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PubMed1986

Adenomatous polyps and atherosclerosis: an autopsy study of Japanese men in Hawaii.

It is generally accepted that most colorectal cancers arise from adenomatous polyps and most coronary heart disease is caused by severe atherosclerosis. In order to compare the frequency of these disease precursors in men of Japanese ancestry in Hawaii, the degree of atherosclerosis of the aorta and coronary arteries was estimated by the panel method in 288 male autopsy subjects. The extent of atherosclerosis was then compared in men who did or did not have adenomatous polyps as determined at autopsy. The degree of atherosclerosis of the coronary arteries and aorta was positively and significantly related not only to the presence of adenomatous polyps, but to their size, multiplicity, and degree of atypia as well. This study suggests that shared environmental events could account for the development of severe atherosclerosis and adenomatous polyps. At the same time, it has been observed that hawaii Japanese men experience colon and rectal cancer rates higher than those of US Whites, but their coronary heart disease (CHD) rates are intermediate between the low rates of Japan and the high rates of the US white population. These differences in disease trends and differences in the serum cholesterol and fat intake of Hawaii Japanese men with CHD and colon cancer have suggested that men with these diseases represent different subsets of the westernized Japanese population. If CHD and colon cancer occur in different subsets of this population, they must stem from the accumulation of other risk factors superimposed upon the initiators of their precursor lesions.

Aged↗
PubMed2002

Epidemiology of Down syndrome (Trisomy 21), Hawaii, 1986-97.

BACKGROUND: The live birth prevalence of Down syndrome is approximately 10 per 10,000 live births in the United States. Down syndrome prevalence has been reported to change over time and to vary by selected demographic factors. METHODS: Data from a population-based birth defects registry in Hawaii involving 363 Down syndrome cases delivered during 1986-97 were used to calculate overall prevalence and to investigate secular trends and differences by selected demographic factors. RESULTS: The total (live birth, fetal death, and elective termination) prevalence was 14.74 per 10,000 live births and fetal deaths. The unadjusted live birth prevalence was 8.67 per 10,000 live births. The adjusted live birth (live births and proportion of elective terminations expected to have resulted in live births) prevalence was 12.59 per 10,000 live births. No significant secular trends were observed for either total prevalence (P = 0.688) or adjusted live birth prevalence (P = 0.604). The total Down syndrome prevalence per 10,000 live births was highest for Far East Asians (22.01), followed by whites (17.06), Filipinos (15.94), and Pacific Islanders (9.21). Prevalence per 10,000 births was higher in metropolitan Honolulu (18.57) than in the rest of Hawaii (14.15). After adjusting for maternal age, however, the differences within the demographic groups were not statistically significant. CONCLUSIONS: The live birth prevalence of Down syndrome in Hawaii during 1986-97 was lower than reported in the literature. Prevalence did not change significantly over time. Any differences in prevalence by maternal race/ethnicity and place of residence appeared to result from differences in maternal age distribution.

Adult↗
PubMed1981

Trends in the anatomical distribution of colorectal carcinoma in Hawaii, 1960-1978.

The incidence of colorectal adenocarcinoma increased in the five major ethnic groups in Hawaii, but more in men than women. The highest rates were in the Chinese and Japanese. The site-specific time trend patterns revealed that the greatest increase occurred in rectosigmoid cancer, followed by cancer of the sigmoid colon and the transverse descending colon. Rectal cancer had minimal changes in rates over time. The comparison of site-specific rates between the Japanese in Hawaii and Miyagi Prefecture, Japan, showed that the occurrence of cancer of the rectosigmoid, sigmoid, and transverse descending colon was far greater in Hawaii than Miyagi with minimal differences in the rates of rectal cancer. The findings from this study indicate that the separate anatomical locations of colorectal cancer probably have some distinct etiologies that need further investigation.

Adenocarcinoma↗
PubMed2006

Comparison of characteristics and survival of colorectal cancer between Japanese-Americans in Hawaii and native Japanese in Japan.

PURPOSE: This study was designed to investigate whether characteristics, prognostic risk factors, and survival of colorectal cancer of Japanese-Americans in Hawaii are different from those of native Japanese in Japan. METHODS: A retrospective review of patients with colorectal cancer surgically resected in single institutions in Hawaii and Japan from 1996 to 2002. RESULTS: A total of 410 Japanese-American patients (218 males; median age, 73 years) and 621 native Japanese patients (382 males; median age, 65 years) were included. There were significant differences in age (P < 0.001), age distribution (P < 0.001), gender (P = 0.008), preoperative carcinoembryonic antigen (P < 0.001), and anatomic site distribution (P < 0.001). The tumor characteristics of Japanese-American patients were close to the general American population compared with the Surveillance, Epidemiology, and End Results data. There were no differences in tumor size, histologic grade, each of T, N, M status and TNM stage between the two groups. The overall five-year survival rates (Japanese-Americans, 75.5 percent; native Japanese, 76.2 percent; P = 0.55) and survival rates in each of four stratified stages were similar. Risk factors associated with survival were not different, except for carcinoembryonic antigen (P = 0.036). CONCLUSIONS: In patients with colorectal cancer in Japanese-Americans in Hawaii, some of tumor characteristics have changed from those of native Japanese in Japan. However, there are no remarkable differences in prognostic factors and survival between the two groups. The present study suggests that certain changes of colorectal cancer characteristics that were seen in Japanese-American may occur in native Japanese in Japan in the near future, although the survival outcome of colorectal cancer may remain the same.

Adult↗
PubMed1993

Basal cell carcinoma in Kauai, Hawaii: the highest documented incidence in the United States.

BACKGROUND: In Kauai, Hawaii, we observed an exceedingly high incidence of basal cell carcinoma in an earlier 1-year study. OBJECTIVE: Our purpose was to report the incidence of basal cell carcinoma in a defined population in Hawaii. METHODS: A prospective 5-year population-based incidence study was conducted on Kauai, Hawaii, between 1983 and 1987 to investigate the frequency of basal cell carcinomas in Caucasian residents. A total of 242 residents, 161 men and 81 women, were identified with an initial episode of basal cell carcinoma during the 5-year period. RESULTS: The average annual incidence per 100,000 Kauai Caucasian residents standardized to the 1980 U.S. white population was 576 for men and 298 for women with a combined incidence of 422. The average patient age was 56.5 years, and men had a significantly higher incidence of cancer than women (p < 0.000001). The head and neck was the most common site. The trunk was the second most common site, representing one third of lesions. Subsequent new basal cell carcinomas occurred in 16.9% of patients. Only 3.3% of patients had recurrent carcinomas after treatment. CONCLUSION: Kauai's incidence rates of basal cell carcinoma are the highest yet documented in the United States. As an unexpected finding, a decreasing incidence trend was noted in the study's later years and may warrant further investigation. Finally, a significant number of basal cell carcinomas developed on the trunk, suggesting and reinforcing the expectation that sun exposure is not limited to the face and neck in this Hawaiian population.

Adult↗
PubMed2005

Epidemiology of oesophageal atresia and tracheo-oesophageal fistula in Hawaii, 1986-2000.

The most common major birth defects affecting the oesophagus and trachea are oesophageal atresia (OA) and tracheo-oesophageal fistula (TOF). Epidemiological information on OA and/or TOF in the USA has been derived from only a few populations. Sixty-one cases of OA or TOF were identified through a population-based birth defects registry in Hawaii during 1986-2000. The relationship between various clinical and demographic factors and OA or TOF were examined. The rate of OA or TOF was 2.2 per 10,000 live births. The cases were 67.2% OA with TOF, 21.3% TOF alone, and 11.5% OA alone. Risk of OA or TOF was significantly higher among multiple births and live births with low birth weight and gestational age. The risk of OA or TOF was significantly higher for whites. The rate of OA or TOF was consistent with that reported elsewhere. The risk of the defects differed significantly between the major racial/ethnic groups in Hawaii. The impact of many factors on OA or TOF in Hawaii was similar to that reported elsewhere.

Adult↗
PubMed2005

Risk factors for infection during a dengue-1 outbreak in Maui, Hawaii, 2001.

Autochthonous dengue virus transmission, last identified in the state of Hawaii in 1945, was detected again in 2001. A seroepidemiological survey in a high-incidence community (Nahiku) and a nearby low-incidence community (Hana Subdivision) was implemented. The two communities studied differed in median household size (two vs. four persons), median lot size (2.8 vs. 0.8acres), proportion of households with mosquito larvae (81 vs. 28%) and incidence of recent infection (39% [28/72] vs. 1% [1/131]). The average number of reported anti-mosquito actions by residents of both locations remained low, and approximately 50% (42/80) of the inspected houses had larvae, evidencing the need for more effective community mosquito control. Logistic regression analysis of risk factors for infection in Nahiku identified residing in properties with birds in the house or yard as significantly associated with infection (odds ratio 7.0, 95% CI 1.7-28.5), probably as an indicator of unspecified environmental characteristics that were attractive to the vector. We documented that nearly 40% of Nahiku residents had acquired dengue locally in 2001 and that undetected dengue outbreaks had occurred in Hawaii. Our data suggest that ecological characteristics may help Hawaii health officials identify communities at increased risk of dengue infection.

Adolescent↗
PubMed2006

Reducing minors' access to tobacco: eight years' experience in Hawaii.

OBJECTIVE: This paper reports the findings of annual Synar inspections to assess compliance with federal and state legislation to limit minors' access to tobacco products in Hawaii. We also report on factors associated with selling tobacco to minors for the most recent year of inspections (2003). METHODS: Annual, random, unannounced inspections were conducted by minors (ages 14-17 years) over an 8-year period (1996-2003). Stores were randomly selected from a list of stores that sell tobacco products in Hawaii. RESULTS: There was a significant decrease in the percent of successful purchases made over the period from 1996 (44.5%) to 2003 (6.2%). Based on multivariate analyses, only two variables were associated with whether a successful purchase was made in 2003: whether the minor's identification or age was requested. CONCLUSION: Findings suggest that surveillance, education, and enforcement efforts in Hawaii have been successful at making substantial reductions in noncompliance rates. Even with the current low rate of sales to minors, failing to request the minor's identification or age was associated with making a successful purchase, while characteristics of the minor and retail environment were not.

Adolescent↗
PubMed1995

Cat-scratch disease in Hawaii: etiology and seroepidemiology.

OBJECTIVE: To study the etiology and seroepidemiology of cat-scratch disease (CSD) in Hawaii. METHODS: Blood and fine-needle aspirate (FNA) from the lymph nodes of 39 consecutive patients with clinical CSD were cultured for Bartonella henselae, and blood samples from index cats, stray cats, and dogs were cultured and their sera were tested by indirect fluorescence antibody test for antibodies to B. henselae and Afipia felis. Sera from age- and sex-matched human subjects without cat exposure served as controls. RESULTS: Warthin-Starry staining showed positive results in only 4 of 32 FNAs, and B. henselae was isolated from only one FNA specimen. All of 38 patients who had two or more sera tested had elevated titers of antibody to B. henselae. Only 1 of 48 human control sera had antibody to B. henselae. Of 31 kittens, 21 had positive blood culture results and elevated antibody titers to B. henselae. Of three adult cats, all had negative blood culture results, but they had serologic evidence of past infection. Of 23 adult stray cats, 18 had elevated titers of antibody to B. henselae, but in only one was the blood culture result positive. Results of IFA tests were marginally positive for A. felis in 1 of 29 patients with CSD and in one adult stray cat and one dog. CONCLUSIONS: This study shows that the B. henselae IFA test is both highly sensitive and specific for the detection of infection caused by B. henselae and for the laboratory diagnosis of CSD, and that FNA is seldom helpful in confirming the diagnosis. We further demonstrated that CSD in Hawaii is due to B. henselae and that infection is directly linked to the scratch or bite of a kitten. Older cats seldom have bacteremia but often have serologic evidence of past infection. Our study fails to implicate dogs in the epidemiology of CSD in Hawaii, and A. felis was not etiologically implicated in CSD in the human subjects and animals we studied.

Adolescent↗
PubMed1997

Incidence rates of falls among Japanese men and women living in Hawaii.

Japanese people in both Japan and in Hawaii have a lower incidence of hip fractures than white people in Hawaii or on the mainland of the United States. Hip fractures usually occur after a fall, and differing incidence rates of falls might contribute to the observed differences in hip fracture rates. To investigate this possibility we undertook a prospective study of falls among elderly Japanese men and women living in Hawaii using intensive surveillance methods similar to those used in studies of predominantly white populations. For our Japanese participants, the incidence rates of total falls were 139 per 1000 person years for men and 276 per 1000 person years for women. Age adjusted rate ratios of falls for predominantly white populations compared with our Japanese participants ranged from 1.8 to 2.3 for women and from 2.6 to 4.7 for men. The risk of injuries when they did fall, however, was not lower for our Japanese participants than reported for white participants. For our Japanese population, past falls, female gender, and daytime hours were associated with an increased incidence of falls.

Accidental Falls↗
PubMed2001

The genome of hawaii virus and its relationship with other members of the caliciviridae.

Hawaii virus (Hu/NLV/GII/Hawaii virus/1971/US), a member of the genus 'Norwalk-like viruses' (NLVs) in the family Caliciviridae, has served as one of the reference strains for the fastidious caliciviruses associated with epidemic gastroenteritis in humans. The consensus sequence of the RNA genome of Hawaii virus was determined in order to establish its relatedness with other members of the family. The RNA genome is 7,513 nucleotides (nts) in length, excluding the 3'-end poly (A) tract, and is organized into three major open reading frames (ORFI, nts 5-5,104; ORF2, nts 5,085-6,692; and ORF3, nts 6,692-7,471). Phylogenetic analysis showed the closest relatedness of Hawaii virus throughout its genome to Lordsdale virus, a Genogroup II NLV. Analysis of the predicted secondary structure of the RNA from the 5'-end of the genome and the putative beginning of the subgenomic RNA showed the presence of two hairpin structures at both ends that are similar to each other and to those of other NLVs.

3' Untranslated Regions↗
PubMed1999

Changing pregnancy outcomes of Samoan women in Hawaii.

In the state of Hawaii, Samoan mothers are known for the large average birthweight and low percentage of low birthweight (< 2500 g) of their infants, in spite of the relatively low socio-economic status of the population. This paper reports the findings of a temporal trend analysis of birth outcomes of Samoan women and identifies worrying changes. Data were obtained from Hawaii birth certificates. Single live births to Hawaii-resident Samoan and Caucasian women from 1979 to 1994 were included in the study. Infants of Samoan women experienced a 75 g decline in mean birthweight and an increase in the percentage of low (< 2500 g) and very low (< 1500 g) birthweight from 2.6 and 0.4 to 3.8 and 0.8 respectively. During the same time, infants of Caucasian mothers experienced an increase in mean birthweight and a decline in low birthweight, while very low birthweight did not change. Maternal socio-demographic characteristics explained only part of the findings and use of prenatal care did not appear to be associated with any birth outcome indicators. Multiple regression analyses identified an adjusted loss of 50.8 g in birthweight and a 1.48 increase in the odds ratio of small-for-gestational-age associated with birth at the end (1991-4) compared with the beginning (1979-82) of the study period. Further studies focusing on maternal health status and psycho-social variables, including the effect of acculturation-related stress, are warranted to identify at least some of the determinants of the changes identified by this analysis.

Adolescent↗
PubMed2002

Newly imported larval parasitoids pose minimal competitive risk to extant egg-larval parasitoid of tephritid fruit flies in Hawaii.

Competitive displacement of fruit fly parasitoids has been a serious issue in the history of fruit fly biological control in Hawaii. This concern regarding competitive risk of new parasitoids has led to an overall tightening of regulations against the use of classical biological control to manage fruit flies. Fopius arisanus (Sonan), an egg-larval parasitoid, is the most effective natural enemy of tephritid fruit flies in Hawaii. This study evaluated the competitive risk of two recently introduced larval parasitoids, Diachasmimorpha kraussii Fullaway and Psyttalia concolor (Szépligeti), to F. arisanus attacking the Mediterranean fruit fly, Ceratitis capitata (Wiedemann). Fopius arisanus won almost all intrinsic competitions against both larval parasitoids through physiological suppression of egg development. 83.3% of D. kraussii eggs and 80.2% of P. concolor eggs were killed within three days in the presence of F. arisanus larvae within the bodies of multi-parasitized hosts. The mechanism that F. arisanusemploys to eliminate both larval parasitoids is similar to that it uses against three other early established larval fruit fly parasitoids: F. vandenboschi (Fullaway), D. longicaudata (Ashmead) and D. tryoni (Cameron). It suggests that introduction of these larval parasitoids poses minimal competitive risk to F. arisanus in Hawaii.

Animals↗
PubMed2005

Breast cancer treatment among women of different ethnicity in Hawaii.

BACKGROUND: An analysis of breast cancer survival for Hawaii's multiethnic women in the 1970s and 1980s showed that Hawaiian and Filipino women experienced a worse survival than their Caucasian and Japanese counterparts even after controlling for stage at diagnosis. We conducted this study to test for ethnic differences in treatment compliance with established guidelines while adjusting for stage at diagnosis and other disease characteristics. METHODS: A total of 406 newly diagnosed breast cancer patients identified through the Hawaii Tumor Registry were available for this project. Two hundred fifty-nine patients of the sample were from Hawaii's predominant fee-for-service multiple private office/community hospital setting and 147 patients were members of a Health Maintenance Organization (HMO). The primary measures assessed were treatment received, ethnicity, age at diagnosis, cancer stage, hormone receptor status, comorbidity, and treatment toxicities. Physician's Data Query (PDQ) guidelines were used as the standard of care. We examined whether there were ethnic-related differences in compliance with PDQ treatment guidelines according to stage at diagnosis. RESULTS: Overall, 25 percent of the sample did not receive treatment that was specifically recommended by PDQ guidelines and 7 percent received treatment that was not recommended by PDQ for the patients' stage of disease. There were no statistically significant ethnic-related differences in compliance with PDQ guidelines. Although not statistically significant, Caucasians and Japanese were less likely than other groups to receive axillary lymph node sampling/dissection and Chinese were more likely than other groups to receive chemotherapy when it was not specifically recommended by the PDQ. There was no difference in adherence to PDQ guidelines between the sample treated in a fee-for-service setting and the sample treated by the HMO. Hawaiians and Chinese experienced lower levels of Grade 3 and 4 chemotherapy-related toxicities than other groups. CONCLUSION: The results of this study do not suggest that treatment compliance with established guidelines differs by ethnicity. Our unexpected finding that Hawaiian and Chinese women experienced lower levels of Grade 3 and 4 chemotherapy-related toxicities deserves further investigation.

Aged↗
PubMedDate not supplied

Changes in the association of low birth weight with socioeconomic status in Hawaii: 1970-1990.

This study examines rates of low birth weight (LBW) in the state of Hawaii and changes in the association of LBW with socioeconomic status from 1970 to 1990. The analysis is based on aggregate data for census tracts. Rates of low birth weight were calculated for each census tract. Relative socioeconomic scores were calculated from average household income and years of education. The results show that (1) there was a decrease in the rate of low birth weight infants in Hawaii; and (2) that the correlation between socioeconomic status and low birth weight was substantially reduced, though a significant correlation remains. The paper suggests likely ceiling effects, but that the progressive public health policies and expansion of access to primary health care in Hawaii during this period played a major role in reducing the rate of low birth weight infants and in decreasing socioeconomic inequality on this important health indicator.

Educational Status↗
PubMed1998

Impact of prenatal diagnosis and elective termination on the prevalence of selected birth defects in Hawaii.

This study examined the effect of prenatal diagnosis and elective termination on the prevalence of neural tube defects, oral clefts, abdominal wall defects, and chromosomal anomalies in Hawaii by using actively ascertained surveillance data collected between 1987 and 1996 by the Hawaii Birth Defects Program. Because the Program has nearly universal access to prenatal diagnostic information and to follow-up data on elective terminations, Hawaii is an ideal setting in which to study their effects on prevalence rates of birth defects. Except for oral clefts, a large proportion of the defects studied were prenatally diagnosed: anencephaly (87%), spina bifida (62%), encephalocele (83%), cleft palate (0%), cleft lip with or without cleft palate (14%), omphalocele (60%), gastroschisis (76%), Down syndrome (43%), trisomy 18 (61 %), and trisomy 13 (40%). The effect of elective terminations on the birth prevalence rates for most of these birth defects was significant. Including electively terminated cases in the calculations of birth prevalence rates increased the rates by more than 50% for five of the 10 birth defects studied.

Abortion, Induced↗
PubMed1975

Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: blood pressure distributions.

Blood pressure measurements were made on three Japanese populations residing in Japan, Honolulu, and Northern California. A common protocol was utilized in an effort to standardize inter-observer variability. Zero terminal digit preference varied among the three areas and there was differential clustering of diastolic values at 80 mm Hg and 90 mm Hg in Hawaii and California, respectively. Diastolic blood pressure did not rise with age in any of the three populations while systolic blood pressure rose in each. Blood pressure levels in Japanese in Japan were intermediate to those in Hawaiian and Northern California Japanese, California having the higher blood pressure levels. Since the relative weights of the Japanese migrants to Hawaii and California were substantially higher than the relative weights of the non-migrant populations in Japan, the blood pressures were adjusted for these differences. When this was done, most of the differences among the various study subgroups were explained. The findings indicate that the blood pressure distributions of the Japanese populations residing in Japan, Hawaii, and Northern California cannot of themselves account for the observed differences in coronary heart disease and stroke occurrence among these populations in which there is a gradient from high stroke rates in Japan to low rates in California and a reverse trend for coronary heart disease.

Age Factors↗
PubMed1984

Evidence for the extinction of plague in Hawaii.

Plague (infection by Yersinia pestis) was present in Hawaii for the period 1899-1957 and caused at least 370 fatalities. The first infections came from immigrant commensal rats, probably Rattus rattus and Rattus norvegicus, on ships from the Orient. Both species were already established in Hawaii and became the widespread local carriers of plague, supplemented by Rattus exulans which had colonized the islands in ancient Polynesian times. The flea Xenopsylla vexabilis arrived with R. exulans, and its near relative Xenopsylla cheopis accompanied the ship rats. Following each introduction to port cities, plague subsided after a few years but remained active in rural areas of two islands for nearly 50 years. In Hamakua District on Hawaii, the demise of plague was characterized by its repeated terminal migrations from persistent foci, a rapid decline in expected numbers of infected rats and fleas, and negative serologic evidence from rodent reservoirs and mongooses in massive surveys. The simple biotic system--bacterium, three rodents, and two fleas--appeared unable to maintain the disease over time. Improved sanitation, mechanized agriculture, gradients in rainfall and temperature, and the collapse of reservoir and vector populations during drought are cited as probable factors in the extinction of plague.

Animals↗