Hawaii medical journal最新文献

Introduction: Traditional Hawaiian thought places children in a position of prominence in the family. Yet in Hawai'i, Native Hawaiian children and adolescents face significant inequity in health outcomes. From prenatal alcohol and tobacco use, late or no prenatal care, macrosomia as well as low birth rates, to exclusive breastfeeding rates at 6 months, and high rates of infant mortality, Native Hawaiians face inequities in pre and early childhood indicators. During childhood and adolescence, Native Hawaiians experience high rates of obesity, and physical, mental and sexual abuse. This review examines the determinants behind the health inequities encountered by Native Hawaiian children and adolescents, and contextualizes those inequities s in a human rights-based approach to health.

Methods: A literature review was conducted for relevant research on Native Hawaiian and other indigenous children and adolescents. Existing data sources were also reviewed for relevant Native Hawaiian data.

Results: There is a significant dearth of data on the determinants of health for Native Hawaiian children and adolescents. Some prenatal data is available from the Prenatal Risk Assessment Monitoring System, while selected youth data is available from the Youth Behavioral Risk Factor system. Available data show significant inequities for Native Hawaiian children and adolescents, compared to other groups in Hawai'i. Based on comparisons with other indigenous and marginalized peoples, the etiology of these disparities may be a lack of health equity, deriving from multigenerational trauma and discrimination as well as poverty and inequities of housing, education, environment, healthcare access, and social capital.

Conclusions: The significant barriers facing Native Hawaiian children and adolescents achieving their full potential constitute a challenge to the fulfillment of the human right to health. Future research needs to more fully articulate the linkage between the health status of Native Hawaiian children and adolescents, the determinants of that status, and the requirements of the human right to health. Needed particularly are longitudinal studies which provide data that may link multigenerational trauma and discrimination to poverty and other factors, ultimately producing healthy inequity for Native Hawaiian children and adolescents.

To meet the needs of a more diverse population, a culturally sensitive approach to end-of-life communication is critical. This paper describes a unique communication workshop that introduces future physicians to the delivery of culturally responsive care for patients in palliative and end-of-life treatment. The workshop is embedded within the required fourth year medical student rotation in Geriatrics and Palliative Care. Using case-vignettes, role playing, and small group discussions, content areas include: breaking bad news, discussing advanced directives, and decisions regarding withdrawal or withholding of treatment. Post workshop student evaluations reveal an overwhelmingly favorable response to the curriculum, with high scores for overall quality of the workshop, practical value, and appropriateness for level of training. This workshop meets the goal for all graduating medical students to engage in culturally competent palliative and end of life patient care.

Background: Culturally competent health care providers are needed to eliminate healthcare disparities. In the State of Hawai'i, Native Hawaiians suffer some of the worst health disparities. Prior to implementing a cultural competency curriculum to address these disparities, the John A. Burns School of Medicine's Department of Native Hawaiian Health Cultural Competency Curriculum Development team asked Native Hawaiian patients about their experiences and recommendations.

Methods: We conducted four focus groups of Native Hawaiians to obtain recommendations on physician training, to be incorporated into the curriculum. Participants came from both rural and urban areas. Classical qualitative analysis of data identified recurrent themes.

Results: Five primary themes, arising in all four groups, were: (1) customer service; (2) respect for the patient; (3) inter-personal skills; (4) thoroughness of care; and (5) costs of medical care. Secondary themes, occurring in three of the four groups, were: (1) cultural competency training; (2) the training of medical office staff; (3) continuity of care; and (4) the role of the patient. Participants specifically requested that medical students receive cultural competency training about the host culture, its history, values, and traditional and alternative healing practices.

Discussion: The emphasis participants placed on the need for cultural competency training of physicians supports the need to address the role of culture in medical education. Although most of the issues raised are not unique to Hawai'i, participants' recommendations to teach students about the host culture and traditional healing practices identify important themes not usually found in medical school curricula.

The Federated States of Micronesia (FSM) and other countries throughout the Pacific are facing an epidemic of non-communicable disease health problems. These are directly related to the increased consumption of unhealthy imported processed foods, the neglect of traditional food systems, and lifestyle changes, including decreased physical activity. The FSM faces the double burden of malnutrition with both non-communicable diseases and micronutrient deficiencies, including vitamin A deficiency and anemia. To help increase the use of traditional island foods and improve health, the Island Food Community of Pohnpei has initiated a program in the FSM to support and promote local food policies, along with its Go Local awareness campaign. Such local food policies are defined broadly and include individual and family commitments, community group local food policies and policies established by government, including presidential proclamations and increased taxation on soft drinks. The aim of this paper is to describe this work. An inter-agency, community- and research-based, participatory and media approach was used. Partners are both non-governmental and governmental. The use of continuing awareness work along with local food policy establishment and the acknowledgement of the individuals and groups involved are essential. The work is still in the preliminary stage but ad hoc examples show that this approach has had success in increased awareness on health issues and improving dietary intake on both an individual and group basis. This indicates that further use of local food policies could have an instrumental impact in FSM as well as other Pacific Island countries in promoting local foods and improving dietary intake and health, including the control of non-communicable diseases and other dietary-related health problems.

Objective: Breast cancer rates are increasing among Samoan and other Pacific Islander women, yet studies of their social support needs are nearly non-existent. The purpose of this paper is to report on the cultural dimensions of social support among Samoan breast cancer survivors in Southern California.

Methods: Data for this paper came from a larger one-and-a-half year study of the social support needs of Samoan breast cancer survivors and their family and friends. In-depth, retrospective, qualitative interviews were conducted with a purposeful sample of 20 Samoan survivors who were recruited from an existing social support program as well as the general community.

Results: We documented important informational needs and behaviors, social support needs and experiences, and spirituality issues for the Samoan breast cancer survivors.

Conclusions: Our findings underscore the need for culturally-specific social support services for Samoans, as well as the necessity of community-based participatory research to define and explore social support and other survivorship needs in this understudied population. Recommendations from the community report-back, stressed the importance of expanding community Samoan cancer social support groups through collaborations with Samoan leaders and churches.

Significance: The Pacific Regional Cancer Coalition (PRCC) provides regional leadership in the U.S. Affiliated Pacific Islands (USAPI) to implement the Regional Comprehensive Control Plan: 2007-2012, and to evaluate its coalition and partnerships. The Pacific Center of Excellence in the Elimination of Disparities (CEED), aims to reduce cancer disparities and conducts evaluation activities relevant to cancer prevention and control in the USAPI.

Purpose: The PRCC Self (internal) and Partner (external) Assessments were conducted to assess coalition functioning, regional and national partnerships, sustainability, and the role of regionalism for integrating all chronic disease prevention and control in the Pacific.

Methods: Self-administered questionnaires and key informant telephone interviews with PRCC members (N=20), and representatives from regional and national partner organizations were administered (N=26). Validated multi item measures using 5-point scales on coalition and partnership characteristics were used. Chronbach's alphas and averages for the measures were computed.

Results: Internal coalition measures: satisfaction (4.2, SD=0.48) communication (4.0, SD=0.56), respect (4.0, SD=0.60) were rated more highly than external partnership measures: resource sharing (3.5, SD=0.74), regionalism (3.9, SD=0.47), use of findings (3.9, SD=0.50). The PRCC specifically identified its level of "collaboration" with external partners including Pacific CEED. External partners identified its partnership with the PRCC in the "coalition" stage.

Principal conclusions: PRCC members and external partners are satisfied with their partnerships. All groups should continue to focus on building collaboration with partners to reflect a truly regional approach to sustain the commitment, the coalitions and the programming to reduce cancer in the USAPI. PRCC and partners should also work together to integrate all chronic disease prevention and control efforts in the Pacific.

Introduction: Cnidarian, or jellyfish, stings are a common malady in tropical Emergency Departments. There are limited studies examining cnidarian stings in the United States. The team investigated the epidemiology and treatments for jellyfish stings presenting to an urban emergency department (ED) in Honolulu, Hawai'i.

Methods: The team performed a retrospective chart analysis of stings presented between 2000 and 2008. A total of 116 patients were identified. Charts were reviewed for patient demographics, incident characteristics, patient arrival condition, and treatments given in the emergency department.

Results: The median age was 24 years (range 9-85). Of patients 58% were men, 64% were Hawai'i non-residents, and 23 % arrived between the hours of 10pm and 2 am. Emergency Medical System transported 64%, and 65% arrived with normal vital signs. Twenty-four different types of IV/PO medications were administered and patients received up to 5 different medications per visit. Intravenous medications were given to 64%. All patients were eventually discharged home from the ED.

Discussion: Risk factors for cnidarian stings include being men, being a Hawai'i non-resident, and nighttime ocean activities. Stings were treated with various medications and routes suggesting that there is no current standard of care for stings. This study suggests that there is a need for public health interventions tailored to tourists. Prevention and education of home treatment could decrease the cost of health care by decreasing ambulance transports and total number of ED visits for a non-urgent disease.