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Sunscreen Products Recommended by Dermatologists in Hawaii

Alan Ahana
Mentor: Norman Goldstein, MD

Background/Purpose: To evaluate what types of sunscreening agents dermatologists in Hawaii are recommending to their patients and why they are recommending them. Methods: A survey was sent to all members of the Hawaii Dermatological Society and results were sent via fax and e-mail to investigators. In addition, the inventories at several pharmacies were examined and recorded. Results and Conclusions: Pending.

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Effects of Upcountry Maui Water Additives on Health: A Quentin Burdick Rural Health Project

Amber Rohner and Damien Tavares
Mentor: Gen Iinuma, MPH, Lorrin Pang, MD, MPH and Jan Shoultz, DrPH

For approximately two years, many Upcountry Maui residents have voiced their concern that additives to control lead levels in their tap water may be linked to health problems. With the assistance of the Maui Department of Health and guidance of the Maui District Health Officer, Dr. Lorrin Pang, a study using phone surveys was conducted to assess this issue. The first half of the study focused on developing a research tool and characterizing the signs and symptoms believed to be associated with the additives in the upcountry water. Upcountry residents who called in with complaints about symptoms from the additives were contacted and asked specific questions about their symptoms. From this portion of the study it was determined that most people suffered a skin rash, while others experienced an eye irritation or breathing problems. For the second half of the study, a randomized, blinded survey with a control group was implemented. Two hundred random phone numbers frpm upcountry and 200 random phone numbers from downtown were called and participants in the survey were asked if they had experienced the types of symptoms reported in the first survey. The downtown participants were used as the control group since that area of Maui does not have the additive in their water. The results of the second survey indicated that a statistically significant (p<0.05) amount of upcountry residents experienced symptoms compared to the downtown residents. These symptoms may have been adverse reactions to the water additives, but more research would be needed to prove this (newspaper article).

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Sentinel Lymph Node Biopsy and the Native Hawaiian Population: Are Sentinel Node Biopsy Results Influenced by Ethnicity?

Amber Shields
Mentor: Laura Weldon Hoque, M.D

Hawaii’s Native Hawaiian population has higher mortality rates from breast cancer than all other ethnic groups in Hawaii, which raises the questions: do these patients begin cancer treatment with a poorer prognosis (i.e., advanced stage cancer, positive nodal status), or are there other reasons for poorer survival? The objective of this study was to determine if patient ethnicity is related to differences in nodal status. In this study we examined the relationship between patient demographics, and the outcome of sentinel lymph node biopsy (SLNB). One hundred seventy-five (175) women ages 32 to 82 years old with T1-T2N0 breast cancer, who underwent SLNB between December 1999 and March 2003 at Kapi’olani Breast Center (KBC) in Honolulu, Hawaii, were entered prospectively into the study. For the analysis, ethnicity was isolated as a key variable and evaluated concurrently with other factors such as age, tumor size, and body mass index (BMI). Patients were grouped by ethnicity, and other cancer data (i.e., tumor size, number of positive lymph nodes) were examined for each group. Since other studies have shown that higher BMI is related to SLNB failures, we also examined the node localization failure rates with BMI categories. This study found that no association between ethnicity and sentinel lymph node status. Thus Native Hawaiians are not more likely than other ethnic groups to present with positive sentinel lymph nodes (when controlling for tumor size). As other studies have shown, we found a link between BMI and blue dye failure rate. We also found the BMI of Native Hawaiians in this study to be significantly higher than other ethnic groups. The blue dye failure rate for Native Hawaiians was also significantly higher than other ethnic groups, highlighting that a combination blue dye and radioisotope localization technique is essential in this population.

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School Health Education Program at Nanakuli High School

Nina Teruya, Kelly Nagasawa, and Andrew Lee
Mentors: Gwen Naguwa, MD and Mike Fukuda, MSW (SHEP website)

Service learning is an experience-based learning method in which students and faculty work in cooperation with communities to address various issues, while simultaneously gaining knowledge and skills. The University of Hawaii John A. Burns School of Medicine developed a program called the School Health Education Program (SHEP), utilizing this model of service learning. Addressing health care topics including nutrition, exercise, and stress management, a team of JABSOM students employed interactive, small group presentations, colorful audio-visual learning aids, and handouts, including references and samples of healthy snacks, to increase the health content knowledge of Nanakuli High School Students between grades 9-12. Utilizing a one-group pretest-posttest design for evaluating student, data analysis revealed that all three classes at Nanakuli increased their mean score of correct answers (t = 4.346, df = 31, significant at the p<0.05).

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Hawaii Cares Asthma Program: "Trying to Improve Hawaii's Asthma Care"

Daisy Asuncion, Jonathan Kitayama, Ashlee Nekoba, and Brandon Teruya
Mentor: Dr. Charles DeMesa

Asthma is a big problem in Hawaii, especially during the months from September to November. As the environment and weather change, or the chance of catching a cold increases, we see an increasing incidence in the presentation of wheezing, coughing or shortness of breath. These are all signs of asthma. The goal of the HI CARES Asthma Research Program is to identify what the causes and triggers of asthma symptoms are. The project also hopes to determine why patients come into the Emergency Room to be treated for asthmatic symptoms. We believe that many patients are negligent and non-compliant when it comes to taking their asthma medication and that this is due to a lack of education in terms of how to treat asthma. The project will eventually involve instituting an intervention for those who come into the emergency room by educating them about asthma and how to treat their asthma by showing an educational DVD. We also hope to encourage all physicians to hand out written Asthma Action Plans to help patients care for their asthma better. Data is currently being obtained by consenting individuals who are 1-17 years old who come into the ER complaining of shortness of breath, coughing, or wheezing regardless of their eventual diagnosis or lack or previous history of asthma, as long as they are getting a treatment of Beta agonists or corticosteroids. These individuals complete a short survey of questions regarding their asthma history and treatment plans. This data will then be analyzed and intervention will begin in October 2003. Results from the preliminary data show that many patients don’t have the proper medications to treat their asthma or are taking them incorrectly which supports the theory that patients are not educated enough.

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Taking Healthy Steps Into the Future: A Quentin Burdick Rural Health Project

Catherine Simonovich with Lauren Hong, Valli Palmer, and Tianna Pascual
Mentors: Eileen Lovell, MSN, Jan Shoultz, DrPH, and John Casken, PhD

Pahoa, located in the Puna District of the Big Island, is known for the diversity and independence of its people. Because of the low cost of its land, many lower-income residents and retirees from Oahu, Maui, and Kauai as well as from parts of the Mainland and Southeast Asia have been moving there in recent years. The Pahoa Family Health Center, a branch of the Bay Clinic, Inc., provides Pahoa with both medical care and social services. It was also the project site of the Quentin Burdick Pahoa team for the summer of 2003. Cat represented medicine, Lauren, food science and human nutrition, and Valli, nursing. We were assisted by Tianna, recent Keaau High School graduate and culinary arts/liberal arts student at Hawaii Community College and by Eileen, Director of Nursing for Bay Clinic, Inc. After discussions with Eileen, Tianna and others who lived in Puna, we realized that many of the main concerns of people in the community were related to poverty, including the crystal methamphetamine epidemic and type 2 diabetes mellitus. Keeping issues related to poverty in mind, but also working within our time constraints, we sought ideas for projects in which we could intervene in the effects of poverty on children. We eventually decided to focus on two main projects: 1) constructing a “Healthy Habits” Booklet and healthy eating lessons for Summer Fun participants in Pahoa and Keaau and 2) creating a Keiki “Slippah” Drive. We felt that our projects were successful and addressed the needs of children in Pahoa in financially and culturally appropriate ways. The first project focused on helping children prevent future disease by teaching them how to eat healthier with the resources they have and the second project assisted them in avoiding injuries to their feet, allowing them to fully participate in school activities and helping them avoid teasing that would be damaging to them psychologically by giving them a way to obtain proper footwear at school. Community members were supportive of both projects, and community leaders thought that they would be helpful for people in the community. Although we all came from different backgrounds in terms of career training and experience living in a rural community, we were able to draw upon each others’ strengths in order to come together as a team. We also realized that rotating leadership roles when needed and distributing tasks based on our talents and experiences was the most effective way for us to operate as a team. Our unique personalities, education, and backgrounds contributed to a combination that was beneficial to our projects and experience as a whole. We did not perceive Pahoa as the dangerous place that some had said. Instead, we found the people of Pahoa to be friendly and supportive of our efforts to help their community. Living and working in this community helped us to recognize its strengths, and to help address some of its problems.

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Comparison of the Systemic Haemodynamic Effects of PDE5 Inhibition in Hypertensives and Age-Matched Controls

Chlesea Walker
Mentors: Drs. Steve Leslie and David Webb

Background. Nitric oxide (NO) is produced by the endothelium and has beneficial effects on the vasculature, such as vasodilatation and inhibition of platelet aggregation. NO stimulates the production of cyclic GMP which is subsequently broken down by phosphodiesterase 5 (PDE5). By preserving the actions of NO, PDE5 inhibition may, therefore, be useful in vascular disease. PDE5 inhibitors also reduce blood pressure (BP)1 and, thus, have potential in the treatment of hypertension. The results of a number of recent studies suggest that PDE5 inhibition with sildenafil has greater haemodynamic effects in hypertensives2 than healthy volunteers.3 However, this has not been investigated directly. Hypothesis. Sildenafil reduces BP to a greater extent in hypertensives than in age-matched controls whereas the effects on BP of isosorbide mononitrate (ISMN) and nifedipine do not differ between these groups. Methods. The study will be a randomised, double blind, 4-way crossover study. Twenty hypertensive patients and 20 age-matched controls will be recruited according to pre-defined inclusion and exclusion criteria. Measurements will be made of peripheral BP and heart rate (HR), pulse wave velocity, and, using pulse wave analysis,4 central BP and augmentation index. At each visit subjects will receive a single dose of sildenafil 100 mg, ISMN 20 mg, nifedipine (Adalat®) 10 mg or placebo (matched to sildenafil). ISMN will be used as a positive control for NO-dependent endothelium-independent responses and nifedipine as a positive control for NO-independent responses. Prior to each study visit subjects will be asked to refrain from alcohol for 24 hours. Tea, coffee and food will not be permitted for at least 12 hours before the study visit. Studies will be conducted in a quiet, temperature-controlled room. Subjects will undergo the protocol outlined in Figure 1. There will be a washout period of at least 4 days between treatments.

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Water Fluoridation Information Found on the World Wide Web

Christine Kim
Mentor: Lorin Yamamoto, MD

There is much controversy over the fluoridation of community water supplies. This study surveyed the informational content of internet sites on the World Wide Web (WWW) regarding water fluoridation. The informational content of WWW sites may range from factual, to unsubstantiated opinions, to frank fraud. However, this information is presented to the public indiscriminately. One hundred websites were identified and 59 were evaluated with a 6 point scoring system using predetermined criteria. Of these 59 sites, 54% recommend water fluoridation as compared to 31% that oppose it. The informational content of the World Wide Web contains varied views and recommendations for community water supply fluoridation. Public health officials and practicing physicians should be aware that the internet
WWW may influence public opinion.

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Identifying Gener, Ethnic and Symptom Characteristics of Subclinical Depression in a Minority Adolescent Population

Dorothy Shigaki
Mentor: Iwalani Else, PhD

Purpose: This study explores gender, ethnic and symptom characteristics identifying sub-clinical depression among a population of Native Hawaiian (i.e. indigenous people of the Hawaiian Islands) adolescents using items from the Diagnostic Interview Schedule for Children (DISC) and the Center for Epidemiologic Studies-Depression Scale (CES-D) scores. Methods: 580 students were randomly selected from a larger sample to participate in the DISC administration. Demographic information, CES-D scores, and DISC diagnoses were obtained for each student. Univariate and logistic regressions were performed to characterize major depressive disorder (MDD), dysthymia disorder (DD), minor depression (MD) and the research diagnostic criteria (RDC) for depression. Analyses using CES-D scores were performed to examine differences among sub-clinical depression groups on DISC diagnosis. Results: Females were more likely to exhibit symptoms and diagnosis of MDD. Native Hawaiians were more likely to exhibit symptoms of weight changes, psychomotor agitation, inability to concentrate. CES-D scores were higher for individuals who were either MDD, DD, MD or RDC. Implications: These results suggest that Native Hawaiians and females exhibit features unlike their counterparts. The sub-clinical constructs used in this study show higher CES-D suggesting their validity. Further studies are needed to explore these differences. (Native Hawaiian Mental Health Research Development Program and The Department of Psychiatry)

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ADHA: Reaching Hawaiian Children Where They Are: An AHEC at the Waianae Coast Comprehensive Health Center Project

Ian Chun with Holly Andrew, Stephanie Aquino
Mentor: Stephanie Bell, LSW, DCSW (Ho'olokahi Program)

Definition of ADHD: ADHD is a neurologically based condition that results from a chemical imbalance or deficiency of certain neurotransmitters in the brain, which help to regulate behavior (Wicks-Nelson & Israel, 2000). People with ADHD have a pattern of inattention (lack of attention) or hyperactivity (too much activity) that is worse and more frequent than what is considered usual for their age (American Academy of Family Physicians, 1999). Purpose of the Cultural Legacy Project: Studies from the State of Hawaii, Department of Health, have shown that there is a rising trend of diagnosis with ADHD in Hawaii, with One-fourth of those children who are diagnosed with ADHD is Part Hawaiian in ancestry (Department of Education, 2001). The purpose of this cultural legacy project is to use the Hawaiian culture in teaching ADHD children. Assessment Tools: Although several tests have been developed to aid in the diagnosis of ADHD, there is no one test by itself that can determine diagnosis of ADHD. However, one tool, which is widely used in aiding in diagnosis of ADHD, is called the T.O.V.A. (Tests of Variables of Attention). The T.O.V.A. is used in conjunction with other diagnostic tests (i.e. Conners and IVA). This test has auditory and visual components (Greenburg 2003). The T.O.V.A. is used to identify both auditory and attention problems. Hawaiian Cultural Perspective and Cultural Conflict: Overall, in western teaching, the teacher is the center of learning. Hawaiian children are “nonverbal” when confronted directly by the teacher and they seldom ask questions. This is in deep contrast to the common Hawaiian practices of teaching where collaboration, cooperation and assisted performance are key. Hawaiian children are highly peer oriented and indeed are taught not to approach adults except on invitation. Cultural Recommendations: Many non-western cultures have similar conflict as those presented by the Hawaiians. Five areas of education are in need of change to create a more culturally aware educational system: social organization, sociolinguistics, cognitive styles, motivation, and learning process. Hawaiians have a four step process that needs to be seen through: 1) Show the child the task, 2) Do the task with the child, 3) Have the child do the task (copy), and 4) Have the parent critique or monitor the task. Conclusion: In conclusion there seems to be an apparent relationship between the diagnosis of Hawaiian children with ADHD and how they are taught at schools. It is imperative that as health professionals we are confident about how cultural differences can impact the educational experience of a child. We must also be the voice of children who are being misdiagnosed as having ADHD. We must not quickly jump to the ADHD diagnosis of children. In our communities, we must educate others about the uniqueness of other cultures such as the Hawaiian culture and its impact on the educational experiences of children. As professionals we must reach out to our fellow colleagues and use a multidisciplinary approach when working within our communities.

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Molokai's Perception of the Nutritional Value of Fruits and Vegetables: A Quentin Burdick Rural Health Project

Ian Chun with Saba Behjati, David Ishii and Ginger Takeshiita
Mentor: Judy Mikami, Sheri Gon, MT, and Jan Shoultz, DrPH

Barriers to the consumption of fruits and vegetables on Molokai were identified in a preliminary study as the high cost and poor quality of store bought produce and the hard labor it takes to grow your own. We decided to create a health book for the mind, body and soul and entitle it "Flava of Molokai." This book includes healthy recipes incorporating local produce, healthy tips from community members, a guide to local healthy resources such as agriculture, fishing, la'au lapa'au, etc., pictures of Molokai's keiki, words of wisdom from the kupuna and a cultural exercise map listing several hiking routes and their description. We distributed the book in the community and received very positive feedback and requests for additional books. The kupuna's caretakers have informed the hospital kitchen to help the kupuna by providing a greater variety of vegetables and fruits with their meals.The Quentin Burdick Rural Health Training Program is a interdisciplinary experience: Ian, medicine, Saba, nursing, Ginger, psychology, David, education.

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Tumor Response and Toxicity with Multiple infusions of High Dose 131I MIBG for Refractory Neuroblastoma

James Howard
Co-Investigators: Drs. John Maris, Janet Veatch, Randy Hawkins, Leslie Kersun, John Huberty, and Katherine K. Matthay

Purpose: 131 I Metaiodobenzylguanidine (131I MIBG)has been shown to an effective targeted radiotherapy against refractory neuroblastoma and responses to treatment have been observed for over 15 years. In phase I/II studies with single high doses of 131I MIBG the response rate was approximately 40% and the major toxicity was myelosuppression which was recoverable by transfusion, G-CSF, or hematopoietic stem cell infusion. The aim of this study is to determine the response and hematologic toxicity with multiple infusions of 131I MIBG. Methods: Twenty eight patients were treated for refractory neuroblastoma with multiple infusions of 131I MIBG. Four patients received dose escalations on a Phase I protocol and the remaining 24 received 18 mCi/kg on a phase II protocol.
Results: Response data and hematologic toxicity are still pending to fully analyze results.

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Association of Hearing and Vision Problems with Low Cognitive Scores and Caregiver Perception of Dementia

Jasmine Ide
Co-Investigators: Akira Fujiyoshi, MD; Kamal Masaki, MD, Eva Ardo, BS; G. Webster Ross, MD; Helen Petrovich, MD and Lon White, MD

Introduction: Mental status tests such as the MMSE and CASI are commonly used tools by healthcare practitioners to determine the patient’s cognitive function. Vision and hearing deficiencies, which are commonplace in the geriatric population, may cause the patient to score poorly on these assessments (even though cognitive function is intact), leading to a misdiagnosis of dementia. Methods: At the Honolulu Heart Program’s fourth examination (1991-1993), cognitive function was assessed with the CASI (Cognitive Abilities Screening Instrument) and determined as demented with the Benson and Cummings criteria. CASI scores < 74 were considered low. Hearing was assessed using the HHIE-S (Hearing Handicap Inventory for the Elderly, abbreviated version), with impairment defined as an HHIE score of > 10. Vision was best corrected near and distant vision tested using hand-held cards. Impairment in either near or distant vision was considered a deficiency. Results: Caregivers were relatively good at determining whether patients were demented (sensitivity = 77%, specificity = 67%). 77.1% reported as having memory problems were shown to be demented. 32.7% of those who were reported as having memory problems were not demented (“false dementia”). Vision and hearing problems were more prevalent in the false dementia group than those with no known or believed dementia (42.9% to 30.7% and 44.4% to 36%, respectively). P values were 0.21 and 0.39, respectively. Patients who had unrecognized dementia also were more likely to have vision and hearing problems than those who were recognized to have dementia (64.8% to 53.5% and 38.8% to 31.9% with P values of 0.14 and 0.37, respectively). CASI scores were shown to be lower in the nondemented with poor vision (41.9% compared to 22.9% with normal CASI scores, p= 0.026), but hearing loss was more prevalent in the nondemented, normal CASI group than the nondemented, low CASI group (42.9% and 34.7%, p= 0.36). After adjusting for age and prevalent stroke, impaired vision and education were significant predictors for low CASI scores in the nondemented (OR= 2.65, 95% CI= 1.06-6.60, vision, and OR= 0.80, 95% CI= 0.69-0.91, education). Conclusions: Vision and hearing may not only contribute to misperceived dementia, but may also mask signs of dementia as well. Impaired vision is significantly associated with an increased risk of poor performance on mental assessment tests in non-demented subjects. Deficiencies such as hearing and vision should be corrected before such testing is executed.

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Comparative Efficacy of Portable Acustimulation (ReliefBand) versus Meclizine (Dramamine Non-Drowsy) for Preventing Motion Sickness

Jay Tokeshi and Ryan Lee
Mentor: Loren Yamamoto, MD

Motion sickness is the normal physiologic response of humans to unfamiliar motion. A neural mismatch or conflict between the visual,
vestibular, and proprioceptive systems oftentimes occurs which result in nausea, vomiting, pallor, and diaphoresis. Although motion
sickness is a common problem affecting most patients at some point in their lives, treatment is limited to anticholinergic, antihistamine, and sympathomimetic drugs with inconsistent efficacy and frequent side effects. A new alternative nonpharmacologic treatment, electrical
acustimulation, has been shown to reduce the symptoms of motion sickness and enhance normal gastric myoelectric activity. The
possibility of using electrical acustimuation for the prevention and/or treatment of motion sickness is discussed.

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Effects of Niacin on Hormone Sensitive Lipase and Lipoprotein Lipase Expression in Patients with HIV Lipodystrophy Syndrome

Jill Ono
Co-Investigators: Dominic Chow, MD, Scott Souza, PharmD, Bruce Shiramizu, MD, Duy Tran

Background: Up to 950,000 people in the U.S. are infected with human immunodeficiency virus (HIV). As patients live longer due to advances in treatment, several adverse effects have been observed, one of which is HIV lipodystrophy syndrome. Niacin reportedly reduces intra-abdominal fat in patients with HIV lipodystrophy syndrome. It is thought that niacin inhibits hormone sensitive lipase (HSL) and enhances lipoprotein lipase (LPL) expression. Objectives: The purpose of this study was to assess the expression of HSL and LPL in adipose tissue samples pre and post-treatment with niacin. Methods: Consent was obtained from patients as per guidelines established by the University of Hawaii IRB. Skin punch biopsies were performed before and after treatment with niacin. RNA was extracted from the fat component of the biopsies. Quality of the RNA was assessed using UV spectrophotometry and RT-PCR with ß-globin primers. Upon confirmation of RNA quality, cDNA from the specimens were amplified using HSL and LPL primers. PCR products were separated using gel electrophoresis.
Results: 8 RNA samples were positive for ß-globin primers. In 2 of 4 patients HSL expression decreased and in 3 of 4 patients LPL expression increased when comparing the pre and post-niacin treated samples. Discussion: This pilot study looked at the effects of niacin on HSL and LPL expression in patients with HIV lipodystrophy syndrome. Preliminary results show the expected increase in HSL expression in half the samples and a relative decrease in LPL expression in 75% of the samples. Future studies should include larger sample size with serial sampling over a period longer than 12 weeks.

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Dimensions of Alcohol Dependence: A Pilot Study

Jonathan Gibson
Mentor: Dr. Deborah Goebert

This study attempts to describe the correlations between alcohol and drug dependency and different ethnic groups (Caucasian, Hawaiian, and Filipino). Based on studies on the mainland using Caucasians, Blacks, and Hispanics, and previous studies done in Hawaii, the NIAAA Collaborative Research Project will apply these methods to Hawaii’s native population. Along with alcohol and drug findings, the NIAAA study will also attempt to identify certain psychosocial issues facing each ethnic group (Caucasian, Hawaiian, and Filipino) such as Phobias, anti-social behavior, anxiety, and compulsive behaviors. This study is ongoing and results are expected next March.

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Optimization of Detecting Glutathione-S-Transferase Mu 1 Polymorphisms in Buccal Cell DNA for Application

Joy Zia
Mentor: Elizabeth Tam, MD

The prevalence of childhood asthma is increasing in Hawaii and throughout the world (10). While environmental factors have been studied extensively, research has begun to explore the genetics that contribute to asthma and wheezing occurrence. For instance, the glutathione s-transferase mu class 1 gene plays a pivotal role in xenobiotic metabolism and antioxidant defenses, both of which may be involved in asthma pathogenesis (2). Also, it has a highly polymorphic locus with a common null allele that results in a complete lack of the enzyme. Individuals of null (-) GSTM1 have been shown to have an increased susceptibility to develop asthma or asthma-like symptoms when compared to individuals with (+) GSTM1 (2) The gene is indeed highly polymorphic being absent in about 30-50%, but the prevalence of the null genotype varies greatly depending on ethnicity (3). Asthma prevalence is significantly higher in the children of mothers who have the (-) GSTM1 genotype and who continue to smoke. To date, the frequency of this allele has not geen elucidated in Asians and Pacific Islanders. The Hawaii Island Children’s Lung Assessment Scientifiic study (HICLASS) provides information about asthma and wheezing , exposure to tobacco smoke, and volcanic air pollution in 1988 schoolchildren on the Big Island. The purpose of this study is to optimize genomic DNA collection and amplification to determine if the null GSTM1 allele contributes to the risk of developing asthma among these schoolchildren.

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Culture Loss and Mortality Rates: AHEC at the Waianae Coast Comprehensive Health Center

Joy Quensell
Mentor: Stephanie Bell, LSW, DCSW (Ho'olokahi Program)

This research project was conducted as part of the Ho’olokahi Department at the Waianae Coast Comprehensive Health Clinic. The WCCHC is involved in cultural assessment of the Waianae community. The major focus of the research project was to investigate a cultural aspect that affects the health of a patient. This paper addresses how culture loss affects mortality rates in Native Hawaiians and is based on one patient’s current situation. It is a case study of a 16-year old morbidly obese Hawaiian patient which looks at how the loss of culture has affected her family over three generations. The paper addresses and compares the health and medical beliefs and practices of Hawaiians and Westerners. It also assesses the importance of understanding and preserving culture to help alleviate the misconceptions and misunderstandings that occur between Western doctors and patients who wish to practice culturally related medicine. This research looks at how the patient has been disconnected from the Hawaiian traditions practiced by her grandmother and is therefore experiencing a decline in spiritual and physical health. She has been morbidly obese and unsuccessful in weight loss plans since she was a teenager. In order to decrease the patient’s mortality at a young age, integration of the Hawaiian culture into her healthcare plan was initiated through education based on Hawaiian language, cultural practices and hula (to encourage physical activity). This plan implements both Western and traditional Hawaiian treatment as a combined effort in providing the best patient care available. The other members of the team were: Gianna Beck and Susan Kondo.

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The Effect of Morinda citrifolia on DLD-1 Colon Cancer Cell Lines

Kandon Kamae
Mentor: Drs. Lawernce Mordan, Sheri Fong, Kathryn Braun, Shannon Hirose-Wong

Morinda citrifolia, locally known as noni, has been traditionally used as a medicinal herb for a variety of diseases. Recently, due to the many anecdotal claims noni users have made, there has been an increased interest in its effects against cancer. A study using MCF-7 breast cancer cells and another study using Lewis Lung cancer cells have shown that noni has inhibitory effects on both types of cell lines. These findings hold significant meaning to the Hawaiian population because both lung and breast cancer is highly prevalent. Just as prevalent as lung and breast cancer is among the Hawaiian people, the rate of increase in deaths due to colon cancer over the last 30 years is alarming. Therefore, this study was designed to see if there is any inhibitory effect of noni on DLD-1 colon adenocarcinoma cells as was seen in the lung and breast cancer studies. If inhibition occurs, noni may be considered as an alternative and culturally sensitive method for treating lung and breast cancer. An ethyl alcohol extraction of semi-ripe noni was used to treat three groups of culture dishes at varying doses to if there was any inhibitory activity and if this activity might be doe related. These dishes were compared to two control groups, one untreated group and another group treated with only ethyl alcohol. The results showed that there was no inhibitory effect of noni on any of the groups of cells. These findings may be due to the type of noni used, the type of extract used, the concentration of the treatment doses, the fact that noni may require a physiological change in the body in order to become active against the cells, or that noni have no effect at all on DLD-1 colon cancer cells. Further studies need to be performed to rule out each of these reasons to see if noni has or does not have inhibitory activity against DLD-1 colon cancer cells.

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The Honey-Sweet Treatment of Wounds

Halvorson, Karin
Mentor: not stated

Personal Account: It is early morning and a woman hobbles into la urgencia. She is the garden-variety stoic Mexican woman. 76 years old, yet able to walk miles to the emergency room with a leg wound from knee to ankle, two inches wide. She had had varicosities burst, but like many people of the area, did not seek medical attention until very late. Upon her admission, her ulceration was cleaned, debrided, and bandaged. Prior to wrapping, honey was spread along the injured area, followed by gauze and ice packs. She returns every three days for cleaning and reapplication of honey, and at each visit, the abrasion and surrounding tissue are in improved condition. Methods: Medical literature was reviewed on the antibacterial properties of honey. The following databases were used: CINAHL/OVID, MDConsult/Publisher, Medline/OVID, and PubMed@HML/NLM. Key search terms were: “honey,” “wounds,” and “ulcers.” Results: Honey has long been used as a remedy for common ailments from ulcers to diarrhea. Its efficacy as an antimicrobial agent in the treatment of wounds has been proven extensively. Conclusions: In the setting where such mediums as silver sulfadiazine are not readily available, honey may establish itself as a cheap, easily accessible, and perhaps better, alternative. I propose a retrospective study to assess the risk of botulism as well as development of easy sterilization techniques that will not denature honey’s antibacterial properties.

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Honoka`a Health Education: Caring for the Mind and Body: A Quentin Burdick Rural Health Project

Kory Kitagawa
Mentors: Bev Cypriano, Kate Thompson, RN, and Jan Shoultz, DrPH

The Quentin N. Burdick program is an interdisciplinary program involving students from the University of Hawaii Schools of Nursing and Dental Hygiene, Medicine, Social Work, Departments of Psychology, Medical Technology, Public Health, and Education. Students are split into groups of three or four and do their summer practicum at one of six rural communities. The main goals of the Quentin Burdick program are to work with an interdisciplinary team to produce tangible results that are community-supported, community-based, and address the specific health care needs of the community. The community of interest in this project was Honoka`a on the Big Island of Hawaii. Team Honoka`a 2003 consisted of a medical student, nursing student, and an education student. The students worked hand in hand with the Hamakua Health Center to focus on health education for the different generations in Honoka`a. This was accomplished by working on projects that targeted both the youth and adults. The students worked on two “Youth” projects: Asthma Camp and the Honoka`a Youth Center. In both events, they acted as teachers and role models covering topics such as Asthma, careers, and drugs. Two “adult” projects were also completed, both focusing on Diabetes. The first project involved establishing the Diabetes Collaborative in the Hamakua Health Center. This was being implemented by the clinic to improve the treatment, education and follow-up of diabetic patients. The second project involved Labman (a mobile research facility) and the Diabetes Awareness, Education, and Screening Project. The students helped to connect the two groups together providing diabetic patients not only with educational and nutritional information, but also with a comprehensive foot exam. A foot care booklet was also produced by the students and it is in the process of being copyrighted. The other members of the team were Owen Sonoda, education, Pualani Gandall-Yamamoto, nursing, and Oscar Botelho and Rebecca Hewetson, Honoka'a High School.

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Evaluating the Usefulness of the Summer Health Fun Program, Nana’s House: A Quentin Burdick Rural Health Project

Lisa Lam and Randy Lau
Mentors: Rebecca Smith, Cliff O'Donnell, PhD, and Jan Shoultz, DrPH

The Quentin N. Burdick Rural Interdisciplinary Waimea Team operated a Summer Health Program as their community project. This year, 2003, is the fourth year in which this summer program had been running. The team interns felt that this was an important time to assess the program and its value to the participants as well as the community. Participants were surveyed primarily on three things: 1) Why they signed up for the program, 2) What they would be doing if they had not participated in the program and 3) How they would rank the various activities in the program. Not all participants completed the survey and more qualitative data may have been useful. In light of the general trends and the availability of comparable programs in the community, such as the Waimea Boys and Girls Club summer program, we feel that this program should NOT be continued in its current form and with its current structure. We recommend a smaller group of participants and perhaps an older age group, such as high school students. One possibility would be a career-shadowing program to prep students for post-secondary school life and education. We believe this would be a more meaningful experience for both the UH interns and the participants and may also be more sustainable in connecting the students with resources and members of the community. The other members of the team were James Moriano, social work and Stephanie Higa, nursing

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Music in Alleviating Anxiety Associated with Surgical Procedures and Treatments in Cancer Patients

Michelle Yamada
Mentor: None

Background: Music therapy is a popular complementary therapy frequently used by cancer patients as a means of relieving anxiety and stress, as an anti-emetic for chemotherapy side effects and as a pain-reliever for chronic, advanced cancer pain. While there is evidence in medical literature that music is effective in decreasing advanced cancer pain and the intensity and duration of chemotherapy-induced nausea and vomiting, little is known of its effectiveness in lowering anxiety levels of cancer patients. Anxiety reduction during the physically, emotionally and mentally debilitating cancer experience has the potential to increase quality of life, in addition to treatment outcomes and survival. Objective: The objective of this review is to determine the effectiveness of music therapy in lowering anxiety levels in cancer patients during surgical procedures (i.e. tissue biopsy) and treatment (i.e. chemotherapy and radiotherapy), two aspects of the cancer experience associated with the highest anxiety levels. Results: Two randomized, controlled trials were included in evaluation for procedural anxiety. One trial measured effect of music on pre-operational anxiety in women awaiting breast biopsy, and the other measured the effect of music on anxiety during tissue biopsy or vascular port placement. One trial demonstrated a significant (p = .046) benefit of music on lowering anxiety levels while the other showed no benefit. Two trials, one randomized and controlled, and the other, non-randomized, but controlled were included in evaluation for anxiety associated with cancer treatment. One trial measured effect of music on anxiety levels associated with chemotherapy treatment and the other with radiation treatment. The trial investigating chemotherapy anxiety demonstrated a significant (p = .015) decrease in anxiety in response to music intervention, while the trial investigating radiation treatment did not show significant benefit (p = .763). Conclusions: The benefit of music therapy in alleviating anxiety associated with surgical procedures and treatment is equivocal based on available evidence from randomized, controlled studies and controlled, clinical studies. However, music therapy, as a complementary therapy, is a non-lethal modality, which has not demonstrated harm in any study participants and has shown some benefit in alleviating anxiety associated with chemotherapy. Therefore, music therapy should be considered as an adjunct to mainstream cancer treatment, and studied more extensively in various aspects of cancer diagnosis and treatment.

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A Survey for Flaviviruses in Culex quinquefasciatus and Aedes albopictus mosquito pools on Oahu, Hawaii

Michelle A.P. Tulang
Mentor: Alison Imrie, Ph.D.

The arboviruses, especially the flaviviruses, have been an insect spread pathogen and a public health threat for many centuries. The rise and fall of human epidemics caused by flaviviruses are due to rise and fall of Aedes and Culex mosquito populations and evolution of the flaviviruses, especially dengue fever. With the recent outbreak of West Nile virus in New York and of dengue in Maui, Hawaii, there has been increased interest in surveillance of mosquito populations for possible viral infections. This study’s purpose was to isolate and amplify flavivirus RNA from mosquito pools of Culex quinquefasciatus and Aedes albopictus collected in locations around Oahu. None of the 193 mosquito pools tested positive for any flaviviruses. Further studies might include getting additional mosquito pools from more locations and optimizing RNA and PCR methodologies.

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Depressive Symptoms Predict Cognitive Decline in Elderly Men

Monica Oshita
Co-Authors: Miki Kiyokawa, M.D., Kamal Masaki, M.D., Randi Chen, M.S., Helen Petrovitch, M.D., G.Webster Ross, M.D., Lon White, M.D.

Background: Recent studies have shown that depression and depressive symptoms may be associated with cognitive decline in the elderly. However, none of the studies examined this association in the Asian population. We tested the hypothesis that elderly Japanese-American men in Hawaii who have depressive symptoms have worse cognitive function at baseline and greater cognitive decline over a 3 and 6 year period.
Methods and Results: The Honolulu Heart Program is a longitudinal study of cardiovascular disease in Japanese American men in Hawaii. Cognitive function was measured using the Cognitive Abilities Screening Instrument (CASI) during the fourth (1991-1993; n=3734), fifth (1994-1996, n=2704), and sixth (1997-1999, n= 1988) exams. Depressive symptoms were assessed during the fourth exam using an 11 question version of the Centers for Epidemiologic Studies Depression Scale (CES-D 11). Pearson correlations showed that increased depressive symptoms correlated with a lower CASI score at baseline, and at 3 and 6 years of follow up (p < 0.0001). For those with depressive symptoms, there was also a greater decrease in CASI scores after 3 (p < 0.02) and 6 years (p < 0.0001). This association persisted even after adjusting for age, education, time of follow up, baseline CASI, Apo E4, and prevalent stroke or Parkinson’s disease at baseline. Conclusions: In this population of Japanese-American men, depressive symptoms are an independent predictor of poor cognitive function at baseline and increased cognitive decline over a 3 year and 6 year period. These findings suggest a need to address depressive symptoms in the elderly to perhaps slow down cognitive decline and improve quality of life.

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Marshalese Beliefs and Cultural Practices Regarding Death and Dying: A Case Study

Shaylin Chock, Laurie Nakashima and Nellie Sgambelluri
Mentor: Mary Ann Antonelli, MD (QEC website)

With more than two dozen ethnic groups residing in Hawaii, it is easy to see that health care providers in Hawaii are faced with a tremendous challenge in the areas of cross-cultural care and cultural competency. There are almost 2500 people of Marshallese descent currently living in Hawaii . In addition, with free immigration between the Marshal islands and the United States, this number is likely to grow. To date, a literature review regarding information concerning the perspectives of death in Marshallese patients is futile for there are no direct references made towards this subject nor is this subject addressed in any of the literature regarding the Marshallese people. The purpose of this study was to examine and understand the emotional journey of a Marshallese spouse after her husband suffered numerous strokes which led to his progressive inability to ambulate, feed himself, and communicate effectively. More specifically, the goal of this study was to get a better understanding of how the Marshallese view death, dying, and burial practices. Participants included a 68-year-old Marshallese male, his wife, a 65-year-old Marshallese woman, and a “resident Marshallese Cultural Expert.” Data was obtained via interview and chart review. The overall results revealed explanations of certain practices common in Marshallese culture with regards to illness, death and dying. These findings helped lead to a better understanding of how cultural factors could contribute to our Marshallese patient’s experience of illness and dying. Furthermore, it helps us to appreciate the family’s emotional journey and expectations regarding our patient’s condition. (AHEC project at Queen Emma Clinics).

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An Investigation of the Active Biological Compounds in Indigenous Popolo (Solanum americanum)

Paradis Uyehara-Aguinaldo
Mentor: Lawernce Mordan, PhD

The popolo plant is considered the foundation of Hawaiian materia and medica and as such has a myriad of uses, including the treatment of asthma. This study was designed to investigate the active biological compounds popolo contains that might be useful in the treatment of asthma. Using thin-layer chromatography, we showed the plant contains the anticholinergic compound solanidine, as well as the acetylcholinesterase inhibitor, solanine.The two compounds have opposing functions in the pathophysiology of asthma. Solanine prolongs bronchoconstriction while solanidine down regulates bronchial smooth muscle constriction. Future studies will investigate the relative concentrations of these two alkaloids.

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Evaluation of Gene Expression Measurements from Commercial Microarray Platforms

Paul Tan
Co-authors: Thomas J. Downey, Edward L. Spitznagel Jr., Pin Xu, Dadin Fu, Dimiter S. Dimitrov, Richard A. Lempicki, Bruce M. Raaka, Margaret C. Cam

Multiple commercial microarrays for measuring genome-wide gene expression levels are currently available, including oligonucleotide and cDNA, single and two-channel formats. This study reports on the results of gene expression measurements generated from identical RNA preparations that were obtained using three commercially available microarray platforms.. RNA was collected from PANC-1 cells grown in serum rich medium and at 24 hours following the removal of serum. Three biological replicates were prepared for each condition, and three experimental replicates were produced for the first biological replicate. RNA was labeled and hybridized to microarrays from 3 major suppliers according to manufacturers’ protocols, and gene expression measurements were obtained using each platform’s standard software. For each platform, gene targets from a subset of 2009 common genes were compared. Correlations in gene expression levels and comparisons for significant gene expression changes in this subset were calculated, and showed considerable divergence across the different platforms, suggesting the need for establishing industrial manufacturing standards, and further independent and thorough validation of the technology. These results also support the notion that with ongoing maturation of microarray technology, current large-scale use for global gene expression profiling and subsequent data interpretation in biomedical research be approached with caution.

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Growing Our Own Healers: A Quentin Burdick Rural Health Project

Quynh Hoang with Marie Watanabe, Kelly Ikemoto, Uilani Wills
Mentor: Cash Lopez, RN, Kenton Kramer, PhD, and Jan Shoultz, DrPH

For the past four years, students of the Quentin Burdick program have worked side by side with Kaua’i to promote and support community capacity building in both Hanalei and Lihu’e. The goal was to develop projects beneficial to the communities and to build on ones that already exist to make them sustainable. The other aim of the program was to strengthen the concept of community medicine, which was met by enlisting an interdisciplinary team of students to carry out the project: Uilani Wills, a psychology student, Kelly Ikemoto, an education major, Marie Watanabe, a nursing student, and Quynh Hoang, a medical student. The Quentin Burdick Program on Kaua‘i is unique in that it is able to experience two different communities: Hanalei and Lihu’e. Both sites focus on the theme of “Growing Our Own Healers” by involving and empowering the island’s youth. The Halele‘a Cultural Exploration Program in Hanalei seeks to make their youngsters aware of their island and community while the Summer Health Academy in Lihue encourages and opens up opportunities for the youth to explore various health care professions. Hanalei’s program efforts to develop potential community leaders are evident in their thematic incorporation of team building activities. Examples of this include the utilization of former students as junior group leaders, recitation of weekly Hawaiian proverbs known as ‘olelo no‘eau, daily values, self-exploration through art, and group interactions. In addition, involvement of the kids with the Quentin Burdick team members this year further expanded their depth of exposure to various issues surrounding their daily lives. This was accomplished by delivering presentations and activities chosen by the Quentin Burdick team to engage the students in interactive learning on various subject matters pertinent to their well-being. The Summer Health Academy in Lihue, on the other hand, seeks to promote healthy living and to introduce underserved populations to health career opportunities. The focus of this year’s program was health and nutrition, which included daily activities involving those concepts as well as fitness and exercise, health occupations, and CPR/First Aid classes. Reinforcement of these themes was enhanced by incorporating lesson plans that were chosen by each member of this year’s Quentin Burdick team into the program.

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Oral Hypoglycemic Compliance in an Insured Population in Hawaii

Rachel Lee
Mentor: Deb Taira, ScD

BACKGROUND: Patient adherence to oral anti-hyperglycemic therapy is important in reducing healthcare cost and health burdens. OBJECTIVE: The goal of this study is to describe patient adherence to oral anti-hyperglycemic agents in a population with drug coverage. METHODS: This retrospective administrative data analysis included claims from January 1 through June 30, 2003 (n=20,685) for patients utilizing oral anti-hyperglycemic agents. Multivariable logistic regression analysis was used to examine the relationship between adherence with oral anti-hyperglycemic and patient characteristics, including age, isle of residence, and ethnicity. Adherence is defined as a drug possession ratio of at least 80%.RESULTS: Adherence differed according to drug class, age, ethnicity, and isle of residence. Adherence to oral anti-hyperglycemic agents was low. Relative to sulfonylureas, the odds ratio of adherence ranged from [Adjusted Odds Ratio (OR) 0.76, 95%CI(0.73-0.78)] for metformin to [Adjusted Odds Ratio (OR) 0.48, 95%CI(0.46-0.49)] for thiazolidinediones and [Adjusted Odds Ratio (OR) 0.42, 95%CI(0.37-0.46)] for alpha-glucosidase inhibitors. Adherence increased with age then declined at the age of 85 and over. Relative to the age subset 55 to 64, adherence increased as age increased reaching a peak at age 75 [Adjusted Odds Ratio (OR) 1.1, 95%CI(1.0-1.1)] and decreasing to [Adjusted Odds Ratio (OR) 0.90, 95%CI(0.82-0.98)] for age 85 and older. Adherence was highest in Japanese and lowest in Filipinos. Relative to white patients, the odds ratio of adherence was highest for Japanese [Adjusted Odds Ratio (OR) 1.2, 95%CI(0.89-1.2)] and lowest for Filipinos [Adjusted Odds Ratio (OR) 0.78, 95%CI(0.77-1.0)]. Adherence was lowest in Lanai. Relative to Oahu, Lanai had the lowest odds ratio [Adjusted Odds Ratio (OR) 0.76, 95%CI(0.73-0.78)]. Gender was not associated with adherence. CONCLUSION: There were significant differences in adherence to oral anti-hyperglycemic pharmacotherapy related to patient characteristics. This information can be used to target patients most in need of improvement, including the younger patients, Filipino patients, and patients on Lanai. Further research is needed to better understand differences in adherence across therapeutic class and to examine the effects of adherence on outcomes.

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A Review Of Muscle Atrophy In The Elderly: -Potential For Curbing Atrophy And -Implications For Functional Independence

Riki Suzuki
Mentor: Dr. Michael Carethers

The aging population (>65 years) is increasing at a rate faster than any other age group, with the fastest growing being the group aged 85 years and older. With such increases in the aging population, it has become apparent that health care providers must gain a better understanding of the health care problems which may be specific to this population, in order to insure the highest quality of life possible with a longer life expectancy. This review summarizes a subset of the literature surrounding one such health care problem, muscle atrophy, often referred to as sarcopenia when it regards the natural and biological atrophy of senescence. The basis for this review is that this progressive aging process, muscle atrophy, has strong implications for functional dependence and frailty in the elderly, with potential for large public health care costs. Strategies for the prevention and management of muscle atrophy are reviewed, with the finding that weight resistance training may be the single most reliable method of both halting and possibly reversing atrophy. While other strategies have been studied, including use of nutritional supplementation, administration of growth and other hormones, and other forms of exercise (endurance and flexibility training), studies to date provide the most convincing evidence for the safety and efficacy of resistance training. Still, despite convincing evidence for resistance training’s utility in managing muscle atrophy, resistance training’s long-term effects continue to be scrutinized by medical authorities. Further long-term experimentation with larger segments of the aging population needs to be pursued to identify the most definitive methods of preventing or delaying sarcopenia and its associated disabilities in our aging population. Such experimentation should ideally integrate the complementary findings regarding debilitations that may result from osteoporosis and other disorders of loss of bone mineral density and bone mass.

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School Health Education Program: A program designed to teach high school students while promoting the civic values of social responsibility to first year medical students

Timothy Chong, Blaine Okino, Darren Herzog
Mentors: Gwen Naguwa, MD and Mike Fukuda, MSW (SHEP website)

Introduction: The School Health Education Program (SHEP) allows medical students to teach selected health education topics to improve adolescent health knowledge and decision making. The medical students also learn the importance of social responsibility, which consists of giving back to the community that is supporting the medical school and students throughout the educational process. This program provides skills to communicate with adolescents, who are a difficult subpopulation for physicians to communicate with and educate. This program benefits high school students by providing peer mentors (medical students) who are similar in age and at the same time authority figures. Methods: Assent and consent forms were given to students and parents for review and acceptance of program participation. They were then given pretests which consisted of multiple choice questions and Likert scales which measured attitude and confidence on the health education topics. Upon completion of the pretest, medical and pre-medical students gave presentations using various approaches to increase the knowledge and confidence of the students in making various health decisions. Results: Castle High School did not show an increase in knowledge; however, it did correlate learning from the presentations with confidence in making health decisions. McKinley students had difficulty recalling their secret identification number, which barred comparisons over time. However, by the spring semester, this problem was resolved with positive results on knowledge, awareness (of subject), and confidence in making health decisions post the sexual health presentation. Discussion: The students at Castle were interested in the healthcare field and used English as their primary language. McKinley consisted of students with learning disabilities, behavioral problems, English as a second language, and people who were forced to take the class as a graduation requirement. Castle on average consisted of 11th and 12th graders, where McKinley consisted of 10th graders.
McKinley had a larger increase in their average test scores. Castle students interested in pursuing health careers, showed a higher mean of correct answers, allowing little room for improvement on the post test. McKinley, which was composed of students who had to take the class, did not have the same motivation to learn the subject matter beforehand; and therefore, had lower pretest scores than Castle. Due to that lack of motivation, the McKinley students also had more potential to learn the subject matter, which was reflected in their 0.882 increase from pretest to posttest. The health presentations still seemed to have an impact on knowledge gained, confidence in making decisions regarding the various aspects of health, and the students felt they learned. Conclusion: An increase in test scores was due to the fact that high school students saw the medical students as authority figures. The combination of characteristics in medical students provided a change in atmosphere that facilitated the learning environment of the students. The students who perceived the medical students as role models were also more compelled to learn and participate in the presentations. Other reasons for the increase in knowledge and confidence gained in health care issues may have been due to the different types of presentations used by medical students. The medical students benefited from SHEP through improved communication skills needed to work with adolescents. This program reinforced the importance of community service and its relationship to learning of the basic sciences.

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Comparative Study of the Same Methodology of Teaching at Two High Schools with Different Educational Backgrounds: A School Health Education Project

Judith Hernaez and Mark Nishihara
Mentors: Gwen Naguwa, MD and Mike Fukuda, MSW (SHEP website)

The School Health Education Program is designed to teach high school students sensitive issues relating to healthy living, substance abuse, sexual health and violence prevention in hopes to enable these students to make better choices. The objective of this study is to see whether the same methods of teaching made a difference in two high schools with different backgrounds. Three pre-med and 3 medical students present health topics once a month to Roosevelt and Waipahu High Schools. Teaching methods included power point presentations, skits, live demonstrations, lectures, videos, and games. A pre-test and a post-test were given to each student to assess improvement in knowledge. Results show the presentations significantly improved the health knowledge of the Roosevelt and Waipahu High School students.

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The Effects of Shade and Nutrients on Intraspecific Secondary Metabolite Variation in the Benthic Cyanobacterium, Lyngbya majuscula

Ronald Pangilinan
Mentor: Dr. Valerie Hope, University of Guam, Marine Laboratory

Intraspecific chemical variation in secondary metabolite production has been noted for a variety of terrestrial plants and marine algae. Cyanobacteria (blue-green algae) are primary producers that can respond to physical environmental factors such as light and nutrients in ways similar to plants. In this study, the responses to these factors were tested in the laboratory by manipulating the light and nutrient resources available to the benthic marine cyanobacterium Lyngbya majuscula, which is known to produce differing amounts and types of secondary metabolites. Low light levels significantly reduced the growth, the concentration of organic extract, and the major secondary metabolite pitipeptolide A. Conversely, enrichment with nitrogen and phosphorus did not influence growth or secondary metabolite concentrations. These results suggest that decreased light intensity may be the major factor influencing secondary metabolite production for L. majuscula.

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Is There Correlation Between the Recording of Daily Weights & 24 Hour Ins/Outs in Acute Care Settings?

Ronald Kuroda
Co-Investigators: Jason R. Leong DO, Larry Kaufman MD FCCP

Estimation of a patient’s fluid volume status is one of the most fundamental, yet most problematic components of clinical assessment. The ability to know a patient’s volume status continues to elude even the most talented of clinicians, despite the existence and use of advanced technological support/devices [1,2,3]. Clearly, reducing elements of doubt inherent to the guesswork in the fluid management of patients would be beneficial. The potential negative consequences of inaccurate data are heightened in caring for the critically ill [4]. Included among common, non-invasive data points collected in acute care settings reflective of volume status are: 1) daily weights and, 2) input and output calculations. Physical law dictates that matter cannot be created nor destroyed. With this in mind, measurement of patient daily weights and 24-hour Input and Output (I/O) ideally must directly trend and correlate with each other. However, the consistency/reliability of these two parameters has never been objectively explored. The objective of our study was primarily to determine if a strong correlation of concordance existed between daily weights and 24-hour input and output charting in the acute care setting. Secondarily, we invited the opinions of various clinicians who care for these same patients.

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Evaluating the Effectiveness of Kukui Nut Oil in the Treatment of Psoriasis

Luis Cruz and Ryan Young
Mentor: Amy Brown, PhD, RD

Background: Psoriasis is a recurring, non-contagious skin disorder that is manifested as silvery-white plaques that are raised, thickened, and often pruritic. Globally, this disease affects approximately 80 million people. In the USA, the incidence of psoriasis is 3 to 5 million individuals, with approximately 150,000 new cases reported each year. There is no cure for this disease so patients are often faced with a lifetime of the physical and emotionally aspects of being disfigured. Current treatment modalities require long-term use and their side effects are numerous and hazardous. There have been anecdotal reports that Kukui Nut oil is an effective treatment for psoriasis, but there is no scientific literature that confirms or refutes these reports. Purpose: The purpose of this study is to identify whether or not Kukui Nut oil is an effective treatment for psoriasis. Methods: Thirty patients with mild stable plaque psoriasis (<15% of total body surface area affected) were evaluated in this 12-week, double-blind, placebo-controlled pilot study. Patients were seen every other week for evaluation at a dermatologist’s office. One targeted lesion was chosen to be evaluated along with the overall severity of the patients’ psoriasis. These were documented using clinical evaluation, the Psoriasis Area and Sensitivity Index (PASI) scoring, the Global Severity of Psoriasis Scale (GSPS), and photos. Patients were also required to keep a log of their own assessment of the GSPS. Results: Results are still pending at this point; the estimated completion date is October 1, 2003.

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Native Hawaiian Nonmedicinal and Medicinal Use of Kukui Tree

Ryan Young and Luis Cruz
Mentor: Amy Brown, PhD, RD

The focus of this paper is to investigate the non-medicinal and medicinal uses of various parts of the kukui tree. Existing literature and audiovisual media were located using electronic and manual databases that were available on the University of Hawaii's Voyager Library Catalong, the Bishop Museum Archives and the Hawaii State Public Library. The Majority of our references were found at Hamilton Library's Native Hawaiian collection. In addition, a Native Hawaiian healer was consulted on the traditional uses of the kukui tree that are still being used today. The entire plant was utilized in everyday life for many non-medicinal reasons. Kukui's most prominent use in ancient Hawaii was as a source of light. Each nut provides approximately 3 minutes of light. Some medicinal uses for kukui were the treatment of thrush, constipation, wounds, infections, asthma, arthritis and skin disorders. Having both internal and external medicinal applications, kukui is considered a powerful la'au by traditional healers, even to this day.

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The Healing Garden - An AHEC at the Waianae Coast Comprehensive Health Center Project

Ryan Lee and Joanna Griffin-Boyce with Janice Lazo
Mentor: Stephanie Bell, LSW, DCSW (Ho'olokahi Program)

Project Healing Garden had a three fold mission: 1) to restore Hawaiian culture loss, 2) to promote physical fitness, and 3) to equip the patient with skills for attaining a health living lifestyle. To obtain these goals, we needed to examine the health of today's Hawaiians and listen to their needs and wants. In the process, we analyzed available resources regarding physical activity and determined their feasibility according to the client's current health status, motivation, financial issues, and other factors. Container gardening was found to be simple, rewarding, appropriate, and economicall feasible for the client. It renewed in him a childhood behavior of intimacy with the land, remembering how he cared for it as it cared for him and his family. The Healing Garden is proposed as an effective mode of treatment for a variety of patients living in an increasingly complex westernized culture.

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Structural Characterization of a Human Chymotryptic Proteinase: Can expressed sequence tags be used to determine its full sequence?

Ryon Nakasone
Mentors: Drs. Claude Jourdan-LeSaux and Elizabeth Tam

A chymotryptic proteinase purified from human lung tissue is structurally similar to azurocidin but functionally similar to mast cell chymase . We hypothesized that additional amino acid sequence of this proteinase might be deduced from searches of databases of amino acid or nucleotide sequences and expressed sequence tags(EST). Nterminal amino acid sequences were compared with amino acid and nucleotide sequences in the National Institutes of Health (NIH) genome database using the Basic Local Alignment Search Tool (BLAST). Three amino acid sequences were found to be 70-90% homologous to azurocidin. These 3 sequences were then used to search the EST database, yielding 2 potential matches. Plans are to obtain additional sequence from an IMAGE clone that contains the homologous EST .

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School Health Assessment of Kalihi Elementary School: AHEC at Kokua Kalihi Valley Comprehensive Family Services

Daisy Asuncion and Sandy Tsumoto with Wynari Agbayani and Stanley Cachola
Mentor: Janet Primiano, MSW (KKV website)

Kokua Kalihi Valley’s (KKV) Professional Education & Training (PET) program unites students and faculty from various disciplines (including medicine, social work, nursing, and nutrition) to explore key aspects of providing high-quality comprehensive care (health, social, financial, etc.), particularly for the local underserved and culturally-diverse community of Kalihi Valley. Aspects considered include cultural sensitivity, professionalism, and collaborative effort and communication among professionals of different fields. Learning objectives were met via tutorial meetings, faculty presentations, and individual and group projects. Assignments included cultural presentations and client case assessments. Our primary team project during the past year was a health assessment of Kalihi Elementary School students. This project is grant-funded and designed to be conducted over the course of 2 years. Its primary objective is to identify and address health concerns of Kalihi families, ultimately providing them with appropriate care by linking them with existing services or by designing and implementing new community programs. In the 2002-2003 academic year, PET students and faculty formulated, distributed, and analyzed a health survey of parents, and conducted a height, weight, and blood pressure screening of students from several grades at the elementary school. In the year ahead, the PET team intends to implement recommendations based on the survey’s results, and to continue screening the students (adding on vision, hearing, and speech testing).

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Tuesday's With Ke Ola ...2002-2003: An AHEC at the Kahili Palama Health Center Project

Amber Rohner, Lloyd Asuncion, Randy Lau, Serena Lo and Haku Kahoano
Mentor: Doris Segal-Matsunaga, MSW (KPHC website)

The AHEC program is a multidisciplinary team of University of Hawaii students representing the fields of medicine, medical technology and social work. Our AHEC site is the community of Kalihi-Palama, a region to which Asian and Pacific Islander immigants establish themselves. Although Hawaii has some of the lowest morbidity and mortality rates associated with cardiovascular and pulmonary disease in the nation, studies have shown that certain ethnic groups making up the population of the Kalihi-Palama area continue to be at high risk. Therefore, we decided to educate the third grade classes of Likelike Elementary School about maintaining a healthy life-style, with a special focus on their heart and lungs. Several methods were employed to develop as age appropriate lesson plan for the heart and lungs. Our methods included a literature review, interviews of key community members, as assessment of the 3rd graders and a questionaire given to the teachers of the students. Judging by the smiles and giggles of our 3rd graders, our efforts will not be soon forgotten. The impact of the experience moved some kids so much that they exclaimed that they too were going to become doctors in the future.

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Meniscal Allograft transplantation (MAT) vs Artificial Meniscus Transplantation in the Restoration of Function and Relief of Pain in the Knee Joint

Amy Cowan
Mentor: not stated

The standard treatment for meniscus surgery has changed considerably over the last century. In the past total meniscectomy was suggested. However surgeons today favor preservation of the menisci because they are thought to knee the knee stable. Total meniscectomy has also shown to yield detrimental effects including but not limited to increased joint laxity, an earlier presentation of osteoarthritis (OA) and other structural changes. In the case of severe meniscal injury, meniscal cartilage replacement has become a surgical option. The purpose of this study was to compare the potential benefits of meniscal allograft transplantation (MAT) to artificial meniscus transplantation and determine which protocol was more advantageous to relieve pain and restore function. Type of Study: A literature review of clinical trials. Methods: A literature review was conducted between June and August 2003. Articles were selected based on the relevance to the topic. Hawaii Medical Library databases were used. Results: MAT initially had favorable outcomes at relieving pain and restoring function. There was little evidence that prosthetic implants could protect cartilage and the joint from degenerating. Additionally, there were many other problems associated with the synthetic implant such as, easy to tear, increased debris formation and plastic malformation. Conclusion: MAT is the better treatment option. Long-term studies will need to be done to determine if the initial favorable results of MAT remain in the future.

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Use of Remote Functional Assessment Tools to Enhance Rehabilitation Research and Practice

Anna Adenine Stanislaus
Mentor: Tina Stoeckman, PT, MS

This research project studies the use of videoconferencing technology to assess functional status from outside the clinic. The technologies under use meet the H.330 and H.324 videoconferencing standards. The Functional Independence Measure, Jebsen-Taylor Hand Function Test, Barthel Test, Fugl-Meyer Assessment, Nine-Hole Peg Test and Motor Activity Log are measures under investigation. For each of these assessment instruments, the aim is to both evaluate whether remote evaluation is as effective as face to face, and to disseminate recommendations regarding specific protocols. This research will identify the means to assess key published measures of functional status in a timely manner from outside the clinic (e.g., the patient's home). Such information is a necessary condition for optimizing therapeutic interventions over the continuum of care.

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White Blood Cell Count Predicts 8-year Incident Coronary Heart Disease in Elderly Japanese-American Men: The Honolulu Heart Program

Serena Lo
Co-Authors: Arun Chaudhary, MD; Kamal Masaki, MD; Kaon Fong, BS; Katsuhiko Yano, MD; Robert Abbott, PhD; Beatriz Rodriguez, MD, PhD; J. David Curb, MD

BACKGROUND: Recent studies have shown that inflammation may be involved in the pathogenesis of coronary heart disease (CHD). White blood cell (WBC) count, a routinely performed test, is a sensitive marker for inflammation and has been found to be an independent risk factor for CHD in middle-aged populations. There are no data in elderly minority populations. METHODS: The Honolulu Heart Program is a prospective community-based cohort of Japanese-American men living in Hawaii, initially established in 1965. At the fourth examination (1991-93), WBC count was measured in 3566 men, ages 71-93 years. Subjects were divided into tertiles of WBC count for analysis (T1=1.1-5.3, T2=5.4-6.6, T3=6.6-17.4 x109/L). Eight years of follow-up data are available for incident CHD, in 2767 subjects free of CHD at baseline. RESULTS: Eight-year age-adjusted incident CHD rates increased by tertiles of WBC (11.3, 17.3 and 20.2 per 1000 person-years, respectively). Using Cox proportional hazards, after adjusting for age, smoking status, diabetes, hypertension, BMI, physical activity, cholesterol (total and HDL), fibrinogen, alcohol intake, and aspirin and/or NSAID use, WBC was a significant independent predictor of eight-year incident CHD (T2 - RR=1.46, 95% CI=1.04-2.06; T3 - RR=1.47, 95% CI=1.03-2.09), using the lowest tertile as the reference group.CONCLUSIONS: WBC count, a non-specific marker of inflammation, was a significant independent predictor of eight-year incident CHD in elderly Japanese-American men, even after adjusting for common risk factors. Along with other markers of inflammation, WBC count may be used to identify those at increased risk of CHD, to be targeted for preventive strategies.

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Psoriasis Treatments: A Review of Published Treatment Regimens

Bryce Higa
Mentor: not stated

Psoriasis is a immune-mediated chronic skin disease that manifests itself in different forms with varying degrees of severity. Most researchers consider psoriasis related to a dysfunction of the immune system. More than 4.5 million adults in the United States have psoriasis. Between 10-30% percent of psoriasis patients develop a related form of arthritis, called psoriatic arthritis. Methods: A review of the literature was conducted on 5 treatment options: 1) weight loss, special diets, oral omega-3 fatty acids, topical plant products and dietary supplements. Conclusions: Of the options investigated none provided long-term relief.

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Intussuception Epidemic Related to Rotashield

Yvonne Lee
Mentor: Loren Yamamoto, MD

The first licensed rotavirus vaccine, Rotashield, was withdrawn several years ago from the market due to incidences of intussusception among vaccine recipients. Various research projects that subsequently followed have either confirmed or failed to demonstrate association between Rotashield and intussusception. An epidemic of intussusception also happened in Hawaii, so the main thrust of this study is to determine the onset and duration of Honolulu’s intussusception epidemic and whether it is or is not temporally consistent with the period of Rotashield accine availability. Other considerations for the cause of the intussusception epidemic are viral infections. This places Hawaii in a unique position because its geographical location can cause a temporal delay in the occurrence of viral infections compared the occurrence of those same viral
infections in the continental USA. If the epidemic of intussusception is due to the introduction of Rotashield vaccine, then the onset and duration of Honolulu’s intussusception epidemic should resemble that of epidemics on the mainland. However, if the timing of Honolulu’s
intussusception epidemic is not temporally consistent with the period of Rotashield vaccine availability, then this evidence would be
inconsistent with the conclusion that Rotashield vaccine is associated with intussusception.

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Obesity and Overweight Children

Catherine Allday Davis
Mentor: none

It is common knowledge that the rate of adult obesity and overweight has dramatically increased in the United States over the last several decades. What is just recently coming to light is the same trend is true for children and adolescents. The number of overweight children has doubled in the last two to three decades. As being overweight or obese in childhood puts one at increased risk for adulthood obesity and overweight it is important to concentrate on this disease as soon as it starts. The added concern over the physicial and emotional sequelae seen in over weight children is another motivating factor. This literature review covers the epidemiology, etiology, physicial and emotional sequelae and treatment of childhood obesity.

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Childhood Obesity: A Baseline Study for Native Hawaiian Children

Sarah K. Nicholson
Mentor: not stated

Based on the literature review showing that childhood obesity is on the rise and given the alarming statistics regarding the health status of Native Hawaiian adults, the current study was undertaken to establish baseline information regarding the BMI's of Native Hawaiian children and adolescents in order to answer the question, "are Native Hawaiian youth following the same trend of increasing rates of obesity as the rest of the nation?" The current study was also undertaken to compare the current overweight status of Native Hawaiian youth with youths nationally.

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Hawaiians Dealing with Obesity: An AHEC at the Waianae Coast Comprehensive Health Center Project

Damien Tavares with Robert Timm
Mentor: Stephanie Bell, LSW, DCSW (Ho'olokahi Program)

Hawaiians, in general, suffer from a high prevalence of obesity and its complications, such as type 2 diabetes mellitus, hypertension, cardiovascular disease, and depression to name a few. The focus of this study is to examine the biological, psychosocial, and cultural aspects and impact of obesity on the Hawaiian community that resides in Waianae, Oahu. A multi-professional approach towards prevention and care of obese patients has been proposed. In addition, a culturally sensitive exercise program has been suggested for future evaluation.

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Kimura’s Disease of the Earlobe

Natalie Parsa
Co-authors: Mark F. Maida M.D., David Wong B.S., and F. Don Parsa M.D.

A 25 year-old woman of part-Hawaiian and part-Japanese ancestry presented with a 10-year history of a recurring mass in her left earlobe. The patient had both ears pierced ten years ago and within one year had developed an infection at the site of the left ear piercing. The earrings were removed, yet within another years time a tender erythematous mass developed in her left earlobe. The mass was diagnosed as a keloid and was injected with steroids six times without benefit. The mass was excised 4 times between 1992 and 1998 and recurred after each excision. The patient presented to us in 2002 with a mass in her left earlobe that had been increasing in size for the past 4 years. (Hawaii Medical Journal 62(2) February 2003).