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Context: Health disparities between rural and urban communities are well documented. There are many suggested causes and many proposed solutions but no one-size-fits-all answer. The most successful community interventions have been introduced by communities themselves. However, before communities invest in such interventions, each group must identify and prioritize their needs. Purpose: This article describes the Hoshin facilitation method as a practical option assisting communities in assessing their needs and gaining consensus for future steps. Methods: Thirty-four meetings were held in 11 rural communities in Hawaii using the Hoshin process to identify factors that impact rural health. Themes were identified by constant comparative analysis and thematic frequency described. Commonality of responses between communities was examined. Informal feedback was collected from meeting participants. Findings: There was a great deal of commonality between community responses, with economic factors, drug use, lack of community leadership, lack of health care services and access to services, lack of healthy activities for youth, and poor public education being the most common issues noted. Group involvement in the meetings was high, and the facilitation method received positive feedback from participants. Conclusions: The Hoshin facilitation method is a very useful tool to help communities rapidly identify and prioritize areas for programmatic attention.

Objective: Japanese-Americans are the sixth largest Asian ethnicity in the United States. They represent a highly heterogeneous population due to their history of immigration dating back to the late 19th century. In comparison to the total Japanese-American population, there are very few neuropsychologists of Japanese descent who are familiar with the culture. The Asian Neuropsychological Association lists 16 licensed members of Japanese descent, and only 7 practice outside of Hawaii or California. These numbers suggest that unless non-Japanese neuropsychologists are knowledgeable of the culture, test translations, and appropriate norms, it would be challenging for many Japanese-Americans to receive culturally and linguistically competent neuropsychological services. The aim of the present study is to provide guidance for conducting neuropsychological assessments with Japanese-Americans with the goal of facilitating competent culturally-informed services to this population. Participants and Methods: Pertinent facets of Japanese culture as identified in the ECLECTIC framework and demographics of the U.S. Japanese-American population, and the available literature on neuropsychological tests that are translated into Japanese and normed with Japanese samples, was reviewed by authors with knowledge of Japanese language and culture. Literature published in both English and Japanese were included for review. Results: Psychological testing is a Western technology fraught with the behavioral expectations and values of the culture in which it was developed. Thus, these tests may be biased against persons coming from cultures that differ from the West. Recommendations for providing neuropsychological services to Japanese-Americans are presented with an aim of maximizing test fairness by addressing the following issues: comfort with the testing situation, test biases, accessibility, and validity. Given the emphasis on education, Japanese-Americans should be familiar and comfortable with cognitive testing, although they may experience undue pressure to perform well to avoid shame. Japanese-Americans may experience discomfort disclosing personal information during the interview, particularly if the evaluation is perceived to be psychiatric in nature, as there is a strong stigma associated with mental illness that could bring shame to the family. Japanese communication styles are indirect in nature, where the message is implied and what is "not said" is just as important as what is directly conveyed. Accessibility issues will primarily impact first generation Japanese-Americans who are native Japanese speakers. Another characteristic that may impact responding is hesitancy for guessing when unsure. Recommendations for providing culturally competent neuropsychological assessment given these considerations will be presented and expanded upon in detail. Finally, an online database of translated and normed neuropsychological tests by cognitive domain has been created and will be presented. Conclusions: Providing neuropsychological services to Japanese-Americans can be challenging as Japanese culture is significantly different from western culture. In addition, Japanese-Americans are heterogenous with salient issues of English proficiency and acculturation. Information to individualize a conceptual understanding of Japanese-Americans, translated and normed tests, and recommendations to maximize fairness in testing are presented to assist clinical neuropsychologists provide competent services to Japanese-Americans. [ABSTRACT FROM AUTHOR]

Recent genome-wide association studies have identified various obesity or metabolic syndrome (MetS) susceptibility loci. However, most studies were conducted in a cross-sectional manner. To address this gap, we performed a longitudinal exome-wide association study to identify susceptibility loci for obesity and MetS in a Japanese population. We traced clinical data of 6,022 Japanese subjects who had annual health check-ups for several years (mean follow-up period, 5 yr) and genotyped ~244,000 genetic variants. The association of single nucleotide polymorphisms (SNPs) with body mass index (BMI) or the prevalence of obesity and MetS was examined in a generalized estimating equation model. Our longitudinal exome-wide association studies detected 21 BMI- and five MetS-associated SNPs (false discovery rate, FDR <0.01). Among these SNPs, 16 have not been previously implicated as determinants of BMI or MetS. Cross-sectional data for obesity- and MetS-related phenotypes in 7,285 Japanese subjects were examined in a replication study. Among the 16 SNPs, three (rs9491140, rs145848316, and rs7863248) were related to BMI in the replication cohort (P<0.05). In conclusion, three SNPs [rs9491140 of NKAIN2 (FDR = 0.003, P = 1.9 × 105), rs145848316 of KMT2C (FDR = 0.007, P = 4.5 × 105), and rs7863248 of AGTPBP1 (FDR = 0.006, P = 4.2 × 105)] were newly identified as susceptibility loci for BMI. [ABSTRACT FROM AUTHOR]

Objectives. We compared the age at admission and the severity of illness of hospitalized Micronesians with 3 other racial/ethnic groups in Hawaii. Methods. With Hawaii Health Information Corporation inpatient data, we determined the age at admission and the severity of illness for 162 152 adult, non-pregnancy-related hospital discharges in Hawaii from 2010 to 2012. We performed multivariable linear regression analyses within major disease categories by racial/ethnic group. We created disease categories with all patient refined-diagnosis related groups. Results. Hospitalized Micronesians were significantly younger at admission than were comparison racial/ethnic groups across all patient refined-diagnosis related group categories. The severity of illness for Micronesians was significantly higher than was that of all comparison racial/ethnic groups for cardiac and infectious diseases, higher than was that of Whites and Japanese for cancer and endocrine hospitalizations, and higher than was that of Native Hawaiians for substance abuse hospitalizations. Conclusions. Micronesians were hospitalized significantly younger and often sicker than were comparison populations. Our results will be useful to researchers, state governments, and hospitals, providers, and health systems for this vulnerable group. [ABSTRACT FROM AUTHOR]

The Federated States of Micronesia and the Republics of Palau and the Marshall Islands signed a series of treaties known as the Compacts of Free Association (COFA) with the United States (U.S.). While the islands became independent nations, certain rights and responsibilities were assigned to the U.S. However since the signing of the treaties, U.S. federal and Hawai'i state policies have reduced health care coverage for COFA migrants living in the U.S. and its territories. This commentary reports the ongoing efforts of the Micronesian community and its allies to rectify a legacy of unjust policies. We outline the need for sound policies that support appropriate health care to all members of society, and highlight the community's strength and ability to mobilize for political action. If health is a human right, providing adequate, equitable health care to all members of society is not up for debate. [ABSTRACT FROM AUTHOR]

Health characteristics were compared among 1193 Japanese in Hiroshima, and 2306 Japanese-Americans in Hawaii. Japanese women experienced later menarche, earlier menopause, and a shorter interval between menarche and menopause than Japanese-Americans. Japanese men and women were shorter and lighter and the men bad lower body mass index than Japanese-Americans. Differences between populations were also found for the prevalence of artificial menopause, number of live births, lactation period, smoking, and alcohol consumption. Within one or both populations, significant trends with birth year were found for age at menarche, age at menopause, interval between menarche and menopause, lactation period, height, weight, and body mass index, suggesting the existence of cohort effects. Some of these trends may also reflect age-related changes. Environmental factors likely contribute to the differences in physique and reproductive factors, which may explain differences in frequency of osteoporosis, cardiovascular diseases, and cancer between the two populations. [ABSTRACT FROM AUTHOR]

Background: Native Hawaiians and other Pacific Islanders (NHOPI) have high prevalence of overweight status, obesity, and hypertension, as well as high rates of asthma and cancer mortality. Some barriers to health care delivery for this population are a physician shortage in Hawai'i and a geographical maldistribution of actively practicing physicians. This study examines the distribution of NHOPI physicians compared to the NHOPI population in Hawai'i through Geographical Information System choropleth mapping. Methods: The maps and results were gathered and constructed from Census Tract data from the US Department of Commerce, the Census Bureau, the Physician Workforce Assessment, and the 'Ahahui of na Kauka reports. Results: With the exception of East Honolulu, all areas of Hawai'i show drastic disparities in the ratio of NHOPI physicians to NHOPI populations as compared to the ratio of total physicians to the total population. Discussion: Given the NHOPI physician shortage and their geographical maldistribution, this study underscores the importance of increasing the number of NHOPI medical school applicants, graduates, residents, and physicians in permanent active practices in rural areas and the neighbor islands. Current institutional and academic programs, such as the John A. Burns School of Medicine, Imi Ho'ola, and the Native Hawaiian Center of Excellence, are contributing to resolving some of the health disparities and should consider expanding their efforts. [ABSTRACT FROM AUTHOR]

During the postpartum period, ethnic minority women have higher rates of inactivity/under-activity than white women. The Nā Mikimiki (“the active ones”) Project is designed to increase moderate-to-vigorous physical activity over 18 months among multiethnic women with infants 2–12 months old. The study was designed to test, via a randomized controlled trial, the effectiveness of a tailored telephone counseling of moderate-to-vigorous physical activity intervention compared to a print/website materials-only condition. Healthy, underactive women (mean age = 32 ± 5.6 years) with a baby (mean age = 5.7 ± 2.8 months) were enrolled from 2008–2009 (N = 278). Of the total sample, 84% were ethnic minority women, predominantly Asian–American and Native Hawaiian. Mean self-reported baseline level of moderate-to-vigorous physical activity was 40 minutes/week with no significant differences by study condition, ethnicity, infant's age, maternal body mass index, or maternal employment. Women had high scores on perceived benefits, self-efficacy, and environmental support for exercise but low scores on social support for exercise. This multiethnic sample's demographic and psychosocial characteristics and their perceived barriers to exercise were comparable to previous physical activity studies conducted largely with white postpartum women. The Nā Mikimiki Project's innovative tailored technology-based intervention and unique population are significant contributions to the literature on moderate-to-vigorous physical activity in postpartum women. [ABSTRACT FROM PUBLISHER]

Presents the outcome of the health education campaign in Hawaii. Influence of tobacco use, poor diet and physical inactivity on the mortality rate in the U.S.; Reason behind the development of a structured focus group discussion; Role of the lack of reimbursement for counseling regarding lifestyles in performing consultation during medical encounters; Need for a variety of methods to reach patients and let them adopt healthy lifestyles.

The article focuses on the neighborhood of the author in Hawaii. The author quotes that less than a mile's walk from the sugar mill, principal landmark of the great M Sugar Company one of the neighboring islands, lies a plantation camp of a little more than fifty homes. Even as plantation camps go, Camp 6 is not a pretty sight. Dust always seems to be in the air. When the mature cane is harvested, and the fields encircling the Camp are plowed, it seeps through the cracks of old and termite ridden homes, it leaves newly washed laundry speckled with dirt particles. Dust is the despair of the housewives of Camp 6. All fifty or more homes are painted the same depressingly drab brown. The brown of the dirt the brown of the homes --to any newcomer to the district, the ugly brownness of it all will undoubtedly be the first impression. Originally, Camp 6 was mainly was inhabited by Japanese. Although they still predominate, a process of invasion by Filipinos has become increasingly evident. On one end of the neighborhood across the street is a little subdivision of the camp, which was once inhabited principally by Chinese. The people who are living in the neighborhood, depend almost wholly upon the plantation for their livelihood.

In Hawai'i, health care is a commodity, not a human right: those who can afford it receive care, those who cannot often don't. As health workers and health professional students, we witness the consequences that public policies and budget considerations have on people, on patients, on the health of those that we are dedicated to assisting. Beginning with a case study, we examine the historical antecedents leading to the increasing migration of Micronesians to Hawai'i, examine the special relation that "Compact of Free Association" citizens have with the United States, and seek to reframe the political discussion regarding their health care status in this state as a debate in which medical considerations, not political or economic ones, should be the primary voice. [ABSTRACT FROM AUTHOR]

Howard Barrows recommends that ‘authentic’ problem-base learning (PBL) use a format in which students query a case module with regards to 202 history items, 121 physical examination items, and an array of laboratory and imaging items. We examine a case that Barrows presented to students at the University of Hawai’i in order to illustrate the problems that we see with this heuristic method. This method portrays the clinical encounter as an interrogation and examination that reveals the diagnosis within some standard nosology. We identify ‘instrumental rationality’, the mode of thinking in which the goal is to find the most efficient means to achieve the ends, as the philosophy underlying this view of medical practice. We suggest instead that physicians need to be skillful at listening to patient narratives, that the case that Barrows presented appears rather different from this perspective. If physicians view moral engagement with patients to be the core task of medicine, it will help transform medicine from a task-oriented endeavor to one driven by ethics, morality, and justice. [ABSTRACT FROM AUTHOR]

The article presents the text of a speech by Doctor Seiji Yamada, associate professor of complementary and alternative medicine at John A. Burns School of Medicine (JABSOM) at the University of Hawai'i at Manoa in Honolulu, delivered at the White Coat Ceremony for the JABSOM Class of 2013 in 2009. He discussed the role being played by physicians in health and social justice, problem-based learning (PBL) curriculum of JABSOM and victims of the wars in Iraq and Afghanistan.

Ants intercepted by the Hawaii Department of Agriculture in 2018 and 2019 identified as Solenopsis spp., and possibly S. invicta, were submitted to the United States Department of Agriculture-Agricultural Research Service-Center for Medical, Agricultural and Veterinary Entomology, Imported Fire Ant and Household Insects Research Unit for further taxonomic assessment using genetic and chemical methods. The 2018 sample consisted of 1 worker ant, and the 2019 sample consisted of 3 worker ants. Thoraces were used for genetic assessment and gasters were used for venom analyses. It was determined readily from genetic and chemical analyses that the intercepted ants were not S. invicta or S. richteri. Mitochondrial COX1 gene sequences were compared with previously published data from Solenopsis species. The closest match for the 2018 sample was S. xyloni, which is native to the shipment's origin (San Diego, California, USA). The 2 major alkaloids found were characteristic of the S. geminata species group. In addition, the alkaloid ratio closely matched that of S. xyloni. Therefore, the alkaloid analysis of the 2018 intercepted ant concurs with the genetic data that the ant was an S. xyloni worker. The COX1 gene sequences of the 2019 interceptions most closely matched S. geminata. The corresponding venom alkaloid profile also eliminated S. invicta and S. richteri as possibilities. However, 1 major alkaloid was unusual (Fig. 2) and normally is found only in trace amounts. We suggest the 2019 specimens are an unusual variant of S. geminata. [ABSTRACT FROM AUTHOR]

The Ala Wai Canal is an artificial waterway in the tourist district of Waikiki in Honolulu, HI. Originally built to collect runoff from industrial, residential, and green spaces dedicated to recreation, the Ala Wai Canal has since experienced potent levels of toxicity due to this runoff entering the watershed and making it hazardous for both marine life and humans at current concentration, including Danio rerio (zebrafish). A community of learners at educations levels from high school to postbaccalaureate from Oahu, HI was connected through the Consortium for Increasing Research and Collaborative Learning Experiences (CIRCLE) distance research program. This team conducted research with an Investigator and team from Mayo Clinic in Rochester, MN, with the Ala Wai Canal as its primary subject. Through CIRCLE, research trainees sent two 32 oz bottles of Ala Wai- acquired water to a partnered laboratory at the Mayo Clinic in which zebrafish embryos were observed at differing concentrations of the sampled water against a variety of developmental and behavioral assays. Research trainees also created atlases of developmental outcomes in zebrafish following exposure to environmental toxins and tables of potential pesticide contaminants to enable the identification of the substances linked to structural defects and enhanced stress during Ala Wai water exposure experiments.