Hawaii medical journal最新文献

Race and ethnicity are commonly used predictor variables in medical and public health research. Including these variables has helped researchers to describe the etiology of certain disease states. Including race and ethnicity in research has been hypothesis generating in terms of the relationship between genetic and environmental factors in the development of disease. Eliminating health disparities among different racial and ethnic groups has become a national priority. However, incorporating race and ethnicity into health research is complex because these variables are difficult to define and individuals often identify with more than one race or ethnicity. As a "minority-majority", multiethnic, multiracial state, Hawai'i faces unique challenges in incorporating race and ethnicity into research. As the demographics of the United States continue to evolve, many of the challenges faced in Hawai'i will apply to the United States as a whole.

Background: Childhood obesity prevention is a national priority. School-based gardening has been proposed as an innovative obesity prevention intervention. Little is known about the perceptions of educators about school-based gardening for child health. As the success of a school-based intervention depends on the support of educators, we investigated perceptions of educators about the benefits of gardening programs to child health.

Methods: Semi-structured interviews of 9 middle school educators at a school with a garden program in rural Hawai'i were conducted. Data were analyzed using a grounded theory approach.

Results: Perceived benefits of school-based gardening included improving children's diet, engaging children in physical activity, creating a link to local tradition, mitigating hunger, and improving social skills. Poverty was cited as a barrier to adoption of healthy eating habits. Opinions about obesity were contradictory; obesity was considered both a health risk, as well as a cultural standard of beauty and strength. Few respondents framed benefits of gardening in terms of health.

Conclusions: In order to be effective at obesity prevention, school-based gardening programs in Hawai'i should be framed as improving diet, addressing hunger, and teaching local tradition. Explicit messages about obesity prevention are likely to alienate the population, as these are in conflict with local standards of beauty. Health researchers and advocates need to further inform educators regarding the potential connections between gardening and health.

While surgical abortion is a safe procedure, the most common complication is excessive bleeding. Methods to conservatively manage hemorrhage are gaining popularity. The authors present a case of a Cesarean scar rupture that occurred after an intrauterine balloon tamponade was placed to treat postabortion bleeding.

Acquired isolated renal phosphate wasting associated with a tumor, known as oncogenic osteomalacia or tumor-induced osteomalacia, is a rare paraneoplastic syndrome caused by overproduction of fibroblast growth factor 23. Oncogenic osteomalacia is usually associated with benign mesenchymal tumors. Syndrome of inappropriate antidiuretic hormone secretion (SIADH), on the other hand, is a common paraneoplastic syndrome caused by small cell carcinoma (SCC). Concomitant oncogenic osteomalacia and SIADH associated with SCC is very rare with only 4 other cases reported in the literature. The authors report a case of small cell lung cancer (SCLC)-related renal wasting hypophosphatemia and concurrent SIADH, and review the literature reporting 9 other cases of SCC associated with oncogenic osteomalacia. Almost half of reported cases of renal phosphate wasting associated with SCC concomitantly presented with SIADH. These cases had initial serum phosphorus level lower and survival periods shorter than those without SIADH. This rare combination of a dual paraneoplastic syndrome and low serum phosphorus may be a poor prognostic sign. In addition, both renal phosphate wasting and SIADH usually occur in a short period of time before identification of SCC. Therefore, renal wasting hypophosphatemia with concomitant SIADH/hyponatremia should prompt a search for SCC rather than a benign mesenchymal tumor.

Increasing active transportation to and from school may reduce childhood obesity rates in Hawai'i. A community partnership was formed to address this issue in Hawai'i's Opportunity for Active Living Advancement (HO'ĀLA), a quasi-experimental study of active transportation in Hawai'i County. The purpose of this study was to determine baseline rates for active transportation rates to and from school and to track changes related to macro-level (statewide) policy, locally-based Safe Routes to School (SRTS) programs and bicycle and pedestrian planning initiatives expected to improve the safety, comfort and ease of walking and bicycling to and from school. Measures included parent surveys, student travel tallies, traffic counts and safety observations. Assessments of the walking and biking environment around each school were made using the Pedestrian Environment Data Scan. Complete Streets and SRTS policy implementation was tracked through the activities of a state transportation-led Task Force and an advocacy-led coalition, respectively. Planning initiatives were tracked through citizen-based advisory committees. Thirteen volunteer schools participated as the intervention (n=8) or comparison (n=5) schools. The majority of students were Asian, Native Hawaiian, and Pacific Islander in schools located in under-resourced communities. Overall, few children walked or biked to school. The majority of children were driven to and from school by their parents. With the influence of HO'ĀLA staff members, two intervention schools were obligated SRTS project funding from the state, schools were identified as key areas in the pedestrian master plan, and one intervention school was slated for a bike plan priority project. As the SRTS programs are implemented in the next phase of the project, post-test data will be collected to ascertain if changes in active transportation rates occur.

In accordance with the sociocultural model, race/ethnicity is considered a major influence on factors associated with body image and body dissatisfaction, and eating disorders are often characterized as problems that are primarily limited to young White women from Western cultures. The purpose of this study was to determine whether there are differences that exist by race in desired body weight; the importance placed on those ideals; and dieting strategies among White, Asian American, Native Hawaiian/Pacific Islanders, and other mixed-race young women in Hawai'i. A total of 144 female college students 18-20 years of age were surveyed about body weight as well as eating and exercise habits. Results demonstrated that all the young women wanted to lose weight. However, there were no differences in desired body weight or desired weight change by race after controlling for body mass index suggesting that current weight rather than race/ethnicity is the predominant influence on weight-related concerns. Young White women placed the greatest level of importance on achieving a lower body weight, which corresponded with a greater likelihood to be attempting weight loss (dieting) and greater endorsement of behaviors consistent with weight loss compared to their counterparts. Findings imply that, for young women, race/ethnicity may not have as significant an impact on factors associated with body weight ideals as previously believed. Rather, differences in the value placed on achieving a desired body weight, as it relates to disordered eating, should be further explored among race/ethnic groups.

The purpose of this study was to explore the prevalence of breast cancer anxiety and risk counseling in women undergoing mammography, and the association with known risk factors for cancer. Women awaiting mammography were surveyed regarding anxiety, prior breast cancer risk counseling, demographic and risk factors. Anxiety was assessed via 7-point Likert-type scale (LS). Risk was defined by Gail model or prior breast cancer. Data were analyzed by nonparametric methods; significance determined at alpha = 0.05. Of 227 women surveyed, 54 were classified "higher risk". Counseling prevalence was similar (52%) for all ethnic groups, but higher (72%, P<0.001) for "higher risk" women. On average, women awaiting screening/diagnostic mammography were somewhat worried (median LS = 4). Worry was significantly higher (P<0.05) in "higher risk" women (LS = 5), and in women living outside Honolulu (LS = 6). Counseling by primary care physicians (PCP) did not correlate with lower worry scores. It was concluded that most women awaiting mammography are not unduly anxious. Additionally, the findings showed a correlation between a woman's concern about developing cancer with known risk factors and rural residence.