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

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.

Native Hawaiian health has been adversely impacted by dietary and cultural changes that resulted from colonization. Farm to Keiki is a farm-to-preschool program that introduces children in Hawai'i to healthy eating through gardening and eating local produce, including traditional Native Hawaiian foods. This study utilized anthropological theory and ethnographic evaluation methods to deepen the understanding of the Farm to Keiki program's impact through interviews with family members and focus groups with teachers at 2 Kamehameha preschools. The results demonstrate that children, families, and teachers learned about plants and healthy eating, and made healthier dietary changes following the program. Additionally, participants described ways in which the program helps bolster Native Hawaiian culture and benefits the local community.

[This corrects the article on p. 195 in vol. 84, PMID: 41356177.].

Brazilian Jiu Jitsu (BJJ) is an increasingly popular martial arts discipline. Yet, BJJ injuries remain understudied in light of increasing popularity. In particular, pediatric injuries have a dearth of literature examining epidemiologic trends and injury profiles. As such, this study's purpose was to evaluate trends in pediatric Brazilian Jiu Jitsu (BJJ) injuries over a 10-year period and formulate an injury profile. The US Consumer Product Safety Commission's (CPSC) National Electronic Injury Surveillance System (NEISS) database was queried for martial arts related injuries from January 1, 2012, to December 31, 2021. Codes, and narratives were examined to compile data for patients 18 years of age or younger sustaining BJJ-related injuries. In the study period there were 7722 recorded martial arts related injuries (national estimate [NE]= 282 315) , with 264 (NE= 8357) pediatric BJJ related injuries identified. In all, 70.4% of the patients were male, and the average age was 11.6 years of age (range 4-18).There was a statistically significant increasing linear trend in pediatric BJJ injuries from 2012 to 2021 (P< .001). Most injuries were treated in emergency departments without admission. The most common diagnoses weresprains/strains (28.3%), fractures (20.1%), and the most injured body parts were head (14.2%), shoulder (9.8%), and lower arm (8.9%). This study presents novel data concerning pediatric BJJ injuries epidemiology and injury profile, providing useful information for health care professionals to treat these patients.

Genetic testing is recommended for young women diagnosed with breast cancer. While studies have demonstrated an increased likelihood of variants of unknown significance (VUS) among racial/ethnic minorities compared to non-Hispanic Whites, results in the ethnically diverse population of Hawai'i are largely unknown. Additionally, current consensus guidelines dictate that VUS mutations are not clinically actionable and surgical decision-making is not standardized. This study aims to examine the utilization of genetic testing in Hawai'i and evaluate for any subsequent impacts on surgical practice patterns. A retrospective chart review of women age <45 diagnosed with breast cancer between 2016 and 2020 was performed at a single institution in Honolulu, Hawai'i. Ethnicity, cancer history, detected genes/variants, and surgical intervention were extracted. Of 236 patients identified, 134 (56.7%) were Asian, 57 (24.1%) Native Hawaiian/Pacific Islander (NHPI), and 45 (19.1%) Other. The majority (n=201, 85.2%) underwent genetic testing. A family history of breast cancer was predictive of testing (P<.001). The most common finding was VUS (n= 95, 47.2%) with no statistical difference by ethnicity. Pathogenic mutations were more common in Other (Non-Asian/Non-NHPI) populations (P=.047). All patients with pathogenic mutations underwent bilateral mastectomy (n=16). In contrast, patients with VUS were more likely to undergo partial (n=53, 50.9%) or unilateral mastectomy (n=28, 26.9%) rather than bilateral mastectomy (n=21, 20.2%) regardless of tumor staging (P<.001). This study demonstrated high utilization of genetic testing among young women diagnosed with breast cancer. Pathogenic and non-pathogenic mutations varied according to race. The high prevalence of VUS in this ethnically diverse cohort emphasizes the importance of genetic testing in this population and warrants further research.

Women with early stage breast cancer have two therapeutic surgical options for local control: breast conserving surgery (BCS) or mastectomy. This study aimed to compare practice patterns for breast cancer surgery in Hawai'i (HI) and the rest of the United States (US). Retrospective data from the National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) program were evaluated for women diagnosed with early stage primary breast cancer between 2004 and 2018. First course surgical treatment was compared between Hawai'i and the rest of the US and evaluated by stage, race/ethnicity, and age. A total of 1 160 914 female breast cancer patients with in situ, stage 1 or 2 disease were evaluated (HI 20 434 vs US SEER 1 140 480). The proportion of patients treated with BCS was higher among Hawai'i patients compared to the rest of the US (HI 56.3% vs. US 53.4%, P≤.001), regardless of stage. Hawai'i had significantly higher percentages of BCS compared to the rest of the US among Asian (HI 58.0% vs. US 49.7%, P<.001) and Native Hawaiian/Other Pacific Islander (HI 54.0% vs. US 51.3%, P=.008) women. The percentage of BCS was also significantly higher among both younger and older women in Hawai'i compared to those in the rest of the US (HI 49.8% vs. US 44.1%, P<.001; HI 8.0% vs. US 55.9%, P<.001). Between 2004 to 2018, there was a gradual reduction in BCS in younger women across the nation. Using a nationwide dataset, higher BCS percentages were seen in Hawai'i compared to the rest of the US with differences seen according to stage, race/ethnicity, and age.

Pacific Islanders (PI) have amongst the highest incidences of hepatocellular carcinoma (HCC), but large studies characterizing this population are limited. This study explores potential disparities in treatment and outcome by comparison of PIs and Whites with HCC treated at a single center. A prospectively collected database of 1608 patients diagnosed with HCC from 1993-2022 at the only liver disease/transplant center in Hawai'i identified 252 PI and 338 White patients. Demographic, medical history, laboratory, tumor characteristics, treatment, survival data were collected. Chi-square, t-test, univariate logistic regression analyses and Kaplan-Meier survival analysis were conducted. Compared to Whites, PIs were younger, had lower educational attainment, and were more likely to be born outside the US. PIs also had a 4-fold higher likelihood of Hepatitis B (HBV) infection and higher rates of metabolic comorbidities. In contrast, Whites were 3 times more likely to have Hepatitis C infection, with higher likelihood of history of high-risk behavior (illicit drugs, incarceration, tattoos) and higher rates of presentation with cirrhosis. Of patients with screenable diseases, PIs were less than half as likely to be diagnosed through screening and presented with larger tumors and more advanced disease. Both groups were equally likely to receive treatment (including surgical treatment). Survival was similar between groups. Disparities in HCC screening and presentation seen in PIs may be attributed to high rates of occult HBV infection in this group. Initiatives to further improve outcomes for HCC in PIs should concentrate on expanding screening for chronic viral hepatitis and addressing barriers to care delivery following diagnosis.

Postoperative ileus is a common complication in patients who undergo colectomies. This study provides an updated analysis of risk factors for prolonged postoperative ileus (PPOI) (≥4 days no return of bowel function) following elective colectomy, highlighting racial differences and site of colectomy. The National Surgical Quality Improvement Project dataset was queried to identify elective colectomy procedures from 2014 to 2019 (n=158 426). Univariate and multivariable logistic regression was used to identify risk factors and adverse outcomes. Twelve percent of all elective colectomies resulted in PPOI. The median age of patients with ileus was 65. The majority of patients in this sample were male (57%), ≥ 65 years (52%) and predominantly White (77%). Variables associated with PPOI include male sex, older age, smoking, right-sided colectomies, open surgery, and longer operative times. Black patients were more likely to have PPOI (AOR: 1.37, P<.001) when compared to White patients, Asian, American Indian/Alaska Native, and Native Hawaiian/Pacific Islander patients. PPOI was also associated with longer hospital stays, more postoperative complications, and higher readmission rates. Black, male patients who undergo open, right-sided colectomies may be at greater risk for PPOI. Age ≥ 65 years, having multiple comorbidities and being a smoker were also associated with the development of PPOI. Early identification of these potential risk factors may lead to improved perioperative management to shorten return of bowel function and decrease hospital stay for patients undergoing colectomy.