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Objective: To determine the effect of a methacrylic preimpregnated resin glass fibre mesh and electro-spun nylon nano fibres on the flexural strength of a heat-cured poly (methyl methacrylate) (PMMA) denture base resin. Methods: A non-reinforced PMMA control group (Vertex™) and two reinforced groups, incorporating glass fibre mesh (Quartz Splint™) and electro-spun nylon nano fibres (Xantu. Layr™) were made according to ISO 20795-1:2013. Flexural strength was measured using a 3-point bend test in a universal testing machine. Statistical analysis was initially done using one-way ANOVA followed by a post-hoc Tukey HSD test (P>0.05) to determine the variance between groups. Results: The PMMA glass fibre mesh reinforced group had a statistically higher mean flexural strength (99.4MPa) compared to the non-reinforced PMMA control (88.5MPa). There was no significant difference between the PMMA nylon nano fibre reinforced group (92.4MPa) and the nonreinforced PMMA control. Conclusions: PMMA denture base resin flexural strength is improved by incorporating the glass fibre mesh, while electro-spun nylon nano fibres produced no significant increase in the flexural strength. [ABSTRACT FROM AUTHOR]

Introduction: Persons living in rural areas tend to have poorer health than do those who live in urban areas. These disparities have been attributed, in part, to lack of access to care. As a proxy measure of access to care, researchers examined the rate of office visits after emergency department (ED) treatment for asthma between rural and urban areas and pediatric and adult patients in Hawaii.Methods: A retrospective review of five-years of insurance claims data was performed on 7064 ED visits for asthma. Demographic information and location and type of visit were analyzed by using logistic regression and survival analysis to examine rural/urban differences.Results: Patients who had an office visit after their initial ED visit were 10% less likely to have a repeat ED visit within the month. Rural residents were significantly less likely to have both follow-up office and ED visits than were their urban counterparts when adjusted for age, sex, and morbidity. When adult patient statistics were compared with pediatric patient statistics, only the adult patients demonstrated a significant difference in time to followup between rural and urban patients.Conclusion: Study results confirm that followup office visits are associated with a decrease in emergency visit rates and that adult rural residents are less likely to receive follow-up care than are their urban counterparts for a diagnosis of asthma. However, no significant differences were seen between followup for rural and urban children, which implies that access barriers are overcome for this group of rural residents. Further research should address the aspects of access that pertain to adults in rural areas. [ABSTRACT FROM AUTHOR]

Background: Palau, an island nation in Micronesia, is a medically underserved area with a shortage of specialty care services. Orthopedic diagnoses in Palau remain among the three most common reasons for costly off-island medical referral. The purpose of this study was to assess Palau's current orthopedic surgery capacity and needs to inform interventions to build capacity to improve care access and quality., Methods: Orthopedic needs and capacity assessment tools developed by global surgical outreach experts were utilized to gather information and prompt discussions with a broad range of Palau's most knowledgeable stakeholders (n = 6). Results were reported descriptively., Results: Finance, community impact, governance, and professional development were the lowest-scored domains from the Capacity Assessment Tool for orthopedic surgery (CAT-os), indicating substantial opportunity to build within these domains. According to administrators (n = 3), governance and finance were the greatest capacity-building priorities, followed by professional development and partnership. Belau National Hospital (BNH) had adequate surgical infrastructure. Skin grafting, soft tissue excision/resection, infection management, and amputation were the most commonly selected procedures by stakeholders reporting orthopedic needs., Conclusions: This study utilizes a framework for orthopedic capacity-building in Palau which may inform partnership between Palau's healthcare system and orthopedic global outreach organizations with the goal of improving the quality, safety, and value of the care delivered. This demonstration of benchmarking, implementation planning, and subsequent re-evaluation lays the foundation for the understanding of capacity-building and may be applied to other medically underserved areas globally to improve access to high-quality orthopedic care., (© 2024 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).)

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.

There is an estimated shortage of 46 000 to 90 000 physicians in the US, especially in rural areas. Physicians working in rural areas often maintain a larger scope of practice compared to their urban counterparts. This scope may include performing procedures which may require additional training, and lack of that training may limit rural physicians' capability to perform procedures. Physicians practicing in rural areas of Hawai'i were surveyed about their scope of practice regarding procedures and the perceived hindrances in performing procedures. Physicians identified as rural practitioners and rural physicians attending local conferences were asked to participate. Forty-seven (out of 301) rural Hawai'i physicians participated in the survey, of which 89% reported performing procedures. The most common procedures performed included suture removal, incision and drainage, wound care, and suturing. Of the 47 respondents, a total of 28 physicians or 60% reported wishing to perform procedures but not doing so. The procedures physicians would like to perform included gynecological (36%), casting (21%) and wound care (14%). Barriers to performing procedures included lack of time (51%), inadequate training (37%), out of practice (22%), and poor reimbursement (17%). While most rural physicians in this study perform procedures, many would like to perform more. Lack of training and support are significant barriers to increasing scope of procedures performed. Medical schools, residencies, and continuing education programs should consider expanding training in these areas, especially for those planning to practice or currently practicing in rural areas., Competing Interests: None of the authors identify a conflict of interest., (©Copyright 2023 by University Health Partners of Hawai‘i (UHP Hawai‘i).)

The Hawai'i Medical Service Association's (HMSA) Population-based Payments for Primary Care (3PC) system has been in effect since 2016. There is limited literature regarding physician opinions on this payment transformation policy change. The objective of this study was to evaluate physician responses to a survey regarding the 3PC payment transformation system and identify methods to support physicians in Hawai'i. An online survey was sent to 2478 Hawai'i physicians and yielded 250 responses. A total of 77% respondents reported being unhappy with payment transformation, while 12.9% and 10.1% reported being indifferent and happy, respectively. Of responding physicians, 60.6% reported a decrease in overall income, whereas 24.9% and 14.5% reported no change or an overall increase, respectively. Open-ended responses were categorized into theme clusters: negative impact on primary care, increased administrative burdens, decreased quality of patient care, decreased physician reimbursement, preference to treat healthier patients, harm to private practice, harm to newer practices, ignored physician sentiments, and worsened physician shortage in Hawai'i. Respondents, especially those working in primary care, are dissatisfied with payment transformation. Future research is needed to compare the thematic clusters identified in the current study with relevant literature., (©Copyright 2022 by University Health Partners of Hawai‘i (UHP Hawai‘i).)

The Hawai'i Physician Workforce project, launched in 2010, investigates state physician workforce trends. Over the past decade, workforce demands have continued to climb as the state struggles to maintain the physician supply. This article describes the current state of the physician workforce, the physician age landscape, past trends, as well as initial changes to the physician supply with the COVID-19 pandemic. Data on practice location, full time equivalency of time spent providing patient care in Hawai'i, and specialty of non-military physicians were clarified and informed via survey, internet search, and direct calling methodologies. A proprietary microsimulation modeling methodology was used to assess physician demand. The current estimated physician shortage is between 710 and 1,008 full time equivalents, the largest shortage in a decade. The unmet demand for numbers of additional physicians is greatest on the largely urban island of O'ahu, however O'ahu's neighboring islands have the largest shortages by percentage of demand. In fact, Hawai'i island has over a 50% shortage of physicians for the first time since the supply has been calculated starting in 2010. Primary care has the greatest demand with a statewide shortage of 412 full time equivalents. The average age of physicians in Hawai'i is 54 compared to the national average of 52. The authors estimate that more than 52% of providers are utilizing telehealth and that 10% of providers have retired or closed their practices since the start of the COVID-19 pandemic. Hawai'i is now in an urgent state of need for recruitment and retention of physicians., (©Copyright 2022 by University Health Partners of Hawai‘i (UHP Hawai‘i).)

A common challenge in the evaluation of K-12 science education is identifying valid scales that are an appropriate fit for both a student's age and the educational outcomes of interest. Though many new scales have been validated in recent years, there is much to learn about the appropriate educational contexts and audiences for these measures. This study investigated two such scales, the DEVISE Self-Efficacy for Science scale and the Career Interest Questionnaire (CIQ), within the context of two related health sciences projects. Consistent patterns were found in the reliability of each scale across three age groups (middle school, high school, early college) and within the context of each project. As expected, self-efficacy and career interest, as measured through these scales, were found to be correlated. The pattern of results for CIQ scores was also similar to that reported in other literature. This study provides examples of how practitioners can validate established measures for new and specific contexts and provides some evidence to support the use of the scales studied in health science education contexts.

Hawai'i faces unique challenges to Electronic Health Record (EHR) adoption due to physician shortages, a widespread distribution of Medically Underserved Areas and Populations (MUA/P), and a higher percentage of small independent practices. However, research on EHR adoption in Hawai'i is limited. To address this gap, this article examines the current state of EHR in Hawai'i, the barriers to adoption, and the future of Health Information Technology (HIT) initiatives to improve the health of Hawai'i's people. Eight focus groups were conducted on Lana'i, Maui, Hawai'i Island, Kaua'i, Moloka'i, and O'ahu. In these groups, a total of 51 diverse health professionals were asked about the functionality of EHR systems, barriers to use, facilitators of use, and what EHRs would look like in a perfect world. Responses were summarized and analyzed based on constant comparative analysis techniques. Responses were then clustered into thirteen themes: system compatibility, loss of productivity, poor interface, IT support, hardware/software, patient factors, education/training, noise in the system, safety, data quality concerns, quality metrics, workflow, and malpractice concerns. Results show that every group mentioned system compatibility. In response to these findings, the Health eNet Community Health Record initiative - which allows providers web-based access to patient health information from the patient's provider network- was developed as a step toward alleviating some of the barriers to sharing information between different EHRs. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) legislation will introduce a new payment model in 2017 that is partially based on EHR utilization. Therefore, more research should be done to understand EHR adoption and how this ruling will affect providers in Hawai'i.

With a growing shortage of physicians, particularly primary care physicians, the issue of adequate pay in Hawai'i is increasingly important. Anecdotal reports of low pay in Hawai'i have rarely been substantiated. Data from FAIR Health, a company that tracks private insurance reimbursement rates, is compared across the United States (US) for the CPT code 99213. In addition, FAIR Health and Medicare rates are compared for cities with both similar and disparate cost of living to Hawai'i. Hawai'i is in the second lowest quintile for payment in the US for private insurances, and providers are reimbursed significantly lower than in cities with similar cost of living by both Medicare and private insurances. Methods for increasing payment to physicians in Hawai'i are essential to recruiting the necessary workforce. Revising payment methodologies that increase pay for services in areas of unmet need, revising Medicare Geographic Price Cost Indices to better balance pay in areas of need, and making use of the 10% Medicare Bonus Program for physicians working in Health Professions Shortage Areas are first steps to creating a sustainable plan for physician payment in the future.

Ensuring the adequacy of the public health workforce requires an understanding of its size and composition, as well as the population's demand for services. The current article describes research undertaken as a first step toward developing an estimate of the supply of and demand for Hawai'i's public health workforce. Using an organizational-level survey, data was obtained from a subset of 34 organizations considered to be major providers of population-based public health services in Hawai'i. The results indicate that estimates of the existing public health workforce range from 3,429 to 3,846 workers. Calculations of functional demand reveal that an additional 317 to 502 employees will be required to compensate for vacancies and projected retirements over the next five years; though, the discussion points to the fact that this number may be closer to 1,005 to 1,664. While, an additional 594 to 848 employees would be needed to meet the current missions of organizations in this sample and to best meet community need. While these findings are neither exhaustive nor definitive, they raise issues concerning the state's supply of public health workers in terms of their ability to adequately meet demand for services. More research is needed to confirm these findings and track Hawai'i's public health workforce to assure a strong local public health system.

Native Hawaiians and Other Pacific Islanders (NHOPI) suffer from a number of poor health outcomes, such as high rates of overweight status, obesity, hypertension, and high rates of asthma and cancer mortality. In addition to a disproportionate burden of illness, barriers to health care access and utilization also exist. This study examines the effect of health insurance coverage on the health status of NHOPI in comparison to Asians. To analyze this relationship, the study uses the Behavioral Risk Factor Surveillance System (BRFSS) 2012 data and logistic regression. Findings show insured NHOPI were significantly more likely than insured Asian Americans to report poor or fair health after sequential cumulative adjustments of socioeconomic, lifestyle and behavioral factors, history of diagnosed diseases, and access to care (OR: 1.66, 95% CI:[1.34, 2.05]). Health insurance alone will not eliminate the present disparities experienced by NHOPI. Other barriers prohibit health care access for NHOPI that should be considered in the investigation and development of strategies to increase healthcare access and eliminate health disparities for NHOPI.

National data reports the number of adults with any diagnosable mental disorder within a given year is nearly 1 in 5. Hawai'i, along with the rest of the nation, faces a serious shortage of mental health providers. This article describes the research undertaken to create a more accurate assessment of the current mental health provider workforce in Hawai'i through developing an estimation strategy to appraise local mental health workforce needs. The results indicate the supply of psychiatrists for Hawai'i's 2010 census population was found to be 161.4 Full Time Equivalents (FTEs) psychiatrists, or 11.86 psychiatrists/100,000 population, with the greatest number of psychiatrists per capita on the island of O'ahu. Of the 161.4 FTEs, 50.4 FTEs or 31.2% were accepting new Medicaid patients. The state's results show that Hawai'i is short of meeting current patient need by more than 100 psychiatrists though the state was only short by 6 FTE psychiatrists with regard to estimates of Medicaid patients' need. While the first number is likely accurate, the second number is likely to be significantly underestimated for a number of reasons. One reason is that practitioners who reported accepting new Medicaid patients likely see comparatively few. Another reason is that it is likely that Medicaid patients make up more than the approximate 20% of the psychiatric patient population. It is reported nationally that a greater percentage of the mentally ill receive Medicaid than the population at large. Thus, there are probably many more patients on Medicaid than our estimations accounted for. It is clear more research and more changes need to be made in Hawai'i's publicly funded healthcare system to incentivize physician acceptance and make mental healthcare more accessible to this growing population.

Hawai'i's Physician Workforce Assessment project was launched in 2010. Over the past 5 years the State has experienced decreases and increases in physician workforce. This current article describes the status of the physician workforce, past trends and anticipated projections as well as recent insights into why people leave Hawai'i. Survey data, internet searches and direct dialing methodologies were utilized to clarify and elucidate practice location, full time equivalency of time providing patient care and specialty of non-military physicians caring for Hawai'i's population. A proprietary microsimulation modeling methodology from the company the US Health Resources and Services Administration employs is utilized to assess demand. The current shortage of physicians is estimated to be between 455 and 707 full time equivalents with the greatest percentage of shortages on neighbor islands. Numerically the greatest total shortage of physicians is on O'ahu and the specialty in greatest demand is primary care with a shortage of 228 Full Time Equivalents (FTEs). Physician average age in Hawai'i is 54.9 compared to a national average of 51. There was an increase in the number of physicians who report using telehealth, from 2% to 15%. Initial improvements in the size of Hawai'i's physician workforce are promising, but we note two reported suicides in the intervening year. More attention must be paid to support practicing physicians in addition to our efforts to recruit new physicians.

Background: National policy experts have estimated that the United States will be 15-20% short of physicians by the year 2020. In 2008, the Big Island of Hawai'i was found to be 15% short of physicians. The current article describes research to determine the physician supply and demand across the State of Hawai'i., Methods: The researchers utilized licensure lists, all available sources of physician practice location information, and contacted provider offices to develop a database of practicing physicians in Hawai'i. A statistical model based on national utilization of physician services by age, ethnicity, gender, insurance, and obesity rates was used to estimate demand for services. Using number of new state licenses per year, the researchers estimated the number of physicians who enter the Hawai'i workforce annually. Physician age data were used to estimate retirements., Results: Researchers found 2,860 full time equivalents of practicing, non-military, patient-care physicians in Hawai'i (excluding those still in residency or fellowship programs). The calculated demand for physician services by specialty indicates a current shortage of physicians of over 600. This shortage may grow by 50 to 100 physicians per year if steps are not taken to reverse this trend. Physician retirement is the single largest element in the loss of physicians, with population growth and aging playing a significant role in increasing demand., Discussion: Study findings indicate that Hawai'i is 20% short of physicians and the situation is likely to worsen if mitigating steps are not taken immediately.

Background: Although the State of Hawai'i overall may have an adequate number of physiatrists, there are physiatrist shortages on the neighbor islands. This study describes the demographics, practice type, and most important concerns of current practicing physiatrists within the state of Hawai'i., Methods: A phone survey was conducted of 44 actively practicing Hawai'i physiatrists. Eligible participants were members of either the American Academy of Physical Medicine and Rehabilitation (AAPMR) or the Hawai'i Society of Physical Medicine and Rehabilitation., Results: Thirty-six of 44 local physiatrists responded to the survey. Thirty-two of the thirty-six (89%) respondents were currently practicing on O'ahu, nine (25% of respondents) completed medical school at University of Hawai'i, 19 (58% of respondents) were not planning on recruiting in their practice for at least five years and the physiatrists' most common concerns included poor reimbursement, practice management problems, and high workload., Discussion: Further recruitment efforts should be tailored to attracting physiatrists to our neighbor islands. Increasing reimbursement, addressing hospital administration issues, developing a musculoskeletal fellowship program, and increasing incentives to practice on neighbor islands are proposed changes that would directly address the concerns of Hawai'i's physiatrists.

Background: Past studies in the continental US have demonstrated that students from rural areas and those who go into primary care are more likely to practice in rural areas than urban-born and specialty physicians., Methods: This study uses two separate data sets to examine whether medical students and young physicians in Hawai'i follow the same pattern. A retrospective study of graduates of the University of Hawai'i John A. Burns School of Medicine from 1993-2006 was performed examining the relationship between practice location and high school attended for those practicing in Hawai'i. In addition, a survey was conducted with the first, second and third year medical students examining their practice intentions as related to where they grew up. Both data sets were analyzed using Chi Squared tests to determine the significance of associations between individuals from rural backgrounds practicing or intending to practice in rural areas., Results: The relationship in both cases showed that students and physicians from rural areas were more likely to practice in rural areas. However, 81% of all respondents reported being willing to consider practicing in rural area, especially if lifestyle, work environment, and employment opportunities were favorable., Discussion: If the State of Hawai'i wants to expand the physician workforce in the rural areas of Hawai'i, recruiting more students from rural areas and increasing desirability of rural practice settings are excellent paths to take.

Background: Anecdotal reports of a doctor shortage on the Big Island have been circulating for years, but a detailed assessment of the health care workforce had not previously been accomplished., Methods: The Hawai'i Island Health Workforce Assessment used licensure data, focus groups, telephone follow up to provider offices, national estimates of average provider supply and analysis of insurance claims data to assess the extent of the existing medical and mental health workforce, approximate how many additional providers might be effectively utilized, develop a population-based estimate of future demand and identify causes and potential solutions for the challenges faced., Results: As of February 2008, the researchers were able to locate 310 practicing physicians, 36 nurse practitioners, 6 physician assistants, 51 psychologists, 57 social workers and 42 other mental health providers. Based on national averages, claims analysis and focus groups, the Island could use approximately 45 additional medical professionals to care for the 85% of the population that is medically insured; a larger number to care for the entire population. Ascertaining a complete roster of mental health professionals was not possible using this methodology., Discussion: The researchers compared the current supply of physicians with the national average of physicians to population and the number of visits to different specialists for the year 2006 and found specific regional shortages of providers. The focus groups concentrated on solutions to the workforce crisis that include the formation of a well-organized, broad collaboration to coordinate recruitment efforts, expand and strengthen retention and renewal activities, and reinvigorate the health profession pipeline and training opportunities. The researchers recommend collaboration between the community, government, business, health center care providers, hospitals and centers to develop a plan before the tenuous state of healthcare on the Big Island worsens. In addition, continued surveillance of the health workforce is vital to tracking the impact of interventions. This could be accomplished through community informants and data collected at the time of professional relicensure to include practice location and practice intensions for future planning estimates.

Introduction: Despite a growing need for physicians providing care to nursing home patients, the characteristics of physicians providing such care are not well described., Methods: A survey was sent to adult primary care physicians in Hawai'i; respondents' demographic data were obtained. Associations between physician characteristics, level of nursing home experience, and island of practice were analyzed using chi square and multivariate logistic regression models., Results: Of 806 physicians, 388 (48%) returned surveys. Controlling for years of experience and other demographic factors, having nursing home experience was associated with physician age (40 years and over compared with under 40 years; OR 3.5, 95% Confidence Interval (CI) 1.4-8.5), Family Medicine specialty (compared with Internal Medicine, General Practice or Other; OR 4.0, 95% CI 1.4-11.4), private practice type (compared with employed, other, and trainee physicians; OR 2.3, 95% CI 1. 1-4.6), and practice location (neighbor islands compared with Oahu, OR 4.5, 95% CI 1.1-17.8). Physicians practicing on the neighbor islands were more likely to be aged 40 years and older (OR 3.9, 95% CI 1.4-10.3), and white (ethnicity compared with all other ethnicities, OR 4.1, 95% CI 2.1-7.7)., Conclusion: The association of higher physician age with both nursing home experience and neighbor island practice has important implications for the training of physicians to provide nursing home care in Hawai'i.

The national death rates from rural trauma are disproportionately higher compared to urban areas. Traumatic brain injury is a major cause of hospital admissions in Hawai'i. This is the first in a two part series to explore this significant public health concern. Data on traumatic brain injuries from 2000-2004 was obtained from 2 sources. Male gender, alcohol use, and lack of protective devices resulted in higher rates of injury. Rates of severe injury were higher in young adults, the elderly, and in rural locations, but rural mortality rates here did not differ compared to urban settings. The greatest potential to reduce morbidity and mortality resides in the formulation and implementation of preventive strategies.

Medical students and residents have shown increasing interest in international health experiences. Before attempting to establish a global health training program in a family medicine residency, program faculty must consider the goals of the international program, whether there are champions to support the program, the resources available, and the specific type of program that best fits with the residency. The program itself should include didactics, peer education, experiential learning in international and domestic settings, and methods for preparing learners and evaluating program outcomes. Several hurdles can be anticipated in developing global health programs, including finances, meeting curricular and supervision requirements, and issues related to employment law, liability, and sustainability.

Background: Cultural interventions to decrease substance abuse must be introduced and evaluated., Methods: Change in risk and protective factor ratings from a brief cultural school-based program were measured., Results: Students demonstrated significant improvements in school commitment, self esteem, and perceived harm of drugs. These changes correlated with decreased report of drug use., Discussion: The Ponocurriculum demonstrated effectiveness using the risk and protective factor model.

The Hawai'i Unified Telehealth program is a distance learning health education program for rural communities, created with federal grant funding from the U.S. Department of Commerce and the National Institutes of Health. These grant funds helped develop a network of rural community learning centers that employ distance learning technologies to provide community-driven peer education to isolated areas across Hawai'i and Majuro, Republic of the Marshall Islands. In this article, the authors briefly describe the development of the ongoing health education program and the results of outcome evaluation completed at the end of the funding period.

Unlabelled: The people of the U.S.- Associated Pacific Islands (USAPI) suffer significant health disparities when compared with industrialized countries. One explanation for this is lack of an adequate supply of skilled healthcare workers. The current research examines the factors that current health professionals from the region describe as helping and hindering them in their pursuit of health careers, as well as the barriers seen by students, educators and health professionals., Methods: Two separate interview studies were conducted with a convenience sample of individuals in the five USAPI jurisdictions in the Northern Pacific. The first study utilized the responses of 15 individuals regarding the barriers to the pursuit of health careers in order to develop a logic model map of the most common problems in the pursuit of health careers. The second study involved in-depth questions of 32 health professionals regarding barriers to and facilitation of health career training. Results were analyzed using constant comparative analysis., Results: Interview results indicate that facilitators of students pursing health careers included having a family member working in healthcare, the desire to help people, available training opportunities and personal experiences. Facilitators of completion of training included family support, financial support, personal commitment and social support during school. Barriers to pursuit and completion of training included:limited academic preparation, exposure and guidance; family obligations, and other careers seen as being more desirable., Discussion: Efforts to improve successful pursuit of health careers should start at the family level and must give a clear message to students that their goal is supported. Furthermore, there should be significant effort given to: improving the academic preparation provided for students, making career information available to students, and providing financial support, mentoring and guidance. Homesickness was a significant barrier that could be decreased by regional programs or a support system at locations with concentrated pockets of students from a given area.

The Yap Area Health Education Center (AHEC) is one of three U.S. Health Resources and Services Administration-funded AHEC programs in the U.S.-Affiliated Pacific Island jurisdictions (together with those in Palau and the Commonwealth of the Northern Mariana Islands). The Pacific Island AHECs are administered through the University of Hawai'i, John A. Burns School of Medicine and were founded in response to recommendations for development of the local health workforce by the U.S. Institute of Medicine in its 1998 report, "Pacific Partnerships for Health". The goal of the Yap AHEC is to build human capacity in the health workforce, and thereby strengthen the health service and improve health status for the people of Yap State. An ancillary goal is to pilot test new approaches to health workforce development, which might be shared with others in the region. These goals have been pursued by building partnerships with colleges in the region, with the new Wa'ab Community Health Center project in Yap and the Yap State Department of Health Services to bring formal college programs for students and health service staff to Yap State. To date, formal relationships have been established with five colleges; Palau Community College (PCC), the College of Micronesia-Federated States of Micronesia (FSM), Fiji School of Medicine (Department of Public Health & Primary Care), University of Hawai'i, Hilo, and the University of Alaska, Anchorage. A total of 143 students have been enrolled in 48 courses in several health worker disciplines, including clinical nurses, health assistant/dispensary managers, community health outreach workers, public health program staff pharmacy technicians and x-ray technicians. In addition to facilitating the delivery of courses in Yap, a new 6-course certificate program has been developed for community outreach workers in collaboration with the College of Micronesia, FSM and the Wa'ab Community Health Center (Wa'ab CHC) in order to support the CHC's innovative health service delivery model. The Yap AHEC has also assisted the College of Micronesia-FSM in the World Health Organization sponsored development of a proposal for the establishment of a nursing program, which is based on the decentralized, on-site (DC-OS) nursing training model that has been pilot tested in partnership with PCC at Yap State Hospital.

The Palau Area Health Education Center (AHEC)--a program of the University of Hawaii's John A. Burns School of Medicine (JABSOM) and based at Palau Community College--was established in 2001 in response to the recommendations of the 1998 Institute of Medicine (IOM) report--Pacific Partnerships for Health--Charting a New Course for the 21st Century1. One of IOM's core recommendations was to promote the training of the primary health care workforce among the U.S.-Associated Pacific Islands. Since its inception in 2001, the Palau AHEC has coordinated overall 37 postgraduate and undergraduate courses in General Practice and Public Health taught by the University of Auckland Faculty of Medicine and Health Sciences and the Fiji School of Medicine's School of Public Health and Primary Care (SPH&PC) in Palau, Yap State, and the Republic of the Marshall Islands. Currently 139 physicians, nurses, health administrators, and environmental health workers are registered as active students in Palau (58), Yap State (22), and the RMI (59). Notably, the Palau AHEC and the SPH&PC have worked in an innovative partnership with the Palau Ministry of Health to operationalize the MOH's public health work plan to implement a comprehensive community health survey of all 4,376 households in Palau, interviewing 79% of the total population, to determine Palau's health indicators. To accomplish this, the SPH&PC developed and taught a curriculum for Palau physicians and public health nurses on how to design the survey, gather, and analyze data in order to develop and implement appropriately responsive intervention and treatment programs to address Palau's old and newer morbidities. In early FY2005, two other Micronesian AHECs--the Yap State and Commonwealth of the Northern Mariana Islands AHECs--were funded through JABSOM administered grants which will also address the primary care training needs of Micronesia's remote and isolated health workforce.

Introduction: In order to improve health literacy in rural areas, the Hawaii/Pacific Basin AHEC and Ke 'Anuenue AHEC are working to connect rural communities via video teleconferencing., Methods: Video teleconferencing connectivity has been established to 15 rural and underserved locations across Hawaii and to the Republic of the Marshall Islands., Results: An average of 15 individuals participate in weekly facilitated health education sessions., Discussion: Participants have reported lifestyle change as a result of sessions and attendance is significantly increasing. In some areas, mid level health care professionals attend in order to obtain information for their patients.

Objectives: To determine the extent of utilization of cancer screening services by Vietnamese in Hawaii, who had sought medical care from 1996 through 2000., Methods: A chart review of 952 adult Vietnamese patients was performed., Results: Of all eligible women, 52% and 26% had Papanicolaou test and mammogram, respectively. Among men age 45 and over, 8.4% had prostate-specific antigen test and 3.4% had digital rectal exam. Flexible sigmoidoscopy and colonoscopy were not utilized by patients., Conclusions: This is the first study to examine the use of cancer screening tests by Vietnamese immigrants in Hawaii. Our findings of lower utilization rates in cancer screening by both male and female strongly support efforts to educate and promote preventive health for this population.

Objectives: We determined the most common diseases among adult Vietnamese men and women in Hawaii., Methods: A chart review of 952 adult Vietnamese patients was conducted between January and February 2000. A data collection form with 39 categories of diagnosed chronic illnesses or problems was used. The study was conducted at a Vietnamese internist's private medical office in Honolulu, HI., Results: Chart review revealed that the five most prevalent diagnostic conditions seen in Vietnamese men, from the highest to lowest frequency, were gastrointestinal disorders (39%), cutaneous conditions (31%), lower back pain (23%), headache (18%), and allergies (18%). In women, gastrointestinal disorders (38%), cutaneous conditions (34%), headache (32%), gynecologic conditions (30%), and arthritic diseases (24%) were most common. Gender, years of U.S. arrival, and types of occupation were significantly correlated with certain diseases (p< or =0.05)., Conclusions: This is the first study to examine frequency of diseases diagnosed in an ambulatory care setting in a cohort of Vietnamese patients in Hawaii.

The U.S. Institute of Medicine in its 1998 review of the health care systems among the U.S.-Associated Pacific Islands (USAPI) identified promotion of primary health care (PHC) and training of the regional health workforce including postgraduate training for physicians as priorities. With the support of the health leadership of the USAPI and the Republic of Palau, the John A. Burns School of Medicine (JABSOM) of the University of Hawaii captured U.S. federal Area Health Education Center (AHEC) funds to implement a postgraduate program to train Family Practitioners - physician specialists in primary care for the region. The Palau AHEC has evolved into ajoint activity of JABSOM, the University of Auckland Faculty of Medicine and Health Sciences (UAFMHS), the School of Public Health & Primary Care--Fiji School of Medicine, and Palau Community College to provide Diploma-level training in Family Practice and Community Health for Micronesian physicians.

Many medical schools use patient-encounter log forms to document and improve training experiences; however, they are expensive and/or time-consuming to analyze. The patient-encounter log form developed at the University of Hawaii is a one-page form on which students in the family medicine clerkship are required to maintain a daily record of patient demographics and diagnoses. The form is reviewed throughout the clerkship, and efforts are made to ensure that students' learning is supplemented to cover any gaps discovered with the log forms. The simple paper log form can be visually analyzed in less than a minute. During the initial implementation period, 44 students completed the forms. Twelve of these students also returned an end-of-year survey, which indicated that updating the logs required less than one minute per patient. The information obtained from the log forms was used to document and improve the consistency of the educational experience and to establish clinical curriculum guidelines for the clerkship. This form can easily be reproduced and adapted to other settings.