Hepatitis B Prevalence and Risk Factors in Foreign-Born Asians and Pacific Islanders at a Federally Qualified Health Center in Hawai'i, 2015-2020.

The objective of this study was to estimate the prevalence of chronic hepatitis B infection in foreign-born Asians and Pacific Islanders at Kalihi-Palama Health Center in Honolulu, Hawai'i, and to assess the association between both chronic and resolved hepatitis B infection and risk factors such as household exposure to hepatitis B virus and geographic location of birthplace. The study involved cross-sectional data from 997 participants who accessed medical services at Kalihi-Palama Health Center between September 2015 and July 2020. The prevalence of chronic hepatitis B was 10.7%. On multivariable logistic regression analysis, the adjusted prevalence odds ratio of chronic hepatitis B infection was 3.3 times greater (95% confidence interval: 1.1, 9.2) for those who reported household contact with a person with hepatitis B infection than those who reported no such contact. No association was found with place of birth in this study population. Age was a significant predictor of chronic hepatitis B, with participants between 35-44 years of age having the highest prevalence. Age was also a significant predictor of resolved hepatitis B infection, with participants 65 years of age or older having the highest prevalence. These findings emphasize the need for targeted screening and appropriate follow-up-including vaccination or treatment-in this at-risk population.

Trends, patterns, and factors associated with HIV infection among males diagnosed with syphilis, 2014-2019, Hawaii.

OBJECTIVE: This study describes HIV infection and associated risk factors among males diagnosed with syphilis in Hawaii. METHODS: Hawaii sexually transmitted infection (STI) registry records of males diagnosed with syphilis, 2014-2019, were crossmatched with Hawaii HIV surveillance registry records through 2020 using CDC's Registry Plus Link Plus software. HIV status from the STI registry was validated by matching results. Logistic regression was used to examine demographic and behavioral factors associated with HIV infection. RESULTS: Among the 947 male syphilis cases, 257 (27.1%) had both syphilis and HIV infections. Dual infection rates were higher in earlier years (39.5% in 2015), among older patients (41.6% among persons ≥45 years old), males who have sex with males (MSM, 36.6%), and cases with repeated syphilis events (59.5%). The overall agreement on HIV status between the STI registry and matching results was 95.7%. CONCLUSIONS: Over a quarter (27.1%) of male syphilis cases were living with HIV. HIV infection rates were higher among older patients, MSM, and males with repeated syphilis events. Periodic matching between STI and HIV registries provides opportunities for quality control to both registries and opportunities to identify patients not linked to HIV care or who have fallen out of HIV care.

Interprofessional Disaster Simulation During the COVID-19 Pandemic: Adapting to Fully Online Learning.

BACKGROUND: This paper describes the rapid conversion of a face-to-face interprofessional (IP) disaster simulation to an online format in response to COVID-19 campus closures. METHODS: The online disaster simulation utilized internet-based tools allowing real-time collaboration between IP students. Team exercises involved disaster triage, disease outbreak investigation, and disaster response. Surveys measuring self-assessment of various IP skills and simulation learning outcomes (SLOs) were compared with responses from previous face-to-face simulations. RESULTS: Results indicated mean scores for IP skills were higher for online students when compared with in-person simulations, and all SLOs were met. CONCLUSIONS: The online disaster simulation provided an effective, innovative IP educational opportunity.

Cross-ethnic comparison of the association between central sleep apnea and atrial fibrillation/flutter: The Kuakini Honolulu-Asia Aging Study and the Osteoporotic Fractures in Men (Mr.OS) study.

INTRODUCTION: Few studies indicated the impact of ethnicity on an association between central sleep apnea (CSA) and atrial fibrillation/flutter (AF) in older populations. We assessed possible ethnic differences in the association among elderly Japanese-American and White-American men. METHODS: We performed a cross-sectional analysis using two population studies of Japanese-American and White-American men. The Kuakini Honolulu-Asia Aging Study is a longitudinal cohort study of Japanese-American men living in Hawaii. Sleep data were collected between 1999 and 2000. The Osteoporotic Fractures in Men (Mr.OS) Sleep Study was conducted between 2003 and 2005 on the continental U.S. The majority of Mr.OS participants were White-American. We selected 79-90 year old males, who had overnight polysomnography from both studies. Total participants were 690 Japanese-American and 871 White-American men. The central apnea index (CAI) was the measure of the number of central apneas. CSA was defined by CAI>=5. Cheyne-Stokes breathing (CSB) was defined as a minimum consecutive 5-10 min period of a crescendo-decrescendo respiratory pattern associated with CSA. RESULTS: The prevalence of AF was 5.7% in Japanese-American men and 9.0% in White-American men. The prevalence of CSA and CSB in White-Americans were higher than in Japanese-Americans (11.5% vs 6.5% and 5.7% vs 3.3%, respectively). In multivariable-adjusted logistic regression models, CSA was associated with higher odds of AF, and the association was stronger in Japanese-Americans [Odds Ratio (OR) = 4.77, 95% confidence interval (CI): 1.95-11.67] than in White-Americans (OR = 2.09, 95 %CI: 1.09-4.01). CSB showed similar trends as CSA. CONCLUSIONS: After adjustment, CSA and CSB were significantly associated with AF in both Japanese-American and White-American men.

Congenital Syphilis: A Case Report Demonstrating Missed Opportunities for Screening and Inadequate Treatment Despite Multiple Health Care Encounters During Pregnancy.

ABSTRACT: A case of congenital syphilis due to multiple missed opportunities, highlights the challenges of treating syphilis during pregnancy. Although cases are increasing in the United States, congenital syphilis, a disease with devastating consequences, is preventable.

Patient and provider characteristics associated with retention in HIV medical care and viral suppression among in care patients in Hawaii.

The percentages of retention in care and viral suppression among persons living with HIV (PLWH) in the United States from 2015 to 2018 were far below the 2020 national goals. This study aims to examine disparities in retention in care and viral suppression. The study population included PLWH diagnosed through 2016, residing in Hawaii at year-end 2016 and 2017, and who were in care in 2017 defined as having ≥1 CD4/viral load tests in 2017. Care providers were categorized as "very frequent" (≥50 patients), "frequent" (25-49 patients), "occasional" (10-24 patients), and "infrequent" (<10 patients). Among the 1752 patients included, 28.0% were not retained in care in 2017 (i.e., <2 CD4/VL tests performed at least 3 months apart), of whom 89.2% had only a single viral load test. Patients receiving care from the "infrequent" group of providers were less likely to be retained in care (adjusted odds ratio (aOR) = 0.48; 95% CI = 0.33, 0.69) or virally suppressed (aOR = 0.39; 95% CI = 0.24, 0.63), than patients receiving care from the "very frequent" group of providers. Percentages of three-year (2016-2018) in care and viral suppression were lowest among patients receiving care from "infrequent" care providers. Patients <45 years old were less likely to be retained in care (aOR = 0.53; 95% CI = 0.41, 0.68) or be virally suppressed (aOR = 0.59; 95% CI = 0.40, 0.86) than those 45 years or older. Patients of multiple races were less likely to be virally suppressed than whites (aOR = 0.38, 95% CI = 0.23, 0.64). Establishing a long-term relationship with an experienced HIV provider appears beneficial to achieve sustainable viral suppression and provision of uninterrupted HIV medical care.

Paradoxical association between atrial fibrillation/flutter and high cholesterol over age 75 years: The Kuakini Honolulu Heart Program and Honolulu-Asia Aging Study.

INTRODUCTION: Several studies have indicated high cholesterol is paradoxically associated with low prevalence of atrial fibrillation/flutter (AF). However, the etiology is uncertain. One potential explanation might be the confounding effect of age exemplifying prevalence-incidence (Neyman's) bias. However, this bias has not often been discussed in depth in the literature. Therefore, we conducted a cross-sectional analysis to test the hypothesis that there is a paradoxical association between lipid profile and AF prevalence. METHODS: This is a cross-sectional study design, using data from the Kuakini Honolulu Heart Program. Participants were 3741 Japanese-American men between 71 and 93 years old living in Hawaii. Serum total cholesterol (TC) level was measured and categorized into quartiles. AF was diagnosed by 12­lead Electrocardiogram. We categorized age into quartiles (71-74, 75-77, 78-80 and 81+ years). RESULTS: We observed opposite associations between AF and TC among different age groups. For participants age ≥75, higher TC levels were paradoxically associated with lower prevalence of AF after multivariable adjustment, i.e. the odds ratios of AF comparing the highest TC quartile with the lowest TC quartile for age 75-77, 78-80 and 81+ years were 0.17 (95% confidence interval [CI], 0.06-0.52), 0.28 (95% CI, 0.07-1.09) and 0.14 (95% CI, 0.03-0.62), respectively. Conversely, for those who were 71-74 years old, the odds ratio of AF was 2.09 (95% CI, 0.76-5.75) between the highest and the lowest TC quartiles. CONCLUSIONS: There is a paradoxical association of TC with AF in Japanese-American men age ≥75, but not <75 years. The paradox might be explained by Neyman's bias.

Evaluating Potential Mosquito Breeding Sites on a University Campus.

In recent decades, mosquito-borne diseases (MBDs) such as Zika, chikungunya, malaria, and dengue have spread to more urban areas previously free of such diseases. Globalization has increased the infection potential for diseases and their vectors, placing tropical tourist destinations, such as Hawai'i, at risk for MBD epidemics. A cross-sectional study was conducted on the University of Hawai'i at Manoa campus to assess potential mosquito breeding sites. The campus was stratified by land use designation and randomly sampled. Residential areas had the highest potential for breeding sites with high numbers of discarded plastic food and beverage containers. Recommended prevention strategies to curb littering in the residential area include awareness campaigns and encouraging collaboration between maintenance authorities to enhance oversight. This study highlights the importance of individual awareness and prevention of environment modifications that could contribute to the development of mosquito breeding sites.

Disaster Aftermath Interprofessional Simulation: Promoting Nursing Students' Preparedness for Interprofessional Teamwork.

BACKGROUND: Nurses are members of interprofessional cadres of health care professions with vital roles as disaster shelter volunteers and leaders for recovery efforts. Nurses must be equipped with the skills needed to care for communities postdisaster. Providing students with opportunities to engage in interprofessional simulated disaster experiences is an effective method for preparing them to work in leadership roles during disasters. This article describes a case study in the use of simulation to enhance health care students' knowledge and interprofessional collaboration roles in disaster management. METHOD: The Disaster Aftermath Interprofessional Simulation (DAIS) tabletop exercise was developed by nursing and public health faculty. RESULTS: Students prioritized health interventions and investigated a foodborne outbreak in an emergency shelter. Students applied knowledge from their respective disciplines, collaborating to develop plans to protect populations. CONCLUSION: The DAIS is an innovative method for preparing nursing students to work as interprofessional team members in disaster response and recovery. [J Nurs Educ. 2020;59(6):353-356.].

Evaluation of distance facilitation and technology in an interprofessional simulation exercise.

INTRODUCTION: This paper explores two objectives: (1) effectiveness of interprofessional education facilitators utilizing distance technology to facilitate and debrief an interprofessional exercise with students located on the islands Oahu and Hawai'i Island (Hilo), and (2) impact of technology on the simulation experience for facilitators and students. METHODS: Four disciplines participated in an interprofessional hospital discharge exercise for the same geriatric patient case. Two questions administered to facilitators and students after each session focused on: (1) satisfaction with the students' ability to work through the simulation, and (2) satisfaction with the use of distance technology. RESULTS: Results showed no significant differences when comparing students to facilitators for the students' ability to work through the simulation. Students gave significantly lower satisfaction scores with distance technology than faculty. There were no significant differences in scores among disciplines between either facilitators or students. Pharmacy distance students had significantly lower scores for satisfaction with the simulation exercise and for the role of distance technology compared to other students. Qualitative analyses showed trend improvements over five semesters in four technology areas; volume, noise, difficulty with clarity/understanding, and seating location/placement issues for the on-site group, but only significant improvement with clarity/understanding in the distance group. CONCLUSIONS: Interprofessional simulation exercises can be successfully facilitated from both on-site and distance site without compromising students' ability to work through the exercise. Satisfaction with distance technology was lower for distance student groups.

Association between central sleep apnea and atrial fibrillation/flutter in Japanese-American men: The Kuakini Honolulu Heart Program (HHP) and Honolulu-Asia Aging Study (HAAS).

INTRODUCTION: While several studies have indicated that central sleep apnea (CSA) is associated with atrial fibrillation and atrial flutter (AF) in older populations, few studies have focused on older Asian populations. METHODS: We conducted a cross- sectional analysis using data from the 1999-2000, 7th exam cycle of the Kuakini Honolulu-Asia Aging Study. Participants were 718 Japanese-American men between 79 and 97 years old, who had overnight polysomnography. Obstructive Apnea-Hypopnea Index (OAHI) was the measure of the number of obstructive apneas and hypopneas with >4% oxygen desaturation. Additionally, the Central Apnea Index (CAI) was the measure of the number of central apneas. Obstructive sleep apnea (OSA) was categorized as none (OAHI <5), mild (OAHI 5-14), moderate (OAHI 15-29) and severe (OAHI ≥30). CSA was defined by CAI of 5 or more. Cheyne-Stokes Breathing (CSB) was defined as a minimum consecutive 5-minute period of a crescendo-decrescendo respiratory pattern associated with CSA. RESULTS: AF prevalence was 5.5% (39 of 709). The prevalence proportions of severe OSA, CSA, and CSB were 20.2% (143 of 709), 6.4% (43 of 673) and 3.2% (22 of 673), respectively. In multivariable-adjusted logistic regression models, CSA and CSB were significantly associated with AF prevalence: odds ratio (OR) 5.15, 95% confidential interval (CI), 2.21-12.52 and OR 6.26, 95% CI, 2.05-19.14, respectively. However, OSA was not significantly associated with AF prevalence. CONCLUSION: AF prevalence is associated with CSA and CSB but not OSA in older Japanese-American men. This information could help target AF prevention strategies in this population.

Emerging Trends in Antibiotic Resistant Neisseria gonorrhoeae: A National and Hawai'i Perspective.

Gonorrhea is the second most common nationally notifiable infectious disease in the United States. Rates have been increasing nationally as have antibiotic-resistant isolates. Both the Centers for Disease Control and Prevention and the World Health Organization have recognized antibiotic-resistant Neisseria gonorrhoeae as a major public health threat and have warned of the emerging threat of "untreatable" gonorrhea. Hawai'i has been on the front lines nationally for gonococcal antimicrobial susceptibility surveillance due to its long-standing, statewide gonococcal isolate surveillance program coupled with antibiotic susceptibility testing of all isolates, and Hawai'i's geographic location between Asia where drug-resistant strains originate, and the continental United States. This article highlights emerging trends in and current status of antibiotic resistant Neisseria gonorrhoeae from a national and Hawai'i perspective.

Association Between Occupational Exposure to Pesticides and Cardiovascular Disease Incidence: The Kuakini Honolulu Heart Program.

Background Previously, Kuakini Honolulu Heart Program researchers reported that occupational exposure to pesticides was significantly associated with total mortality. The current study examines occupational exposure to pesticides in relation to incident cardiovascular disease, defined as coronary heart disease or cerebrovascular accident. Methods and Results With the Occupational Safety Health Administration exposure scale used as an estimate of exposure, statistical analyses were performed on a cohort of 7557 Japanese-American men from the Kuakini Honolulu Heart Program. Hazard ratios for cardiovascular disease incidence were calculated for various levels of pesticide exposure using Cox proportional hazards models. In the first 10 years of follow-up, a positive association was observed between age-adjusted cardiovascular disease incidence and high levels of pesticide exposure (hazard ratio=1.46, 95% CI=1.10-1.95, P=0.009). This relationship remained significant after adjustment for other cardiovascular disease risk factors (hazard ratio=1.42, 95% CI=1.05-1.92, P=0.021). No significant association for coronary heart disease or cerebrovascular accident incidence with pesticide exposure was observed when examined separately, possibly due to a smaller number of events. Conclusions These findings suggest that occupational exposure to pesticides may play a role in the development of cardiovascular diseases. The results are novel, as the association between occupational exposure to pesticides and cardiovascular disease incidence has not been examined previously in this unique cohort.

Dermatologically challenging syphilis presentation.

An atypical early primary syphilis case presentation with multiple umbilicated papular lesions on the penis and a nonreactive syphilis serology was misdiagnosed as molluscum contagiosum. Over a period of eight weeks, prior to dermatologic consultation, the papules enlarged, ulcerated, and healed. New plaque and patch formation on the penis and scrotum led to a differential diagnosis of inverse psoriasis vs. syphilis. Histological examination of a shave biopsy specimen revealed numerous Treponema pallidum organisms and repeat syphilis serological test results confirmed a syphilis diagnosis. Lesions responded to treatment with benzathine penicillin. One must keep a high index of suspicion for syphilis in light of its diverse presentation and increasing incidence.

An interprofessional team simulation exercise about a complex geriatric patient.

Interprofessional collaboration is an essential skill to optimize the care of older adults with complex problems. We successfully developed and evaluated an interprofessional teamwork simulation exercise for medical, nursing, pharmacy, and social work students. Pharmacy students participated via video conferencing. Before the simulation, students watched a teamwork video and reviewed the patient case. Following an icebreaker exercise, interdisciplinary faculty facilitated a discussion highlighting effective teamwork strategies. Students then collaborated to develop a discharge plan, followed by a simulated family meeting with a theater student. Interdisciplinary faculty again provided structured debriefing highlighting principles of effective teamwork. Students self-rated interprofessional practice core competencies were evaluated using a retrospective pre/post survey and analyzed using paired t-tests. We qualitatively examined the use of distance technology and assessed learner's satisfaction with the project. All core competency categories for all disciplines demonstrated significant improvements in mean scores. Students' qualitative comments demonstrated positive impact on learning interprofessional core competencies.

Trends and Racial Disparities of Late-Stage HIV Diagnosis: Hawaii, 2010-2016.

OBJECTIVES: To examine racial/ethnic disparities in Hawaii in stage 3 classification at HIV diagnosis and trends in such disparities from 2010 through 2016. METHODS: We analyzed data including patients' demographic information, behavioral risk factors, residential county at HIV diagnosis, and type of facility where HIV was diagnosed. Multivariable logistic regression modeling was used to examine racial/ethnic disparities in late-stage diagnoses after adjustment for known or possible confounders. RESULTS: About 30% of HIV diagnoses were classified as late-stage (stage 3) diagnoses, and there were significant racial/ethnic disparities in stage 3 classification at diagnosis. Relative to Whites, the odds of being diagnosed at stage 3 were 3.7 times higher among Native Hawaiians and other Pacific Islanders (NHPIs; odds ratio [OR] = 3.69; 95% confidence interval [CI] = 1.89, 7.22) and more than twice as high among Asians (OR = 2.46; 95% CI = 1.16, 5.20). Older age and being diagnosed in an inpatient setting were associated with stage 3 classification. CONCLUSIONS: Targeted preventive services need to be strengthened for Asians and NHPIs in Hawaii.

Assessing the Accuracy of Physician Self-disclosed PID Reporting: A Comparison of Data from a Physician Survey and Actual PID Case Reports from a State Surveillance System.

Pelvic inflammatory disease is a state-mandated notifiable disease in Hawai'i. A survey assessing pelvic inflammatory disease (PID) reporting to the Hawai'i Department of Health (HDOH) PID surveillance system, was administered to physicians in Hawai'i in April 2012. To measure the accuracy of self-disclosed PID reporting, data from the survey were compared to HDOH PID surveillance system case reports. Concordance between the two data sources was assessed using Cohen's kappa statistic. We first linked data by physician name. An adjusted kappa was also calculated to minimize prevalence and bias effects. A second analysis linked data according to physician name or practice setting. In the name-based analysis, the HDOH PID surveillance database successfully matched only ten of 118 physicians (8.5%) who self-disclosed reporting a PID case. Only "slight agreement" (k= 0.09, 95% confidence interval [CI]: 0.02-0.16) was demonstrated between the two databases. The prevalence-adjusted, bias-adjusted kappa demonstrated "moderate agreement" (κ=0.53, 95% CI: 0.45-0.60). In the second (name or practice-based setting) analysis, 77 physicians with linkages were found in the HDOH surveillance database, reflecting "moderate agreement" (κ=0.52, 95% CI 0.43, 0.61). Our findings provide evidence that individual physicians are submerging their case reports into group practice/HMO aggregate reports and not reporting individually as legally mandated and hence are compromising PID surveillance quality.