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

Methamphetamine use has increased throughout the United States in recent years, and is historically prevalent in Hawai'i. This retrospective study aimed to determine the effect of methamphetamine use on emergency department (ED) resources, by examining visits to an emergency department (ED) in an urban hospital in Hawai'i from 2007 - 2011. The rate of patients who tested positive for amphetamine was measured and broken down by year. Primary outcomes included length of ED stay, the administration of medication or physical restraints for safety, and the rate of psychiatric hospitalization. Overall, 15.1% of drug-screened patients (N = 16,018) tested positive for amphetamines over the study period. Amphetamine-positive patients spent more time per visit on average in the ED, and were more likely to require medication and physical restraints, compared to amphetamine-negative patients. Amphetamine positive patients were admitted to inpatient psychiatry less frequently than negative-testing patients. In summary, there is higher resource utilization per psychiatric emergency service visit by amphetamine-positive patients; however if patients can be stabilized in the ED, the increased ED resources utilized may be offset by the reduced burden on inpatient facilities.

Gelastic seizures (GS) are a rare form of epilepsy characterized by inappropriate, uncontrolled laughter. They are highly associated with abnormal cognitive development and behavioral problems in patients. Research has shown that GS can originate from hypothalamic hamartomas (HH), non- neoplastic masses consisting of gray matter with large and small neurons interspersed with glial nuclei. GS have also been observed in patients with frontal and temporal lobe lesions. The patient in this case report is a 40-year-old man with a past medical history significant for brain tumor, diabetes mellitus, and schizophrenia who presented with a long standing history of sudden, involuntary laughter occurring 2-3 times a week since 8 years old. Since the onset of these laughing spells the patient has displayed gradual cognitive impairment and increasing behavioral problems. Subsequent EEG (21-channel electroencephalogram) showed focal epileptiform activity in the right frontotemporal region and MRI studies revealed a mass arising from the hypothalamus suggestive of a HH. Other conditions should be considered in the differential diagnosis for laughing spells and distinguishing different causes can be challenging. As demonstrated by this case report, in patients with behavioral issues, especially those with inappropriate uncontrolled laughter, gelastic seizures need to be included in the differential diagnosis. Thus, a thorough workup should include neuroimaging with attention to the suprasellar region and EEG. Accurate, early diagnosis and patient education are critical in avoiding excessive and unnecessary treatments. This condition may be pharmacoresistant and is often associated with progressive cognitive and behavioral issues. Studies have shown a surgical treatment approach may be effective.

In order to successfully address social determinants of health and to achieve social justice for kanaka and all the people of Hawai'i, we must broaden our understanding of and approach to healing/health through interdisciplinary, culturally-informed education. Strengthening cultural competence within an Interprofessional Education framework, has potential in meeting important challenges in patient and population health, including meeting the increased demand for culturally trained professionals, increasing access to providers, and reducing health inequities in kanaka (Native Hawaiians). We present a model of course design and delivery, Ke A'o Mau (Learning Preserved), intended to provide haumana (students) with a unique body of culturally-anchored and community-based knowledge, skills and values that facilitate work with kanaka. Ke A'o Mau was implemented in the 2017-2018 academic year at University of Hawai'i (UH) at Manoa and optimized the authenticity of cultural learning through the engagement of kumu loea (expert teachers) to instruct in their area of expertise. Design and delivery of the course began with the understanding and honoring of kanaka worldviews, knowledge, and practices. Appraisal of haumana learning showed strong evaluative scores, of knowledge development, skills training, and instructional materials. This course not only seeks to resolve critical challenges in patient and population health but also provides a model to support the UH Manoa strategic priority of "striving to be a foremost indigenous-serving institution."

The four serotypes of dengue virus (DENV) cause the most important and common arthropod-borne viral diseases in humans. There have been three major dengue outbreaks in Hawai'i since 1946. The most recent and largest outbreak occurred on Hawai'i Island in 2015-2016. This article reviews the public health response to dengue outbreaks over the period 2001-2016, as well as scientific literature on dengue outbreaks in Hawai'i. As summarized in the assessment by the Centers for Disease Control and Prevention in 2015, Hawaii's response to the dengue outbreak was timely, appropriate, and well-coordinated. All facets of a public health response to the outbreak were adequately addressed, but communications and medical entomologic capacities could be improved. The observations of Aedes aegypti on Hawai'i Island and of its co-localization with confirmed human cases highlight the importance of continuous vector surveillance and entomologic research. In-depth studies on the molecular epidemiology, entomology, and epidemiological investigation would provide new insights into the latest outbreak and into strategies to combat DENV and other arboviruses in the future.

As part of the strategic plan to improve preconception care, health care providers are advised to counsel women about developing a reproductive life plan. Women are asked think about whether they want to become pregnant and have children and if so, when they would like to do so. The utility of a reproductive life plan is based on the premise that an individual has control over their own health and reproduction. Less is known regarding the beliefs of health care providers which may be important for strategizing educational and training programs. We conducted this project to examine whether health care providers in the Pacific Basin region who are providing reproductive health care, believe they have control over their own health. The Multidimensional Health Locus of Control Scale was used to survey attendees of the Annual Title X Reproductive Health Conference in Saipan, Commonwealth of the Northern Marianas. The cohort of reproductive health care providers surveyed (n=21) showed high internal control scores with a mean of 29.9 (SD = 3.5) and a range of 21 to 36 (maximum score = 36) consistent with individuals who have a strong belief that their health is most influenced by their own behavior. Chance and "powerful others" scores were consistent with means noted in other studies of healthy individuals. Understanding providers' health beliefs can aid in designing and executing more effective interventions to improve reproductive health outcomes.

Hawai'i has the lowest rate of community water fluoridation in the nation, which has contributed to poor oral health for children statewide. When properly prescribed, the benefits of fluoride supplementation for oral health outweigh any potential side effects to the body. Official recommendations give pediatric healthcare providers the authority to prescribe fluoride supplements and guide parents in daily usage. However, knowledge of actual practice and adherence for both providers and patients have never been examined in Hawai'i. This study aims to evaluate pediatric healthcare providers' attitudes, knowledge, and practices, regarding fluoride supplementation. A 37-item survey was developed investigating these domains, and was distributed to pediatric dentists, family practitioners, and pediatricians in the state. One hundred and three responses were collected during the time period of May 2014 through May 2015. Descriptive and bivariate associations with several outcomes were assessed. The majority (87%) reported at least some knowledge of the official guidelines. There was uncertainty in knowledge of fluorosis and the seriousness of the health risk. A recent educational session on fluoride was associated with more knowledge of the guidelines and the signs and symptoms of fluorosis. The majority of providers started fluoride at the recommended age whereas there was more variablility on stopping fluoride. On the patient side, providers reported that 67% of the parents forget to administer and 53% reported that their child does not like the taste. This study provides some information regarding the clinical use of fluoride supplementation in children. More efforts are needed to raise awareness in a consistent manner by both the dental and medical communities on the importance of fluoride supplementation to promote oral health in children while addressing concerns of professionals and the community.

Non-communicable disease (NCD) related behaviors among adolescents are on the rise globally and in the Pacific region. To better understand and elucidate the prevalence of NCD risk factors among adolescents in Pohnpei state, Federated States of Micronesia, a cross-sectional study was conducted among secondary school students. Of 2965 students enrolled in the 2015-2016 academic year, 2555 (86.2%) completed the survey, and 2386 (80.5%) were included in the final analysis. Of the survey respondents, 21.7% of students self-reported smoking tobacco in the past 30 days, 30.3% self-reported drinking alcohol in the past 30 days, 40.9% self-reported chewing betel nut in the past 30 days, and 21.2% self-reported chewing tobacco with or without betel nut in the last 30 days. Male students, older students, and public school students had higher prevalence of substance use. Additionally, about 17.3% of students were overweight and 10.1% were obese according to physical measures of height and weight. Female students and private school students had higher prevalence of overweight and obesity than male students, and prevalence of overweight was higher in older age groups. These findings indicate a cohort of adolescents at substantial risk for the development of NCDs and signal an urgent need for public health interventions to address NCD risk factors.