Hawaii medical journal最新文献

Obesity is a widespread national issue that affects the health and well-being of millions of people; particular attention has been focused on the burden among children. The National Survey of Children's Health data from 2007 was used to examine the relationship of child health status and unhealthy weight (overweight/obese defined as body mass index in ≥ 85 th percentile) among 874 children aged 10 to 17 years of age in Hawai'i. In particular, the parentally reported child's general health status was assessed comparing those with a poorer health status (defined as "good/fair/poor") to those with a better one (defined as "excellent/very good"). Descriptive analysis and multiple logistic regression analysis examined risk for overweight/obese with child's general health status, accounting for gender, race, and socioeconomic factors. More children with a poorer health status (46.5%; 95%CI=33.2-60.2) were overweight/obese compared to those of better health status (25.8%; 95%CI=21.9-30.2). Estimates of overweight/obese were high in Native Hawaiian/Pacific Islander (38.6%; 95%CI: 28.9-49.4), multiracial (30.9%; 95%CI=24.2-38.6) children, and children whose parents had less than 12 years education (56.8%; 95%CI=32.8-78.0). Multivariate logistic regression modeling showed a 2.92 (95%CI=1.52-5.61) greater odds for overweight/obese status in children with a poorer health status compared to those of better health status after accounting for age, race, gender, and parental education. Gender, race, and parental education were also significant factors associated with overweight/obese in the final adjusted model. It is important that children that are overweight or obese receive appropriate health screenings including assessments of general health status. Children in high risk socioeconomic groups should be a particular focus of prevention efforts to promote health equity and provide opportunities for children to reach their potential.

With Koch's announcement in 1882 of his work with the tubercle bacillus, his famous postulates launched the rational world of infectious disease and an abrupt social change--strict patient isolation. The postulates, so successful at their inception, soon began to show some problems, particularly with cholera, which clearly violated some of Koch's requirements. Subsequent studies of other diseases and the discovery of entirely new ones have so altered and expanded the original postulates that they now are little but a precious touch of history. The present additions and replacements of the original concepts are skillful changes that several authors have devised to introduce new order into understanding complex viral and prion diseases. In 1988, this knowledge, with the totally rational response of the British population and its cattle industry, was critical in promptly blocking the threatened epidemic of human prion disease. In contrast, the recent upsurge of tuberculosis (TB) in the worldwide AIDS epidemic in developing countries, and the sudden increase in metabolic syndrome in wealthy ones, suggests the need for focused sociobiologic research seeking ways to affect the damaging lifestyle behavior of many less educated populations in both settings. The world awaits an equivalent of Koch's Postulates in sociobiology to explain and possibly avert large self-destructive behaviors.

This paper presents details the Healthy Foods Hawai'i (HFH) intervention trial, aimed to improve children's dietary behavior to prevent child obesity, by modifying the food environment with community-selected foods. Four communities were selected by ethnic composition, income level, two on O'ahu and one neighbor island. On each island one community was randomly assigned to intervention and one to control. The intervention was implemented through food stores in the intervention communities. HFH was designed to strengthen the network between local food producers, food distributors, storeowners and consumers, to increase the availability of healthier less energy dense foods for children in underserved rural communities of Hawai'i. The intervention includes phases: healthier beverages, snacks, condiments, and family meals. Moderate to high fidelity was achieved for educational materials (shelf labels, posters and educational displays). The number of educational displays varied by intervention phase and community. Posters were found in place 100% of the time. Shelf labels were found intact in the correct location. Low to moderate fidelity was achieved for distributors, with some products not stocked. In the intervention communities, 6-8 week phases focused on target foods with 40 food demonstrations. A total of 1582 food related samples were distributed. A high to moderate dose and reach of the overall intervention was achieved in delivery of the cooking demonstrations. A high to moderate dose and reach of the intervention was achieved overall; fidelity to the intervention protocol was moderate. To improve healthy local food availability in stores in rural communities in Hawai'i, agricultural producers reported needing additional support to sell and transport product to local stores, rather than to centralized distributors.

Objective: This study evaluated the impact of the Fun 5 program on fruit and vegetable intake, physical activity, and body mass index (BMI) percentile of overweight and obese children in Hawai'i's A+ After-School Program.

Methods: Children in 4th - 6th grades (n=119, 55% female) from six randomly selected schools participated in this longitudinal study. Time 1 (T1) measures were taken October 2007 and time 2 (T2) measures April 2008. Height and weight along with a self-report survey were used to measure fruit and vegetable intake, physical activity, and BMI.

Results: The "at risk" population, defined as fruit and vegetable intake <5 servings per day (n=30), physical activity <300 minutes per week (n=78), or Body Mass Index >85th percentile (n=48) at T1, showed a significant increase in fruit and vegetable intake, from 2.97 (± 1.16) servings per day at T1 to 5.60 (± 3.93) servings per day at T2 (P=<0.01) and physical activity, from 125.26 (± 76.03) minutes per week of physical activity at T1 to 222.18 (± 180.90) minutes per week at T2 (P=<0.01) and no change in Body Mass Index.

Conclusion: The Fun 5 program had an impact on improving fruit and vegetable intake and physical activity on the at risk population.

Objective: To present prevalence rates of adolescents in Hawai'i at-risk weight (85 percentile or higher = overweight or obese) and the relationship with comorbidities.

Methods: The Hawai'i Youth Risk Behavior Survey aggregated for 2005, 2007, and 2009 was analyzed addressing at-risk weight prevalence by sex, race/ethnicity, and grade. Comorbidities were related to at-risk weight using regression.

Results: Over 1/4 of Hawai'i adolescents were at-risk weight. There were no differences by grade, but boys had higher prevalence (31.0%) than girls (22.4%). Overall, Other Pacific Islanders and Hawaiians had the highest prevalence (43.9% and 37.4%, respectively), followed by multi-race (27.1%), Filipino (25.7%), and Whites with the lowest (16.1%). Most associations between at-risk weight and various co-morbidities (including sexual behavior, nutrition, physical activity, mental health, bullying, alcohol, and other drug use) were not significant (p>.05). However, girls and boys trying to lose weight; and boys with 3+ hours of screen time (TV, video, or computer games) each day were at increased odds of at-risk weight (p<.05).

Conclusion: Adolescent gender and ethnic disparities exist such that a single intervention approach (one size fits all) may be counterproductive. More research is required on the determinants and mechanisms to guide weight management interventions.

In the past 20-30 years, the number of overweight children in the United States has doubled.1 Overweight children are acquiring conditions such as hypertension, type II diabetes, hypercholesterolemia, sleep apnea, and orthopedic problems. The purpose of this study was to explore the prevalence of and factors associated with at risk and overweight in children 2-10 years of age in a Health Maintenance Organization (HMO) in Hawai'i. This quantitative, retrospective cross-sectional study included a stratified random sample of 554 children ages 2-10 years who received a well child health care exam at a HMO in 2003. The prevalence of at risk and overweight were examined including the relationship between ethnicity, socioeconomic status, place of residence, and a child being overweight. Thirteen percent were at risk for overweight (BMI 85-95%) and 19% (BMI >95%) were overweight. In the 6-10 year age group, 42 % were overweight or at risk for being overweight. Boys had a higher incidence of being overweight (54%) than the girls (46%). Pacific Islanders had the highest incidence of overweight (40%), followed by the Hawaiian/Part Hawaiians (19%) and Filipinos (19%). Ethnicity and place of residence were significantly associated with being at risk or overweight. Pacific Islanders were 4 times more likely to be overweight/at risk for overweight and those residing in the West O'ahu, Honolulu, and Central O'ahu/North Shore areas were 2-3 times more likely to be at risk for overweight when compared to children living in the Windward side. With increased age, the prevalence of overweight increased. Findings suggest that targeted obesity prevention strategies need to be initiated early in life and geared for ethnically and geographically diverse children and their families.

Background: Superior patient care and optimal physician training are often mutually elusive in the Emergency Department setting. Highfidelity patient simulators (HFPSs) are being used with increasing frequency in the training of medical students (MS) because they enable students to develop and refine medical competency in a non-threatening and safe environment. However, learner outcomes using HFPSs in this setting have not been well studied.

Objectives: The objective of this pilot study was to determine the effectiveness of HFPSs in simulation (SIM) training as a learning tool for preclinical second-year MS to further increase their toxicology knowledge.

Methods: Second-year MS at a Problem Based Learning (PBL) medical school received a PBL toxicology teaching session in the middle of the semester. One week later, the students participated in a SIM exercise based on issues taken from the PBL case. The SIM exercise required that students address learning issues such as identifying abnormal findings, ordering tests, and, ultimately, initiating treatment on a full-scale HFPS mannequin. A supervised on-line test consisting of 10 multiple choice questions regarding the student's understanding of the learning issues was completed before the PBL class and directly before and after the SIM to determine the effectiveness of the HFPS use. Immediate video-assisted feedback was provided by emergency medicine attendings.

Results: Use of HFPSs during SIM exercises and in combination with PBL significantly increased toxicology knowledge in secondyear MS as determined by the improvement of on-line test scores (% correct answers) from 59% before PBL / before SIM to 69% after PBL / before SIM to 80% after PBL / after SIM.

Conclusion: This study suggests that HFPS may be a valuable tool in helping to improve toxicology knowledge in second-year MS at a key transition period prior to beginning clerkship experiences. Incorporation of HFPS into PBL curricula may also be beneficial to MS in other areas of study where interactive learning could assist in evoking emotional realism while also enhancing critical thinking and acquisition of knowledge thereby facilitating the transition from theory to practice.