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

Physical Activity (PA) is essential for the prevention of non-communicable diseases (NCD). The risk of developing NCDs is three times as high among people with disabilities than people without disabilities. In 2016, an estimated 158,570 people in Hawai'i had disabilities. So far, only limited studies have considered increasing PA opportunities for people with disabilities. AccesSurf is a non-profit organization empowering people with disabilities to perform adaptive swimming and surfing. The purpose of this study was to conduct qualitative process and pilot outcome evaluation of AccesSurf. A focus group was conducted to explore the perspectives of six AccesSurf participants on AccesSurf's process, participants' outcomes, and suggestions. Participants were individuals with neurological health conditions, aged between 30 to 64 years. The analysis followed a deductive-inductive approach. Focus group participants reported on process variables, such as the positive environment and the provision of a range of PA opportunities (eg, adaptive swimming & surfing, stand up/outrigger/va'a paddling, kayaking, and surf skiing). They recognized AccesSurf's positive contribution to their physical, mental, and social health. Participants not only felt empowered through AccesSurf, but also increased their PA frequency and built athletic identities. A comfortable environment and provision of a variety of opportunities for participants were identified as advantageous AccesSurf outputs, fostering progressive short- and long-term outcomes that result in life-changing effects. This research shows that AccesSurf may play an important role towards increasing PA among participants.

Risk behaviors are known to adversely affect health outcomes, but the relationship between youth risk behaviors and oral health remains unclear. The objective of this study is to examine the likelihood of dental visiting among Hawai'i public high school students by demographic factors and number of adverse risk behaviors. Aggregated 2013 and 2015 Hawai'i public high school Youth Risk and Behavior Survey (YRBS) data was analyzed from 10,720 students. Results showed that, overall, 77.1% of students reported a dental visit in the past 12 months. Students who were ages 15, 16, 17, and ≥ 18 years old were less likely than students who were ≤ 14 years old to visit a dentist. Those who identified as Hispanic, Native Hawaiian, Filipino, Other Pacific Islander, and students who identified as more than one race/ethnicity were less likely to visit the dentist than their white counterparts. In addition, students having either 4 risk behaviors or ≥ 5 risk behaviors were less likely to report a dental visit than those with no risk behaviors. These findings support the presence of disparities in oral health care utilization among high school students in Hawai'i and reveal a significant association between age, number of risk behaviors, and race/ethnicity with the likelihood of utilizing dental services. Oral health programs should consider screening for risk factors and multiple risk behaviors, integrating with other health programs that share similar risk behaviors, and account for cultural differences in their development, implementation, and evaluation.

Gout is the most common inflammatory arthritic condition affecting more men than women. Hyperuricemia and the deposition of urate crystals into the joints are the hallmarks of gout. The prevalence of gout and hyperuricemia is rising in the United States and world-wide possibly due to the aging population, comorbidities, and other lifestyle factors. Gout and serum uric acid (SUA) levels are highly heritable, underscoring the role of genetics on disease risk and possibly the racial disparities in gout prevalence. However, high consumption of high fructose corn syrup, alcohol, select dietary lifestyles, and use of diuretics are associated with higher SUA levels and increased risk for developing gout. Adopting healthy diet and lifestyle modifications can lower SUA levels. Nonetheless, diet-based approaches for the management of gout should remain a secondary approach to urate lowering therapy.

This retrospective cohort study examined associations between maternal body mass index (BMI), race, and obstetric anal sphincter injury (OASI) (3rd/4th degree perineal lacerations). Obstetric anal sphincter injury may lead to significant maternal morbidity, and a more thorough understanding of risk factors for this complication may guide providers in patient counseling and procedures such as episiotomy or operative vaginal delivery. Vaginal deliveries performed at Kapi'olani Medical Center for Women and Children from 2008-2015 were included. Maternal body mass index at delivery was used and OASIs identified through International Classification of Diseases codes. Demographic/clinical variables were summarized through descriptive statistics. Adjusted odds ratios were calculated using multiple logistic regression. Of the 25,594 deliveries included, 1,198 (4.7%) involved an OASI. OASI prevalence differed by BMI (P < .0001). The prevalence was highest in women with BMI < 30 kg/m² (5.3%) and then decreased as BMI increased with women with BMI ≥ 50 demonstrating the lowest prevalence (1.7%). Compared to women with BMI < 30 kg/m², women with BMI > 50 kg/m² had a lower odds of OASI (OR 0.31 [95%CI 0.11 - 0.83]), which persisted after adjustment (aOR 0.28 [95%CI 0.08-0.96]). OASI also differed by race (P < .0001), with Native Hawaiian and other Pacific Islanders (NHOPI) demonstrating the lowest prevalence (3.0%) and Asians the highest (5.6%). After adjustment, compared to White women, NHOPI women had lower OASI prevalence that met the borderline of statistical significance (aOR 0.79 [95%CI 0.62-1.01]), while Asian women continued to demonstrate increased prevalence (aOR 1.50 [95% CI 1.22-1.85]). We conclude that obese women, including those with BMI ≥ 50 kg/m², have lower OASI prevalence. Race is also a significant factor, with Asians almost double the prevalence of NHOPIs. These findings contribute to evidence-based, individualized patient counseling on OASI.

Diabetes Mellitus (DM) is the leading cause of morbidity and mortality in the Republic of the Marshall Islands (RMI), a small Pacific nation located in Micronesia (population 53,184). Although generally preventable, diabetic foot disease is among the most frequently reported complication of DM globally and in the RMI. Over 25% of people with DM globally will have at least one DM-related foot ulcer, which may require surgical intervention. The purpose of this study is to determine the incidence of DM-related foot surgeries at the Leroij Atama Zedkaia Majuro Hospital, the main tertiary referral centre for the RMI, and where 90% of all DM-related foot surgeries in the country are conducted. A retrospective review of surgical and clinical records at Majuro Hospital for the 12-month period January 2015 to December 2015 was conducted to determine the incidence and characteristics of DM-related foot surgeries (foot ulcer debridement or lower limb amputation [LLA]). DM-related foot surgery was the fourth most common surgical procedure conducted in the RMI during the 12-month period reviewed. Four percent of people with DM presenting to the Majuro Hospital during the review period required DM-related foot surgery. The incidence of DM-related major LLAs was 103 per 100,000 population. As age increased, so did the proportion of patients requiring DM-related foot surgery. Eighty six percent of those requiring surgery were 50 years and older, and the majority were male (54.6%). The incidence of DM-related foot surgeries in the RMI remains high by international standards. The study findings confirm the need to address the burden of DM in the RMI and support the country's NCD Crisis Action Plan.

The Hawai'i Patient Reward And Incentives to Support Empowerment (HI-PRAISE) project, part of the Medicaid Incentives for Prevention of Chronic Diseases program of the Affordable Care Act, examined the impact of financial incentives on Medicaid beneficiaries with diabetes. It included an observational pre-post study which was conducted at nine Federally Qualified Health Centers (FQHCs) between 2013 to 2015. The observational study enrolled 2,003 participants. Participants could earn up to $320/year in financial incentives. Primary outcomes were change in hemoglobin A1c, blood pressure, and cholesterol; secondary outcomes included compliance with American Diabetes Association (ADA) standards of diabetes care and cost effectiveness. Generalized estimating equation models were used to assess differences in clinical outcomes and general linear models were utilized to estimate the medical costs per patient/day. Changes in clinical outcomes in the observational study were statistically significant: mean hemoglobin A1c decreased from 8.56% to 8.24% (P < .0001); mean systolic blood pressure decreased from 125.16 to 124.18 mm Hg (P = .0137); mean diastolic blood pressure decreased from 75.54 to 74.78 mm Hg (P = .0005); total cholesterol decreased from 180.77 to 174.21 mg/dl (P < .0001); and low-density lipoprotein decreased from 106.17 to 98.55 mg/dl (P < .0001). Improved ADA compliance was also observed. A key limitation was a reduced sample size due to participant's fluctuating Medicaid eligibility status. HI-PRAISE showed no reduction in total health cost during the project period.

Diabetes distress (DD) generally refers to the emotional and cognitive stress caused by the daily management of diabetes. The Diabetes Distress Scale (DDS)-17 is a 17-item instrument that is frequently used to screen DD and the Fisher's DDS2, developed by Fisher, et al, is a two-item instrument to quickly identify DD. However, these scales have been validated in Caucasian populations but not in Asian Pacific Islander (API) populations. This study aimed to 1) evaluate content validity of the DDS17 by evaluating correlation with hemoglobin A1c and 2) identify two items to develop a brief screening tool, DDS2, for an API population. We conducted a retrospective chart review of 443 patients at a diabetes center in Hawai'i. On their initial visit, patients filled out the DDS17 as a part of the standard of care. The DDS17 showed high reliability (Cronbach's alpha = 0.94). The two items of our DDS2 with the highest phi coefficient (0.59 each) to the total DDS17 subscales were selected from the interpersonal distress and the emotional burden subscales. The phi coefficient (0.74) of our DDS2 was higher than that of the Fisher's DDS2 (0.60). All DDS items showed positive correlation with hemoglobin A1c (DDS17: r = 0.18, DDS2: r = 0.16, Fisher's DDS2: r = 0.21, respectively). Therefore, these scales can be used to measure DD in an API population and the positive correlation suggests that addressing DD may improve glycemic control and vice versa. Clinicians with limited time may consider using our DDS2 rather than DDS17 to quickly screen the API population for DD.