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.
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.
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.
The Robert T Wong MD lectureship.
(1991-02) Reppun, J I
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.
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.
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.
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.
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.
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.
The medical issue of our polluted environment.
(1991-03) Moser, S M
Electromagnetic fields: biological and clinical aspects.
(1991-03) Tabrah, F L; Batkin, S
Our entire biosphere is immersed in a sea of man-made electromagnetic fields (EMF). Occupational and public health data suggest that these fields may be a health hazard, possibly involving cancer and fetal loss. This paper reviews the history and pertinent physics of electromagnetic fields and presents evidence from the authors' work, and that of others, of biological interaction with living systems. Epidemiological data suggesting EMF hazards are reviewed including a discussion of possible risks associated with Hawaii's Lualualei transmitter site, TV and FM antennas in high-density population areas, fields surrounding electric power transmission and computer terminals, and the plan to route a major highway through the near-field of an operating Omega signal-source. In the face of current public fear and controversial research reports about long-term EMF exposure, suggestions are presented for public policy about these local sources of concern, as well as for the EMF risks common to any similarly developed areas.
Evaluation of human exposure to the heptachlor epoxide contamination of milk in Hawaii.
(1991-03) Baker, D B; Loo, S; Barker, J
The commercial milk supply on Oahu was contaminated by heptachlor epoxide for as long as 15 months during 1981-82 at levels possibly as high as 1.2 ug/g, fat basis. Following the contamination, several investigators attempted to evaluate potential adverse health outcomes, especially among infants and young children. However, results of the initial investigations are inconclusive due to lack of reliable measures of heptachlor exposure, use of non-random sampling techniques, and lack of definitive health outcomes attributable to heptachlor epoxide. The design of a current study to assess the body concentrations of heptachlor epoxide and related pesticides in Hawaii is presented. The study is designed (1) to relate these concentrations to prior exposure via the milk contamination, and (2) to assess the reliability of breast milk and serum pesticide concentrations as objective biological markers of body burden. No attempt is made to relate these data to health outcomes; instead, the findings may provide the foundation for future health studies or surveillance of environmental exposure to pesticides in Hawaii.
Toxic substances in the environment affecting respiratory function of people in Hawaii.
(1991-03) Hallenborg, C P; Marsh, N; Moser, S
In this trilogy we have collected data from authors who are concerned with patients with respiratory complaints. Surprisingly there are unique problems in the residents of our State. The full impact of problems known to cause respiratory illnesses, such as asbestosis, will not be known for years to come. Other problems such as the effect of sugarcane burning are just now being identified and may show a parallel to the inhalation of asbestos dust. VOG may be simply an irritant or it may explain in part the high incidence of asthma in our State. Clearly more work needs to be done to explain the pathophysiology, the risk and possible treatment for the consequences on people of these putative toxic substances.
The family as victim in trauma.
(1991-04) Brown, V
In trauma, the intense immediate need for medical intervention and stabilization has focused attention on the victim's physical injuries, and away from the traumatic psychosocial impact on his life and family. Trauma teams are prepared to respond quickly and efficiently to sudden life and death situations, with the most up-to-date knowledge, technology and care. Until recently however, little organized, comprehensive attention has been given to the psychosocial responses of the patient and the family. It is now time to prepare ourselves to offer this other important aspect of trauma care--the psychosocial component. As a part of this preparation, I would like to present the Family as Victim in Trauma.
Patient satisfaction with physician care.
(1991-04) Soh, G
Patient satisfaction is known to be related to many desired outcomes in medical care. This study employees multidimensional scaling techniques to identify factors affecting satisfaction with physician care in 1,210 patients. Stepwise regression analysis of factors that met predetermined criteria showed that accessibility explained the greatest amount of variance in patient satisfaction. The patient's perceived efficacy of physician care and greater continuity of care also have significant correlations with satisfaction. Perceived susceptibility to illness, utilization of physician services, and levels of education have lesser but significant effects on patient satisfaction. Despite methodological constraints, economic and psychological benefits make evaluation of patient satisfaction an important exercise.
Doctor to patient, doctor to colleague: the ethics of medical practice.
(1991-04) Reppun, J I
We were invited to speak at a medical conference on Kauai: "Kauai Calls: People caring for people" held at the Kauai Hilton 21 to 25 February 1991. It was presented by the Society of General Practitioners, the British Columbia Medical Association and the BC Chapter of the College of Family Physicians, all of Canada, together with and by special invitation from the Department of CME of Wilcox Memorial Hospital and the Kauai County Medical Society. David Elpern MD and Paul Esaki MD, of Lihue and Kapaa respectively, were the local sparkplugs and organizers.
Compliance with Hawaii's Workers' Compensation Law.
(1991-04) Regent, A
The late United States Supreme Court Justice Brandeis once stated: "Don't assume that the interests of employer and employee are necessarily hostile--that what is good for one is necessarily bad for the other. The opposite is more apt to be the case. While they have different interests, they are likely to suffer or prosper together". Working toward resolving the employee's physical and/or emotional problems will confer a benefit on both employer and employee. It has become apparent to me that the issues of concurrent care, consultations and treatment plans are of great concern to physicians in Hawaii. I have therefore chosen to discuss these areas in light of recent Labor and Industrial Relations Appeals Board decisions.
The Maluhia Project: Home Health Care for the Uninsured.
(1991-05) Hayashida, C T; Anderson, K
This is a report of preliminary findings of the Maluhia Project: Home Health Care for the Uninsured based on its first 12 months of experience in providing services to clients from September 1989 to August 1990. This Project is now in its third year. This report will initially discuss the rationale for Hawaii's participation in this 5-state national demonstration project. It will cover the basic components of the Hawaii Project and its relative impact followed by a brief description of the clients enrolled. A major component of this program is case management. Given the variety of previous programs that have been referred to as case-management services, a comparison has been provided to note significant differences in approaches and target groups between the Maluhia Project and other existing programs. Finally, this report discusses a number of implementation and public policy issues which have emerged and require further discussion. We hope that as a result of this preliminary report from our first 12 months of operation, it will be possible to inform the medical community of the needs faced by this public health problem that has been previously not addressed.
Sarcoidosis: a Hawaii rarity.
(1991-06) Charles, J; Elpern, D J
Sarcoidosis is so rarely seen in residents of Hawaii that it may not be considered as a diagnostic possibility. The differential diagnosis is more complex in Hawaii due to the presence of granulomatous diseases such as tuberculosis and leprosy. We present the first known case of sarcoidosis in a Hawaii resident together with an overview of the disorder.

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