Hawai'i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health最新文献

Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections are increasing among young adults, and males who have sex with males (MSM) are at high risk for both infections. Limited Hawai'i data exists on the extent to which populations, such as MSM, are engaging in behaviors that place them at increased risk for either infection. This analysis quantified the proportion of Hawai'i public high school students who are MSM and are at risk for HCV and HIV infections. Data from the 2013, 2015, and 2017 Hawai'i Youth Risk Behavior Surveys (YRBS) were combined (n=16,751) to investigate the prevalence of risk factors associated with HIV and HCV infections (eg, sexual risk behaviors, substance use) and protective factors among MSM public high school students. Among sexually experienced male students (n=3,391), 13.1% were classified as MSM and among these, 40.3% identified as heterosexual despite reporting same-sex sexual contact. Multivariate modeling demonstrated that MSM students are significantly more likely than non-MSM students to engage in behaviors that increase their risk for HIV and HCV infections (composite risk variable; adjusted Prevalence Ratio: 1.40, 95% CI 1.15 - 1.70) and are significantly less likely to have protective factors. Evidence-based prevention strategies for reducing HIV and HCV risk behaviors while improving protective factors among sexual minority youth in Hawai'i are necessary and must address sexual behavior along with other dimensions of sexual orientation.

Community health workers (CHWs) have been important contributors to the health and wellness of disenfranchised and minority communities for more than 50 years in the United States. Recently the Centers for Disease Control and Prevention (CDC) recommended several policy initiatives to support and advance the CHW workforce, including formalizing a state-level definition for CHWs. Such state-wide standards can lay the groundwork for health insurance reimbursement for CHW services, help establish a professional identity, and generate cohesion among CHWs. Some states have already adopted a formal definition of CHWs. Hawai'i has had grassroots and political movement in this direction, although no widespread, formal consensus has been reached. This paper reviews decisions in other states in formally defining CHWs in order to inform efforts in Hawai'i. As of February 2019, data has been collected on states which have formally defined CHWs. Two independent reviewers compared the definitions used in 15 states with formalized definitions using the American Public Health Association (APHA) CHW Section definition. We found that most states built upon the APHA definition to create working definitions that were codified into law, sometimes with minor modifications for relevance to their communities. Given the widespread use of the APHA definition, Hawai'i may also find benefit from using the APHA definition as a backbone for a state-level definition. Critically, following best practices, it will be important to take steps to ensure CHW self-determination in all aspects of the processes towards a state-level definition of and scope of care for CHWs.

Staphylococcus aureus is a pathogen that causes skin and soft tissue infections (SSTIs) in dermatology patients. There is an increasing rate of methicillin-resistant S aureus (MRSA) reported in the dermatology literature since 1987. This report profiles the antibiotic susceptibilities of methicillin-sensitive S aureus (MSSA) and MRSA in an outpatient office in Hawai'i. This is a retrospective study done by chart review from 2012 to 2014. Demographics, anatomical site of infection, clinical diagnoses and antimicrobial susceptibility patterns were analyzed and compared. Of the 66 samples, 57% were males and 43% were females. S aureus was more commonly found in impetigo, folliculitis, furuncles and secondarily infected psoriasis and more commonly located on the extremities. MSSA accounted for 73% (48) of the cases and MRSA accounted for 27% (18) of the cases. The antibiotics most effective against all S aureus cultures for outpatients were linezolid (100%), trimethoprim sulfamethoxazole (95%) and tetracyclines (94%). Linezolid (100%), trimethoprim sulfamethoxazole (100%) were most effective against MRSA isolates. Our S aureus and MRSA antimicrobial susceptibility results are similar to the local Hawai'i outpatient antibiogram collected from a large private laboratory in Hawai'i in 2014 and the current Infectious Disease Society of America guidelines. This study may be helpful in guiding empiric treatment of SSTIs suspected to be caused by S aureus.

Concussion, also referred to as mild traumatic brain injury (mTBI), is caused by a direct or indirect blow to the head or body causing the brain to move rapidly within the skull, resulting in immediate, but temporary, brain dysfunction. Developing awareness and promoting concussion education can reduce the number of short and long-term injuries associated with sports and non-sports related concussions in Hawai'i. The purpose of this study was two-fold: (1) to describe the number of concussions in 67 Hawai'i high school athletic programs using the ImPACT database; and (2) to describe which contact and collision sports had the highest rate of concussions in 67 Hawai'i high schools. This was a retrospective study that described the number of concussions generated across school years 2010-2016, concussion data across 14 contact sports, and athletic exposure rating for the 14 contact sports. Data were analyzed and aggregated from a data-bank associated with the Hawai'i Concussion Awareness and Management program. Findings suggest that for Hawai'i high school student athletes' concussions increased from 2010-2013 with a gradual decrease from 2014-2016, specific sports had higher number of concussions (eg, football), and when evaluating concussion rate per 1000 exposures, girls' judo was the highest. These findings stress the need for continued data collection, monitoring, education/awareness and research that will reduce the number of concussions among student athletes.

A 43-year-old male with a history of allergic rhinitis on chronic intranasal corticosteroids presented with complaints of a "black band" in his right eye visual field. On examination, he had subretinal fluid and lab tests and imaging studies including optical coherence tomography (OCT) and fluorescein angiography (FA) did not show any evidence of inflammatory, degenerative, or malignant process. He was diagnosed with central serous chorioretinopathy (CSCR). Symptoms improved and the subretinal fluid resolved after the discontinuation of intranasal corticosteroid medication. Intranasal corticosteroids are rarely associated with CSCR. Patients and providers should be aware of the potential risk of vision loss caused by intranasal corticosteroids.

The purpose of this project was to utilize pharmacists and pharmacy students to perform comprehensive medication reconciliation by telephone prior to a patient's office visit with their primary care physician, to address any medication issues. The project's aims were to decrease polypharmacy, improve the accuracy of medication reconciliation, and to allow more time for the physician to meet with the patient. Patients were called prior to appointment and a thorough medication reconciliation was conducted including verification of current prescription medications, over-the-counter medications, and herbal supplements. A total of 21 patients were enrolled in the study, and in 36% of patients, the number of medications decreased after the intervention. However, overall, the average number of medications used by patients increased from an average of 8.9 to 9.5 medications (P = .39). All patients included in the study had at least one medication change in the electronic medical record system. Most of the changes were to add medications that were not on the medication list or to remove medications on the list that the patient was no longer taking. This study demonstrated improved accuracy with pharmacist/pharmacy student involvement in the medication reconciliation process.

The purpose of this paper is to report on a community-designed and led talkstory intervention to increase awareness of intimate partner violence (IPV), decrease acceptability of IPV, and increase community leadership to address IPV. In collaboration with women engaged in prior IPV outreach and education in Hawai'i, a talkstory intervention for IPV was developed, and a single-group, pre-post-test design was used to test it. The intervention included five talkstory sessions over seven months with community groups interested in violence prevention. Pre- and post-testing were conducted to determine changes in group means on three measures. Ninety-two individuals participated in the intervention, 77 (84%) of these completed the 1-month follow-up measure, and 59 (64%) of these also completed the 6-month follow-up measure. The findings included: (1) participants in the talkstory intervention groups decreased their acceptability of violence and increased their awareness, knowledge, and confidence to address IPV; (2) the community leaders in the intervention groups gained skills in facilitation; and (3) intervention groups continued to sponsor other IPV awareness-raising activities in their communities following completion of the study. Working with community leaders to design and facilitate the intervention not only provided IPV education within the context of the community, but also led to sustainable efforts to enhance the safety and wellbeing of women experiencing violence.