Hawaii medical journal最新文献

The elderly consume a disproportionate amount of health care resources, and the recent trend in obesity will only escalate costs. EnhanceFitness® (EF) is an exercise program designed to increase the strength, flexibility, and balance of older adults. A comprehensive controlled study in Washington state of an elderly population has shown that participants who attend at least one EF class per week reduce healthcare costs by 20% per year. The present study reports the costs and potential benefits of replicating EF on Kaua'i. For Kaua'i the annual cost of an EF pilot program for 132 clients would be $204,735. Attendance records of the Kaua'i program showed that 96 (73%) of those enrolled attended at least weekly. Based on national reports of healthcare costs for the elderly, averting 20% of the costs for these 96 elderly would save $344,256 per year. The expected investment to return ratio, I-R ratio, for EF on Kaua'i is about 1-1.8. On economic grounds, a case can be made to support and expand these types of programs. In these times of budget cuts, cost-benefit analysis provides a common economic "language" to prioritize among different programs.

The growth and aging of the population of Hawai'i with a high incidence of diabetes mandates a need for more effective strategies to manage the healing of complicated wounds. Maggot debridement therapy (MDT) is one alternative utilized with successful results. Observations have indicated that maggots have the ability to debride wound beds, provide anti-microbial activity and also stimulate wound healing in diabetic patients. None of the patients refused MDT due to aversion of this treatment modality and the majority of patients had minimal discomfort. In 17 of 23 patients with multiple co-morbidities, the treatment of their complex diabetic wounds by MDT resulted in improvement or cure. Maggot debridement therapy is an effective treatment of diabetic wounds.

Widely used for local anesthesia, especially prior to endoscopic procedures, benzocaine spray is one of the most common causes of iatrogenic methemoglobinemia. The authors report an atypical case of methemoglobinemia in a woman presenting with pale skin and severe hypoxemia, after a delayed repeat exposure to benzocaine spray. Early recognition and prompt management of methemoglobinemia is needed in order to lessen morbidity and mortality from this entity.

Good clinician-family communication is essential for the provision of high-quality patient care. Families rate the communication skills of clinicians as critical clinical skills. However, there has been no structured training of fellow communication skills while leading family meetings in the University of Hawai'i Geriatric Medicine Fellowship Program. Effective training to develop communication skills with families will better prepare Geriatric Medicine fellows for this important task, and ultimately improve the quality of care they provide to these patients and patients' families.

Background: Ovarian Hyperstimulation syndrome (OHSS) is one of the most serious complications of controlled ovarian hyperstimulation. Recent prospective data revealed possible increased prevalence of thrombophilia markers in women who develop severe ovarian hyperstimulation syndrome (OHSS).

Case: A 26-year-old nulliparous woman underwent ovarian stimulation for in vitro fertilization with recombinant follicle stimulating hormone and developed severe OHSS. She was screened for hereditary and inherited thrombophilia markers and was found to be homozygous for MTHFR mutation and had decreased antithrombin levels.

Conclusion: This case adds to the limited information that there may be an association between women who develop severe ovarian hyperstimulation syndrome and an increased prevalence of underlying thrombophilia markers. If further research demonstrates a cost effective strategy, screening for those markers may identify women who are at a higher risk for development of severe ovarian hyperstimulation syndrome.

Objective: The purpose of the current study was to examine the prevalence of intimate partner violence (IPV) among teens in Hawai'i.

Methods: Youth from two O'ahu high schools (N = 623) were asked to complete a quantitative survey about their experiences, as victims and perpetrators, of IPV.

Results: The most frequently reported type of violence was monitoring/controlling behaviors. Girls reported higher rates of victimization and perpetration than boys for most violence types.

Conclusions: Future research should examine the contexts in which teen IPV occurs. It will also be important to engage community-based organizations in prevention efforts. Therefore, a train-the-trainer curriculum for IPV prevention and intervention is proposed.

Idiopathic granulomatous mastitis (IGM) is a rare inflammatory condition of the breast. The etiology and treatments options of IGM remain controversial. Previous case reports have suggested that Corynebacterium sp., a gram-positive bacillus endogenous to the skin, may be associated with IGM. In the present report, we describe the first case of IGM with a positive culture for Corynebacterium sp. reported in the United States.

Purpose: In response to a study published by the Centers for Disease Control and Prevention (CDC) in 2009, which indicated that the prevalence of Down syndrome births was increasing in the 10 regions studied, this study examined whether a similar trend was occurring in Hawai'i.

Methods: Data were obtained from the Hawai'i State Department of : Health Birth Defects Program for the years 1997-2005. The information was analyzed by numbers of live births and outcomes of Down syndrome pregnancies, by ratio of terminations to live births, by age of mother (< 35 years or ≥ 35 years), by maternal ethnicity, and by whether the baby was born with a congenital heart defect (a frequent concomitant condition of babies born with Down Syndrome). These results were compared with previously published studies on the prevalence of Down syndrome births and pregnancies in Hawai'i and were also compared with recently published data of the CDC.

Findings: THE STUDY FOUND THAT THE PREVALENCE OF DOWN SYNDROME : births for Hawai'i over the nine-year period did not change significantly. Thus, this finding did not match the findings of the CDC study. Additionally, the data showed that the prevalence of congenital heart defects was higher in Hawai'i than in other areas. However, because of changes in the resources available to the Hawai'i Birth Defects Program, fully comparing in all respects data from the 1997-2005 period with studies conducted earlier in Hawai'i was not possible.

Conclusions: THE DATA IDENTIFIED A NUMBER OF AREAS IN NEED OF FURTHER : study. These areas include the following: 1) an examination of the kinds of information and counseling given by primary care providers to women following a prenatal diagnosis of Down syndrome; 2) analysis of the characteristics, values, and choices made by these women to terminate the pregnancy or continue it to term; and 3) determination of why the prevalence of congenital heart defects appears higher among births of babies with Down syndrome in Hawai'i than elsewhere.