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

COVID-19 vaccines are a critical intervention for controlling the spread of COVID-19 and may be administered at fixed clinic locations or mobile clinics. This study compares the demographics of the populations vaccinated at fixed and mobile clinics to investigate whether mobile clinics vaccinate a different population from fixed clinics and to assess whether mobile clinics improve vaccination rate and success. A retrospective chart review was conducted for all COVID-19 vaccinations (N=325 988) administered by a major Hawai'i health care provider at its affiliated fixed and mobile clinics between January 2021 and May 2022. Data collected included location of vaccination, age, sex, primary race, health insurance provider, and billing zip code. Mobile clinics vaccinated younger patients on average (P<.001). Native Hawaiians and other Pacific Islanders (risk-adjusted odds ratio = 2.03, 95% CI=1.96, 2.11) as well as those with non-commercial health insurance (risk-adjusted odds ratio = 4.26, 95% CI = 4.02,4.51) were most likely to be vaccinated at a mobile clinic rather than a fixed clinic, as compared to White patients. The differences between the patient populations vaccinated at fixed and mobile clinics suggest that mobile clinics may be a useful tool in expanding the reach of vaccination efforts to a more demographically diverse patient population.

Life expectancy in Hawai'i is the longest among US states. However, Hawai'i is a multi-ethnic state, and significant disparities exist across racial and ethnic groups. From 1950 to 2010, disparities have been reflected in life expectancy, with a 10-year gap between the longest living racial and ethnic groups in Hawai'i (Japanese and Chinese) and Native Hawaiians. The current study estimated life expectancy in Hawai'i for 2020 across 7 racial and ethnic groups: Native Hawaiian, other Pacific Islanders, White, Filipino, Korean, Japanese, and Chinese. In 2020, life expectancy in Hawai'i was 81.9 years for the total population, 78.9 for males, and 85.2 for females. Disparities were observed across racial and ethnic groups, with life expectancy of 69.6 years for other Pacific Islanders, 77.4 years for Native Hawaiians, 81.8 years for Whites, 83.4 years for Filipinos, 84.3 years for Koreans, 84.9 years for Japanese, and 88.2 years for Chinese. The difference in life expectancy between sexes was 6.3 years, with variations ranging from 3.4 years among Chinese to 7.2 years among other Pacific Islanders. These findings highlight persistent disparities in life expectancy among Hawai'i's racial and ethnic groups, with much shorter life expectancy for Native Hawaiians and other Pacific Islanders compared to other groups. The results emphasize the need for targeted health interventions, enhanced access to health care, and culturally appropriate preventive measures to address these inequities.

Hatha yoga, Qigong, Tai Chi, all ancient practices of the mind, continue to be studied and recognized for their mental and spiritual benefits. However, Tummo meditation and Niguma yoga, ancient practices with origins in the 8th and 11th centuries from the Himalayan Vajrayana tradition, remain obscure and have yet to be disseminated and studied. Previously only practiced by Vajrayana monks during a 3-year retreat, practitioners of Tummo and Niguma often report increased mindfulness and emotional calm following the exercises. In an effort to explore these once secret practices, the Manakai O Mālama Integrative Healthcare Group investigated changes in brain activity prior to and following Tummo combined with Niguma in a seasoned Vajrayana practitioner. Using quantitative electroencephalogram imaging and spectral analysis, an increase in alpha band power and intra-connectivity was observed immediately post-practice, suggesting increased activation of the default mode network (DMN), a brain network directly involved in internalized cognition, self-reflection, emotional regulation, and creativity. These findings not only offer a scientific basis for further research, but also provide neurological evidence for the mental and cognitive benefits of Tummo meditation and Niguma yoga. With continued study, it is possible to validate ancient practices of Tummo and Niguma as effective health interventions. Moreover, this study furthers research showing how yoga and meditation techniques may be of benefit for behavioral health. In particular, cultural healing components of yoga and meditation may be more easily deployed in minority populations like Native Hawaiians, who are disproportionately at risk for mental health issues in Hawai'i.

The psychosocial impact of COVID-19 on sexual and gender minority (SGM) populations has been widely studied, but risk for severe infection remains less clear, especially in Hawai'i. National studies are not generalizable to Hawai'i's unique racial demographics. This Hawai'i cross-sectional study examined associations between SGM status stratified by race and underlying health conditions and SGM status in Hawai'i, stratified by race, that may increase risk for severe COVID-19. Data from the 2015-2019 Behavioral Risk Factor Surveillance System (BRFSS) of non-institutionalized adults aged 18 years and older in Hawai'i was analyzed using descriptive and regression methods. Sexual and/or gender minority adults accounted for 5.2% and 0.6% of the population, respectively. Compared to Native Hawaiian heterosexual adults, Native Hawaiian sexual minority adults had higher age-adjusted odds of asthma (current - AOR 1.8, CI: 1.33, 2.44 and ever - AOR 1.59, CI: 1.21, 2.09), cancer (AOR 2.07, CI: 1.25, 3.42), and diabetes (AOR 1.58, CI: 1.11, 2.26). Compared to White cisgender adults, Native Hawaiian transgender adults had significantly higher odds of asthma - current (AOR 4.13, CI: 1.44, 11.92), asthma - ever (AOR 4.02, CI: 1.68, 9.66), cancer (AOR 6.67, CI: 1.98, 22.5), diabetes (AOR 4.59, CI: 1.67, 12.62), obesity (AOR 3.76, CI: 1.64, 8.59), a stroke (AOR 3.19, CI: 1.12, 9.06) and cigarette smoking (AOR 3.38, CI: 1.43, 8.02). These chronic health conditions increase vulnerability to severe COVID-19 outcomes. Findings highlight the need for increased chronic disease prevention and management in Hawai'i's SGM communities. Further research is necessary to understand COVID-19's long-term impact and informing equitable public health strategies.

Many counties in the US do not have an abortion provider despite abortion being one of the most common medical procedures among reproductive aged women. Increasing the number of abortion providers in the country is a multi-faceted endeavor. Understanding the factors that influence obstetrics and gynecology residents to include abortion in their future practice is an essential component. This study sought to determine the relationship between knowledge and attitudes about abortion during residency training and the intention to provide abortion care after residency training completion. An anonymous online survey was distributed to obstetrics and gynecology residents via an invitation to program directors at accredited obstetrics and gynecology residency programs in the US. Eligible participants were obstetrics and gynecology residents enrolled at accredited residency programs in the US at the time of distribution. Survey data were collected from August 2019-February 2020 and were compiled online. Our multivariable analysis found that participation or planned participation in abortion training during residency positively influenced residents' intention to provide abortion care post-residency which supports the importance of abortion training during residency thereby improving access to abortion care. As comprehensive abortion training for obstetrics and gynecology residents is threatened with the overturn of Roe v Wade by the US Supreme Court in 2022, this research demonstrates the value of hands-on abortion experience in ensuring that this skill remains a core component of obstetrics and gynecology practice.

Cocaine induced postictal psychosis is a rare and underreported phenomenon. When patients ingest large amounts of cocaine, patients can experience seizures. Despite returning to baseline after several days to weeks, patients can suddenly decompensate, exhibiting what is called postictal psychosis despite being abstinent from the substance. This condition can lead to chronic psychosis if not properly treated. In this case, a male in his twenties, presented with 1 month of auditory hallucinations, visual hallucinations, and paranoid delusions. After his last cocaine use 1 month ago, the patient developed seizure-like activity and shortly after returned to baseline. Approximately 1 week later, the patient started to experience psychosis. Due to persistent symptoms, the patient was admitted and started on Risperidone 2mg twice a day but did not respond. Clonazepam 1mg twice a day was added, which helped patient to return to baseline. Cocaine induced postictal psychosis is underreported, and it can be difficult to recognize. Similarly, there are few guidelines as to how to treat this condition. Clinicians need to rapidly address if they suspect that the patient is experiencing possible postictal psychosis given that this can lead to chronic psychosis.

In response to feedback from previous medical students, the office of medical education at a state-funded medical school (University of Hawaii) conducted an IRB-approved survey study to formally evaluate the experience of current medical students regarding their confidence with MSK examination skills, and solicited suggestions for improvement. We collected data from students who were transitioning from second to third year regarding the following: (1) confidence in various physical exams, (2) perceived preparedness for clerkships, (3) usefulness of existing MSK clinical activities, and (4) suggestions for improvement. A majority of students expressed lack of confidence in the MSK physical exam, which was notably lower than other organ system exams. Recommendations for curriculum improvement included early integration of MSK examination teaching with corresponding anatomy laboratory sessions, inclusion of physiatry teaching, and increased small-group learning sessions. This study revealed the need for (1) synchronizing MSK clinical skills training with anatomy curriculum during the first year, and (2) inclusion of physiatry teaching in the MSK curriculum. Ideally, this study will serve as a starting point for further innovations and improvements in MSK medical education.

The authors performed a follow-up COVID pandemic era employee well-being survey in spring 2022 during the period of vaccine and antiviral therapy availability. The survey results for medical school employees were compared with the results of a pre-vaccine survey from fall of 2020 to assess employees' continued concerns. At the time of the follow-up survey, employee well-being programs and resources along with telework policies had been introduced. The survey findings reinforced the need to tailor such programs differently for staff members, given their different work context. Priority areas should include providing well-being programs during working hours, time-off for well-being or mental health needs, and attention to equity in access to the well-being and telework programs.