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

Past research has examined the complex reasons for the apparent reluctance of East Asian Americans (ie, Chinese, Japanese, Koreans) to seek mental health services when needed. The current study analyzed East Asian American (EAA) mental health, utilizing inpatient hospitalization data from the Hawai'i Health Information Corporation (HHIC) database. Frequency of inpatient hospitalizations for specific mental health diagnoses (depression, bipolar disorder, schizophrenia, and suicide attempts/ideation) in EAA patients was examined. White, Native Hawaiian, and Filipino patients were included for comparative purposes. Retrospective data on adult (18 years and over) inpatient visits in Hawai'i from 2007 to 2017 were analyzed. Variables available for analysis were detailed race/ethnicity, age, sex, island, and insurance type as well as readmission rates, severity of illness (SOI), and initial length of stay (LOS). Overall, there were no significant differences between race/ethnicity groups in regards to readmission, SOI, or LOS for a majority of the diagnoses. However, for depression, even when adjusting for other demographics, Japanese and Chinese patients had significantly higher initial LOS and SOI than White patients, though the strength of this association was weak (R Squared model fits being less than .1 for both outcomes). The reason for these findings requires further examination, including whether EAAs may be reticent to seek help and/or whether healthcare providers are not recognizing the need for assistance.

Hawai'i Island faces a growing shortage of obstetric and gynecology providers. Increased exposure of obstetrics and gynecology residents to rural rotations during their core training may increase their interest in rural practice after graduation. In an effort to address the health care needs of women on Hawai'i Island, the University of Hawai'i Obstetrics and Gynecology Residency Program established a 4-week required gynecology rotation in the town of Hilo. Between July 2019 and June 2020, third- and fourth-year obstetrics and gynecology residents provided outpatient gynecologic care and participated in gynecologic surgeries at Hilo-based medical facilities. A total of 9 residents participated in this Hilo-based rotation. This retrospective study extracted data from post-rotation evaluations. Eight out of 9 participating residents (89%) felt that the rotation slightly or far exceeded their expectations. After the rotation, 7 residents (78%) reported an interest in practicing in a rural community, while only 3 residents (33%) reported having this interest prior to the rotation. Underserved rural areas seeking to recruit and retain obstetrics and gynecology physicians may benefit from partnering with residency training programs.

Hypertension and diabetes are major causes of disability and mortality in the US-Affiliated Pacific Islands (USAPI). Control of these conditions has the potential to avert much of the burden of non-communicable diseases in the region. To realize this potential, people living with hypertension and diabetes must be identified and receive treatment of sufficient intensity to control their blood pressure and blood glucose. Data from recent cross-sectional surveys conducted in 5 jurisdictions-Pohnpei, Palau, Kosrae, Marshall Islands and American Samoa-were used to estimate the adult prevalence of hypertension and diabetes as well as diagnosis awareness, treatment, and control status of the adults with these conditions. In addition to traditional prevalence indicators, the authors provide a novel presentation of non-communicable disease (NCD) data, using the concept of "protection gaps", defined as the number of people living in a community who have an NCD for which effective control is not attained. The protection gap is determined by applying survey-derived population prevalence estimates to the community's population size using census data. The protection gap is further divided into 3 groups: (1) case-finding gap-those who are unaware of their conditions; (2) tracking and outreach gap-those who are aware of their condition but not receiving treatment; and (3) treatment efficacy gap-those who are receiving treatment but whose disease is not under control. The findings show a large protection gap, with a majority of adults living with hypertension (80.8%) and diabetes (91.6%) not having their condition under control. The case-finding gap accounts for more than half of these, followed by treatment efficacy, and tracking and outreach gaps. These findings can guide public health strategies and monitoring for control of hypertension and diabetes in the USAPI region.

Native healing practitioners have been incorporated into health centers serving large populations of Kānaka 'Ōiwi (Native Hawaiians). However, no studies have examined their impact. A community based participatory research study at Waimanalo Health Center from 2017 to 2019 examined the added value of integrating native healing practices into primary care, including whether there is acceptability of the integration, cultural connectedness due to integration, and empowerment for patients, providers, and staff. Semi-structured interviews were conducted by the research team with 24 patients, providers and staff, and community residents. Through content analysis, 5 themes emerged. The integration of native healing practices provides an alternative to western medicine, recalls ancestral knowledge, focuses on the whole person, generates increased disclosure leading to behavior change, and is central to a decolonizing process. The findings support the integration of native healing practices providing added value in primary care.

In response to the COVID-19 pandemic, federal and state recommendations included the postponement of elective arthroplasties until adequate safety measures could be implemented. Following resumption of arthroplasties, exposure fears and financial concerns may have restricted access for some demographics. Therefore, the purpose of this study was to (1) investigate how the COVID-19 pandemic impacted the incidence of arthroplasty, both overall and by various demographics, and (2) evaluate if pre-operative patient-reported measures were different throughout the pandemic. Data were collected prospectively as part of an on-site joint registry between January 2019 and April 2021. Phase 1 (N=518) included all patients prior to the cancelation of elective procedures (average 36 cases/month), Phase 2 (N=121) was defined from restart until monthly caseload met/surpassed the average Phase 1 caseload (5 months), and Phase 3 (N=277) included all remaining cases. Multiple analysis of variance and chi-squared tests were performed to compare patient demographics and outcomes between phases. No significant differences were noted in patient demographics, with the exception of a decrease in Native Hawaiian/Pacific Islander patients and an increase in Asian patients during Phase 2 (P =.004). Length of stay decreased for unilateral arthroplasty from Phase 1 (0.9±1.1 days) to Phase 2 (0.4±0.6 days) and Phase 3 (0.6±0.7 days) (P <.001), while pre-operative patient reported outcomes remained similar across the 3 time periods. By implementing proper safety measures, the current orthopedic center achieved a timely recovery with no long-lasting inconsistencies in patient cohorts upon resumption of arthroplasties.

Orthopaedic surgery is no stranger to health care disparities and the American Academy of Orthopaedic Surgeons (AAOS) has expressed a commitment to a culturally competent and diverse workforce. Addressing workforce diversification is critical to recruiting a more diverse orthopaedic workforce and engaging the community to improve patient care and ensure equitable care for all. Unfortunately, these concerns were acknowledged by the AAOS almost 2 decades ago, without much significant progress. This article discusses mentoring as a means to address workforce diversification in orthopaedics and provides recommendations on how orthopaedics can enhance its efforts.