-American men in Hawaii: the INTERLIPID study.

Epidemiologic evidence shows an inverse relationship between fish consumption and coronary heart disease (CHD) mortality. Associations between dietary intake of long chain n-3 polyunsaturated fatty acids (PUFA) and serum high density lipoprotein (HDL) cholesterol concentration are unknown. In this study, the association between n-3 PUFA (eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and docosapentaenoic acid (DPA)) intake and serum HDL cholesterol among Japanese men and women in Japan and Hawaii was examined. The study population consisted of Japanese ancestries from five research centers of the International Study of Macronutrients and Blood Pressure (INTERMAP) study, in Japan and Hawaii (672 men and 676 women), surveyed between 1996 and 1998. Four 24-h dietary recalls and one set of serum lipid measurements were performed. For men, n-3 PUFA intake and HDL cholesterol were higher in Japan than in Hawaii (n-3 PUFA: 1.32 g/day versus 0.47 g/day, p<0.001). For women, n-3 PUFA intake was higher in Japan than in Hawaii (p<0.001) but HDL cholesterol was not significantly different (p=0.752). After adjustment for age, body mass index, physical activity, number of cigarettes per day, alcohol intake, and hormone replacement therapy (for women), n-3 PUFA intake was positively associated with serum HDL cholesterol in men (4.6 mg/dl higher HDL cholesterol with 1%kcal higher n-3 PUFA intake, p=0.011). This association was not observed in women. This positive association of dietary n-3 PUFA with serum HDL cholesterol may partially explain the low mortality from CHD among Japanese men.

Adult↗
PubMed2006

Ethnicity and nutrition of adolescent girls in Hawaii.

OBJECTIVE: To describe the ethnicity and nutrition of adolescent girls in Hawaii. DESIGN: This was a cross-sectional survey. SUBJECTS: Girls, aged 9 to 14 years, were identified from the membership files of Kaiser Permanente Hawaii, a large Hawaii health maintenance organization. MAIN OUTCOME MEASURES: Nutrient and food group intakes were compared against recommended intakes, physical activity levels, and anthropometric measurements of height, weight, body mass index (BMI), and subscapular and iliac skinfold thicknesses. STATISTICAL ANALYSIS PERFORMED: Asian girls, girls of mixed ethnicity, and white girls were compared using analysis of variance. RESULTS: Although Asian girls weighed the least and were the most sedentary, white girls had the lowest BMIs. Mixed ethnicity girls had the highest weights, BMIs, and subscapular and iliac skinfold thicknesses. No significant differences were found in major macronutrient intake. However, mixed ethnicity and Asian girls had lower fiber, iron, folate, and calcium intake than white girls. All groups met recommendations for iron intake, whereas none met fiber and calcium recommendations. All girls met folate recommendations. No differences were found in intakes for tofu, soy, grains, vegetables, or fruit and nuts food groups. Mixed ethnicity girls had the highest sweetened carbonated beverage intake although overall sugar intake was highest in white girls. Asian and mixed ethnicity girls' meat intakes were higher than white girls'. Intakes of mixed ethnicity girls more closely resembled those of Asians, although they exhibited the highest BMIs. CONCLUSIONS: These data suggest grain, vegetable, fruit, and dairy intake should be encouraged as part of a balanced diet for adolescent girls in Hawaii.

Adolescent↗
PubMed2006

Emergence of community-associated methicillin resistant Staphylococcus aureus in Hawaii, 2001-2003.

OBJECTIVES: We conducted a retrospective study to determine trends and characteristics of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in Hawaii. METHODS: We reviewed medical records of patients with MRSA infections during July 2001-June 2003 in four healthcare facilities. A case was defined as a patient with MRSA infection (colonization excluded), diagnosed in ambulatory settings or < or = 48 h after hospitalization, without previous MRSA or healthcare risk factors. Pulsed-field gel electrophoresis (PFGE) and typing of resistance and toxin genes was performed in 40 MRSA isolates. RESULTS: CA-MRSA infections increased from 28 (23% of MRSA infections) to 65 (32%) per quarter over the 2-year period (P<0.05). Pacific islanders accounted for 51% of 389 case-patients, but only 24% of the Hawaii population. In the pediatric hospital, Pacific Islanders represented 76% of 90 case-patients versus 35% of the hospital population. Hospital admission, required for 40% (154/389), was associated with prior antimicrobial treatment (P<0.01). The staphylococcal cassette chromosome mec type IV was detected in 38/40 isolates; 31 isolates carried Panton-Valentine leukocidin genes and 22 belonged to the same staphylococcal lineage. CONCLUSIONS: In Hawaii, prevention strategies for CA-MRSA infections should focus on Pacific Islanders. CA-MRSA infections in Hawaii appear to be related to strains causing disease throughout the United States.

Adolescent↗
PubMed1977

Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California. Incidence of myocardial infarction and death from coronary heart disease.

The incidence of myocardial infarction and death from coronary heart disease was studied in defined samples of 45 to 68 year old Japanese men in Japan, Hawaii and California. The incidence rate was lowest in Japan where it was half that observed in Hawaii (P less than 0.01). The youngest men in the sample in Japan were at particularly low risk. The incidence among Japanese men in California was nearly 50 percent greater than that of Japanese in Hawaii (P less than 0.05). A striking increase in the incidence of myocardial infarction appears to have occurred in the Japanese who migrated to the United States; this increase is more pronounced in California than in Hawaii.

Age Factors↗
PubMed1989

Characteristics of emigrants from Hawaii.

As part of an ongoing study on young adult psychological and social development, data were obtained through parental reports on the present residences and educational and occupational attainments of 718 present or former residents of Hawaii (average age 31 years). These subjects, as well as their parents, had been tested between 1972 and 1976 on measures of cognitive abilities and personality. The extent of emigration to the mainland in this middle to upper-middle class sample was over 40%. On average, former Hawaii residents now living on the US mainland were of higher intelligence and educational background than their counterparts still living in Hawaii. Differences were also found for number of children, cross-ethnic marriages, and occupational attainment (males only). In addition, parents of US mainland residents scored significantly higher on measures of cognitive abilities and education than parents of current Hawaii residents.

Adult↗
PubMed2003

Early weaning among Japanese women in Hawaii.

This study examined factors associated with early weaning among Japanese women in comparison with Caucasian women in Hawaii. A mailed survey was sent to all women who delivered an infant in Hawaii between January 1st 1989 and March 31st 1989. Only Japanese (N=228) and Caucasian women (N=439) were included in this study. All Japanese breast-feeding women in the study introduced formula at some point in time. Cox multivariate regression analysis was conducted in two separate models of Japanese and Caucasian women, respectively. Higher maternal age and working part-time among Japanese women, and multiparity, college education, rural island and long-term Hawaii residence among Caucasian women were protective against early weaning. Introduction of formula was strongly associated with early weaning for both groups, the association being stronger for Japanese women. The early practice of partial breast-feeding may play an important role for early weaning among Japanese women in Hawaii.

Adult↗
PubMed2000

Bottlenecks and multiple introductions: population genetics of the vector of avian malaria in Hawaii.

Avian malaria has had a profound impact on the demographics and behaviour of Hawaiian forest birds since its vector, Culex quinquefasciatus the southern house mosquito, was first introduced to Hawaii around 1830. In order to understand the dynamics of the disease in Hawaii and gain insights into the evolution of vector-mediated parasite-host interactions in general we studied the population genetics of Cx. quinquefasciatus in the Hawaiian Islands. We used both microsatellite and mitochondrial loci. Not surprisingly we found that mosquitoes in Midway, a small island in the Western group, are quite distinct from the populations in the main Hawaiian Islands. However, we also found that in general mosquito populations are relatively isolated even among the main islands, in particular between Hawaii (the Big Island) and the remaining Hawaiian Islands. We found evidence of bottlenecks among populations within the Big Island and an excess of alleles in Maui, the site of the original introduction. The mitochondrial diversity was typically low but higher than expected. The current distribution of mitochondrial haplotypes combined with the microsatellite information lead us to conclude that there have been several introductions and to speculate on some processes that may be responsible for the current population genetics of vectors of avian malaria in Hawaii.

Animals↗
PubMed1999

Cross-cultural comparison of long-term psychiatric patients hospitalized in Tokyo, Japan and Honolulu, Hawaii.

The aim of this study is to cross-culturally explore the crucial and often conflicting issues of least restrictive placement of long-term psychiatric patients in Hawaii and Japan, and the need to provide high-quality care for such patients. Policy implications are discussed. A survey instrument facilitated the comparison of records from psychiatric patients hospitalized over 1 year in Hawaii, as of January 1993, and psychiatric patients hospitalized over 1 year in Japan, as of January 1996. The survey instrument was translated and validated for use in both countries. Interrater reliability averaged 0.96. The 30 subjects in Japan were all men (Japanese), and primarily unmarried. The 83 subjects in Hawaii were mostly men (Hawaiian or other ethnic minority), and unmarried. Subjects in Japan tended to be older, hospitalized longer, and were judged to be more dysfunctional than those in Hawaii. No significant relationship was revealed between nursing diagnoses and Axis I diagnoses in either sample. Although significant clinical differences were found between the two groups, the policy issues are similar: how to place patients in the least restrictive environment and how to provide high quality of care given the limited available resources. Nurses in both countries must become more vocal advocates for policy changes to improve the care of long-term patients.

Adult↗
PubMed2000

Breastfeeding duration in a multiethnic population in Hawaii.

BACKGROUND: The increasing ethnic diversity in the United States necessitates a study of variations in infant feeding patterns among ethnic groups. This study was conducted as part of Hawaii's surveillance system to identify infant feeding patterns in Hawaii; specifically, to identify factors influencing duration of breastfeeding among ethnically diverse mothers. METHODS: All women who delivered an infant in Hawaii between January 1 and March 31, 1989, were mailed surveys 14 to 19 months after delivery. Fifty-one percent (n = 2011) of women responded, of whom 1574 (78%) did some breastfeeding and are included in the analysis of prediction of weaning (cessation of breastfeeding). Cox regression (survival) analysis was used to predict weaning. RESULTS: The median duration of breastfeeding was 150 days; 45 percent of infants were still breastfeeding at age 6 months and 16 percent at age 1 year. Factors associated with early weaning were Japanese ethnicity; mother born in a country other than the United States, Japan, or the Philippines; first language other than English, or two languages at home; employed full-time outside the home; introduced formula or fruit before age 6 months; received formula from the WIC program; and stopped breastfeeding for convenience, breast problems, problems getting breastfeeding started, insufficient milk, baby refusing the breast, and a sick baby. Factors associated with late weaning were older maternal age; college education; living on a rural island; previous breastfeeding experience; helpful breastfeeding advice from family or friends; receiving WIC for breastfeeding mothers; introducing the cup before age 6 months; and not giving fruit to the baby. CONCLUSION: In Hawaii, programs that address how and when to introduce foods, use of formula, and management of outside employment and breastfeeding should be made available to those groups of women at risk for early weaning to lengthen their duration of breastfeeding.

Breast Feeding↗
PubMed1975

Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: prevalence of coronary and hypertensive heart disease and associated risk factors.

A study of coronary heart disease (CHD) among Japanese migrants compared with Japanese living in Japan provided the opportunity to study factors possibly responsible for the high rates of CHD in America as compared with Japan. Comparable methods were employed in examining 11,900 men of Japanese ancestry aged 45--69 living in Japan, Hawaii and California. The age-adjusted prevalence rates for definite CHD as determined by ECG were: Japan 5.3, Hawaii 5.2 and California 10.8/1000. For definite plus possible CHD the rates were 25.4, 34.7 and 44.6. The prevalence of angina pectoris and pain of possible myocardial infarction, determined by questionnaire, showed a similar gradient. Elevated serum cholesterol showed a Japan-Hawaii-California gradient, but the prevalence of hypertension in Japan was intermediate between the prevalence in Hawaii and the higher prevalence in California. The three geographic locations were compared as to prevalence of CHD at comparable levels of blood pressure and cholesterol. At each blood pressure level and at each cholesterol level, the greater prevalence of CHD in California persisted. These facts, plus the near universality of smoking in Japan, suggest that conventional risk factors only partly explain the observed gradient in CHD.

Age Factors↗
PubMed1998

Total hip replacement rates are higher among Caucasians than Asians in Hawaii.

The etiology of hip osteoarthritis remains unknown but may involve genetic or lifestyle factors. Most cases of total hip replacement are performed because of osteoarthritis. To examine possible ethnic differences, hospital records in Hawaii from 1985 to 1989 were reviewed. Preoperative radiographs were reviewed for a subset of patients to ascertain the reason for total hip replacement. Osteoarthritis accounted for a greater percentage of total hip replacements among whites (59% for women and 66% for men) than among Japanese (36% of women and 30% of men). The incidence of total hip replacement for whites was three to 25 times greater than that of other ethnic groups (Japanese, Chinese, Filipino, and Hawaiians). For example, the risk of total hip replacement for white women 40 years to 84 years of age was 4.4%, compared with 1.1% for Japanese women and 1.7% for Chinese women of the same age group. Compared with published data, the incidence was similar for Chinese in Hawaii and San Francisco; however; whites in Hawaii had a total hip replacement incidence less than half that of whites in San Francisco. Lifestyle differences might account for the lower incidence of total hip replacement for whites in Hawaii, compared with those in San Francisco. The lower incidence among Asians suggests a possible genetic basis for osteoarthritis.

Adult↗