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AHEC at the Waianae Coast Comprehensive Health Center: A Case Report

Kanani Dilcher, Lori Hermosura, Michael Tarape
Advisors: Stephanie Bell and Bobbie Kelii

Living with Diabetes Mellitus can be a challenge for anyone, but even more so if you are a teenager. As a Hawaiian African teenager, my client has lived since age one with Diabetes Mellitus Type 1. He has poor blood sugar control, and is non-adherent in his medical care of his condition. Additionally, my client is ashamed about his condition, and therefore fails to check his blood sugars regularly at school. Although of Hawaiian descent, my client does not identify with his culture, but instead identifies with a more Western teenage culture. In doing so, he holds values such as independence for himself. Therefore, in coping with his Diabetes Mellitus, my client doe not seek support, and in fact hides his condition from those around him. Additionally, my client does not consume the traditional Hawaiian diet, which would be ideal for his health condition, given his native Hawaiian heritage. Instead, he chooses to eat the foods of this Western teenage culture. In working with my client, the cultural loss suffered by the Native Hawaiian culture was evident in many aspects of his life. First, he had no ohana or support group to help him cope with his medical condition. Second, unlike his ancestors, he did not believe in pono, or being at one with oneself. The native Hawaiian people believed that mind and body were connected in health, and that you could not have health in one area without health in the other (http://kahanapono.tripod.com/ KaHanaPono.PDF). Interestingly enough, the native Hawaiians were a healthy and robust people before the arrival of the Westerners, and led a very active lifestyle. However, post Western contact, the Hawaiian people were forced to adhere to a completely different and more sedentary lifestyle, spending many hours a day in school. Today the Native Hawaiians still adhere to the Western values and lifestyle. However, unlike the Westerners who always lived in this fashion, the Native Hawaiians were forced to live the Western lifestyle. Therefore, the Hawaiian people did not evolve living this lifestyle, and as a result there has been a large prevalence of chronic illness arising in the Native Hawaiian people( Blaisdell, www.hawaiiheart.com/health2.html).

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Treatment of box jellyfish stings

Andrew Yeo
Research Mentor: Loren Yamamoto, MD, Department of Pediatrics, Kapiolani Hospital

In Hawaii, many swimmers and beachgoers have been stung by Jellyfish that are floating in the water or that have been washed up on the beach. These stings are painful and most people want something that will make the pain disappear quickly. Some methods that are commonly used are vinegar, meat tenderizer, hot water, cold packs, or papaya on the area of the sting. The purpose of this study is to compare these treatments to determine which one is better. We are looking at comparing papaya pulp and cold packs with hot water immersion (which was previously determined to be the most effective cutaneous treatment in a prior study. The information gained from this study will help physicians, paramedics, and lifeguards better understand how to treat Jellyfish stings.

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Effect of Small Groups on Learning and Application to Health Decision Making

Misha Kassel & Cassie Lee
Research Mentors: Gwen Naguwa, MD & Mike Fukuda, MSW, Office of Medical Education

Background: The purpose of this project was to determine the effectiveness of small groups on high school students’ ability to learn and apply scientific and health concepts into everyday decision making skills affecting their health. Methods: Prior to presenting at the schools, faculty provided lecture and resource materials on the biological, clinical, behavioral and populational aspects of the health topic. Health topics were selected by the Hawaii State Department of Education, Health Content standards. Prior to the actual presentation, students developed their teaching plan and received feedback from faculty and peers. Instructional methods were modified based on the feedback. A one-group pretest-posttest design was used to measure health knowledge and confidence with health decisions of high school learners based on the presentations. Discussion: Small groups facilitated the ability of students to gain scientific knowledge and apply it to improve health decision making skills. Small groups allowed one on one attention, and increased participation and engagement with activities. As an example, student’s role played refusal skills in scenarios of pressuring one to have sex or use drugs. The small groups allowed students to be less self-conscious and more engaged in the role playing. To the contrary, students were less involved when the whole class was together as one large group. To start off SHEP presentations, students were lead through a simple yoga routine, to get them moving and introduce them to healthy lifestyles, in one large group; some of the students would not participate and merely stand off to the side. There was also less involvement when we would review concepts discussed that day as a large group at the end. In the large group setting, it was more threatening to speak up and less pressure to participate because of the ability to blend in with all of the other students. In a small group of four or five students, it is difficult to sit back and not participate as no crowd of students to existed blend in with. The small groups provided an environment to practice skills in a safe environment, which encouraged participation and discussion. In the small groups, discussions occurred frequently, while it was a rarity for many students to get involved in a discussion in the large group setting.

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Retrospective case studies on wire recanulization of the ductus arteriosus and balloon dilatation of the ductus arteriosus in the cardiac catheterization laboratory

Mireille Anawati
Research Mentor: Dr. Frank Ing, Chldren's Hospital in San Diego, CA.

I worked with Dr. Frank Ing on clinical research involving retrospective case studies in four patients. One patient underwent wire recanulization of the ductus arteriosus and the subsequent three patients underwent balloon dilatation of the ductus arteriosus in the cardiac catheterization laboratory. Although balloon dilatation has been accomplished in a patent ductus or on post-mortem specimens, balloon dilatation of a functionally closed ductus arteriosus has never been documented in clinical practice as far as I know. It was very interesting to read about various studies that have been done, and even more intriguing to think that no one has put further effort into clinical application of ductal balloon dilation. The first two weeks I spent at Childrens Hospital in San Diego, I read background information in textbooks and journal articles to better familiarize myself with various forms of congenital heart diseases, specifically focusing on critical pulmonary stenosis and truncus arteriosus. I then read about the ductus arteriosus and the histological changes involving in the natural progression from an elastic vessel to a ligament and the physiological triggers involved. Then, I spent a few weeks familiarizing myself with patient charts and information retrieval in the system used here at the hospital. I compared procedural information and results, I read about each patient’s past medical history and any follow up data available and then I began to document the case reports. Each case report consisted of the patient’s age, diagnosis, initial angiographic and echocardiographic findings, and finally the cardiac catheterization procedure report, as dictated by the attending physician (Dr. Ing). After thoroughly reading through patient charts and medical information, I began to read journal articles published on the clinical application of balloon dilation of a ductus arteriosus. I found three reports: 1) In 1989, transcatheter occlusion of the ductus was hindered by a patent but narrow ductus in five patients who underwent ductal dilation with balloon angioplasty to allow appropriate cannulation and avoid arterial puncture; 2) in 1991, four newborn infants with intractable heart failure due to severe obstruction of the left heart underwent balloon dilation of the ductus arteriosus after prostaglandin therapy failed to improve their clinical condition; and 3) In 1992, two neonates presenting with cyanosis due to critical pulmonary valve stenosis with severe right ventricular hypoplasia underwent angioplasty of the arterial duct which resulted in increased arterial oxygen saturations and allowed for adequate pulmonary flow while the right ventricle could grow to a sufficient size. Finally, with all previous publications and current pediatric literature in mind, I began to write an article acknowledging the accomplishments of Dr. Ing in four case reports. I used 19 references and made two versions of the article. Initially, I tried to compile the information in a case report format. Then, it was suggested that I try to organize the information in a series-type format. After completing two versions of the article, I submitted them to Dr. Ing and I will continue to work with him via e-mail from Hawaii in an attempt to submit the article for publication next year.

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Quantifying the Content of Prime-Time Television

Sherrie Suzuki
Research Mentor: Loren Yamamoto, MD, Department of Pediatrics, Kapiolani Hospital

Qquantifying the material on prime-time television is relevant to pediatric medicine. Thus, after completing on online IRB course and obtaining exemption approval from Kapiolani Medical Center’s IRB, we designed a study that monitored the content of four different networks (FOX, NBC, ABC, and CBS) during prime-time hours (7 p.m. - 10 p.m.) for two weeks, for a total of 168 hours of television. We created a data sheet that included the major categories of sex, violence, drugs, alcohol, smoking, sports, and health, and we also included subcategories that tracked messages such as anti-smoking ads and instances of people exercising. I set up four VCRs to record one network each day and recruited two volunteers to help me gather the data. Each time an image of or reference to any of these subjects was made, we recorded a tally mark on the data sheet. We divided the data sheet into separate columns for each hour, as well as differentiated between commercials and programs. I have now put the data into an Excel spreadsheet and am attempting to analyze the data.

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A non-invasive assessment of skin elasticity as a marker of arterial stiffness

Michael Semenza
Research Mentors: Dr. James Oliver and Bushra Ilyas

Background. Arterial Stiffness has been shown to be associated with coronary artery disease, hyper-cholesterolemia, hypertension and atherosclerosis. Collagen and elastin of blood vessel walls are responsible in a large part for the passive tension of the wall and therefore help to determine the mechanical properties of the wall. The elastin lamellae fibers are easily stretched and serve to distribute pressure uniformly across the wall. As the pressure and diameter of the artery increase, the force is gradually transferred to the more rigid collagen fibers. Structural changes that occur with age include fragmentation and degeneration of elastin, increases in collagen, and a thickening of the arterial wall. In aging skin, collagen fibers become thicker and less soluble and the synthesis of collagen declines. The dermis consists of eccrine and apocrine glands, hair follicles, veins, nerves, and a fine network of collagen fibers, elastin fibers and other components of the extracellular matrix (fibrillar networks and a ground substance). Collagen in skin provides tensile strength, while elastin maintains skin elasticity and resilience. Dermal elastic fibers become thicker and fragmented and oxytalan fibers appear fragmented and shortened with age. As a result of the decreased number of elastic fibers in aged skin, the elastic recovery of skin decreases. Disintegration of elastic fibers is already seen in a minority of fibers between the ages of 30 and 70 years, but the changes are more profound after the age of 70 years affecting a majority of the fibers. The mechanical behavior of skin can be assessed by inducing a surface deformation and measuring the skin’s resisting force or by applying a load and assessing the deformation. Given that elastin and collagen are a major constituent of both the arteries and skin, loss of skin elasticity may be a marker of increasing arterial stiffness. The underlying process of arterial stiffness may stem from genetic polymorphisms. A number of genes have been shown to be associated with stiffer arteries. Examples include the Fibrillin-1 gene which plays an important role in large artery stiffness and elevated pulse pressure in people with coronary disease. Hypotheses. 1. Reduced skin elasticity is a predictor of arterial stiffness independent of age. 2. Arterial stiffness and skin elasticity share common genetic determinants. Methods. Sixty subjects comprising healthy volunteers will be recruited according to pre-defined inclusion and exclusion criteria. Measurements will be made of peripheral BP and heart rate, pulse wave velocity, pulse wave analysis, digital volume pulse (DVP) and skin elasticity. Blood will be taken for full blood count, renal and liver function, total, LDL and HDL cholesterol and glucose. A part of the blood sample will also be used for genetic analysis. This study will be carried out in a temperature-controlled environment as best possible with a relative temperature of 20 to 22 C and a relative humidity between 40 and 50%. All subjects will be requested to avoid the use of moisturizing bath products or skin moisturizers on the day of the study. Subjects will be studied in the morning after an overnight fast, and subjects will be asked to refrain from alcohol for 24 hours prior to the study.

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Maternal HIV-1 prevalence in a rural Iambi hospital– Iramba District, Tanzania

Ronald Tanaka
Reserach Mentors: Lori Kamemoto, MD, MPH, Hawaii AIDS Clinical Research Program
Dennis Lofstrom, MD, Iambi Hospital Project

Worldwide, it is estimated that 39.4 million people are HIV infected, and about 25.4 million of those live in sub-Saharan Africa. Worldwide, HIV is increasingly a female disease. In some parts of sub-Saharan Africa, close to 60% of all those infected are women. The recent regional stabilization of HIV prevalence can be misleading and there is dramatic geographic variability that exists between and within countries of this very large area.. Tanzania ranks among the top 10 nations in the world most affected by the HIV epidemic, and demonstrates significant differences in HIV prevalence in the various regions within its borders. In Tanzania’s Mbeya region, a fall in HIV-1 prevalence among 15-24 year old women from 20.5% to 14.6% between 1994 and 2000 was attributed to prevention interventions that increased condom use, significantly delayed the age of first sex, and increased the treatment for other sexually transmitted diseases. On the other hand, the neighboring Rukwa region experienced an increase in HIV-1 prevalence in a similar population from 22.5% to 30.2% within the same time period. Prevention efforts were said to be less intense in this area. Monitoring HIV-1 prevalence within populations not only evaluates the effectiveness of intervention efforts, it can also define infection trends that enable the development or reassessment of public health strategies and the prioritization of efforts in certain populations. Antenatal (ANC) clinic attendants as a sentinel surveillance population to assess HIV-1 prevalence of the general population has been the most widely used and preferred method. While some studies suggest that the use of ANC attendants can underestimate HIV-1 prevalence in the general population and despite the recent use of national household surveys throughout sub-Saharan Africa, the ANC sentinel population has some unique advantages. National surveys, for example, are costly and difficult to execute and are therefore may be conducted at 3-to-5-year, or more, intervals. ANC data, on the other hand, has the potential capacity to gauge HIV-1 trends annually over multiple years, providing closer monitoring and predictive data on which to base future disease patterns. Furthermore, a recent study conducted in several locations throughout Sub-Saharan Africa investigated factors influencing differences between ANC and general population prevalence. Few factors were found, suggesting that it may be possible to develop procedures based on ANC data, to calculate population estimates. A drawback of the ANC sentinel surveillance strategy is its limited geographic coverage and ability to reflect larger populations on a national level. Many of these clinic based studies have been located in urban areas. This study will therefore determine the prevalence of HIV-1 in a small rural hospital in northern Tanzania through a retrospective chart review. This data be useful at the hospital level to determine HIV-1 prevalence in a consecutive group of deliveries to assist in determining local policies. This rural population data may also be added to data already collected on a national level, to potentially assist in the assessment of HIV-1 prevention strategies in this region.

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Do drugs traditionally used to treat type 2 diabetes, Rosiglitazone and Glipizide, influence the development of atherosclerosis in patients with type 2 diabetes and cardiovascular disease?

Janine Doneza
Research Mentor: Joseph Barrera, MD, Mission Viejo, CA

The aim of the study is to compare the effects of drugs traditionally used to treat type 2 diabetes, Rosiglitazone and Glipizide, on development of atherosclerosis in patients with type 2 diabetes and cardiovascular disease. The hypothesis is that these drugs will reduce plaque size. My role in the study was to identify patients with both type 2 diabetes and heart disease. Patients who had narrowing of coronary vessels were identified on the basis of an abnormal treadmill stress test; these patients were scheduled to undergo cardiac catheterization. Plaque size would be measured at the time of catheterization using intravascular ultrasound (IVUS) and after use of either Rosiglitazone and Glipizide.

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The School Health Education Program: Assessing Adaptive Communication Strategies in the Classroom as a Model for Developing Effective Doctor-Patient Communication

Gina Fujikami, Courtney Lee & Lauren Okamoto
Research Mentors: Gwen Naguwa, MD & Mike Fukuda, MSW, Office of Medical Education

Introduction: The School Health Education Program (SHEP) partners physicians-to-be with local public high schools in an effort to teach the high school students health topics, while allowing first year medical students an opportunity to gain experience in patient education. Studies have shown that effective instructional methods are also beneficial for doctors in helping patients. Physicians’ ability to adjust communication techniques to different clinical settings may have a positive impact on patient education, leading to improved health outcomes. Objective: The objective of this study was to determine what adaptive communication strategies would be useful in the delivery of health education content to high school students with language barriers as a model for effective doctor-patient communication. Methods: As part of the SHEP (School Health Education Program), first year medical students presented monthly health education topics to high school students at six different Hawaii public schools; initially using traditional didactic methods followed by small groups discussions. Presentation topics included healthy living, substance abuse, and sexual health. Prior to the education sessions, the following occurred: information sessions were held by the medical faculty to acquaint medical students with resources, topic knowledge, and Hawaii State Health Education Standards. Subsequently, individual groups presented their lesson plan for peer and faculty review. Gain in content knowledge over time (a one-group pretest-posttest design) was utilized to assess the efficacy of instructional methods. Based on the students’ age and grade level, instructional methods were prepared in order to maximize learning potential, and were used by one group at both Nanakuli and Farrington despite varying demographic make-up and English proficiency. The students at Farrington High School were predominantly ethnically Filipino, while those at Nanakuli were predominantly Hawaiian or Part-Hawaiian. At Nanakuli High School, 96.4% of students passed the English proficiency test, while 80% of Farrington High School’s students passed the same test.

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AHEC at the Kalihi Palama Health Center: Evaluation of the efficacy of KP's Community Health Seminar

James Fernandez, Maria Ham, Kristen McGrew, Jon Narimasu, Graeme Reed
Advisors: Glenn Rediger, MD & Doris Segal-Matsumaga, MSW, Kalihi Palama Health Center

This study was designed to evaluate the efficacy of the Kalihi-Palama Community Health Seminar, which is a community-based educational program. The focus of this paper was on the evaluation of an educational lesson on puberty for fifth grade students at the Princess Miriam K. Likelike Elementary School. Prior to the puberty lesson, the students filled out a pre-test questionnaire to assess prior knowledge and understanding of puberty. The lesson then consisted of gender-segregated small group discussions on the human life cycle and development, self-care, relationships, and self-image. After the lesson, the students completed a post-test questionnaire (a modified version of the pre-test). The results of both questionnaires were then compared. The average knowledge and understanding score for the girls was 71.9% on the pre-test and 75.4% on the post-test, which did not show a statistically significant difference. The average knowledge and understanding score for the boys was 66.0% on the pre-test and 80.2% on the post-test, which demonstrated a statistically significant difference. The results of the study indicated that the community-based educational program was ineffective in increasing the girls' level of understanding and knowledge of puberty, and only somewhat effective in increasing that of the boys.

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Investigation of HIV seropositive subjects taken from the Hawaii Aging and HIV cohort based at Leahi Hospital

Priscilla Yee
Research Mentor: Victor Valcour, MD, Hawaii AIDS Clinical Research Program

My research this summer was an investigation of HIV seropositive subjects taken from the Hawaii Aging and HIV cohort based at Leahi Hospital. Patients were enrolled in the study and underwent yearly clinical evaluations which included neuropsychological testing, neurologic exams, laboratory evaluation, and immunologic evaluations. I compared self reported CD4 nadir obtained on patients' initial visits with historical data obtained from HSPAMM, ACTU, and physician medical records to determine the reliability of a patient self report as a possible marker for the presence of HIV associated Dementia (HAD) and neuropathy. In addition, risk assessment was performed to determine the risk associated with having a low historical CD4 nadir in correlation with disease frequency. Our objective of the study was to determine the predictive value of a self reported CD4 nadir as a possible risk factor for HAD and neuropathy. This may be helpful in the case in the elderly who have been infected for prolonged periods of time, and quite possibly were severely immunosuppressed prior to the introduction of HAART therapy, thus putting them at risk for development of neurological and cognitive deficits caused by HIV infection.

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Ke olakino o ka ‘ohana Kamehameha. Current Health Status of Kamehameha Alumni: Morbidity and Behavioral Risks

Ashley Ono
Research Mentor: Dr. Shannon Hirose-Wong, Native Hawaiian Center of Excellence

BACKGROUND: Among the five major ethnic groups in Hawaii, Native Hawaiians have the worst health status indicators. Although the state of Hawaii generally experiences lower rates of disease than the total US population, rates for morbidity, mortality and behavioral risks from preventable diseases such as heart disease, diabetes and cancer remain disproportionately high in Native Hawaiians. The Kamehameha Schools (a private, independent educational institution for Native Hawaiian children) were established in 1887, through the provision and will of Princess Bernice Pauahi Bishop, to improve the well-being of Native Hawaiians through education. Since its founding, Kamehameha’s educational curriculum and strategic plan have evolved dynamically in efforts to fulfill this mission and meet the needs of the Native Hawaiian community. What began as a small, vocational School for Boys, now serves over 5000 students, grades K-12, on 3 separate campuses, providing them with a comprehensive education focused on physical, spiritual and intellectual development. METHODS: Using cross- sectional survey methods, this project analyzes ethnic health data obtained for Native Hawaiian alumni from the Kamehameha Schools. The current health status of this unique population is assessed through evaluation of morbidity and behavioral risks.

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Survey of HIV Positive Patients at the Clint Spencer Clinic, Honolulu HI

Erin Gertz
Research Mentor: Cecilia Shikuma, MD, AIDS Clinical Trials

Project Description: This qualitative study of patients at the Clint Spencer Clinic will explore how patients found the clinic, what barriers, if any, patients experienced when seeking care for their HIV positive status. Research has shown that early access to quality care for HIV positive patients improves outcomes. However, various studies have found that certain groups of people access care later than others. According to Wong, et al. “Compared with other racial/ethnic groups in the United States, Asian Americans and Pacific Islanders (AAPIs) are more likely to be at an advanced stage of AIDS disease and have opportunistic infections at the time of diagnosis. However, it is not clear how these two findings are related to issues such as HIV testing and access to HIV care-related services.” In order to improve care for these and other underserved patients, we must understand why they do not or cannot access care early on in their disease. A study by Bond, et al. concludes that “efforts to increase HIV testing must consider how structural factors, including access to health care, may deter or facilitate opportunities for HIV testing.” Once providers understand what kind of barriers underserved populations face, programs can be designed to reach out to and meet the specific needs of these populations. In addition to exploring these questions about access to care, it is important to understand if the care that is currently being provided is appropriate and of a high quality. A survey by Davis-Michaud, et al. of HIV positive patients in Portland and San Francisco showed that these patients believe quality HIV care consists of “effective relationship with provider, prevention of opportunistic infections, involvement in care and treatment decisions, being offered antiretroviral treatment, and access to health care services.” No studies have been done to assess the quality and appropriateness of the current care being provided to Hawaii’s HIV positive population. The data from such studies can be used to both assess current care and, as the Davis-Michaud survey states, “Patient perspectives can assist in the design of services that meet patients' demographic and socioeconomic needs.” In order to explore these questions, interviews of HIV positive patients that receive care through the Hawaii AIDS Clinical Research Program and Clint Spencer Clinic will be conducted.

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Does hand grip strength predict cognitive decline in the elderly?

Traci Murakami
Research Mentor: Kamal Maskai, MD, Geriatric Program, JABSOM

This is an epidemiological study using the data from the Honolulu Heart Study, which collected data from Japanese American WWII veterans. This study looked at hand-grip strength at mid-life and late-life (measured using the Smedley Hand Dynamometer) and cognitive decline, which was measured using the CASI (the Cognitive Abilities Screening Instrument). The research question was whether hand-grip strength could be used as a clinical predictor of cognitive decline.

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Does `olena (Curcuma longa) inhibit the growth of bacteria that commonly cause otitis media?

Kristi Lopez
Research Mentors: Shannon Hirose-Wong, PhD, Chung-Eun Ha, PhD, Native Hawaiian Center of Excellence

`Olena, which is also known as turmeric (Curcuma longa) was a plant used in la`au lapa`au or traditional Hawaiian healing with plants. It was traditionally used by the Hawaiians in ceremonies, used to bless the home, protection from the sun during long canoe voyages, as a dye for kapa, tapa cloth, and as a blood purifier. Some contemporary uses of `olena include treatment for ear infection, sinus infection, cancer. Given that native Hawaiian plants were found to have antimicrobial properties, essential oil of turmeric was found to have antimicrobial properties, and `olena was traditionally used by kahuna la`au lapa`au for ear infections like otitis media. The purpose of this study was to determine if `olena inhibited the growth of bacteria that commonly cause otitis media. A disk diffusion method was used and zone of inhibition was measure to determine the efficacy of the `olena.

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Antiretrovial therapy in a patient with HIV and mitrochondrial dysfunction

Erica Walsh
Research Mentor: Mariana Gerschenson, PhD, Hawaii AIDS Clinical Research Program

We describe a 50-year-old Caucasian man with a family history of myoclonic epilepsy associated with ragged red fibers (MERRF) and a diagnosis of Human Immunodeficiency Virus (HIV). The patient had multiple risk factors for contracting HIV and was being followed in our clinic at the time of his diagnosis. Initial testing following seroconversion revealed a baseline CD4+ T lymphocyte count of 652 X 106 cells/I and a HIV-1 RNA or 14,781 copies/ml. He reported exercise intolerance and had mild neurologic deficits, which worsened around the time of HIV seroconversion. These symptoms led to his subsequent diagnosis of MERRF by the detection of the A8344G point mutation in the tRNALys gene of mitochondrial DNA (mtDNA). The baseline estimated proportion of mutant genome was 39%. He showed a rapid course of HIV disease progression with a CD4+ T-lymphocyte nadir of 174 X 106 cells/I associated with a HIV-1 RNA of 238,178 copies/ml, within 17 months following HIV seroconversion. To avoid further mitochondrial insult, a protease inhibitor regimen consisting of hard gel saquinavir (InviraseTM) and lopinavir/ritonavir (KaletraTM) was chosen for the patient. The patient’s CD4+ T-lymphocyte count increased to 282 X 106 cells/I and his viral load became undetectable 7 months following the initiation of antiretroviral therapy. His neurologic symptoms did not worsen on his antiretroviral regimen. When initiating HIV therapy in individuals with metabolic myopathies related to mitochondrial dysfunction, it may be important to design an antiviral regimen that minimizes mitochondrial damage, yet effectively maintains durable viral suppression.

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Two projects with the EMS of Honolulu

Steven Kramer
Advisor: Allan Young, paramedic, KCC EMT and Paramedic Program

There were two projects that I worked with Mr Young on. The first dealt with the potential threat of avian bird flu in Hawaii. I was in charge of creating a powerpoint presentation on how the EMS should best prepare for a possible avian bird flu invasion. The second research project was an airway study. Basically I entered data on all the cases in the last 4 years when the PATI protocal was used to intubate a patient. Eventually the data will be used to compare Honolulu with other EMS services around the nation.

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Assessment of the current state of heart failure patient education in the ambulatory setting

Julie Andrada, Angelina Amian, May Nguyen, Todd Nishimoto
Advisor: Todd Seto, MD Center for Best Healthcare Practices, Queen's Medical Center

Heart failure is a sginificant public health problem in Hawaii. Patients' understanding of their disease process and management is important to maintaining optimal health. Patients look to their healthcare providers for guidance and education to help them manage their health. We wanted to assess the current state of heart failure patient education in the ambulatory setting as it relates to methods, resources and barriers. Our goal is to identify areas of need and to develop interventions that will aid providers with patient education. We have developed a survey to identify these needs.We compared cardiologists and primary care physicians on the use of established guidelines for educating their HF patient.

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Utilization of cell phone cameras to photograph x-rays and send them to radiologists for consultation

Matthew Taylor
Research Mentor: Loren Yamamoto, MD, Department Pediatrics, Kapiolani Hospital

I began my project with Dr. Loren Yamamoto to determine if it was feasible to utilize cell phone cameras to photograph x-rays and send them to a another physician for a consultation. We were to determine if the quality of the photograph was good enough to enable a trained clinician to make an accurate diagnosis. We utilized x-rays that were already in the possession of Dr. Yamamoto. I purchased a cell phone with the best photographic capabilities specifically for this project (1.2 megapixels). Unfortunately, we determined the quality to be so poor as to not even be worth the attempt of sending the images for consultation. Then we began exploring other options and trying to acquire the ability to use other devices (like a Palm Treo). This is the stage where I am currently at and am still trying to gain the use of another device. I plan on continuing this project until its completion.

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A Relationship between Native Hawaiian Health and the Health of Marine Ecosystems in Waimanalo: depleted marine resources leads to the consumption of less healthy foods

Kristi Cottral, Neal Kellenberger, Erika Kwock, and Katy Linskey
Advisor: Dr. Bruce Wilcox

The prevalence of obesity in America and other industrialized nations has increased dramatically over the past decade, but it is even higher in many indigenous cultures that are experiencing changes in their traditional lifestyles. In Hawaii, it is well known that native Hawaiians have very high rates of obesity which lead to diabetes, heart disease, hypertension, and other health problems. However, it is less clear as to which factors cause obesity in this population. In Waimanalo, the declining marine ecosystem has caused a decrease in local fishing, which has led to the replacement of fish and seafood with less healthy foods in native Hawaiians’ every day diet. This change is hypothesized to be a significant contributor to poor dietary habits. The replacement of fish and seafood with other foods, coupled with an ever-changing cultural and ecological environment, has led native Hawaiians to high rates of obesity and poor health outcomes. Identifying the impact of the marine ecosystem’s health in Waimanalo on the local community’s health may help drive remediation efforts to repair the marine ecosystem and allow future generations to resume fishing. Ultimately, this may lead to a diet more similar to the traditional Hawaiian diet and improved health for families that choose to utilize the marine resources available to them.

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Early detection of pancreatic cancer using biomarkers

Grace Amazona
Research Mentor: Teri Brentnall, MD, Seattle Washington

My project at the University of Washington Medical Center involved determining early biomarkers for the progression of pancreatic cancer. I performed western blots to determine differences in protein concentration between normal and pancreatic cancer patient biopsies and serum.

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Expression of Mutant Human Serum Albumin

Chelestes Grace & Kristine Saiki
Research Mentor: Cheung Eun-Ha, PhD, Imi Ho'ola

This research project involved making and purifying mutated human serum albumin (HSA), quantifying the HSA yield, and performing drug-binding affinity studies on the resultant HSA mutant. The HSA was expressed in Pichia yeast cells. The HSA mutation involved a single amino acid replacemnt at position 146 (His to Phe).

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Hua Kanawao Ka Liko Study (Moloka’i Native Hawaiian Heart Health Study): A Longitudinal Approach to Evaluating Cardiovascular Disease in Native Hawaiians

Kristine Saiki
Research Mentor: Shannon Hirose-Wong, PhD, Native Hawaiian Center of Excellence

Native Hawaiians disproportionately suffer from heart disease compared to other ethnic groups in the State of Hawai’i. The 1985 Moloka’i heart study discovered that high blood cholesterol, hypertension, cigarette smoking, obesity and diabetes mellitus are significant cardiovascular risk factors amongst Native Hawaiians. Since this study established that Native Hawaiians are prevalent for these risk factors and hence, heart disease, it facilitated the formation of programs to improve Native Hawaiian health. Organizations such as Na Pu’uwai Cardiovascular Risk Clinics were established to address the lack of intervention and follow-up services for these high risk Native Hawaiian individuals. Due to the services provided by Na Pu’uwai, access to health care for Native Hawaiians has greatly improved. Consequently, the prevalence of these cardiovascular risk factors among Native Hawaiians may have changed, and for that reason, this study was created. This study used a longitudinal approach to investigate former Native Hawaiian participants of Na Pu’uwai’s Cardiovascular Risk Clinics for the prevalence of cardiovascular related health conditions and risk factors over a four year period (2003-2007). This study designed and implemented a cardiovascular disease and diabetes mellitus surveillance system in partnership with the Native Hawaiian community on the island of Moloka’i. This study re-assessed the prevalence of cardiovascular risk factors amongst Native Hawaiians on Moloka’i subsequent to improved health care access, and heart disease prevention and management programs. Participants of the study desired protocols to be created regarding use of the information prior to student continuation on the project. Therefore, participation on the study has halted until the protocol has been finalized.

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Does JABSOM's Community Health Program influence first year medical student's perception of medical eduction?

Marc Kaneshiro & Cindy Ta
Research Mentors: Gwen Naguwa, MD & Mike Fukuda, MSW, Office of Medical Education

The goal of our project was to determine the impact that the School Health Education Program (SHEP) and other community medicine programs had upon the first year medical students. We wanted to know if their experiences affected their desire to be a part of medical education, serve an underserved community and practice in a certain specialty of medicine. We polled 25 of our classmates from various community medicine locations that covered a range of education, clinical and research experience within these programs. Our results showed that students who participated in a program that allowed them to practice education were more interested in pursuing a career in medical education in the future. Also, because all of these programs are directed towards helping underserved populations, a majority of students had increased interest in serving underserved communities in the future. Future research could poll even more community medicine programs, or choose to do a long term study throughout the years of medical school.

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The Kame Project: Exploring Causes of Death in a Cohort Study of Dementia

Christine O. Palermo
Research Mentor: Wayne C. McCormick, M.D., M.P.H., University of Washington School of Medicine

Background: A cohort of 1142 older Japanese Americans was identified to study preferences and attitudes regarding use of long-term care, LTC, (nursing home or home care). Subjects were asked to consider hypothetical situations in which they were temporarily disabled by hip fracture or permanently disabled by dementing illness. If they fractured a hip, only 12% intended to use a nursing home; 29% intended to recover at home with the help of family or friends; another 54% intended to use paid home health care. If they became demented, the majority, 53%, intended to use a nursing home; only 11% intended to rely on family or friends for care, and another 29% intended to use paid home health care. Similar responses were observed when subjects were asked what most members of their family or friends would wish them to do; however, they tended to value the perceived wishes of religious figures of the Japanese American community-at-large less than those of family or friends. Significant correlates with intention to enter nursing homes were lack of social support (unmarried, few or no close relatives or housemates), female gender, and high levels of acculturation into American society (never lived in Japan, English-speaking only). Other factors that were not significantly correlated with health were health perceptions, satisfaction and life control scales, and health care utilization (hospitalization and MD visits). Marital status and level of acculturation were the most powerful independent predictors of intention to enter nursing homes. Age and female gender were predictors of intention to use home care. In the base populations of subjects, the prevalence of nursing homes use (5%) was similar to that of the general United Sates older population. Objectives: In this stage of the LTC study, we will determine whether subjects who intended to use LTC services in the event of permanent disability did, in fact, enter a nursing home or use paid home health. Futhermore, we will look at the incidence of dementia in this cohort and its possible correlation with the cause(s) of death in these individuals and their use of LTC.

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Barriers Towards Pediatric Asthma Management in the Native Hawaiian Community

Liana Au
Research Mentor: Donna-Marie Palakiko, Ke Ola Mamo

The State of Hawaii has an asthma prevalence well above the national average, and children in Hawaii demonstrate an especially high prevalence of asthma. Among these children, ones of Native Hawaiian ancestry have the highest prevalence rates in comparison with other ethnicities in Hawaii. This was a qualitative research study that sought to identify barriers of asthma management in the pediatric Native Hawaiian community. The research paradigm used was the community-oriented participatory research approach, in which issues important to the community are addressed and information is provided on how practitioners can work with the participants to improve health services. Eight families (including one primary caregiver and one child between 6-14 years of age) throughout the island of Oahu were interviewed and redundancy in the data was achieved. One of the largest themes found throughout the interviews was that there was a lack of asthma education for the children and their parents. Some means of effective education mentioned would be the schools and physicians. Techniques that were effective for participants were pictures and the use of a straw to demonstrate how it feels to have asthma. Other themes of alternative medicine use and perceptions of asthma being "embarrassing” may also be barriers to effective asthma management. With the findings from this study and the larger “Family Perspectives of Asthma Study” done by Ke Ola Mamo, there is a base upon which those in the health care system may create and implement strategies to make asthma management and education for Native Hawaiian children and their families more efficient.

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Association of Plasma Oxytocinas with Pregnancy Outcomes

Michael Lee
Research Mentor: John Claybaugh, MD Tripler Army Medical Center

Introduction: Human oxytocinase/insulin-regulated aminopeptidase (Otase/IRAP), also known as placental leucine aminopeptidase, is a type II integral membrane protein with enzymatic properties capable of cleaving two peptide hormones, vasopressin and oxytocin. The inactivating mechanism of oxytocinase is carried out by cleavage of the peptide bond between the amino-terminal hemicystine and tyrosine in oxytocin and vasopressin, which characterizes the enzyme as an aminopeptidase. Oxytocinase is thought to be produced in syncytiotrophoblasts and released into maternal circulation. Levels of serum oxytocinase rises progressively with gestational age until term when the levels drops dramatically. It is believed that the oxytocinase levels are able to repress the effects of oxytocin in inducing labor. The objective of the study is to find a correlation between oxytocinase level and plasma osmolality, sodium potassium and hematocrit. In addition, oxytocinase levels will be compared to factors of the labor such as length of labor, signs of preeclampsia, and need for induction. High oxytocinase levels may affect the pregnancy by delaying labor due to oxytocin’s effect on contraction of smooth muscle in the uterus and cause high serum sodium concentrations due to oxytocinase’s effects on vasopressin, which can lead to disorientation. Low oxytocinase levels can lead to hyponatremia through its effects on vasopressin, and low levels may be associated with preeclampsia. Methods: Oxytocinase levels can be measured by its action on the hydrolysis of L-leucyl-ß-naphthylamide. Samples of maternal blood was added to assay tubes with L-leucyl-ß-naphthylamide as the substrate. L-methionine reagent was added because of its ability to inhibit normal serum oxytocinase while pregnancy serum oxytocinase is insensitive to inhibition by L-methionine. A spectrophotometer at wavelength of 465nm was used to measure the levels of L-leucyl-ß-naphthylamide hydrolysis which correlates to the oxytocinase levels. The synthesis of oxytocinase was quantitated by the amount of mRNA using RT-PCR. Primers and a Taqman probe were designed to develop an amplicon with primers attaching to the ends of separate exons. Total RNA was isolated from the placenta by using the Trizol reagent. RNA was then converted to cDNA using reverse transcriptase and real-time PCR was used to quantitate the cDNA. Agarose gel electrophoresis was then used to confirm the length of the amplicon and the generation of a single product.

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What impact does diabetes control have upon the development of chronic kidney disease among diabetes in Hawaii's multi-ethnic population: A preliminary assessment of the Renal Research in Communities Studies

Michael Hirota
Research Mentor: Marjorie Mau, MD & Margaret West, Department of Native Hawaiian Health

CKD is of great concern because it is a public health problem with an increasing incidence and prevalence, both in the United States and globally. Moreover, this disease contributes to significant morbidity, mortality, and increasing health care costs due to its progression to kidney failure, or end stage renal disease (ESRD). Among ethnic minority groups such as Asian-Americans and Pacific Islanders, the incidence of ESRD has been increasing. In fact, Asian-Americans and Pacific Islanders, with their 11 % annual increase in ESRD incidence rates, have been shown to have the highest rate of increase of all ethnic groups. In Hawaii, the leading causes of ESRD in 2000 were: a.) diabetes mellitus (55.2%), b.) glomerulonephritis (18.3%), and c.) hypertension (13.3%). Of great concern is the fact that among Native Hawaiians, the prevalence of diabetes, which is the leading cause of ESRD in Hawaii, has been reported to be as high as 22.4% in those adults 30 years of age or older, and 15.6% have increased risk of developing diabetes. Strict diabetes control, including blood pressure and HbA1c, is critical to preventing the development of numerous diabetic complications, including CKD, among diabetics of all ethnicities. Accordingly, the American Diabetes Association (ADA), has devised standards of medical care for the treatment of diabetic patients, with the goal of decreasing the development of diabetic complications such as CKD. Among the recommendations, or treatment goals, made by the ADA are: 1.) that the systolic blood pressure (SBP) should be kept below 130 mmHg, 2.) that the diastolic blood pressure (DBP) should be kept below 80 mmHg, and 3.) that the hemoglobin A1c (HbA1c) should be kept below 7.0%. Unlike other minority populations in the United States, the development of CKD amongst ethnic minorities of Hawaii has not been studied. This issue is of great interest because CKD, and its
progression to ESRD, are prevalent among Native Hawaiians, and they represent significant causes of both morbidity and mortality. Diabetes mellitus is the number one cause of ESRD, and is also highly prevalent among Native Hawaiians. Thus, the study of diabetes and the factors that affect its progression to CKD in Native Hawaiians, and other ethnic minorities in Hawaii is important to improving the understanding of how to best rectify the disproportionately high rates of CKD and ESRD among these groups. Accordingly, this retrospective case-control study seeks to determine if significant differences in ADA recommended measures of diabetes control, such as systolic blood pressure (< 130 mmHg), diastolic blood pressure (< 80mmHg), and HbA1c (< 7.0%), exist between diabetics who develop CKD and those who do not. This exploratory study included both an evaluation of the patients’ medical data from the eighteen months prior to screening for CKD and ascertainment of case risk exposure through a research interview and review of medical records, which were obtained through the participant's primary care provider. New cases and controls were recruited from the ongoing KEEP project database and private physician offices. After informed consent was obtained, each participant was scheduled to undergo a 15 minute interview by phone or at a convenient location. The interview consisted of close ended questions, read by the interviewer, and a request for permission to review their medical records. Medical records were requested from physicians identified by participants to be their primary provider of their diabetes care. The information taken from the medical chart review provided an indication of diabetes control in the eighteen months prior to KEEP screening. The clinical measurements included: glucose, HbAlc, microalbuminuria, serum creatinine, blood pressure, and weight. Information was also collected regarding patients’ medications and number of office visits. Statistical analyses of the cases and controls were performed with SAS to control for each of the covariates that had been taken into account by the original study design. Statistically significant differences were sought utilizing paired t-tests for continuous variables such as age and duration of diabetes, and chi-square tests for non-continuous variables such as gender and ethnicity. Bivariate analyses with SAS were performed where indicated.

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Carotid Intima-Media Thickness (IMT) as a Predictor of Coronary Artery Disease and Cerebral Vascular Accident including an analysis of IMT and its relationship to Diabetes and Smoking

Kelsey Shikuma
Research Mentor: Neal Shikuma, MD, Medical Diagnosis Center

In the landmark study from 1999 by O’Leary et al. it was shown that carotid artery intima-media thickness (IMT) as measured by ultrasonography, is “directly associated with an increased risk of cardiovascular disease (O’Leary et al, 2002).” More specifically IMT thickness has been used as a predictor for risk of coronary artery disease (CAD) including myocardial infarction and the need for coronary artery bypass grafts as well in predicting a patient’s risk for cerebral vascular accident (CVA). The usage of IMT thickness as a predictor for CAD and CVA risk as suggested by O’Leary et al. has been disputed since its publication. This pilot study aims to examine the validity of IMT thickness as a CAD and CVA predictor as well as examine the possible correlations between diabetes and smoking with IMT thickness. A review of 798 carotid IMT studies has thus far been completed. The initial review of the data has revealed a less than predicted incidence of CAD and CVA as would have been expected by the published projected incidence of disease. Currently the evaluation of data is still underway. Further clinical correlations and further data analysis is continuing and will be reported at a future time. Additional data is needed to confirm this study and should be pursued further.

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Two Case Reports: 1) Bullosis disbeticorum & 2) inappropriate antidiuretic hormone secretion

Sean Hirota
Research Mentor: Jinichi Tokeshi, MD

This summer I have been working on two case reports. This first is on a rare complication of diabetes mellitus called bullosis diabeticorum. The rationale for reporting it is its sheer rarity and the gross size of the blister, which to our knowledge is the largest that has been yet reported. The next case concerns a 90 year-old Japanese women with a past history of hypertension, gastrectomy secondary to gastric ulcer, and osteoporosis with severe kyphoscoliosis. She had been admitted to Kuakini Medical Center for acute altered mental status in association with significant weight loss and chest and abdominal pain. During her hosptial course, she developed severe hyponatremia and was later diagnosed with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) upon further evaluation. An abdominal CT scan was taken to look for a malignant etiology of the SIADH. The CT scan revealed a pancreatic tumor. Unfortunately, due to potential morbidity, a biopsy of the lesion could not be obtained. However, based on the CT scan and elevated serum tumor markers in association with a clinincal picture of SIADH, we are condifient that this is a case of an ectopic ADH-secreting tumor. Usually these types of tumors that are associated with SIADH are bronchiogenic in orign. Pancretaic ADH-secreting tumors are extremely rare. In fact we could only find 9 reportings of it since 1968. The rarity of this case served as a our basis for reporting it.

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Ethnic differences in responses to tests of autonomic function

Jared Oyama
Research Mentors: Dominic Chow, MD, MPH and Andrew Grandinetti, PhD

Autonomic neuropathy is a common complication of diabetes and is associated with increased mortality and morbidity from heart disease and stroke. Additionally, autonomic dysfunction in non-diabetic individuals has predicted mortality from cardiovascular disease (CVD) in a large epidemiological study. Native Hawaiians are reported to have the highest mortality from CVD in Hawaii, despite a similar prevalence of conventional CVD risk factors among other Asian/Pacific Islander ethnic groups. The goal of this project was to look at markers of autonomic function in a multiethnic population and determine whether differences in autonomic function may be involved with this discrepancy in mortality. A total of 125 Asian, Caucasian, and Hawaiian participants were recruited from the 1,459-member Kohala Research Project cohort. Autonomic function assessment was done following the Mayo Clinic’s autonomic physiology laboratory protocol and consisted of quantitative sudomotor axon reflex testing as well as heart rate variations during paced breathing and Valsalva maneuver. Results and conclusions are pending.

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Solid-state NMR studies of a novel recombinant elastin peptide with alternating hydrophobic and crosslinking domains

Tracie Kurano
Research Mentor: Kristin Kumashiro, PhD, Department of Chemistry, University of Hawaii

Elastin is a crosslinked protein found in the connective tissue, skin, and blood vessels of vertebrates. Although clearly an important protein, its structure-function relationships are poorly understood. One reason for the controversy is related to its extensive nature; the elastin gene encodes tropoelastin, which is crosslinked in post-translational modification to form insoluble elastin or, simply, elastin. Tropoelastin itself is significantly large, with molecular weights ranging from 70-80 kDa, and its high-resolution structure is not yet solved. The size of tropoelastin makes solving the structure of insoluble elastin even more daunting. In addition, the predominance of small hydrophobic residues make elastin insoluble in all but the harshest conditions, therefore rendering solution nuclear magnetic resonance (NMR) and x-ray crystallography useless for high-resolution structure determination.Chemical shifts and relative intensities for each EP preparation are described with a brief discussion of possible structural implications. Some of the samples display a temperature dependence that is also discussed. Deconvolution results for the backbone carbonyl regions are provided for each sample, as this result may be a good starting point for looking at the overall structure of the protein. Editing followed by deconvolution of the methyl peaks is used to elucidate information on the environment of the sidechains. To complement the information obtained with CP, direct-polarization (DP) data are also presented. The latter are used to identify and characterize the non-cross-polarizable carbons that are found in regions of high mobility. Finally, T1 measurements give a relative measure of local dynamics for the different preparations.

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Youth and parent assessment of Kalihi Valley Home Residents: AHEC at Kokua Kalihi Valley Comprehensive Family Services

Brian Nishiguchi and Hy Gia Park
Advisor: Janet Premiano, MSW, KKV Comprehensive Family Services

Kokua Kalihi Valley's (KKV) Professional Education & Training (PET) program is comprised of students and faculty from various disciplines including medicine, social work, nursing, and nutrition. The program synergizes the mission of KKV by providing comprehensive health and social services to Kalihi Valley residents. Assessing the effectiveness of their current programs through surveys is an important part of achieving their mission. Between October 2004 and April 2005 youth were surveyed about their school activities, after school activities and experiences, social skills, family, and health. Parents were asked about their demographics, relationship with their children as it relates to school, health and other issues. The survey results showed a significant lack of interest in reading, a strong demand for tutoring services, and a need for sex and drug education, since these topics are often not addressed by their parents. Based on these results, specific recommendations were made on how KKV can better serve the families in the community.

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AHEC at the Queen Emma Clinics

Christopher Soon
Advisor: Mary Ann Antonelli, MD, Department of Medicine, Queen Emma Clinics

In the QEC Keola Program, we made home visits to patients and spent the time finding out how we could assist them to overcome various problems that they were experiencing. Once a week, we would visit these patients and talk to them. After this, we would return to QEC to discuss our findings with the program coordinator, Dr. Maryann Antonelli as well as other QEC faculty members. We would formulate plans on what we could do as students in order to help these patients overcome these problems. Such issues including things such as forgetting to take pills, getting help doing housework, etc. Throughout the program, we would present our cases to faculty and students associated with the Keola Program. The purpose of the program was to allow us to understand the cross-cultural nature of healthcare in Hawaii as well as give us the opportunity to visit patients in a more social work type of setting instead of as patients in the clinic. In addition, we would also visit the Punchbowl homes and do presentations for the elderly who lived there, including safety tips, osteoporosis, and blood pressure screenings.

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Alternative antibiotics for methicillin-resistant Staphylococcus aureus (MRSA)

Jennifer Kaya
Research Mentor: Francis Pien, MD, Honolulu, HI

Methicillin-resistant Staphylococcus aureus (MRSA) is an emerging problem in infectious diseases, especially among patients with hospital-acquired infections. Hawaii, with its special climate, is especially hard-hit, with an incidence of Staph skin and soft tissue infections much higher than the national average. Currently, the drug-of-choice for MRSA infections is Vancomycin, but many physicians of infectious diseases warn against the overuse of Vancomycin, as the advent of anti-Vancomycin resistance among S. aureus is imminent. Locally, two national and international antibiotic double-blind clinical trials currently under way are investigating alternative drugs to Vancomycin against severe gram positive infections containing bacteria such as MRSA. One of them, sponsored by Theravance, is a comparative study of a new anti-MRSA drug, televancin, against Vancomycin in a Phase III skin and skin structure infections study. The other, sponsored by Johnson & Johnson, is a similar comparative study of ceftobiprole, a new cephalosporin, versus Vancomycin. Endpoints are based on clinical criteria, such as wound characteristics and wound measurements, laboratory and imaging data, and obtaining a microbiological cure (sterile wound culture).

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AHEC at Queen Emma Clinics

Angela Yip
Advisor: Mary Ann Antonelli, MD Queen Emma Clinics

For the Queen Emma Clinic AHEC program, we had a number of opportunities to work with patients and members of the community, assessing their needs and providing them with our researched information. Our projects throughout the year included:
1. Working with two patients during weekly home visits on daily challenges that involved: · Taking their pills
· Becoming more physically active · Finding ways to exercise at home · Becoming more independent
· Finding ways to exercise at home · Helping them deal with their family/relationship issues
2. Giving monthly presentations at the Punchbowl homes center for the seniors and residents of that area on topics that included: · Tips on how to be safe (identity theft, physical harm, robbery) · Importance of calcium and preventing osteoporosis · How to stay active and healthy at any age · Importance of getting the flu shot
3. Semester final presentations on health care topics that affect our community including: · Dementia, memory loss, and depression in the elderly · Caregiver burden and how to deal with it in a positive manner.

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Funding opportunities for the Sunny Buddies Program

Larissa Fujii & Krisen Nagata
Advisor: Kenton Kramer, PhD, Office of Medical Educaiton

Sunny Buddies is a non-profit organization founded and run by the medical students of the University of Hawaii's John A Burns School of Medicine. The program's objective is to provide services and support to individuals with mental retardation and their caregivers. In collaboration with the Hawaii State Department of Health, Sunny Buddies pairs medical students and community volunteers with matched clients in an effort to promote integration of individuals with MR into society, to develop self-confidence and independence with these individuals, as well as to encourage the interest in the field of psychiatry among the medical students. We investigated funding opportunities for Sunny Buddies to defray the cost of insurance and program activities. Once appropriate agencies were identified grant proposal were written and submitted for funding consideration.

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Assessing the correlation between standardized testing scores and performance on lesson-based evaluations in Hawaii High School students.

Kyle Chun
Research Mentors: Mike Fukuda, MSW & Ivy Nip, MD, Office of Medical Education

The John A. Burns School of Medicine’s (JABSOM) School Health Education Program (SHEP) is a community medicine curriculum for first-year medical students aimed at improving the health and education of Hawaii’s high schools. Lessons spanning various adolescent health issues were delivered to tenth grade classes at six O’ahu high schools over the past eight months. Lesson-based evaluations were developed to assess the effectiveness of each session. Methods Medical students began the year learning the pedagogical model used by the State of Hawaii Department of Education (DOE) to teach health education topics. Medical school faculty introduced the biological and behavioral aspects of the DOE curriculum, which focused on accessing and analyzing core health topics to make appropriate health decisions. A faculty-led resource session was followed by medical student development of health education presentations. The presentations covered core topics across all schools, with instructional method variability based on the school’s learners.A one-group pretest-posttest design was used to measure student health knowledge and confidence in making informed health decisions. Further studies will include longitudinal assessment of curricular modification within SHEP, as well as the identification of possible demographic and cultural pressures contributing to this trend.

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Slipped Capital Femoral Epiphysis in the Polynesian Population

Grant Harada
Research Mentor: Suzanne Yandow, MD, Shriner's Hospital, Honolulu, HI

My research project is focused on SCFE (slipped capital femoral epiphysis). The IRB is still currently reviewing my proposal. Therefore my work up until now has been looking into what SCFE is, how it is commonly diagnosed and treated, and possible reasons for why it is more commonly seen in polynesians.

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Determining Potential Effectiveness of a Book to Modify Health-Seeking Behavior

Sara E Barwise
Mentor: Maryanne Antonelli, MD

After spending nearly two semesters visiting designated Queen Emma Clinic patients in their homes each week, it became clear that patients often do not receive proper health care due to poor health-seeking behavior. The main causes were identified to be a lack of prevention by the patients, poor home treatment when problems arose, and waiting so long when problems arose that the conditions were exacerbated. A small survey was conducted to determine what effect the Healthwise Handbook, a book designed to help patients know how to prevent medical problems, treat them at home, and know when to seek professional medical care, would have on each of those areas. Survey participants were asked questions to ascertain what type of health-seeking behavior each participant had. They were then introduced to the Healthwise Handbook and shown how to use it. They were then asked if they would use the book, and if so, what they would use it for and if they believed it would change their behavior. From this, a trend was discovered showing that those with the best health-seeking behavior were the most likely to use the book, while those with the worst health-seeking behavior were the least likely to use it.

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Strangers in their own land

Seralyn Yee and Jeannette Choy
Advisor: Stephenie Bell, MSW, Waianae Coast Comprehensive Health Center

The purpose of this research project was to conduct a literature review on the causes of depression in the Kanaka Maoli as well as design a theoretical model that could help in the management of depression in Kanaka Maoli. Through the literature review we came to the conclusion that the cause of depression in Kanaka Maoli is multicausal and the Social Disintegration theory explained the causes most comprehensively. The social disintegration theory takes into account the Kanaka Maoli were stripped of their original culture and forced to adapt to a culture completely alien to that of what they were used to. This new culture and way of life was drastically different from their past; it condemned their traditional practices and the Kanaka Maoli struggled with departing from their agrarian economy. Under the social disintergration theory it states that the Kanaka Maoli are living in a westernized society but were never able to fully intergrate into it due to its conflicts with their traditional way of life as well as political reasons. We analyzed current medical approaches to treating depression within the Kanaka Maoli and came to the conclusion that it may not be the most effective way to manage their depression. Westernized medicine deals a lot with pharmaceutical management of depression as well as one on one counseling. Within traditional approaches illness was often perceived to be the burden of the family than just the individual. We proposed Ho`oponopono as an approach to managing depression within the Kanaka Maoli. Literally meaning “to set things right” Ho`oponopono involves a meeting of all family members to discuss the problem at hand and formulate a solution through input from all members of the family. Since the importance of family is central to Kanaka Maoli tradition we felt that emphasizing health care within the family would be a more effective means of delivering quality health care to these patients.

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Quentin Burdick Rural Health Interdisciplinary Program 2005 - Pahoa Team

Joy Sakai
Advisor: Eileen Lovell, RN, Pahoa Family Health Center and Jan Schultz, RN, Quentin Burdick Program

Background: The rural town of Pahoa is located around 16 miles south of Hilo on the Big Island of Hawaii. At its heart lies a single main street lined with old, false-fronted buildings housing many locally owned shops and businesses. Only recently have more established chains such as Subway and Lex Brodie become a part of the landscape of Pahoa. Pahoa is currently home to approximately 35,000 people, around 41% of which receive some type of government aid. Many homes in the area are considered to be old, rickety, and obtain water via catchment systems. This summer, through the Quentin Burdick Rural Health Interdisciplinary Program, I was able to reside in Pahoa town with two other graduate students: one from the school of social work and the other from the William S. Richardson School of Law. Together, the team surveyed the town, built relationships with key community members and organizations, and came to the conclusion that what the town needed most of all was a cheap, if not free, summer program for the children of Pahoa town. The team discovered that although more prosperous towns such as Hilo had a plethora of activities for children to participate in during the summer months, Pahoa town only had a single summer program that was available to only a limited number of students at a cost that most could not afford in the area. With the local schools not offering any summer school courses either, children in the area had nothing to do. Project: With funds provided by the Quentin Burdick Program as well as through generous donations from local businesses, the team was able to secure a program site at the Pahoa High and Elementary School for 2 weeks from July 5th to July 15th from 10:00 a.m. to 2:00 p.m. Monday through Friday. The program, geared towards children ages 8 to 14, was officially named "Malama I Na Opio 0 Pahoa" or "Helping the Children of Pahoa" and was advertised as such via public service announcements, flyers, and mostly importantly, word of mouth. Arts and crafts, ukulele, drama, and dance were the featured courses to be taught by the team members according to their skills. A field trip to the Mauna Kea Observatory Visitors Center was also planned. Lunch was prepared and provided for the children by the Quentin Burdick Team after obtaining a permit from the Department of Health. Permission forms from the department of parks and recreation were also obtained and tailored for the Malama program. Although the team had set a goal of having 25 children participate in the program, 33 children ended up attending the summer fun program. A formal evaluation of the program was not completed, however, many of children voiced sadness at the completion of the program. Many even asked if the program was going to held again next year. The Malama I Na Opio 0 Pahoa Program would not have been a success without the help of community organizations such as the Queen Liliuokalani Children's Center, the Hawaii County Economic Opportunity Council, the Pahoa Family Health Center, or vital community members such as Ophelia Kenneally, "Betsy", Sarafin Likiche, LeiDean Guillot, and Jackie Ganiron.

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AHEC at the Waianae Coast Comprehensive Health Center: Cultural Legacy Project

Alex Soon
Advisor: Stephenie Bell, MSW, Waianae Coast Comprehensive Health Center

Treating a patient involves a collaboration of many healthcare disciplines. At the Ho’olokahi program, we are placed into muitliprofessional teams consisting of social worker, nursing, and medical students. In this regard, we draw upon each other’s discipline and integrate ideas to better treat our patients. The project will provide an opportunity for students to explore the relationship between culture and health, increase our understanding of the dynamics of community health, develop and practice community health planning skills, and make a tangible contribution to our patient and to the knowledge base of the Waianae community. While completing this project, we the students will: Collaborate with a patient in the identification and design of an innovative health intervention, develop muiltiprofessional skills, leave a legacy of useful information and a tangible product that benefits the patient, develop and present current, authoritative information regarding the influence of culture on the perception and treatment of a specific health condition or issue. Our patient is afflicted with type 2 diabetes and is referred to our multi-professional team to help her manage the disease. The lei of life entail three components:
1. management of their disease from western practice
2. management of their disease from Hawaiian practice
3. management of their disease from a spiritual practice
Purpose of legacy project: Our client is a part Hawaiian, Chinese, Spanish woman who has been managing her diabetes sine 1987. However, she has only been exposed to western medicine in order to manage her disease. Generally, western medicine treats disease with medication and lifestyle changes, such as exercise and diet. However, often times it fails to completely address cultural and spiritual practices of the patient. In this respect, western treatment to some patient is a passive approach that may lead patient feeling that they are no in control of their disease management and ultimately, decreases adherence to treatment (Glazier, Richard H. 2003). However, by intertwining Hawaiian medicinal and spirituality practices into her western diabetes management regime, we feel may encourage her manage diabetes more effectively. This project explores the possibility of combining traditional Hawaiian healing along with religion and western medicine for a more effective positive outcome for Hawaiian people.

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Ascariasis in the Philippines

Samanthan Onnagan & Sebastian Sugay
Advisor: Dr. Fernando Ona

Ascariasis is the one of the most common helminthic infections worldwide with increased prevalence in tropical and developing countries such as the Philippines. This disease is caused by Ascaris lumbricoides which is an intestinal roundworm that is transmitted by swallowing infective eggs in contaminated soil, food or water. Poor socio-economic status is among the key factors linked with higher prevalences of Ascariasis. In the Philippines, there are government funded programs that were established to control soil-transmitted helminthiasis (STH). One aspect of these programs is deworming missions, which provide prophylactic medications to communities that are at the highest risk for parasitism. These communities include those with limited restroom facilities, poor hygiene practice, as well as inadequate housing. During a deworming mission to Barangay Kalusugan, mebendazole (500 mg) was distributed to children (3-6 years of age) who appeared malnourished and exhibited bad hygiene (dirty nails). For those children who had a history of passing worms, diphenhydramine was also distributed for its sedative effects. To confirm the diagnosis of Ascariasis, a stool exam is usually the standard; however, according to Doctora Nimfa Zarate, MD, MPH of the Kamuning Super Clinic, a stool exam is not necessary because of the high prevalence of parasitism associated with poor barangays. In addition to deworming missions, general census data pertaining to parasitism is collected from a group of communities in order to assess the prevalence of parasitism. During the Kamuning Super Clinic Outreach, general census data was gathered from five barangays, which included Kalusugan, Kristong Hari, Kamuning, Mariana, and Sacred Heart. These data approximated that of the 300 children examined about 45% had parasitism.

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