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

Background: Squamous cell carcinoma in situ (SCCIS), also known as Bowen's disease, is a precancerous intradermal lesion that commonly arises in sun-exposed areas. Other risk factors include radiation, inflammation, carcinogen exposure, and human papilloma virus exposure. Its presentation on the nipple-areolar complex is extremely rare with 14 cases reported in literature.

Case presentation: We report a case of a postmenopausal woman with remote history of breast cancer and DCIS treated with bilateral breast conserving surgery followed by adjuvant radiation. She developed SCCIS of the right nipple nearly 30 years later. Associated symptoms included bloody nipple discharge, nipple rash, and nipple pruritus for 1.5 years. A punch biopsy of the right nipple lesion identified epithelioid cells in the intradermal space staining CK7 (+) and p40 (+)/p63 (+), classifying the lesion as Paget's disease. The patient elected to proceed with bilateral mastectomies without reconstruction. Final surgical pathology revealed radiation induced atypia and atypical keratinocytes that focally extend throughout the full epidermal thickness. Immunohistochemical staining demonstrated CK7 (-), CK5/6 (+), p40 (+), HER2 (-) and GCDFP15 (-) consistent with the diagnosis of SCCIS.

Conclusion: Paget's disease of the nipple and SCCIS may present with similar clinical and histopathologic features; however, they are managed differently. Nipple lesions in the setting of prior radiation should raise concern for SCCIS. Clinicians should be aware of this rare, but potential sequelae in patients with a history of breast cancer treated with breast conserving therapy and nipple complaints.

Indigenous ways of knowing center on balance and holism, with an emphasis of learning through ancestral and intergenerational knowledge, which continue to be revitalized as a demonstration of the ongoing resilience of Indigenous Peoples. The Native Hawaiian and Indigenous Health (NHIH) Summer Health Academy (SHA) program was developed and implemented with an objective of increasing diversity, equity, and inclusion in higher education, fostering relationships at multiple levels, addressing gaps in education and academia, preparing students to work with and for Native and Indigenous communities, and changing the narrative of health and healing to better align with Native Hawaiian and Indigenous worldviews of health. Program activities included individualized mentoring, critical self-reflections through activities such as Indigenous photovoice, experiential opportunities to learn about social determinants of health, and community-engaged research projects. Overarching themes from the critical self-reflections included holistic and relational health, the importance of 'ohana (family), intergenerational relationships, and thriving 'Āina (land) as thriving health. Results of the pre and post-test surveys demonstrated the promise and success of the NHIH SHA course, with a statistically significant change in knowledge related to cultural humility, community-based research, Indigenous methodologies, and Indigenous frameworks of health. This program demonstrates the importance of creating a pathway of success for Native Hawaiian and Indigenous students to address gaps and disparities in higher education for Native Hawaiian and Indigenous communities at large, while increasing the pursuit of health-related fields by Native Hawaiian and other Indigenous students.

Environmental health (EH) is a critical branch of public health that addresses current and emerging health threats related to issues such as climate change and pollution. The state of Hawai'i faces distinct EH challenges, including air pollution from volcanic activity, widespread vulnerability to sea level rise, wildfire, exposure to pollution from accidental spills from military sites, and a tropical environment that contributes to heat-related illness and that is conducive to mosquito-borne illnesses. A robust EH workforce is essential to respond to these concerns. This article uses a combination of targeted literature review and qualitative interview methods to synthesize evidence relevant to the issue for the state of Hawai'i. Such a workforce includes professionals in state and federal agencies, academia, and the non-profit and community sectors. Many academic disciplines and professionals can contribute to the EH workforce, including environmental scientists and epidemiologists, toxicologists, exposure assessment scientists, risk characterization scientists, environmental policy and communication experts and community-based EH workers. Currently, there is an insufficient EH workforce in Hawai'i and addressing this gap will require strategic investments in academia and the Hawai'i Department of Health, as well as expanded collaboration. Training programs are also critical, in particular cross-sector ones. Finally, a proficient EH workforce in Hawai'i needs to be able to communicate effectively with the diverse populations of the state and demonstrate commitment to and understanding of the unique populations of the state and their EH concerns.

Public Health serves a critical role in ensuring and maintaining population health by recognizing that health is influenced by individual, social, economic, environmental, structural, and political factors. Despite the core role that public health plays in communities, the field's workforce faces shortages which were already dire pre-pandemic. The Department of Public Health Sciences (DPHS) at the University of Hawai'i at Mānoa (UHM) provides bachelor, masters, and doctoral degrees and serves as an essential training ground for the public health workforce in Hawai'i. The purpose of this paper is to describe some of the ways DPHS is meeting the ever-growing demand for qualified health professionals, in local and global government and community health departments and organizations. Since the first graduating class in 1967, more than 7000 individuals have earned accredited degrees through DPHS, including over 500 diverse undergraduate and graduate alumni since Fall 2015. The quality of DPHS' program and instruction are consistently highly rated by students and alumni. The curriculum is continually enhanced through innovative programs, and actively engages students in advancing public health practice and gaining applied research skills through all steps of scholarship including publications. DPHS is proud to be part of the movement towards building and revitalizing the public health workforce through teaching, research, and service and continues to strive to foster practitioners who will represent and serve local communities, engage in meaningful research and service, and bridge connections across disciplines and geographies.

Health care workers with specialized knowledge and skills to work with people living with symptoms of dementia are needed in all sectors of the health care industry in Hawai'i as the number of people in the population diagnosed with Alzheimer's disease and related dementias (ADRD) is expected to increase along with the overall number of older adults (ages 65+). This article provides a scoping review of relevant population data that suggest an urgency to address this need even as the state contends with an overall shortage of workers throughout the public health and health care industry. The authors then provide practical solutions, recommending a multi-pronged approach to introduce or enhance dementia-care competencies at various levels of education - from high school to graduate or professional studies - and through continuing education and professional development programs for practicing health professionals. Consistent with the public health philosophy of health equity, the authors propose that providing quality care to persons living with dementia is a social justice goal that can be achieved through this multi-pronged approach.

The public health workforce is critical to community well-being and too often overlooked. The goal of public health is to prevent disease, promote health, and protect the public from current and emerging health threats. This work is vital to the health, safety, security, and prosperity of all communities and requires an adequate workforce. Despite the well-articulated gaps in the clinical health care workforce, Hawai'i's public health workforce needs and capacities are not as well understood. Public health workforce enumeration is complex. The field lacks a consistent definition of its full workforce and agreed-upon mechanisms for measuring it. Resolving these issues is an active area of scholarship and action, particularly given the COVID-19 pandemic-induced workforce capacity strain. This article reviews existing literature on public health workforce enumeration as a step toward filling this knowledge gap for practical use in the state of Hawai'i. Specifically, using a critical literature review method, this article (1) consolidates existing data about Hawai'i's public health workforce, (2) summarizes public health workforce measurement challenges, (3) shares existing frameworks and models for quantifying the public health workforce, and (4) discusses next steps to provide actionable information for ensuring Hawai'i's public health workforce can fulfill its mission. The article confirms that core public health functions as articulated in the (a) updated 10 Essential Public Health Services framework and (b) Foundational Public Health Services framework provide useful guidance for public health workforce enumeration in Hawai'i. The article also concludes that the US Department of Health and Human Services (HHS) definition of public health workers provides comprehensive framing for this enumeration. Based on this literature synthesis, a descriptive figure of the public health workforce in Hawai'i was developed to guide future work and prioritization.

The United States public health workforce is facing a critical shortage, with a significant exodus of professionals from state and local health departments. This column discusses the importance of internship programs in developing a sustainable pipeline for new generations of public health professionals. The Hawai'i Public Health Institute's internship program is examined as an example to provide insights for organizations seeking to establish or enhance their internship programs. From 2020 to 2023, HIPHI received 258 applications and accepted 119 interns, with an acceptance rate of 46%. Interns were mostly bachelor's level students (69%), followed by master's level students (24%). Most interns (66%) were public health majors, with others from related fields. The program offered diverse placements across various public health areas and provided training opportunities including orientation, webinars, and field excursions. Recommendations for workforce development include fostering stakeholder collaboration, supporting practicum host sites and job supervisors, sharing information and best practices, and promoting leadership development. A holistic strategy involving stakeholder collaboration, leadership development, evaluation, and ongoing workforce assessment is essential for developing a robust public health workforce capable of promoting health, preventing disease, reducing mortality, and responding effectively to future crises. Program evaluation is a necessary next step to understand how best to assist interns and early career professionals during their practicums.