In-flight psychiatric emergencies.

BACKGROUND: Although studies have been published regarding airline in-flight medical emergencies, there is a lack of any specific studies about in-flight psychiatric emergencies. This study seeks to ascertain the incidence of in-flight psychiatric emergencies, their associated factors, and outcomes. METHODS: All in-flight calls for physician consultation to MedAire, a leading medical resource for airlines, during 1997 were reviewed for psychiatric symptomatology. RESULTS: Of 1375 consultations, 3.5% were characterized as psychiatric, with a large majority (90%) of these cases presenting primarily as acute anxiety. Most of the psychiatric cases (69%) required arrangements for the passenger to be evaluated on arrival, and three cases required emergency flight diversion and landing. CONCLUSIONS: This study suggests that an anxiolytic agent with a rapid onset may be indicated for the on-board medical kit.

Equivalencies regarding the measurement and constructs of self-esteem and major life events in an Asian/Pacific islander sample.

Construct, scalar, and functional measurement equivalencies of the Rosenberg Self-Esteem Scale (RSES) and Major Life Events checklist (MLE) and the constructs assessed were investigated across groups differentiated on Hawaiian/part-Hawaiian and non-Hawaiian (e.g., Caucasian, Filipino, Hispanic, Japanese, and mixed/2 or more) ethnicity and gender. Initial results from maximum likelihood factoring with promax rotation showed that RSES negatively worded Item 5 loaded with the positively worded Items 1, 2, 4, 6, and 7 on 1 of 2 factors for Hawaiian/part-Hawaiian female participants. Similarly, negatively worded Item 8 and the same positively worded items comprised 1 of 2 factors for non-Hawaiian male participants. For the other 2 Ethnicity x Gender groups, factors were respectively comprised of the 5 positively and 5 negatively worded RSES items. Construct equivalence or simple (2-factor) structure underlying the RSES was indicated across the 4 groups after Items 5 and 8 were excluded from a subsequent factoring procedure. Simple structure showed that Factor 1 comprised the positively worded Items 1, 2, 4, 6, and 7, and the remaining negatively worded Items 3, 9, and 10 loaded on Factor 2. Scalar equivalence of the self-esteem and major life events measures was supported by the statistical nonsignificance of the Major Life Events x Ethnicity x Gender interaction effect in multiple regression models. The consistency in the absolute size and direction of the intercorrelations between overall self-esteem, self-esteem Factors 1 and 2, and major life events variables indicated the functional equivalence of respective measures and constructs assessed. Measurement equivalency findings concerning the RSES and MLE, the constructs measured, and their utility versus caution against their use in multiethnic studies were discussed.

Occurrence of thrombocytopenia in psychiatric patients taking valproate.

OBJECTIVE: Few studies, with conflicting results, have examined the occurrence of thrombocytopenia with valproate administration. This study assessed whether the platelet-lowering effects of valproate are increased among elderly psychiatric patients. METHOD: The charts of 39 psychiatric inpatients taking valproate were reviewed. Information on hematologic function and on doses and serum levels of valproate at sequential intervals over a 12-month period was abstracted. Data for subjects age <60 years (nonelderly subjects) and those age >/=60 years (elderly subjects) were compared. RESULTS: More than half (53.8%) of the elderly patients but only 13.0% of the nonelderly patients had at least one episode of thrombocytopenia. This difference corresponded to a significantly greater lowering of platelet counts among elderly patients than among nonelderly patients. CONCLUSIONS: The high rate of thrombocytopenia in our study suggests the need for routine monitoring of platelet counts among patients taking valproate, particularly among elderly patients.

Prediction of anxiety disorders using the state-trait anxiety inventory for multiethnic adolescents.

The purpose of this study was to determine the validity of the State-Trait Anxiety Inventory (STAI) in predicting DSM-III-R anxiety disorders based on the Diagnostic Interview Schedule for Children (DISC, Version 2.3) and using Asian/Pacific Islander adolescents. An overall prevalence rate of 9.19% for generalized anxiety disorder, overanxious disorder, or social phobia was consistent with past studies. As hypothesized, STAI negatively worded (i.e., Factor 2) items were better predictors than positively stated (i.e., Factor 1) items. The STAI State mean was a better predictor of concurrent DISC anxiety disorders as compared to STAI State Factors I or 2. In contrast, the STAI Trait Factor 2 (negatively worded) composite was the best predictor for nonconcurrent DISC anxiety disorders as compared to STAI Trait Factor 1 or the overall STAI Trait subscale. Satisfactory predictive-validity values were obtained when using the STAI State mean and Trait Factor 2 composite. Implications of these findings are discussed, including using the STAI as a screening measure for ethnically diverse adolescents.

Prediction of DISC substance abuse and dependency for ethnically diverse adolescents.

PURPOSE: This study examines the validity of selected items from the Substance Abuse Subtle Screening Inventory-Adolescent (SASSI-A) version in predicting Diagnostic Interview Schedule for Children (DISC version 2.3) Substance abuse and dependency (SA/D) for Native Hawaiian (i.e., indigenous people of the Hawaiian Islands) and non-Hawaiian adolescents (youth without any Native Hawaiian indigenous ancestry). METHODS: 542 students were randomly selected from the larger sample to participate in the DISC administration. Demographic information, SASSI-A scores, and DISC diagnoses were obtained for each student. Univariate and multiple logistic regressions were performed in the prediction of DISC SA/D. RESULTS: SASSI-A Factor 1, consisting of three items measuring substance use, was found to have the best utility, accounting for 18.1% of the variance, in predicting DISC SA/D. IMPLICATIONS: These results support selected SASSI-A items in screening for SA/D for Native Hawaiian and non-Hawaiian adolescents in Hawaii as compared to other community-based screening instruments for other populations.

Sociocultural and community factors influencing the use of Native Hawaiian healers and healing practices among adolescents in Hawai'i.

Recently, there has been much emphasis placed on both alternative approaches to health care and the provision of culturally competent care. Despite these trends, few studies have examined the use of alternative therapies on the part of adolescents. Even fewer studies have been done focusing on traditional Hawaiian approaches to health care. This is essential, especially in Hawai'i, where Hawaiians have not attained health parity with other majority ethnic populations, despite significant efforts and funding to achieve this end. This study examines the sociocultural and community factors influencing the use of traditional Native Hawaiian healers and healing practices by adolescents in Hawai'i. The Hawaiian High Schools Health Survey was administered at five high schools on three islands in Hawai'i during the 1993-1994 school year. The sample included 1,321 high school students who preferred either an allopathic or alternative practitioner. Ethnicity, gender, community access, healer preference, health status, level of education, and health insurance status were used to predict healer use and participation in healing practices. Community access and healer preference predicted both healer use and participation in native healing practices. Mental health predicted healer use (i.e., seeing a Native Hawaiian healer in the past six months), but did not predict taking part in native healing practices, such as ho'oponopono and lomilomi. Hawaiian ethnicity, female gender, and a measure of health insurance predicted participation in native healing practices, but not healer use. These results suggest that native healing practices and traditional healers are being used in Native Hawaiian communities and this is perhaps not due to a lack of health insurance. Given the general separation between Western and Native Hawaiian health services, traditional healing practices should be made available in Native Hawaiian communities to see whether a collaboration between Western practitioners and traditional healers can have a greater positive impact on the health of Native Hawaiians, particularly for adolescents.

Health care utilization among women on O'ahu: implications for Native Hawaiian women.

Women generally seek and use more health care services than do men. Women are also more likely to encounter financial and non-financial barriers to care than do their male counterparts. These differences are accentuated among low income and minority women. We examined health care utilization patterns among women on O'ahu using survey data, and compared those patterns among Native Hawaiian and other ethnic groups. We also provide prevalence rates for several critical women's health issues by ethnic group and explore demographic predictors for health care utilization. Although the vast majority of women have seen health care providers in the last year, ethnic and socioeconomic disparities were identified, especially with respect to our Native Hawaiian female population. A pattern for Native Hawaiian women reveals among the highest rates of depression, as well as sexual/physical/emotional abuse. Alarmingly, Native Hawaiian women are also less likely to have seen a provider in the last year, less likely to have insurance coverage, and more likely to visit emergency departments. Differences by provider type served to reinforce these disparities. In order to reduce barriers to health care utilization for Native Hawaiian women--and for all women in Hawai'i--we recommend universal insurance coverage that includes screening and counseling services. Additionally, training for health care providers is essential in order to improve culturally competent, psychological assessments of health issues for women, particularly Native Hawaiian women.

Sociocultural factors influencing adolescent preference and use of native Hawaiian healers.

OBJECTIVE: Few studies have examined the use of alternative therapies among adolescents. This study examines the predictors of Native Hawaiian healer preference in the treatment of physical or emotional problems as well as the predictors of healer use. DESIGN: This study is a longitudinal cross-sectional design. SETTING: The survey was conducted in five high schools in Hawai'i. PARTICIPANTS: 1,322 high school students selected preference for and/or use of allopathic or alternative practitioners. MAIN OUTCOME MEASURES: Grade level, gender, ethnicity and cultural identity were used to predict healer preference. Healer preference, socioeconomic status and health status were used to predict healer use. RESULTS: Identification with the Hawaiian culture was the strongest predictor of healer preference for both Hawaiian and non-Hawaiian adolescents. Mental health was also predictive of healer preference for non-Hawaiians. Healer use by Native Hawaiian adolescents was also predicted by Hawaiian cultural identity. Gender, grade level, and socioeconomic variables were not predictive of healer preference or use. CONCLUSION: Cultural identity plays a significant role in the preference and use of alternative practitioners, especially for minority adolescent populations.

Longitudinal analysis of development among single and nonsingle children in Nanjing, China: ten-year follow-up study.

In order to examine the impact of "one-child-per-couple" family planning policy on child development, a longitudinal study of a group of children in Nanjing, China, was carried out between 1984 and 1995. The same cohort of children was examined at four stages of development: preschool, early school, preadolescence, and adolescence. Achenbach's Child Behavior Checklist was used to measure the child's behavior. A total of 274 children were surveyed in all four stages. The total behavior problem scores obtained at different stages of development were compared among boys and girls. The results showed that the total score declined significantly in association with the time. As the child grew older, the problems score decreased significantly. This maturation effect was seen for both boys and girls. On average, boys' scores dropped from 21 to 11, whereas girls' scores went from 19.5 to 12. In comparing single with nonsingle boys, there were no significant differences throughout the four stages of development. However, girls who were single children, in contrast to girls with siblings, had significantly higher scores of total behavior problems at each stage of development. These findings illustrate that the longitudinal effect of being a "single-child" is similar to other studies, indicating a minimal impact of family policy. However, the effects were more prominent among girls. This phenomenon can be explained by parents' different attitude toward single-children because of gender difference.

Chronic pain disorder following physical injury.

Pain disorders that are primarily associated with psychological factors are of great clinical concern, but they are difficult to study because of the inability to make valid or reliable diagnoses by structured interview alone. The authors confront this difficulty by using an injured subject population that had extensive psychiatric and medical evaluations. Those who developed somatoform pain disorder (SPD) were compared with a control group who did not. The SPD group had distinctive associated factors: more sites of pain, spread of pain beyond area of original injury, and substantially more opiate and benzodiazepine use. Compensation/litigation influenced symptoms more in the SPD group. Psychotherapists often supported the patient's viewpoint that the pain was physical and to be endured.

Cumulative effect of family environment on psychiatric symptomatology among multiethnic adolescents.

PURPOSE: To examine the influence of family adversity and support on levels of psychiatric symptomatology in Hawaiian and non-Hawaiian adolescents. METHOD: More than 4000 students from five high schools in Hawaii completed a survey during the 1992-1993 school year about their family environment and mental health. The response rate was approximately 60%. Logistic regression analyses were performed and responses for Hawaiians and non-Hawaiians were compared. RESULTS: Hawaiian adolescents experienced significantly more adversity than their non-Hawaiian counterparts. The cumulative effect of family adversity had a greater effect on psychiatric symptomatology than any single indicator. Family support reduced the risk for internalizing symptoms, particularly for Hawaiian adolescents. The influence of family support was less clear for externalizing symptoms, increasing the risk for some adolescents and decreasing the risk for others. CONCLUSION: We identified strong associations between family adversity and levels of psychiatric symptomatology. We found that Hawaiian adolescents are at increased risk for psychiatric symptomatology, given the presence of family adversity and the effect of reduced family support. However, risk was also substantial for non-Hawaiians. Clinicians need to assess the family environment routinely and implement family-oriented interventions.

Psychometric properties of the state-trait anxiety inventory for Asian/Pacific-islander adolescents.

Anxiety disorders are said to be universal across all cultures and recent reviews have found relatively high prevalence rates across different countries. However, the experience and interpretation of anxiety are strongly influenced by cultural factors. Demonstrating cross-cultural equivalence of measures of anxiety is essential to assure that comparisons between cultures will result in meaningful interpretations. Despite the State-Trait Anxiety Inventory being the most researched of anxiety measures from a cross-cultural basis, there is a lack of empirical studies on the psychometric properties of the STAI with adolescent Asian/Pacific Islanders. The present study examined the STAI using a large sample of ethnically diverse high school students in Hawaii. In general, a four-factor model (State-Anxiety Absent, State-Anxiety Present, Trait-Anxiety Absent, and Trait-Anxiety Present) provided the best fit based on a series of confirmatory factor analyses. Indicators of internal consistency supported the reliability of the factors and subscales, and the inter-factor correlations reflected positively on the concurrent validity of the different STAI factor and subscale measures. This study suggested cautious use and interpretation of one particular item (Trait Item 14 = I try to avoid facing a crisis or difficulty ), and cautious application of the STAI to Filipino adolescents (particularly Filipino males). Domains for further research are discussed.

A review of male violence against women in Hawaii.

This review attempts to emphasize the urgency in addressing issues of violence against women in Hawaii. It demonstrates that violence against women is a significant, challenging, and often overwhelming and overlooked public health problem. While attention to this problem has dramatically increased, more needs to be done to end violence against women and improve the well-being of women and our society as a whole.

St. John's wort for depression: a meta-analysis of well-defined clinical trials.

Studies concluding that St. John's wort (Hypericum perforatum) is an effective antidepressant can be challenged due to questionable methodology. We attempt to correct this by a meta-analysis utilizing only well-defined clinical trials. Controlled, double-blind studies using strictly defined depression criteria were analyzed by the rate of change of depression and by the number of "treatment responders." Rates of side effects and dropouts were also analyzed. Hypericum was 1.5 times more likely to result in an antidepressant response than placebo and was equivalent to tricyclic antidepressants (TCAs). The meta-analysis also showed that there was a higher dropout rate in the TCA group and that the TCAs were nearly twice as likely to cause side effects, including those more severe than hypericum. Hypericum perforatum was more effective than placebo and similar in effectiveness to low-dose TCAs in the short-term treatment of mild to moderately severe depression. However, design problems in existing studies prevent definitively concluding that St. John's wort is an effective antidepressant.

Effectiveness of a psychiatric pain clinic.

Medical charts were reviewed for 101 consecutive outpatients seen between January 1, 1993 and July 1, 1996 at a unidisciplinary, psychiatric pain clinic, which exists within a hospital-based, university-run, outpatient service with primary and specialty care clinics. Mean duration of pain was 7 years. Multiple sites of pain were present in 69% of patients. Eighty-eight percent fulfilled DSM-IV criteria for pain disorder. The patients had significantly fewer medical visits and diagnostic tests 6 months after attending the pain clinic, compared with 6 months before (P < 0.0001). Interventions frequently included detoxification and reduction and substitution of medication, and always included psychotherapeutic approaches, particularly support and suggestions.

Admissions, length of stay, and discharge barriers at the Hawaii State Hospital.

Based on data gathered from patients, psychiatrists, and social workers at the Hawaii State Hospital, it was determined that the majority of patients had been in the hospital for more than one year, were committed for forensic reasons, and did not need continued hospitalization. An inter-agency systems approach is needed to address the issue of length of patient stay.

Morbidity on Kauai before and after Hurricane Iniki.

BACKGROUND: On September 11, 1992, Hurricane Iniki, a Class III/IV storm, passed directly over Kauai. This study is the first attempt to measure increases in injuries and other health outcomes among an entire population in the impact zone of a hurricane. METHODS: Medical chart data were abstracted from all facilities providing primary and emergency care on Kauai. Incidence of injury, cardiovascular disease, and asthma for the 2-week period following Hurricane Iniki were compared to those for the 2-week period preceding Iniki. RESULTS: A total of 1,584 injuries were treated in the post-Iniki period compared with 231 injuries treated in the pre-Iniki period (relative risk = 6.86, 95% confidence interval 5.98-7.87). Open wounds constituted over half of these injuries. Physician visits for asthma and cardiovascular disease were also significantly increased in the post-Iniki period (relative risks, respectively: 2.81, 95% confidence interval 1.93-4.09; 2.73, 95% confidence interval 1.51-4.94). CONCLUSIONS: Significant increases in the incidence of injuries, asthma, and cardiovascular disease occurred following Hurricane Iniki. Although no changes occurred in the proportion of patients needing hospitalization, additional injuries and illnesses after a natural disaster can burden existing medical facilities in a rural community with limited resources. Disaster preparedness plans need to include methods to increase services and supplies at existing medical facilities.

Hospitalizations for hip fractures among elderly persons in Hawaii, 1986-1990.

Hawaii differs ethnically, geographically, and culturally from other states; therefore, United States hip fracture data cannot be assumed to apply to Hawaii. The purpose of this research was to gain new knowledge about hip fracture in Hawaii to plan and target appropriate services and design preventive measures. Peer Review Organization Medicare data were analyzed for persons age 65+ over a 4-year period. Average length of hospital stay was 20 days resulting in an average estimated charge per hospitalization of $20,000. Of those with E-Codes, 94% sustained falls. Fifty-five percent had one or more complicating illness. Unexpected significant differences were found among the islands: the average annual hospitalization incidence rate/1,000 on Kauai (8.4) was almost twice that of the Island of Hawaii (4.4), and Maui (3.9), and significantly greater than Oahu (5.4), primarily in women over 85. The island differences raise important questions in need of investigation, and suggest target populations and locations for prevention.

Rehabilitation technicians for remote rural communities.

A programme is described in which indigenous personnel are trained to provide culturally appropriate rehabilitation services for islanders of the Pacific Basin. The disabling conditions most commonly dealt with are associated with stroke, diabetes, arthritis, trauma, and back and neck pain. The programme could be adapted to meet needs in other remote rural communities lacking suitably trained carers.

Traumatic spinal cord injury in Hawaii.

As a prelude to continuing surveillance in Hawaii, a 2-year retrospective study (1987-1989) was conducted by the Pacific Basin Rehabilitation Research & Training Center (PBRRTC) and the Rehabilitation Hospital of the Pacific (REHAB) in order to examine the frequency and causes of traumatic spinal cord injury (SCI) at REHAB; determine similarities and differences when compared to national statistics and make recommendations for future study. Data were abstracted from patient records at REHAB. During the period of study, 59 persons were treated for SCI. Similar to the national database, 85% were males and 70% were teenagers and young adults. Motor Vehicle Accidents (MVAs) contributed to 38% of the injuries followed by falls (28%), sports (19%) and violence (16%); however, etiology differed according to age. Sixty-two percent of the lesions were cervical. Almost 50% were neurologically complete. Sixty-six percent were in wheelchairs. Over 50% were independent in mobility and feeding and nearly 40% were independent in bathing and dressing. Eighty-eight percent returned to their homes. In general, the case at REHAB did not differ from the national database. Because reporting has not been mandatory, actual SCI incidence in Hawaii is most likely higher. Information derived from a mandatory reporting system would lead to identification of high risk groups, development and evaluation of prevention programs, identification of patients requiring early intervention and rehabilitation, and better planning of health care services.