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PubMed2001

Molecular epidemiology of Neisseria gonorrhoeae exhibiting decreased susceptibility and resistance to ciprofloxacin in Hawaii, 1991-1999.

BACKGROUND: Clinically significant resistance to Centers for Disease Control and Prevention (CDC)-recommended doses of fluoroquinolones (ciprofloxacin and ofloxacin) has been reported for Neisseria gonorrhoeae. In Hawaii, fluoroquinolone-resistant gonococcal isolates were first identified in 1991. GOAL: To assess the diversity, based on phenotypic and genotypic characterization, of gonococcal isolates exhibiting decreased susceptibility (CipI; MICs = 0.125-0.5 microg/ml) or clinically significant resistance (CipR; MICs > or = 1 microg/ml) to ciprofloxacin in Hawaii from 1991 through 1999. STUDY DESIGN: Antimicrobial susceptibilities, auxotype/serovar (A/S) class, GyrA/ParC alteration patterns, and plasmid profiles were determined for gonococci isolated in Honolulu from 1991 through 1999 that exhibited intermediate or clinically significant resistance to ciprofloxacin. Strain phenotypes were defined by A/S class, GyrA/ParC alteration pattern, and penicillin-tetracycline resistance phenotype supplemented with plasmid profiles for beta-lactamase-producing isolates. RESULTS: Altogether, 68 isolates exhibiting intermediate or clinically significant resistance to ciprofloxacin belonged to 23 and 19 strain phenotypes, respectively. Among the CipI and CipR isolates, 4 and 13 GyrA/ParC alterations patterns were identified, respectively. The 91,95/Asp-86 alteration pattern occurred most frequently among CipR isolates. Forty-four strain phenotypes were represented by only one isolate. In addition, seven pairs and two clusters of isolates were identified. CONCLUSIONS: From 1991 through 1997, few gonococcal strains exhibiting intermediate or clinically significant resistance to CDC-recommended doses of fluoroquinolones were identified from Hawaii. Isolates belonged to a large number of phenotypic and genotypic types, suggesting that most cases were imported, with only a few instances in which isolate pairs indicated that secondary transmission of infections had occurred in Hawaii. Beginning in 1998, the number of CipR isolates increased markedly, and more isolates belonged to fewer phenotypic and genotypic types, suggesting either more frequent importation of fewer strain types or the possibility that the endemic spread of a few strains is beginning to occur.

Anti-Infective Agents↗
PubMed2006

Global phylogeographic limits of Hawaii's avian malaria.

The introduction of avian malaria (Plasmodium relictum) to Hawaii has provided a model system for studying the influence of exotic disease on naive host populations. Little is known, however, about the origin or the genetic variation of Hawaii's malaria and traditional classification methods have confounded attempts to place the parasite within a global ecological and evolutionary context. Using fragments of the parasite mitochondrial gene cytochrome b and the nuclear gene dihydrofolate reductase-thymidylate synthase obtained from a global survey of greater than 13000 avian samples, we show that Hawaii's avian malaria, which can cause high mortality and is a major limiting factor for many species of native passerines, represents just one of the numerous lineages composing the morphological parasite species. The single parasite lineage detected in Hawaii exhibits a broad host distribution worldwide and is dominant on several other remote oceanic islands, including Bermuda and Moorea, French Polynesia. The rarity of this lineage in the continental New World and the restriction of closely related lineages to the Old World suggest limitations to the transmission of reproductively isolated parasite groups within the morphological species.

Animals↗
PubMedDate not supplied

Incidence of Paneth cells in colorectal adenomas of Japanese descendants in Hawaii.

The main purpose of the present study was to demonstrate the incidence of Paneth cells in colorectal tubular adenomas of Japanese descendants in Hawaii. Paneth cells were found in 73 of 322 adenomas (22.7%) of Japanese descendants in Hawaii. The incidence of Paneth cells in adenomas located from the caecum to the transverse colon was significantly higher than that of adenomas from the descending colon to the rectum. The same trend of a higher incidence of Paneth cells in adenomas from the caecum to the transverse colon was observed in Japanese descendants and Caucasian residents in Hawaii and in native Japanese. The incidence of Paneth cells in adenomas of Japanese descendants in Hawaii was higher than that of native Japanese, and also that of Caucasian residents was higher than that of native Japanese.

Adenoma↗
PubMed2000

Evaluation of the indirect hemagglutination assay for diagnosis of acute leptospirosis in Hawaii.

Timely diagnosis of leptospirosis is important to ensure a favorable clinical outcome. The definitive serologic assay, the microscopic agglutination test (MAT), requires paired sera and is not useful for guiding early clinical management. The only screening test approved for use in the United States, the indirect hemagglutination assay (IHA), has not undergone extensive field evaluation. To assess the performance of the leptospirosis IHA in Hawaii, serum from patients evaluated for leptospirosis between 1992 and 1997 were tested with the IHA at the Hawaii State Laboratories Division and with the MAT at the Centers for Disease Control and Prevention. Leptospirosis was considered confirmed by a fourfold rise in MAT titer and/or a positive culture. A total of 92 (41%) of 226 specimens from 114 persons with confirmed leptospirosis were found positive by IHA. Only 18 (15%) of 119 specimens obtained within 14 days of onset were IHA positive, compared to 74 (69%) of 107 specimens collected more than 14 days after onset (P <0.001). Repeat testing ultimately resulted in 78 (68%) of the confirmed cases having at least one specimen found positive by IHA. Thirteen different presumptive infecting serogroups were identified among 251 specimens with an MAT titer of >/=200 and obtained from persons with confirmed or probable leptospirosis. Fifty (68%) of 73 specimens with Icterohaemorrhagiae as the presumptive infecting serogroup were found positive by IHA, compared to 44 (47%) of 93 specimens with Australis as the presumptive infecting serogroup (P, 0.01). The IHA test was positive for 3 (1%) of 236 specimens from 154 persons without leptospirosis. The sensitivity of the leptospirosis IHA in Hawaii was substantially below figures reported previously, particularly early in the course of illness, limiting its usefulness for diagnosing acute infection. Since the presumptive infecting serogroup affected IHA results and the prevalence of serovars varies with geography, the performance of the IHA should be assessed locally. More sensitive leptospirosis screening tests are needed in Hawaii.

Acute Disease↗
PubMed1978

Primary antituberculous drug resistance in Hawaii, 1957 to 1977.

A study of primary antituberculous drug resistance in Hawaii was conducted from 1957 to 1977 to determine the incidence of primary resistance with respect to time. A total of 1,869 initial cultures of Mycobacterium tuberculosis submitted to Leahi Hospital in Honolulu were screened to identify drug resistance. Of 256 patients who excreted resistant bacilli, only 55 had no history of previous antituberculous chemotherapy. The frequencies of primary drug resistance from July 1957 to July 1977 were as follows: streptomycin, 0.86 per cent; isoniazid, 1.2 per cent; para-aminosalicylic acid, 1.5 per cent. No strains were resistant to ethambutol or rifampin. A slight decrease in the incidence of drug resistance during a 20-year period was observed. This was especially significant because Hawaii's tuberculosis problem is principally confined to its foreighn-born population. Although no serious primary drug resistance problem was discovered, Hawaii possesses both the highest immigration rate and the highest incidence of tuberculosis in the United states. Therefore, there is a need for continued periodic monitoring of drug resistance in Hawaii.

Aminosalicylic Acid↗
PubMed1997

Breast cancer and pesticides in Hawaii: the need for further study.

Only 30% of all breast cancer can be explained by known risk factors. Increases in breast cancer incidence rates in Hawaii over the past few decades cannot be attributed solely to improvements in screening and detection. Avoidable environmental factors may contribute to a proportion of the unexplained cases. Emerging evidence on endocrine disruption suggests that environmental chemicals may play a role in the development of breast cancer. Agricultural chemicals, including endocrine disruptors, have been used intensively in Hawaii's island ecosystem over the past 40 years leaching into groundwater, and leading to unusually widespread occupational and general population exposures. This paper discusses breast cancer patterns in Hawaii in the context of documented episodes of exposure to two endocrine-disrupting chemicals, chlordane/heptachlor and 1,2-dibromo-3-chloropropane (DBCP), at levels that sometimes exceeded federal standards by several orders of magnitude. In light of this history, detailed geographic-based studies should be undertaken in Hawaii to elucidate the potential role of environmental factors in the development of breast cancer and other diseases.

Adult↗
PubMed2004

Modeling the population dynamics of Culex quinquefasciatus (Diptera: Culicidae), along an elevational gradient in Hawaii.

We present a population model to understand the effects of temperature and rainfall on the population dynamics of the southern house mosquito, Culex quinquefasciatus Say, along an elevational gradient in Hawaii. We use a novel approach to model the effects of temperature on population growth by dynamically incorporating developmental rate into the transition matrix, by using physiological ages of immatures instead of chronological age or stages. We also model the effects of rainfall on survival of immatures as the cumulative number of days below a certain rain threshold. Finally, we incorporate density dependence into the model as competition between immatures within breeding sites. Our model predicts the upper altitudinal distributions of Cx. quinquefasciatus on the Big Island of Hawaii for self-sustaining mosquito and migrating summer sink populations at 1,475 and 1,715 m above sea level, respectively. Our model predicts that mosquitoes at lower elevations can grow under a broader range of rainfall parameters than middle and high elevation populations. Density dependence in conjunction with the seasonal forcing imposed by temperature and rain creates cycles in the dynamics of the population that peak in the summer and early fall. The model provides a reasonable fit to the available data on mosquito abundance for the east side of Mauna Loa, Hawaii. The predictions of our model indicate the importance of abiotic conditions on mosquito dynamics and have important implications for the management of diseases transmitted by Cx. quinquefasciatus in Hawaii and elsewhere.

Altitude↗
PubMed2000

Transport of helminths to Hawaii via the brown anole, Anolis sagrei (Polychrotidae).

Sixty-two brown anoles, Anolis sagrei, from Oahu, Hawaii were examined for helminths. Anolis sagrei was introduced to Hawaii, presumably from the Caribbean. Two species of trematodes, Mesocoelium monas and Platynosomum fastosum, 3 species of nematodes, Atractis scelopori, Physaloptera squamatae, and Physocephalus sp., 1 acanthocephalan, Acanthocephalus bufonis, and 1 pentastome, Raillietiellafrenatus, were found. Atractis scelopori and P. squamatae, previously unknown in Hawaii, are widely distributed in the Caribbean and were most likely transported to Hawaii with the introduced anoles. Mesocoelium monas, P. fastosum, Physocephalus sp., A. bufonis, and R. frenatus have been previously reported from Hawaiian herptiles; A. sagrei most likely acquired infections of these parasites from Hawaiian populations. This study indicates that helminths can be transported with their introduced hosts and become established in the colonized areas and that introduced lizards may quickly acquire species of previously established helminthes.

Animals↗
PubMed2000

An international comparison of cancer survival: metropolitan Toronto, Ontario, and Honolulu, Hawaii.

OBJECTIVES: Comparisons of cancer survival in Canadian and US metropolitan areas have shown consistent Canadian advantages. This study tests a health insurance hypothesis by comparing cancer survival in Toronto, Ontario, and Honolulu, Hawaii. METHODS: Ontario and Hawaii registries provided a total of 9190 and 2895 cancer cases (breast and prostate, 1986-1990, followed until 1996). Socioeconomic data for each person's residence at the time of diagnosis were taken from population censuses. RESULTS: Socioeconomic status and cancer survival were directly associated in the US cohort, but not in the Canadian cohort. Compared with similar patients in Honolulu, residents of low-income areas in Toronto experienced 5-year survival advantages for breast and prostate cancer. In support of the health insurance hypothesis, between-country differences were smaller than those observed with other state samples and the Canadian advantage was larger among younger women. CONCLUSIONS: Hawaii seems to provide better cancer care than many other states, but patients in Toronto still enjoy a significant survival advantage. Although Hawaii's employer-mandated health insurance coverage seems an effective step toward providing equitable health care, even better care could be expected with a universally accessible, single-payer system.

Adult↗
PubMed2005

Introduction and establishment of Aedes (Finlaya) Japonicus japonicus (Theobald) on the island of Hawaii: implications for arbovirus transmission.

On November 24, 2003, 1 female adult specimen of Aedes (Finlaya) japonicus japonicus (Theobald) was collected in a New Jersey (NJ) light trap on the island of Hawaii. From June through October, 2004, female and male adults were collected by NJ light traps and gravid traps placed at multiple sites on the island of Hawaii. Larvae were collected in artificial containers and reared to adults for identification. Aedes (Fin.) j. japonicus is the 8th mosquito species to be introduced and established in the State of Hawaii. Currently, this species is known only from the island of Hawaii. Aedes (Fin.) j. japonicus is a competent laboratory vector for a number of arboviruses. Increased quarantine inspections, inspection and treatment of imported used tires and plants, disinsection of airline cargo holds, enhanced vector surveillance, and the development of sanitary corridors around airports and port facilities are necessary to reduce the introduction of vectors and pathogens.

Aedes↗
PubMed1997

Asthma in Hawaii: a tradition of excess mortality.

Hawaii has the highest asthma mortality in the nation and clinically has always had high rates. In contrast, international consensus has it that deaths have been rare over the past two centuries to 1950. The objective of this study was to document Hawaii's asthma mortality over the centuries to 1950. Asthma mortality was examined from pre- and early European times through kahunas, aphorisms, historical libraries, and materia medica. In 1879, vital statistics became available locally and from 1901 from the federal government. Asthma deaths were not rare in ancient Hawaii. Vital statistics in 1879 revealed an asthma mortality of 83/100,000 which declined to 4.0 by 1950. U.S. and international mortality, at least to 1930, was almost unknown. Compared to U.S. and international rates, Hawaii's asthma mortality has been excessive since ancient days.

Adolescent↗
PubMed1992

Health status and lifestyle in elderly Hawaii Japanese and Australian men. Exploring known differences in longevity.

OBJECTIVE: To contrast health status and lifestyle in two elderly populations with differing longevity. DESIGN: Comparison of two cross-sectional data sets. SETTING: Non-institutionalised subjects. SUBJECTS: Men aged 60-81 years resident in Dubbo, New South Wales (n = 1183, 1988-1989) and Japanese men of the same ages resident in Hawaii (n = 1376, 1980-1982). MAIN OUTCOME MEASURES: Cardiovascular and non-cardiovascular disease prevalence, risk factors, social and health status. RESULTS: A history of heart attack, angina and stroke was twice as prevalent in Dubbo men as in Hawaii Japanese. Other diseases were many times more prevalent in Dubbo--liver disease sixfold, prostate and renal disease twofold, and arthritis 1.5-fold. Hypercholesterolaemia and untreated hypertension were more prevalent in Dubbo (threefold and 1.5-fold respectively). Current smoking was similar in both groups, while diabetes was twice as prevalent in the Hawaii Japanese. More Dubbo men were widowed or lived alone, and fewer remained in paid employment. Dubbo men had more limited physical mobility. CONCLUSIONS: Elderly Dubbo men have an excess of cardiovascular disease and associated risk factors, as well as an excess of non-cardiovascular disease, compared with Hawaii Japanese. This may account, in part, for a higher total mortality rate in elderly Australians compared with Japanese. Some of this disease burden may be amenable to risk factor intervention.

Aged↗
PubMed2000

Alcohol use in Hawaii.

This article provides a review of the existing literature on alcohol use in Hawaii (i.e., epidemiology, reasons for use, associated problems, and intervention) and offers clinical implications of the findings and suggestions for further areas of research. In general, Caucasians, Hawaiians, younger Filipinos, males, adolescents, young adults, and those with lower educational attainment were found to be at higher risk. Overall, Hawaii's rates were either comparable or lower than those for the entire United States. Factors associated with different rates of alcohol use included accessibility, ability to resist offers, parent use and sanctions, peer influence and use, attitudes and beliefs (e.g., perceived normal drinking, dangerousness), religious affiliation, social occasions, and school intervention. Variable rates and trends in help-seeking behaviors, treatment admissions, and treatment utilization reflected the socio-cultural diversity in Hawaii. Perceived effectiveness of different treatments were generally consistent across ethnic groups, but did not necessarily represent actual efficacy. There is a clear need for additional prevention, screening, and intervention programs in Hawaii, including socio-culturally appropriate ones, as well as a need for further research.

Adolescent↗
PubMed1979

Colon cancer: its precursors and companions in Hawaii Japanese.

Following migration to Hawaii, the Japanese have acquired the same risk of developing large bowel cancer as that experienced by Caucasians. This tumor is uncommon in Japan. Other conditions are also more common in Hawaii Japanese, e.g., myocardial infarction, severe atherosclerosis, diverticulosis, and polyposis of the colon. Comparative studies in Hawaii and Japan suggest that the basis of these differences is probably related to the consumption of characteristically western foods by Hawaii Japanese.

Aged↗
PubMed1992

Hospitalizations for hip fractures among elderly persons in Hawaii, 1986-1990.

Hawaii differs ethnically, geographically, and culturally from other states; therefore, United States hip fracture data cannot be assumed to apply to Hawaii. The purpose of this research was to gain new knowledge about hip fracture in Hawaii to plan and target appropriate services and design preventive measures. Peer Review Organization Medicare data were analyzed for persons age 65+ over a 4-year period. Average length of hospital stay was 20 days resulting in an average estimated charge per hospitalization of $20,000. Of those with E-Codes, 94% sustained falls. Fifty-five percent had one or more complicating illness. Unexpected significant differences were found among the islands: the average annual hospitalization incidence rate/1,000 on Kauai (8.4) was almost twice that of the Island of Hawaii (4.4), and Maui (3.9), and significantly greater than Oahu (5.4), primarily in women over 85. The island differences raise important questions in need of investigation, and suggest target populations and locations for prevention.

Aged↗
PubMed1990

Atherosclerosis in Japanese in Japan and in Hawaii: a summary review of pathology studies in Honolulu and Hiroshima.

The mortality rate from heart disease is much higher among the Japanese of Hawaii than those of Japan. A comparison of autopsy specimens from men who died in Honolulu and Hiroshima indicated that this difference can be explained by more frequent myocardial infarcts in the Hawaii population. The basis for this difference can, in turn, be explained by the presence of more severe degrees of coronary atherosclerosis among the Hawaii men. The mortality rates for stroke, on the other hand, are higher among the indigenous Japanese than among Hawaii Japanese men. The basis for this difference cannot be explained on the basis of atherosclerosis of the aorta or of the circle of Willis. This report summarizes the comparative anatomic studies of coronary arteries, aorta and circle of Willis that form the basis for these conclusions.

Aorta↗
PubMed1989

Citizens' groups rank Hawaii 51st in the nation.

This special edition of the Hawaii Medical Journal presents a collection of articles that describe and comment upon the spectrum of health care services for the seriously disabled mentally ill (SDMI) in Hawaii. It is but one of several statewide responses to the publication, "Care of the Seriously Mentally Ill; A Rating of State Programs," by E. Fuller Torrey, MD, Sidney M. Wolfe, MD and Laurie M. Flynn, Second Edition, 1988. Published jointly by the Public Citizen Health Research Group and the National Alliance for the Mentally Ill, first in 1986 and again in 1988; the study sought to compare and rate all states, plus the District of Columbia, using hospital, outpatient, rehabilitation and housing services as indices of care. The published results ranked Hawaii last (51st) in the Nation in its care of the SDMI in both years of the survey. On a scale of 1 to 20, no state ranked higher than a total of 14 points across the four categories of care (Table 1: Summary of State Ratings by Points). Additionally, only 12 states showed significant improvement between 1986 and 1988. Hawaii is included among those states deemed to be "going nowhere."

Community Mental Health Centers↗
PubMed1985

Multiethnic studies of diet, nutrition, and cancer in Hawaii.

Epidemiologic studies of diet and cancer have been facilitated in Hawaii by the multiethnic composition of its population and the consequent heterogeneity in dietary intakes. Studies of migrant populations, particularly the Japanese, have firmly supported the conclusions that environmental factors are of predominant etiologic significance for most major sites of cancer, and that these factors may exert their influences at particular periods of life. Recent observations on Filipino migrants reproduce most of the findings in the Japanese, although they do not show the same abrupt increase in colon cancer rates to the high levels found in Caucasians. Data on dietary intakes in these populations support several of the prevailing hypotheses regarding the etiology of certain gastrointestinal and hormone-dependent cancers. Several case-control studies of diet and cancer have been completed or are ongoing in Hawaii. Some of these have included comparable studies in Japan, but the findings in Hawaii have generally not been reproduced in Japan. Weak associations with dietary fat have been found in Hawaii for breast cancer (particularly in Japanese women) and for prostate cancer (particularly in men greater than or equal to 70 years of age). Vitamin A (especially carotene) has been shown to be inversely associated with lung cancer risk in men, but positively associated with prostate cancer risk in older men. Vitamin C may be inversely related to bladder cancer risk, but has shown no relationship to lung or prostate cancer risk. These and other findings are discussed in terms of future needs for epidemiologic research in this field.

Diet↗