RESUMO
PURPOSE: Racial differences in diabetes care and outcomes, particularly among African Americans and Hispanics, have been well-recognized. The goal of this study was to evaluate the quality of diabetes care, using nationally recognized standards of care, in a multispecialty, hospital-based clinic that cares for a predominantly Native Hawaiian and Pacific Islander population. METHODS: We identified patients with a new primary or secondary diagnosis of diabetes during a visit (baseline visit) between January 2005 and June 2006 at the Queen Emma Clinics. Each patient's medical record was reviewed to obtain demographic and clinical information related to diabetes, including laboratory and test results and medications, from the baseline visit through 12 months follow-up. Performance indicators were selected from those recommended by the National Diabetes Quality Improvement Alliance and included selected 8 measures: 1) Hemoglobin A1c ≥9.0%; 2) Annual lipid panel checked; 3) Systolic blood pressure <140 mmHg; 4) LDL cholesterol <130 mg/dL) 5) Annual fundoscopic examination; 6) Foot examination; 7) Aspirin use; 8) Annual evaluation for urine protein. RESULTS: We identified 364 patients, the majority Pacific Islanders (58%), with Asians (15%) and Native Hawaiians (17%) more frequent than Caucasians (10%). Compared with Caucasians, Native Hawaiians and Pacific Islanders were significantly more likely to have poor glucose control. There were no significant differences between groups for the other measures. Patients compared favorably when compared with national benchmarks. For 2 indicators, adherence was significantly higher for the total study population compared with the US average (systolic blood pressure <140 mmHg, aspirin therapy). For 2 indicators, there were no significant difference (LDL cholesterol <130 mg/dL, annual foot exam) and for 2 indicators, adherence was significantly lower for the study population (hemoglobin A1c >9%, annual fundoscopic examination). CONCLUSIONS: Native Hawaiians and Pacific Islanders with diabetes have poorer blood glucose control compared with Caucasians and Asians, but the overall care is otherwise generally similar. The diabetes care received by patients in this clinic that treats a generally underserved population compares favorably with national benchmarks.
Assuntos
Diabetes Mellitus/terapia , Havaiano Nativo ou Outro Ilhéu do Pacífico/estatística & dados numéricos , Avaliação de Processos e Resultados em Cuidados de Saúde/normas , Melhoria de Qualidade , Indicadores de Qualidade em Assistência à Saúde , Adulto , Idoso , Benchmarking , Glicemia/metabolismo , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/etnologia , Feminino , Seguimentos , Hemoglobinas Glicadas/análise , Havaí , Disparidades em Assistência à Saúde , Humanos , Hiperlipidemias/complicações , Hipertensão/complicações , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais/estatística & dados numéricos , Estudos Retrospectivos , Distribuição por Sexo , Adulto JovemRESUMO
OBJECTIVE: To compare the prevalence of gastroesophageal reflux disease (GERD) in surfers versus nonsurfers who participate in other sports activities based on the hypothesis that paddling in the prone position on hard surfboard surfaces leads to increased intra-abdominal pressure and GERD. STUDY DESIGN: A questionnaire survey using a modified Gastrointestinal Symptom Rating Scale. SETTING: Data obtained from surfers and nonsurfer athletes on the island of Oahu in the state of Hawaii. PARTICIPANTS: One hundred eighty-five surfers and 178 nonsurfers who participate in sports activities. ASSESSMENT OF RISK FACTORS: Surfer or nonsurfer status, type of surfboard used, frequency of surfing, and duration of surfing experience. MAIN OUTCOME MEASURES: The prevalence of reflux symptoms at least twice a week (GERD). RESULTS: The prevalence of GERD was significantly higher in short-board surfers than in nonsurfers with an odds ratio of 4.6 (28% versus 7%, P < 0.001) after adjustment for demographic variables using the multivariate regression model. GERD was more prevalent in short-boarders than long-boarders (28% and 12%, respectively). The prevalence of GERD increased significantly as both the frequency and duration of surfing experience increased (P < 0.001). CONCLUSION: Surfing is strongly associated with GERD. Short-board surfing appears to have a stronger association with GERD than long-board surfing.
Assuntos
Refluxo Gastroesofágico/etiologia , Natação , Adulto , Estudos de Casos e Controles , Exercício Físico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Decúbito Ventral , Fatores de Risco , Adulto JovemRESUMO
Although thousands of people ascend 4205 m to visit the summit of Mauna Kea each year, there has been no information on the rate of altitude illness triggered by such visits. Two surveys were used: one for tourists driving up to the summit and the other for summit astronomy workers staying at lodging facilities at intermediate altitude. The surveys included the standardized Lake Louise Self-report Acute Mountain Sickness (AMS) Questionnaire that, when scored, gave the Lake Louise Symptoms Score (LLSS). Thirty percent of surveyed day visitors and 69% of surveyed professional astronomy staff had AMS, defined as a LLSS score of 3 or greater, with headache. Nine participants reported "disorientation/confusion" or greater consciousness changes. A majority of astronomy professionals reported fatigue, disturbed sleep, reduced activity, and mental status changes. Few took any AMS medications. The incidence of AMS in visitors to Mauna Kea's summit warrants increased education and increased availability of supplemental oxygen at the summit. The absence of reported serious altitude illness in the community is probably due to the rapid descent available on Mauna Kea, with prompt reversibility of adverse effects.
Assuntos
Doença da Altitude/diagnóstico , Doença da Altitude/epidemiologia , Montanhismo/estatística & dados numéricos , Viagem , Doença Aguda , Adulto , Feminino , Havaí/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Vigilância da População , Análise de Regressão , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Inquéritos e QuestionáriosRESUMO
PURPOSE: To determine the effects of traditionally prepared kava beverages on the liver function tests of regular kava beverage consumers in a population of Tongan and non-Tongan residents of Hawaii (Oahu). METHODS: The liver function tests of 31 healthy adult kava drinkers were compared against a control group of 31 healthy adult non-kava drinkers. Subjects were recruited from the general population, a kava bar, and Tongan kava drinking circles. The liver function profile included AST, ALT, ALP, GGT, and bilirubin (total and direct). Other tests included total protein, albumin, and screens for viral hepatitis and hemochromatosis when indicated. RESULTS: Chronic kava beverage consumption was associated with elevation of GGT in 65% of the kava drinkers versus 26% in the controls (P = .005). ALP was elevated in 23% of kava drinkers versus 3% in the controls (P = .053). CONCLUSION: Heavy kava beverage consumption was associated with significantly elevated GGT levels.
Assuntos
Fosfatase Alcalina/sangue , Bebidas/efeitos adversos , Kava/química , gama-Glutamiltransferase/sangue , Adolescente , Adulto , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Bilirrubina/sangue , Feminino , Havaí , Humanos , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Havaiano Nativo ou Outro Ilhéu do Pacífico , Extratos Vegetais/efeitos adversosRESUMO
OBJECTIVE: To evaluate the efficacy of ginkgo biloba, acetazolamide, and their combination as prophylaxis against acute mountain sickness. DESIGN: Prospective, double blind, randomised, placebo controlled trial. SETTING: Approach to Mount Everest base camp in the Nepal Himalayas at 4280 m or 4358 m and study end point at 4928 m during October and November 2002. PARTICIPANTS: 614 healthy western trekkers (487 completed the trial) assigned to receive ginkgo, acetazolamide, combined acetazolamide and ginkgo, or placebo, initially taking at least three or four doses before continued ascent. MAIN OUTCOME MEASURES: Incidence measured by Lake Louise acute mountain sickness score > or = 3 with headache and one other symptom. Secondary outcome measures included blood oxygen content, severity of syndrome (Lake Louise scores > or = 5), incidence of headache, and severity of headache. RESULTS: Ginkgo was not significantly different from placebo for any outcome; however participants in the acetazolamide group showed significant levels of protection. The incidence of acute mountain sickness was 34% for placebo, 12% for acetazolamide (odds ratio 3.76, 95% confidence interval 1.91 to 7.39, number needed to treat 4), 35% for ginkgo (0.95, 0.56 to 1.62), and 14% for combined ginkgo and acetazolamide (3.04, 1.62 to 5.69). The proportion of patients with increased severity of acute mountain sickness was 18% for placebo, 3% for acetazoalmide (6.46, 2.15 to 19.40, number needed to treat 7), 18% for ginkgo (1, 0.52 to 1.90), and 7% for combined ginkgo and acetazolamide (2.95, 1.30 to 6.70). CONCLUSIONS: When compared with placebo, ginkgo is not effective at preventing acute mountain sickness. Acetazolamide 250 mg twice daily afforded robust protection against symptoms of acute mountain sickness.
Assuntos
Acetazolamida/uso terapêutico , Doença da Altitude/prevenção & controle , Ginkgo biloba , Fitoterapia/métodos , Adolescente , Adulto , Idoso , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Montanhismo , Estudos ProspectivosRESUMO
Previous studies suggest that 5 days of prophylactic ginkgo decreases the incidence of acute mountain sickness (AMS) during gradual ascent. This trial was designed to determine if ginkgo is an effective prophylactic agent if begun 1 day prior to rapid ascent. In this double-blind, randomized, placebo-controlled trial, 26 participants residing at sea level received ginkgo (60 mg TID) or placebo starting 24 h before ascending Mauna Kea, Hawaii. Subjects were transported from sea level to the summit (4205 m) over 3 hours, including 1 hour at 2835 m. The Lake Louise Self-report Questionnaire constituted the primary outcome measure at baseline, 2835 m, and after 4 h at 4205 m. AMS was defined as a Lake Louise Self-report Score (LLSR) >/= 3 with headache. Subjects who developed severe AMS were promptly transported to lower altitude for the remainder of the study. The ginkgo (n = 12) and placebo (n = 14) groups were well matched (58% vs. 50% female; median age 28 yr, range 22-53 vs. 33 yr, range 21-53; 58% vs. 57% Caucasian). Two (17%) subjects on ginkgo and nine (64%) on placebo developed severe AMS and required descent for their safety (p = 0.021); all recovered without sequelae. Median LLSR at 4205 m was significantly lower for ginkgo versus placebo (4, range 1-8 vs. 5, range 2-9, p = 0.03). Ginkgo use did not reach statistical significance for lowering incidence of AMS compared with placebo (ginkgo 7/12, 58.3% vs. placebo 13/14, 92.9%, p = 0.07). Twenty-one of 26 (81%) subjects developed AMS overall. This is the first study to demonstrate that 1 day of pretreatment with ginkgo 60 mg TID may significantly reduce the severity of AMS prior to rapid ascent from sea level to 4205 m.