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

The transition to virtual learning formats during the COVID-19 pandemic necessitated substantial curricular adjustments to the University of Hawai'i John A. Burns School of Medicine. This study compares student satisfaction and academic performance between the pre-pandemic (up through March 25, 2020) and pandemic (after March 25, 2020) periods. Standard end of course surveys for first year (M1) and second year (M2) courses and exam scores were compared between the pre-pandemic and pandemic groups. The median exam scores for problem-based learning generally increased for M1 and M2 courses during the pandemic, whereas Anatomy scores showed variability with some declining and some remaining stable or inclining. End-course evaluations indicated a significant decrease in student-perceived effectiveness for PBL, Lecture and Anatomy during the initial pandemic period. However, survey ratings for the learning environment improved in later courses, suggesting adaptation over time. Notably, Anatomy exam scores and course ratings improved significantly later in the pandemic which may be attributed to the development of virtual resources and early introduction of in-person sessions. This study provides insight into the dynamic effects of the pandemic on medical education, enhancing understanding of student experiences and academic outcomes during this challenging time. This study underlines adaptations in the curriculum that were effective, highlighting the resilience of the curriculum and students in maintaining quality education during the pandemic.

Information on companion animals in Hawai'i is lacking. The Hawai'i Department of Health's Hawai'i Health Survey, collected data on adults and households by telephone interview. National estimates of companion animals range from 50-67%. However, the estimate from Hawai'i was lower with 39% of households in Hawai'i having a companion animal that spends part or all of the day indoors, including 29.5% of households with dogs and 14.7% with cats. There may be multiple reasons the count is lower for Hawai'i and possible factors are identified. There were significant differences in companion animals by ethnicity with Whites having the highest percentage of cats (25.8%) and Japanese the highest percentage of dogs (33.8%). Differences were observed between Asian ethnicities and Native Hawaiians. Specifically, individuals of Japanese ethnicity were more likely to have dogs, while Native Hawaiians were more likely to have cats compared to other Asian and Other Pacific Island ethnicities. Furthermore, companion animals were associated with counties other than Honolulu, lower poverty, ownership of a car or home, women, education, and middle-aged adults. Thus, many households in Hawai'i may not have the resources for a companion animal. Adults who rated their general health excellent had the highest association with having a cat(s). Asthma was higher for women living with dogs than women without cats or dogs. Asthma was lowest for men with cats compared to other groups for men and women. This study contributes to the understanding of complex interrelationships of humans, animals, and their environment which is gaining momentum under the umbrella of "One Health" by supporting increased collaboration and new data sources.

Since 2017, Hawai'i has had a statute requiring health plans to update their provider directories at least monthly. However, the results of this study suggest that despite this regulation, errors in physician directories may be an ongoing problem. Using publicly available online Medicaid physician directories from Med-QUEST, Hawaii Medical Service Association (HMSA), AlohaCare, 'Ohana Health Plan, and United Healthcare, 473 unique listings for dermatologists were reviewed and 411 (86.9%) of these listings contained at least 1 inaccuracy. Using the deficiency scoring methodology designed by the Centers for Medicare & Medicaid Services (CMS), it was found that the proportions of deficient listings were significantly different among the directories (P<.001). Med-QUEST had the highest weighted final deficiency score of 92.9% and HMSA had the lowest weighted final score of 49.2%. In between were United Healthcare (71.0%), 'Ohana Health Plan (69.7%), and AlohaCare (65.7%). It is unknown whether these results are an improvement from the implementation of the statute. Nevertheless, this issue can cause additional barriers for Medicaid patients who already experience narrower networks and longer wait times for dermatologists. Furthermore, it would also be worth investigating if this issue is also prevalent in listings for other specialties.

Commensality, the act of eating together, when organized around facilitated discussion is an evidence-based intervention that can promote engagement and reduce physician burnout. The purpose of this pilot study is to evaluate the feasibility, acceptance, and impact of a commensality intervention for physicians. The Commensality Intervention was based on a Mayo Clinic model that consisted of 6, 2-hour dinner meetings at local restaurants over 6 months with facilitated discussion. Seven physicians participated, with controls matched by specialty and career stage. All completed the Maslach Burnout Inventory and Areas of Worklife Survey (MBI/AWS) at baseline, 6 months, and 12 months. Results were analyzed using Mann-Whitney tests for comparison of intervention group members to controls. At baseline, 4 of 7 in the intervention group and 3 of 7 controls met criteria for burnout. At 6 months, MBI improved in all dimensions: emotional exhaustion (EE) 24.3 to 17.2; depersonalization (DP) 7.1 to 5.1; personal accomplishment (PA) 40.0 to 43.3. Improvement in EE was significantly greater for intervention group members vs. controls (P=.015). Similarly, every AWS dimension (except reward) improved in the intervention group, with significant improvements in Workload (P=.012), Control (P=.027), and Community (P=.039). At 12 months, improvements in EE (21.6), DP (5.3) and PA (42.7) persisted but were attenuated, with none of the MBI/AWS changes from baseline statistically significant. Findings suggest significant improvements in physician burnout following the intervention, with attenuation at 12-months. Results will be used to support the broader implementation of commensality within the group practice.

During the COVID-19 pandemic, there was a marked increase in alcohol and drug-induced deaths. In the US, there was a rapid increase in the rate of alcohol- and drug-induced deaths within the first year of the COVID-19 pandemic compared to pre-pandemic years. This study examines mortality data within Hawai'i to assess both alcohol and drug-induced mortality during the pandemic compared to the nation overall. Data from the Centers for Disease Control and Prevention Underlying Cause of Death database were used to compare numbers and rates of alcohol-induced, drug-induced, and all-cause deaths among individuals aged 15 years or older between 2018 and 2021. The percentage of alcohol-induced and drug-induced deaths in the US and Hawai'i increased annually in 2018, 2019, 2020, and 2021. Unlike the US, in Hawai'i between 2020 and 2021 the age-adjusted rate of drug-induced deaths per 100 000 people decreased from 20.6 to 18.6. Overall, this study found that alcohol-related deaths in Hawai'i increased similarly to those in the US during the COVID-19 pandemic.

Medical students, like many health professional students, are at risk for burnout and other negative well-being outcomes. Research suggests that building resilience may help to mitigate these risks. A multi-disciplinary team developed, delivered, and evaluated a training on building resilience for medical students entitled, "Resilience for Health Providers - Strengthening You to Strengthen Them." The training program provided parallel learning intended to teach medical students how to apply protective factors to both themselves and their patients. The research team proposed that training medical students to understand mechanisms that support resilience such as motivation and self-efficacy may increase the development of resilience as part of their medical training. Through parallel learning, students can also learn how to apply these mechanisms to their patients. The evaluation of the training's effectiveness consisted of pre- and post-tests. Medical students' resilience was measured using the Connor-Davidson Resilience Scale (CD-RISC-10), a tested and validated scale. Findings indicated that post-test scores increased in each domain from pre-test. Participants reported enhanced skill building for both their own resilience and that of patients after the training. Results from the CD-RISC-10 scale showed that the medical students rated slightly lower than the mean identified by the CD-RISC-10 creators. The results from this initial study to strengthen health professionals' self-reported resilience showed that the training improved medical students' self-reported resilience and their confidence in assisting houseless participants to improve their understanding of building their own self-resilience.

Although biliary atresia (BA) is a rare neonatal disorder, it remains the leading cause of pediatric end-stage liver disease. Early diagnosis of BA and treatment with the Kasai procedure can significantly reduce the need for pediatric liver transplant. Current data suggests that performing the Kasai procedure at 30-45 days of life is associated with longer native liver survival rates and reduction of the need for liver transplant. The incidence rate of BA in the state of Hawai'i is nearly double the incidence rate in the continental US. International studies have demonstrated that screening programs for BA reduce the age at diagnosis and treatment. However, there has been no statewide analysis on the ages at diagnosis or at Kasai, nor does a statewide screening program for BA exist. The purpose of this study is to review the age of diagnosis and treatment of BA to determine if the current practice in Hawai'i is in line with the published data. A retrospective chart review of all patients diagnosed with BA at the state's primary children's hospital was performed (2009-2023) and 19 patients who underwent the Kasai procedure were identified. The mean age at diagnosis is 71.4 days (n=19) and the mean age at Kasai procedure is 72.0 days (n=19). Both the average age at diagnosis and treatment for BA in Hawai'i is significantly higher than published data suggesting best outcomes at 30-45 days of life. This review suggests that the implementation of a statewide screening program for BA in Hawai'i is warranted.