Hawai''i journal of health & social welfare最新文献

Veterans experiencing homelessness have elevated rates of traumatic brain injury (TBI) diagnoses. There remains limited research on subsets of homeless Veterans, including Native Hawaiian and Pacific Islander (NHPI) Veterans. Department of Veterans Affairs (VA) electronic medical records of 724 752 Veterans who accessed Veterans Health Administration (VHA) homeless services from January 2005-December 2018 were examined. Of the total sample, 1177 identified as NHPI, with comparator samples of non-NHPI (n=723 575) and White (n=418 085) Veterans also generated. Rates of TBI were compared between NHPI Veterans relative to non-NHPI Veterans, as well as between NHPI and White Veterans (a subset of the non-NHPI Veteran sample). NHPI homeless Veterans were more likely to have a documented TBI diagnosis relative to non-NHPI homeless Veterans (AOR=1.82, 95% CI: 1.57-2.11), including the White homeless Veteran subgroup specifically (AOR=1.51, 95% CI: 1.30-1.75). This persisted in the presence of several covariates, including sex, ethnicity, rurality, VA service-connected disability, posttraumatic stress disorder, depression, and VHA mental health and general service use. NHPI homeless Veterans were also significantly less likely to utilize VHA services, suggesting an important gap in health service delivery. Results support potentially heightened risk for TBI among NHPI homeless Veterans, and a need to elucidate if such injuries occur during or outside of military service. Alternatively, given potential sociocultural differences, understanding the experience and expression of TBI sequelae among NHPI homeless Veterans is essential. Further research is requisite to understand how to optimally engage homeless NHPI Veterans in care to ensure TBI-related sequelae are adequately identified and addressed.

Although claims of penicillin allergy are common, after evaluation they are seldom confirmed and can lead to unnecessary interventions. National recommendations are to thoroughly evaluate potential allergies and, if appropriate, to delabel. This retrospective study reviewed records of children hospitalized at Kapi'olani Medical Center for Women and Children in Honolulu, Hawai'i, between January 1, 2021 and June 30, 2023 to assess the frequency of penicillin allergy claims, the appropriateness of their evaluation, and initiation of interventions. Of 3484 hospitalized children, 97 (2.8%) reported penicillin allergy. Documentation, by the admitting team, of the nature of allergy was incomplete for most (97%) of the hospitalizations, leading to deficient risk stratification, lack of implementation of recommended interventions, and frequent use of second-line antibiotics in 46.8% of those who required antibiotic treatment. While this problem is not unique to Hawai'i, it emphasizes the need for education among local providers to improve outcomes.

This study aimed to determine the prevalence of vitamin D deficiency and insufficiency among military dependent infants in the state of Hawai'i. A cross-sectional study was conducted at Tripler Army Medical Center and included samples from 30 healthy, full-term infants around 4 months of age. Serum 25-hydroxyvitamin D levels were measured, and caregivers completed questionnaires about the infant's diet, vitamin D supplementation, race/ethnicity, and military sponsor pay grade. Results revealed that 90% of infants had sufficient vitamin D levels (>20 ng/mL), with 3% deficient and 7% insufficient. The prevalence of deficiency and insufficiency was comparable to studies conducted in other regions of the United States. This is the first study to investigate infant vitamin D status in Hawai'i using serum 25-hydroxyvitamin D. Vitamin D status varied significantly by race/ethnicity. The average vitamin D level of Black or African American infants was in the insufficient range and was significantly lower than that observed in White/Caucasian and Hispanic infants. Notably, several exclusively breastfed infants who did not receive vitamin D supplementation had sufficient vitamin D levels. While study limitations include a small sample size and cross-sectional design, the findings warrant continued investigation into the prevalence of vitamin D deficiency and insufficiency among military dependent infants in Hawai'i. Future research should explore the influence of race/ethnicity and socioeconomic status on infant vitamin D levels in Hawai'i and consider the impact of maternal vitamin D status, especially in exclusively breastfed infants. This could lead to more targeted vitamin D supplementation recommendations in clinical practice and potentially improve resource allocation.

Substance use is a significant public health and social welfare issue in the state of Hawai'i. Literature and data about the most affected populations and geographies in Hawai'i are scattered. A scoping review was conducted to assess the extent of available information about substance use in Hawai'i. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) Checklist was used as a guide, using 3 databases: PubMed, Web of Science, and CINAHL for publication years 2010-2023. A manual search was conducted to identify other reports. A total of 21 documents were included in the synthesis. The synthesis revealed a large focus on substance use among Native Hawaiians and adolescents. The granularity of geographical data was found to be at island-level and the 3 most common substances reported were alcohol, marijuana, and methamphetamine. There were data for a wide range of racial and ethnic groups, which is unique due to the diversity in the state of Hawai'i. Most documents used national datasets for reporting substance use in Hawai'i. The findings identified gaps in the literature that can be filled by future research such as focusing on the rise of substance use among older adults, disaggregating data on Pacific Islander populations in Hawai'i, reporting substance use data in geographical areas smaller than island-level, increasing the collection of data on groups that have a high risk for health problems or are underserved by health services, and intensifying collection of data about fentanyl use in Hawai'i.

Oral nicotine pouches (ONPs) represent a rapidly emerging nicotine product. Little is known about the current state of quantitative research regarding patterns of ONP use; perceptions and motives related to ONP use; adverse consequences of ONP use; and use of ONPs relative to other tobacco products. To address this gap, this review aimed to summarize the findings of published, population-based research on ONPs. A comprehensive search of electronic databases (PubMed, Scopus, Web of Science, and Google Scholar) was conducted in March 2024 to identify relevant studies on ONP use. A narrative synthesis of the findings was performed. A total of 11 studies were identified including experimental (n=3), cross-sectional (n=7), or intervention-based (n=1). Nine to 10% of adolescents and young adults report ever using ONPs. ONP use is most common among young people who also currently smoke cigarettes or use electronic-cigarettes (e-cigarettes). Marketing messages centered around flavors and social facilitation appear to resonate with young people and experiencing pleasant flavors appears to a key motive for ONP use. Immediate adverse consequences of ONP use appear to be mild. Some evidence suggests that ONPs may be appealing as a reduced-harm alternative for habitual smokers. Evidence regarding ONP use patterns among adolescents and adults appears to be lacking. More longitudinal studies are needed to better understand the antecedents and consequences of ONP use. In addition, more studies are needed to compare the health effects of ONP vs. e-cigarettes and to better understand the dynamics of exclusive and dual use of e-cigarettes and ONP.

Wildfires pose acute and long-term threats to public health. This study used Google Trends to assess real-time public interest in health-related topics before, during and after the August 2023 Maui wildfires. Search terms were grouped into four categories: health care access, physical health, mental health, and help-seeking behavior. Daily search interest scores were aggregated and analyzed across three periods: pre-wildfire, wildfire, and post-wildfire. Findings revealed that physical health and health care access search interest remained relatively stable throughout the study period, with no measurable surge during or after the wildfire event. This lack of increase may reflect reliance on pre-established care plans among individuals with chronic respiratory conditions, in-person care-seeking, or prioritization of immediate safety over online information-seeking. In contrast, mental health-related searches rose substantially in the weeks following the wildfire, while help-seeking searches showed episodic fluctuations with notable peaks post-disaster. These findings illustrate how online search patterns can reveal evolving public health priorities in the wake of disasters. Google Trends offers a timely and scalable tool to monitor evolving health concerns during disasters, complementing traditional surveillance systems. Integrating search data into disaster response planning could enhance resource allocation, guide communication strategies, and ensure timely support for emerging needs, particularly mental health recovery following wildfire events.

The specialty of emergency medicine has emphasized the importance of the rapid diagnosis and treatment of time-dependent conditions. Recognition of the emergency patient at high risk for myocardial ischemia is one such condition. In collaboration with cardiologists and laboratory medicine specialists, emergency physicians have revolutionized the approach to diagnosing patients at risk for myocardial ischemia in the emergency department. This article provides a historical viewpoint based upon the authors' practice and research in myocardial ischemia risk recognition beginning in the 1980s, along with the work of selected researchers in the field to describe an evolving understanding of the underlying pathophysiology, the application of serial laboratory diagnostic techniques, and resultant goal-directed multidisciplinary care of the at-risk patient. Such an approach lends itself to the clinical assessment of patients in a multicultural, multiethnic environment as seen in Hawai'i. The evolution of acute myocardial ischemia risk assessment through emergency medicine research is detailed, including (a) the recognition of the limitations of patient discomfort subjective language descriptors, (b) the incorporation of highly specific and sensitive laboratory biomarkers for MI, and (c) the use of mechanistically-driven, serial clinical and laboratory assessments. Today's objective emergency approach to acute myocardial ischemia risk assessment is relevant to cross-cultural applications, as is required for medical care in the Pacific Basin.

Socioeconomic status and race/ethnicity are widely understood to be determinants of adverse birth outcomes, but studies have been limited by lack of income data in health records and aggregation of racial groups in reporting. This study aims to evaluate the relationship of socioeconomic status to extreme preterm birth outcomes in the diverse ethnic population of Hawai'i. Statistical analyses were conducted on Hawai'i birth records 2004-2013 linked to American Community Survey data by maternal residence. Community-level income demographics were stratified into wealth quintiles and stratum specific odds ratios were calculated for extreme preterm birth with analysis focused on the highest and lowest income-quintiles. The overall rates of extreme preterm birth were similar in high vs low-income communities, yet the individual risk factors were significantly different. In low-income communities, increased risk of extreme preterm birth was identified for women less than 20 years old and Black women, while in high-income communities, Native Hawaiian and Black women were at increased risk. Previous preterm birth, birth of a first child and cumulative maternal medical conditions were significant risk factors at all income levels. For Native Hawaiian women, the significant overall increased risk of extreme preterm birth persists in high-income communities but not in low-income communities, suggesting that increased risks previously attributed to Native Hawaiian race/ethnicity may be partially explained by low socioeconomic status.