Hawaii Medical Journal Articles For 1991

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    Human anisakiasis transmitted by marine food products.
    ( 1991-01) Deardorff, T L ; Kayes, S G ; Fukumura, T
    Seafood-transmitted parasitic diseases represent an emerging area of interest to the U.S. Food and Drug Administration. Human infections with marine parasites are generally the result of ingesting uncooked seafood products. Over 50 species of helminthic parasites are known to infect humans worldwide. Recently, the number of infections with one of these helminths, the juvenile stage of the marine nematode, Anisakis simplex, has increased in the United States. Raw fish dishes such as lomi lomi salmon and sashimi are known to transmit the parasite to unsuspecting citizens and the most frequently implicated fish in the transmission of this zoonotic disease is the Pacific salmon (Oncorhynchus spp.). The risk of infection from fishes caught in Hawaiian waters is slight; however, a juvenile Anisakis simplex infected one patient from either locally caught aku or ahi. We report 4 new cases, which brings the total number of known cases in Hawaii to 7. Five of the 7 cases were diagnosed and treated by means of an endoscope and biopsy forceps. Serological profiles are presented in several of these cases. One case represents the first known instance of reinfection; the initial infection occurred 2 years prior. The second infection gave an opportunity to compare the human response to a challenge infection and to investigate the validity of the "double hit" theory. Increased awareness by physicians to the clinical features of this disease is warranted. The zoonotic disease, anisakiasis, should be considered in patients presenting with intense abdominal pain, if these patients admit they have recently eaten raw or undercooked seafoods.
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    The health status of working women in Hawaii.
    ( 1991-01) Halfon, S T ; Kodama, A M ; Arbeit, W
    The effect of work on women's health was examined in this study by comparing selected health indicators and specific chronic conditions among employed men, employed women and housewives. The study analyzed data from the Hawaii Health Surveillance Program. The study group was comprised of 56,203 subjects and represented a randomly stratified sample of the population interviewed during the period 1981-1986. Housewives as a group were older, less educated and reported the lowest family income compared to employed men or employed women. The prevalence of several specific chronic conditions were higher among housewives than in employed men and employed women. Multiple regression analysis tested the difference in several health indicators (chronic conditions, hospital episodes and restricted activity days) between employed men, employed women and housewives, controlled for sociodemographic variables. The health status of housewives was clearly worse than that of employed men and employed women by all health indicators; employed women had more hospital episodes than employed men. The results suggest that mostly healthy women are selected for the labor force. Among employed women, those in poor health and needing hospital services more frequently, are probably at high risk of dropping out of work. Our study projects the importance of promoting occupational good health for employed women during their working life.
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    Traumatic spinal cord injury in Hawaii.
    ( 1991-02) Goebert, D A ; Ng, M Y ; Varney, J M ; Sheetz, D A
    As a prelude to continuing surveillance in Hawaii, a 2-year retrospective study (1987-1989) was conducted by the Pacific Basin Rehabilitation Research & Training Center (PBRRTC) and the Rehabilitation Hospital of the Pacific (REHAB) in order to examine the frequency and causes of traumatic spinal cord injury (SCI) at REHAB; determine similarities and differences when compared to national statistics and make recommendations for future study. Data were abstracted from patient records at REHAB. During the period of study, 59 persons were treated for SCI. Similar to the national database, 85% were males and 70% were teenagers and young adults. Motor Vehicle Accidents (MVAs) contributed to 38% of the injuries followed by falls (28%), sports (19%) and violence (16%); however, etiology differed according to age. Sixty-two percent of the lesions were cervical. Almost 50% were neurologically complete. Sixty-six percent were in wheelchairs. Over 50% were independent in mobility and feeding and nearly 40% were independent in bathing and dressing. Eighty-eight percent returned to their homes. In general, the case at REHAB did not differ from the national database. Because reporting has not been mandatory, actual SCI incidence in Hawaii is most likely higher. Information derived from a mandatory reporting system would lead to identification of high risk groups, development and evaluation of prevention programs, identification of patients requiring early intervention and rehabilitation, and better planning of health care services.
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    The Robert T Wong MD lectureship.
    ( 1991-02) Reppun, J I
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    Medical consequences of acute exposure to high altitude.
    ( 1991-03) Hallenborg, C P
    People who ascend rapidly to altitudes greater than 3,000 meters (10,000 ft) may become ill; rarely, some may die from an inability to adapt to hypoxia. Age, pre-existing cardiopulmonary or hematologic disease, and the rate and degree of ascent are known to limit man's adaptation to high altitudes. Other factors, such as blunted hypoxic respiratory drive and sublinical disease of the pulmonary vascular bed are probably also important. Pre-exposure with acetozolamide (Diamox) helps, but once symptoms of high altitude pulmonary edema (HAPE) occur, supplemental oxygen and rapid descent to lower altitudes are the only known remedies. In view of the steady increase in the number of people who work and play at high altitudes, physicians must understand the pathophysiologic mechanisms involved in order to treat properly and to counsel patients.
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    Lead poisoning in Hawaii: 1990.
    ( 1991-03) Wiebe, R A ; Anderson, B S ; Lehman, C W ; Fu, D J
    Although lead (Pb) is one of the oldest known and most thoroughly described toxins, it continues to be a significant health hazard in 1990. There has been much progress in defining the nature and extent of low-level lead toxicity during the past decade. There continues to be insidious sources of lead toxicity in our environment, in water, food, paint and contaminated soil. As the epidemiology of lead poisoning is more clearly defined, toxicities are recognized as the result of lower and lower levels of exposure. Recognition of low-level lead exposure and the primary prevention of its effects on health requires a keen awareness of high-risk environments as well as the subtle symptoms and signs of lead poisoning. A high index of suspicion by primary care physicians plus government support are necessary to implement successful prevention programs.
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    Occupational-health training at the University of Hawaii.
    ( 1991-03) Kodama, A M ; Hashimoto, H H ; Morris, J
    Occupational-health training at the University of Hawaii School of Public Health (UH-SPH) is a graduate-level program focusing on industrial hygiene; it also offers courses of interest to other health professionals, particularly physicians and nurses. The current training at the UH-SPH is designed primarily to prepare occupational-health practitioners at the master's degree level. The occupational-health program elective is considered to be an area of emphasis within a broader program of study in public health. The program offers special opportunities for occupational-health training and research in cross-cultural and international settings. Post-graduate and continuing-education occupational-health training in the community is also discussed.
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    Risk of death among Honolulu fire fighters.
    ( 1991-03) Grimes, G ; Hirsch, D ; Borgeson, D
    To examine possible health risks associated with fire fighting, a 20-year Proportionate Mortality Ratio (PMR) study was conducted involving all male fire fighters with at least one year of service in the City of Honolulu Fire Department. The observed cause of death, as determined by the death certificates, was compared statistically to the expected numbers of deaths for all males over age 20 in Hawaii's general population. Significant increases in risk of death were found for brain cancer (Risk Ratio = 3.78), prostate cancer (Risk Ratio = 2.61), and cirrhosis of the liver (Risk Ratio = 2.3). A significant decrease in mortality was found for lung disease with a risk ratio of 0.37. No deaths were attributed to suicide nor to a category which included allergic, endocrine and nutritional diseases. Since fire fighters are known to suffer exposure to carcinogens and toxins, additional studies would be helpful in order to clarify possible risks to health associated with fire fighting on a long-term exposure basis.
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    Environmental epidemiology: an introduction to its merits and problems.
    ( 1991-03) Maskarinec, G
    During the course of this century the science of epidemiology has expanded its interest from only infectious diseases to include a wide variety of diseases and health events. It has become more of a systematic methodology which can be used for the description and the analysis of diverse health events. The basic assumption of epidemiologic research is that diseases do not occur randomly, but in patterns which reflect the underlying causes. By studying the patterns etiologic factors can be discovered. Recently, Environmental Epidemiology has been emerging as a new subspecialty. In 1989 the newly founded International Society for Environmental Epidemiology held its first Annual Meeting; its second meeting was held in August 1990 in Berkeley, California.
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    The relative safety of Hawaii's drinking water.
    ( 1991-03) Au, L K
    There are two types of drinking water sources: groundwater and surface water (the latter includes catchment of rain). Surface water runs over the surface of the earth in rivers and watercourses, or is stored in lakes and reservoirs. groundwater is water that is stored below ground level; it feeds artesian wells and springs. It is important to remember that untreated groundwater may not be the same thing as treated drinking water. A contaminant in groundwater represents a threat to a drinking water source but not necessarily a threat to health, if the contaminant's concentration is decreased before it becomes available as potable.