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

The purpose of this study is to investigate whether there are gender differences in the psychological effects of ethnic identity and discrimination in Hawai'i. Using data from an anonymous survey of undergraduate students (N = 1,033) at a university in Hawai'i, regression results revealed that higher levels of ethnic identification were associated with significantly lower levels of depressive symptoms. This association was statistically significant (P < .001), adjusting for gender, age, socioeconomic status, racial/ethnic group, mixed racial/ethnic status, years living in Hawai'i, immigrant status, and discrimination. Interaction effects (b = 2.55; P < .05) further indicated that the inverse relationship between ethnic identity and symptoms of depression was stronger for men than women. Also, everyday discrimination was significantly more psychologically distressing for women (b = 0.19; P < .05) than men. Overall, these findings suggest that a strong ethnic identity, which encompasses ethnic pride and knowledge, involvement in ethnic practices, and a cultural commitment or feeling of belonging to one's ethnic group, significantly benefits mental health, and to a greater extent among men. Although the chronic stress of discrimination (not necessarily due to race/ethnicity) was linked with increased levels of distress among both men and women, it was significantly more intense among women. Future research is needed to uncover why the mental health consequences of everyday discrimination and a salient ethnic identity would be different for young men and women in this cultural context and whether this holds true in other locations in the United States.

The Youth Risk Behavior Survey is administered biennially in odd years to public middle and high school students in Hawai'i. Data highlights are presented from Hawaii's 2017 high school survey results to enhance understanding of the relationship between health and academic achievement. This article reviews a select set of health-risk behaviors and their association with academic grades for Hawai'i public school students. The findings demonstrate that students who self-reported engaging in health protective behaviors also reported higher academic grades in school, while those who engaged in health-risk behaviors were more likely to report lower grades in school. This discussion can provide useful background information and benchmarks for research, policy, and local initiatives. It also supports the need for continued collaboration and a synergistic approach between education and health partners in Hawai'i in order to improve the health and academic achievement of our youth.

This exploratory study aimed to assess obesity, physical activity, and nutrition among Pacific Islander youth and young adults in Southern California. A total of 129 Tongan, Samoan, and Marshallese participated in the study, including relatively similar proportions of males and females and age groups. We calculated Body Mass Index (BMI), dietary intake by a food frequency questionnaire (FFQ), and 7-day physical activity levels with accelerometers. Overall, 84% of Tongan, 76% of Samoan, and 24% of Marshallese participants were overweight or obese, with mean BMI of 31.2 and 34.3 kg/m² (for Tongan males and females), 32.3 and 33.4 kg/m² (Samoan males and females), and 25.3 and 22.1 kg/m² (Marshallese males and females). We found moderate- and vigorous-intensity physical activity (MVPA) fell below current guidelines at 38 min/day, with over 87% engaging in light-intensity PA and large sedentary times. Daily percent of energy from saturated fat, fiber/1,000 kcal and dairy intake were higher in Tongans compared to Samoans and Marshallese. Despite promising outcomes from this study, high prevalence of overweight, low physical activity levels, and high caloric intake put Pacific Islander youth and young adults at risk for a variety of health concerns and future efforts should focus on further research as well as community-wide prevention and amelioration efforts.

The cause of Henoch-Schonlein purpura, or IgA vasculitis, is largely unknown. It has been associated with infections, other rheumatologic triggers, and adverse drug reactions. Rarely, adult Henoch-Schonlein purpura is also associated with solid-tumor malignancies. We present the case of a 66 year-old woman who presented with Henoch-Schonlein purpura associated with a metastatic malignancy of unknown primary origin. We recommend that adult patients presenting with Henoch-Schonlein purpura, especially those with no identifiable trigger, receive age-appropriate work-up for potential malignancy.

Methicillin-resistant Staphylococcus aureus (MRSA) causes about 80,000 severe infections each year. Compared to Methicillin-susceptible Staphylococcus aureus (MSSA), MRSA is associated with higher mortality and increased hospital length of stay (LOS). Vancomycin hydrochloride, an antibiotic with activity against MRSA is often used as empiric therapy for pneumonia. However, current pneumonia treatment guidelines recommend against the routine use of MRSA coverage since MRSA prevalence rates are low. In this retrospective, observational study, 38.3% of the population received vancomycin while only 2.6% had evidence of a MRSA infection. Data was gathered manually from electronic medical records from four hospitals over a six-month period. To identify a well-balanced comparison and account for potential confounders, matching on the propensity scores was conducted. Prior to matching, those who received vancomycin had a significantly higher rate of mortality (14.3% vs 4.9%, P < .001) and higher LOS (9.6 days vs 7.2 days, P < .001). Those who were de-escalated from vancomycin had a significantly lower LOS (8.3 days vs 11.6 days, P = .001) with no difference in mortality. After performing a survival analysis on matching data, those who received vancomycin had a significantly higher LOS (9.2 days vs 7.5 days, P = .002) with no difference in mortality (P = .1737). Those who were de-escalated had a significantly lower LOS (8.3 days vs 11.3 days, P=.005) with no difference in mortality (P = .8624). This study demonstrates a low prevalence of MRSA with the potential overuse of vancomycin. This along with no difference in mortality and a lower LOS supports the recommendation to limit vancomycin use as clinically appropriate. If vancomycin is used, assessment for rapid de-escalation is needed.

Pelvic inflammatory disease is a state-mandated notifiable disease in Hawai'i. A survey assessing pelvic inflammatory disease (PID) reporting to the Hawai'i Department of Health (HDOH) PID surveillance system, was administered to physicians in Hawai'i in April 2012. To measure the accuracy of self-disclosed PID reporting, data from the survey were compared to HDOH PID surveillance system case reports. Concordance between the two data sources was assessed using Cohen's kappa statistic. We first linked data by physician name. An adjusted kappa was also calculated to minimize prevalence and bias effects. A second analysis linked data according to physician name or practice setting. In the name-based analysis, the HDOH PID surveillance database successfully matched only ten of 118 physicians (8.5%) who self-disclosed reporting a PID case. Only "slight agreement" (k= 0.09, 95% confidence interval [CI]: 0.02-0.16) was demonstrated between the two databases. The prevalence-adjusted, bias-adjusted kappa demonstrated "moderate agreement" (κ=0.53, 95% CI: 0.45-0.60). In the second (name or practice-based setting) analysis, 77 physicians with linkages were found in the HDOH surveillance database, reflecting "moderate agreement" (κ=0.52, 95% CI 0.43, 0.61). Our findings provide evidence that individual physicians are submerging their case reports into group practice/HMO aggregate reports and not reporting individually as legally mandated and hence are compromising PID surveillance quality.

Lana'i is a geographically isolated Hawaiian island of approximately 3,100 residents. During the 2017-2018 school year, 22 Lana'i High and Elementary School juniors and seniors engaged with community members, kupuna (elders, those who stand at the source), stakeholders, and expert consultants to conduct an island-wide Community Food Assessment (CFA). A CFA can provide a community comprehensive information about their food systems. Particular attention was given to indigenous, Native Hawaiian food culture and needs. Students collected 656 surveys from a population of about 2,200 adults. Students also completed 14 separate focus groups, interviewing a total of 43 adults in the Lana'i community. This high school student-driven project was the product of many years of engagement and preparation, generosity from community members and content experts, and fortunate circumstances. This paper (1) describes the history of the project, providing useful details around the process of building capacity, leveraging connections, and engaging high school students and community members around a critical health issue in this rural community; and (2) highlights key findings that will be useful for policy development and advocacy.