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

Social work is an academic and professional discipline that has been part of the Hawai'i social service workforce since the late 1800s. As the largest provider of mental health services in the United States, social work is a regulated profession in Hawai'i, but current information about the size and scope of the profession is limited by significant data issues stemming from varying definitions at state and federal levels. However, the need for more social work professionals in the state, which is already experiencing a social work workforce shortage, is clear. In addition, opportunities to support the social work workforce exist through advocacy efforts and policy changes that would increase education and training opportunities as well as increase providers to meet the demands of the community.

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a rare phenomenon. Review of the literature revealed 2425 DRESS syndrome case reports and only 175 case reports secondary to allopurinol, with this being the first published report of DRESS Syndrome in the state of Hawai'i. This case report describes a Han-Chinese patient diagnosed with DRESS syndrome secondary to allopurinol use, which has been reported to be a high-risk group for allopurinol-related drug reactions. Given Hawaii's unique patient population, compromised of a large Chinese and mixed-race population, it is important to maintain a higher level of suspicion when prescribing allopurinol.

On August 8th, 2023, Lāhainā, the first capital of the Kingdom of Hawai'i, experienced one of the deadliest wildfires in US history in over a century. Through historical and cultural data, the role of westernization in Maui's regional climate change is investigated. Since the 1800s, Lāhainā has fallen victim to climate-change-driven human activity. Whaling altered the ocean's carbon sink, the sugar industry diverted water from Native Hawaiian farmlands and increased carbon dioxide emissions, the opportunistic invasive, more flammable grasses predisposed the land to fire, and tourism perpetuated these harmful environmental impacts. Combined with climate change on a global scale, these factors contributed to the destruction in Lāhainā and to the physical and mental toll on its people, especially the Native Hawaiians. This manuscript's primary focus is to discuss the impact on Native Hawaiians given the deep ancestral connection with the land and the ancestry of the authors. As Native Hawaiians, this article serves as a platform for the authors' personal experiences to advocate for climate change awareness as future physicians and to emphasize inclusion of Native Hawaiians in the rebuilding of Lāhainā.

Young infants under the age of 60 days are at high risk of invasive bacterial infection. Historically, several different criteria were developed to risk stratify this population and guide management yet since then epidemiology of invasive bacterial infection has changed. In 2021, the American Academy of Pediatrics released a clinical practice guideline on the evaluation and management of well-appearing infants aged 8 to 60 days with fever, with subcategories 8-21 days, 22-28 days, and 29-60 days. At the only pediatric hospital in the state of Hawai'i, practices for evaluation and management of infants 22-60 days differed from the published clinical practice guidelines. In 2022, a local quality improvement initiative was implemented in connection to a larger national quality improvement initiative to align the institution's practice with the guidelines, thereby decreasing unnecessary hospitalizations, procedures, and medications. After implementation, the admission rate for infants 22 to 60 days decreased significantly from 19% to 2% (P=.010). Lumbar puncture rates decreased for infants 22 to 60 days from 39 out of 47 (83%) to 12 out of 59 (20%) (P<.0001). There was a significant decrease in the number of infants 29 to 60 days with normal inflammatory markers and normal urinalysis who received antibiotics 74% to 20% (P<.0001). There was no increase in delayed diagnosis of invasive bacterial infection (P=NS). Within one year of implementation, there was significant change in clinical practice with adherence to the clinical practice guideline, resulting in fewer unnecessary hospitalizations, antibiotic administration, and lumbar punctures.

The Children's Healthy Living Center of Excellence (CHL Center) conducted a food cost survey (CHL FCS) in the United States Affiliated Pacific Region (USAPR) that was modified from the United States Department of Agriculture Community Food Security Assessment Toolkit (CFSAT). The CFSAT is based on the 1999 United States Department of Agriculture (USDA) Thrifty Food Plan (TFP). The TFP estimates the cost of consuming a healthy, cost-conscious diet at home and is based on food cost, nutrients in food, nutrition guidance and What We Eat in America (WWEIA). The USAPR is not included in the WWEIA survey. The CFSAT's 87 food items were included in the CHL FCS. The purpose of this study is to describe the availability of the food items in stores within the USAPR and what items were locally produced. In March 2021, food cost data were collected from 92 stores in the jurisdictions of Alaska, American Samoa, Commonwealth of the Northern Mariana Islands, Guam, and Hawai'i. Most CHL FCS food items were available in at least 1 store in each jurisdiction with a range from 0 to 14 items missing from all stores. The presence of local food items was limited across jurisdictions, ranging from 8 to 27 items. Geographic isolation and small populations affect the availability of food items. Inclusion of the region's cultural and dietary practices in national nutritional guidance is crucial in preserving local food cultures, and the production and consumption of local foods.

Despite mounting evidence of the link between oral health and systemic health, there are limited studies on individual- and community-level race/ethnic and socioeconomic correlates of tooth loss and cardiovascular disease (CVD), particularly with regard to Asian and Indigenous populations. This cross-sectional study examined the association between severe tooth loss and CVD and the individual- and community-level sociodemographic correlates of CVD in Hawai'i, where Native Hawaiian and Asian populations are predominant, utilizing 5 waves of even year data from the Hawai'i Behavioral Risk Factor Surveillance System collected between 2012 and 2020. Weighted Poisson regression was used to estimate the unadjusted and adjusted prevalence of CVD. Independent variables included demographic variables (age, sex, race and ethnicity), socioeconomic status indicators (education, annual household income, health insurance), and health-related variables (BMI, smoking status, diabetes). A significant association was revealed between severe tooth loss and CVD, which persisted (but was attenuated) with adjustment for sociodemographic and health variables. There were also disparities in CVD prevalence by race and ethnicity (Native Hawaiians had a higher prevalence than White respondents, even after adjustment) and community. The tooth loss-CVD linkage, and racial/ethnic disparities in the prevalence of CVD, point to the importance of a holistic, multi-level approach to public health and collaboration between medical and dental health professionals.

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.