Gastric adenocarcinoma location and postoperative complication rates in Asian patients: A 2014-2019 NSQIP analysis.

BACKGROUND: Asian gastric cancer patients have higher long-term survival rates post-gastrectomy. This study compares 30-day post-gastrectomy outcomes between Asians and non-Asians. METHODS: Gastric cancer patients undergoing elective gastrectomies were identified in 2014-2019 NSQIP datasets (n â€‹= â€‹1,438). Demographics, comorbidities, and postoperative outcomes were analyzed. RESULTS: Asians had lower odds of total gastrectomy (AOR â€‹= â€‹0.52, p â€‹= â€‹0.003), age ≥65 (AOR â€‹= â€‹0.60, p â€‹= â€‹0.006), smoking history (AOR â€‹= â€‹0.35, p â€‹< â€‹0.001), dyspnea (AOR â€‹= â€‹0.25, p â€‹= â€‹0.01), and hypoalbuminemia (AOR â€‹= â€‹0.62, p â€‹= â€‹0.025); they also had lower BMI (p â€‹< â€‹0.001). Postoperative outcomes were not significantly different aside from a shorter median length of hospital stay in days (LOS) (Asians: 7 (6, 11); non-Asians: 8 (6, 11); p â€‹< â€‹0.001). CONCLUSIONS: Asian gastric cancer patients have significantly lower odds of having select preoperative comorbidities and have shorter hospital LOS.

Neighborhood-Level Stressors and Individual-Level Cardiovascular Disease Risk in Native Hawaiians: a Cross-Sectional Study.

Introduction: Native Hawaiian people have higher rates of illness and death related to cardiovascular disease (CVD) than non-Hispanic White people. Research in other populations has shown that individual-level CVD risk factors (ie, high-fat diet, physical inactivity, obesity, and tobacco use) are associated with neighborhood characteristics (ie, social cohesion, walkability, availability of healthy food, and safety). This association has yet to be examined among Native Hawaiians. Methods: We conducted a cross-sectional survey of community-dwelling Native Hawaiian people in 2020. Three multiple regression models and 1 logistic regression model were assessed. Each model included individual-level CVD risk factors, age, sex, education, income, and neighborhood characteristics. Results: The regression models for body mass index (BMI) and physical activity showed significant results. The BMI model (R2 = 0.22, F = 4.81, P < .001) demonstrated that age, sex, education level, physical activity, and percentage of fat in the diet were significantly related to BMI. The availability of healthy foods had a significant, independent relationship with BMI (standardized ß = -1.47, SE = 0.53, P = .01). The physical activity model (R2 = 0.21, F = 4.46, P < .001) demonstrated that age, sex, education, and BMI were significantly related to physical activity. None of the neighborhood characteristics had significant, independent relationships to physical activity. Conclusions: We found that neighborhood-level factors improved the model's ability to explain variance in BMI. Efforts to decrease BMI would benefit from improving the availability of healthy foods in neighborhoods, a finding supported by research in other populations.

Subtotal vs total cholecystectomy for difficult gallbladders: A systematic review and meta-analysis.

INTRODUCTION: With severely inflamed gallbladders, laparoscopic cholecystectomy can be difficult and may require procedures like subtotal cholecystectomy (SC). Few studies exist comparing SC and total cholecystectomy (TC) in the setting of severe biliary inflammation. This meta-analysis aims to compare SC and TC for difficult gallbladders. METHODS: Medline-OVID, Embase-OVID, and Cinahl were searched including only studies comparing SC to TC for difficult gallbladders. Primary outcome was CBD injury. Secondary outcomes included bile leak, duodenal injury, retained stone, bleeding, intraabdominal collection, wound infection, reoperation, and mortality. RESULTS: Ten studies were included. Compared to TC, SC significantly lowered the risk for CBD injury (0 â€‹% vs. 1.6 â€‹%, RR 0.30, 95%CI 0.10-0.87) but increased risk of bile leaks (RR 3.5, 95%CI 1.79-6.84), postoperative ERCP (RR 2.86, 95%CI 1.53-5.35), intraabdominal collections (RR 2.55, 95%CI 1.32-4.93), and reoperation (RR 2.92, 95%CI 1.14-7.47). CONCLUSION: SC is a reasonable alternative to difficult gallbladders that may decrease the risk of CBD injuries. Knowing both approaches is crucial to manage the difficult gallbladder while minimizing harm. Further studies are needed to understand the value of SC for difficult cholecystectomy.

Assessing Concussion Knowledge Among Recreational Surfers and Comparing Results to Concussion Knowledge Among Soccer Players: A Pilot Study.

Concussions are caused by physical trauma to the head, face, or neck and can be sustained while surfing, increasing the risk of drowning. The purpose of this pilot study was to establish a preliminary assessment of concussion knowledge in a group of adult recreational surfers. Using the standardized Concussion Knowledge Index, an anonymous survey was conducted with 55 surfers. The Concussion Knowledge Index and similar statistical measures were used in a previous study of adult soccer players in England. Data from these 2 groups were compared. The preliminary data suggests that the group of adult surfers demonstrate more concussion knowledge than the group of adult soccer players. Further study into surfers' knowledge of concussion with a larger sample size could increase the clinical utility and generalizability of this study.

Stepwise Proportional Weighting Algorithm for Single-Race Population Estimation Using Hawai'i Census Data.

Many health and health disparities studies require population prevalence information of various race groups, but the estimation of single-race population sizes using the US Census data has been challenging. For each Census race group, Census only provides the counts of those reported being single race ("race alone") and those reported of that specific race regardless of whether the individuals were multiracial or not ("race alone or in (any) combination"). The issue of how to classify Census multiracial individuals is especially important for the state of Hawai'i due to its large multiracial population. The current study developed the Stepwise Proportional Weighting Algorithm (SPWA) for single-race population estimation using US Census data for major race groups in the Census and their nested detailed races. Additionally, given that "partial Native Hawaiian" has often been treated as "Native Hawaiian" in health disparities studies in Hawai'i, the algorithm can also adjust for the unique partial Native Hawaiian race categorization. This paper describes the estimation process with the SPWA and demonstrates its ability to estimate single-races for the 5 most common race groups in Hawai'i. This new methodology addresses an important concern regarding how to classify multiracial individuals to strengthen health and health disparities research in Hawai'i.

Age and Sex Distributions of 31 Common Racial Groups in Hawai'i: A Shiny Web Application.

Hawai'i is the most ethnically diverse state with the highest proportion of multiracial individuals in the United States. The Stepwise Proportional Weighting Algorithm (SPWA) was developed to bridge the categorization of multiracial Census data into single-race population estimates for common races in Hawai'i. However, these estimates have not been publicly available. A Shiny web application, the Hawai'i Single-Race Categorization Tool, was developed as a user friendly research tool to obtain the age and sex distributions of single-race estimates for common racial groups in Hawai'i. The Categorization Tool implements the SPWA and presents the results in tabular and graphic formats, stratified by sex and age. It also allows the categorization of partial Native Hawaiians as Native Hawaiians in the population estimation. Using this tool, the current paper reports population estimates and distributions for 31 common racial groups using Hawai'i Census 2010 data. Among the major Census races, Asian had the largest population (631 881; 46.5%) in Hawai'i, followed by White (431 635; 31.7%) and Native Hawaiian and Other Pacific Islander (227 588; 16.7%). Among Census detailed races within Asian, Filipino had the largest population estimate (244 730; 18.0%), followed by Japanese (227 165; 16.7%) and Chinese (103 600; 7.6%). Native Hawaiian accounted for 12.3% of the Hawai'i population (166 944). After recategorizing part-Native Hawaiians as Native Hawaiians, Native Hawaiian increased by 150.0%, with the greatest increase among the young. This publicly available tool would be valuable for race-related resource allocation, policy development, and health disparities research in Hawai'i.

Potential Errors in Health Disparities Research Resulting from Lack of Unique Patient Identifiers: Analysis of Diabetes-related Preventable Hospitalizations.

All-payer, population-level hospital discharge data have been used to identify health disparities across racial/ethnic and other demographic groups. However, researchers are often unable to identify unique patients in the data sets if a unique patient identifier is not provided. The lack of the unique patient identifier can result in biased estimates of research outcomes using discharge data. This could then mislead the researchers, public, or policy-makers who utilize such biased results. This study examined estimation bias of health disparities due to rehospitalizations considering diabetes-related preventable hospitalizations using 6 years of state-level data from Hawai'i Health Information Corporation. Different analyses methods showed different probabilities of having multiple visits by age, race/ethnicity and payer subgroups. Charge analysis results also showed that ignoring the multiple visits could result in significance error. For a patient with multiple hospitalizations, rehospitalizations are often dependent upon the discharge status of previous visits, and the independence assumption of the multiple visits may not be appropriate. Ignoring the multiple visits in population-level analyses could result in severe health disparities significance errors. In this hospitalization charge analysis, the Chinese group was not significantly different than the White group (relative risk ratio - RR: [95% CI]: 0.93 [0.80, 1.08]), while the difference was signficant (RR [95% CI]: 0.86 [0.77,0.96]) when the multiple visits were ignored.

Glenoid Bone Loss in Recurrent Shoulder Instability After Arthroscopic Bankart Repair: A Systematic Review.

BACKGROUND: Glenoid bone loss has been reported to occur in as many as 86% of patients with recurrent shoulder stability. This systematic review evaluated the amount of glenoid bone loss associated with recurrent shoulder dislocation or subluxation and with worse patient-reported outcomes after arthroscopic Bankart repair. We hypothesized that the percentage of glenoid bone loss associated with recurrent instability after arthroscopic Bankart repair is lower than the previously proposed critical value of 25%. METHODS: The systematic review included 528 patients with glenoid bone loss from 3 clinical studies. The percentage of bone loss was the value quantified and reported in each study. Failure was defined as recurrent dislocation or subluxation. The percentage of glenoid bone loss associated with recurrent shoulder dislocation or subluxation after arthroscopic Bankart labral repair was analyzed with receiver operating characteristic (ROC) curve analysis. RESULTS: Recurrent dislocation or subluxation occurred in 23.7% (125) of 528 patients in the pooled study cohort. There was a significant difference in age between those in whom the arthroscopic Bankart repair failed and those in whom it did not (22.9 versus 24.3 years; p = 0.009). The ROC curve analysis demonstrated that ≥16.0% glenoid bone loss was predictive of recurrent shoulder dislocation or subluxation (Youden index = 0.59, sensitivity = 80%, specificity = 80%). In patients who did not sustain a recurrent dislocation or subluxation, the ROC curve analysis demonstrated that 20.0% glenoid bone loss was predictive of a Single Assessment Numeric Evaluation (SANE) score of <85% (Youden index = 0.93, sensitivity = 93%, specificity = 100%). CONCLUSIONS: The critical amount of glenoid bone loss associated with an increased risk of persistent instability was found to be less than previously reported. Glenoid bone loss of ≥16.0% was found to place patients at higher risk for recurrent shoulder dislocation or subluxation after treatment with arthroscopic Bankart repair alone. LEVEL OF EVIDENCE: Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

Food Insecurity and Blood Pressure in a Multiethnic Population.

Food insecurity is a social determinant of health and is increasingly recognized as a risk factor for hypertension. Native Hawaiians bear a disproportionate burden of hypertension and known risk factors. Despite this, the relative effects of food insecurity and financial instability on blood pressure have yet to be investigated in this population. This study examines the relative effects of food insecurity and financial instability on blood pressure, controlling for potential confounders in a multiethnic sample. Participants (n = 124) were recruited from a U.S. Department of Agriculture-funded study called the Children's Healthy Living Center of Excellence. Biometrics (i.e., blood pressure, weight, and height) were measured. Demographics, physical activity, diet, psychosocial variables, food insecurity, and financial instability were assessed via self-report questionnaires. Hierarchical linear regression models were conducted. Model 1, which included sociodemographic variables and known biological risk factors, explained a small but significant amount of variance in systolic blood pressure. Model 2 added physical activity and daily intake of fruit, fiber, and whole grains, significantly improving the model. Model 3 added financial instability and food insecurity, further improving the model (R2 = 0.37, F = 2.67, p = 0.031). Food insecurity, female sex, and BMI were significantly and independently associated with increased systolic blood pressure. These results suggest a direct relationship between food insecurity and systolic blood pressure, which persisted after controlling for physical activity, consumption of fruits, fiber, and whole grains, and BMI. Efforts to reduce food insecurity, particularly among Native Hawaiians, may help reduce hypertension in this high-risk population.

Efficacy of Telehealth in Preoperative Pediatric Surgery Consultations.

INTRODUCTION: The Coronavirus disease 2019 pandemic created a sudden need to transition outpatient pediatric surgical care to a telehealth platform, allotting little time to study the efficacy of these changes. In particular, the accuracy of telehealth preoperative assessment remains unclear. Therefore, we sought to study the prevalence of errors in diagnosis and procedure cancellations between preoperative in-person evaluations and telehealth evaluations. METHODS: We conducted a single institution, retrospective chart review of perioperative medical records at a tertiary children's hospital over a 2-year period. Data included patient demographics (age, sex, county, primary language, and insurance), preoperative diagnosis, postoperative diagnosis, and surgical cancellation rates. Data were analyzed using Fisher's exact and chi-square tests. Alpha was set at 0.05. RESULTS: A total of 523 patients were analyzed, with 445 in-person visits and 78 telehealth visits. There were no demographic differences between the in-person and telehealth cohorts. The frequency of changes from the preoperative to the postoperative diagnosis was not significantly different between in-person preoperative visits and telehealth preoperative visits (0.99% versus 1.41%, P = 0.557). The frequency of case cancellations between the two consultation modalities was not significantly different (9.44% versus 8.97%, P = 0.899). CONCLUSIONS: Our results demonstrate that preoperative pediatric surgical consultations held via telehealth were neither associated with a decrease in the accuracy of preoperative diagnosis, nor an increased rate of surgery cancellations, compared to those held in-person. Further study is needed to better determine the advantages, disadvantages, and limitations of telehealth in the delivery of pediatric surgical care.

Racial Disparities in General Surgery Outcomes.

INTRODUCTION: While disparities in Black and Hispanic and Latino patients undergoing general surgeries are well described, most analyses leave out Asian, American Indian or Alaskan Native (AIAN), and native Hawaiian or Pacific Islander patients. This study identified general surgery outcomes for each racial group in the National Surgical Quality Improvement Program. METHODS: National Surgical Quality Improvement Program was queried to identify all procedures conducted by a general surgeon from 2017 to 2020 (n = 2,664,197). Multivariable regression models were used to investigate the impact of race and ethnicity on 30-day mortality, readmission, reoperation, major and minor medical complications, and non-home discharge destinations. Adjusted odds ratios (AOR) and 95% confidence intervals were calculated. RESULTS: Compared to non-Hispanic White patients, Black patients had higher odds of readmission and reoperation, and Hispanic and Latino patients had higher odds of major and minor complications. AIAN patients had higher odds of mortality (AOR: 1.003 (1.002-1.005), P < 0.001), major complication (AOR: 1.013 (1.006-1.020), P < 0.001), reoperation (AOR: 1.009, (1.005-1.013), P < 0.001), and non-home discharge destination (AOR: 1.006 (1.001-1.012), P = 0.025), while native Hawaiian or Pacific Islander patients had lower odds of readmission (AOR: 0.991 (0.983-0.999), P = 0.035) and non-home discharge destination (AOR: 0.983 (0.975-0.990), P < 0.001) compared to non-Hispanic White patients. Asian patients had lower odds of each adverse outcome. CONCLUSIONS: Black, Hispanic and Latino, and AIAN patients are at higher odds for poor postoperative results than non-Hispanic White patients. AIANs had some of the highest odds of mortality, major complications, reoperation, and non-home discharge. Social health determinants and policy adjustments must be targeted to ensure optimal operative results for all patients.

Disparities and Risk Factors for Surgical Complication in American Indians and Native Hawaiians.

INTRODUCTION: American Indian and Alaskan Natives (AIAN) and Native Hawaiian and Pacific Islanders (NHPI) research is limited, particularly in postoperative surgical outcomes. This study analyzes disparities in AIAN and NHPI surgical complications across all surgical types and identifies factors that contribute to postoperative complications. METHODS: This retrospective cohort study examined all surgeries from 2011 to 2020 in the National Surgical Quality Improvement Program, queried by race. Multivariable models analyzed the association of race and ethnicity and 30-day postoperative complication. Next, multivariable models were used to identify preoperative variables associated with postoperative complications, specifically in AIAN and NHPI patients. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated. RESULTS: AIAN patients were associated with higher odds of postoperative complication (AOR: 1.008 [CI: 1.005-1.011], P < 0.001) compared to non-Hispanic white patients. The comorbidities that were of higher incidence in AIAN patients, which also adversely contributed to postoperative complication, included dependent functional status, diabetes, congestive heart failure (CHF), open wounds, preoperative weight loss, bleeding disorders, preoperative transfusion, sepsis, hypoalbuminemia, along with an active smoking status and ASA ≥3. In NHPI patients, dependent functional status, CHF, renal failure, preoperative transfusion, open wounds, and sepsis were of higher incidence and significantly contributed to postoperative complication. CONCLUSIONS: Surgical outcome disparities exist particularly in AIAN patients. Identification of modifiable patient risk factors may benefit perioperative care for AIAN and NHPI patients, which are historically understudied racial groups.

Implementation of a Business of Healthcare Curriculum for General Surgery Residents.

OBJECTIVE: To better prepare general surgery residents for handling the business aspects of healthcare, this project evaluation reports on the implementation of a business of healthcare curriculum (BHC) in a general surgery residency program. We evaluated (pre and post curriculum) self-perceived knowledge and attitudes toward common business topics. DESIGN: General surgery residents were administered a 13-item survey (7 Likert-type and 3 open-ended items assessing self-perceived knowledge and attitudes toward BHC, and 3 demographic questions) prior to the start of the curriculum. The curriculum was comprised of four core sessions, which included didactic lectures and group projects, including the creation of a business plan. At the conclusion of the curriculum, a post-test with the same items was administered. A total of 21 residents completed both the pre and post-tests. SETTING: The BHC was a mandatory part of the general surgery residency program and was conducted in Honolulu, Hawaii (University of Hawaii at Manoa). PARTICIPANTS: All general surgery residents, PGY-1 to PGY-5, were required to participate in the curriculum. RESULTS: Statistically significant increases in resident knowledge were found overall and specifically for healthcare reform legislation, differences between practice settings, financial matters, contracting and coding and billing for services. Additionally, responses to open-ended questions showed that residents had a positive attitude toward the curriculum and found it useful. CONCLUSIONS: General surgery residency programs can successfully create an impactful business of healthcare curriculum with minimal cost if volunteers and existing resources are utilized.

Implicit Racial Attitudes and Associations Among Obstetricians in Hawai'i: a Pilot Study.

INTRODUCTION: Pacific Islanders living in Hawai'i with ancestral ties to islands in the western Pacific region of Micronesia are common targets of uninhibited forms of prejudice in multiple sectors, including healthcare. Whether the explicit societal-level attitudes toward this group are reflected in implicit attitudes among healthcare providers is unknown; therefore, we designed a pilot study to investigate this question. Our study measures implicit racial bias toward Pacific Islanders from Micronesia among Obstetrician-Gynecologists (OB-GYNs) in Hawai'i. METHODS: We developed 4 new implicit association tests (IATs) to measure implicit attitudes and associations (i.e., stereotypes) toward Pacific Islanders from Micronesia in 2 conditions: (1) Micronesians vs. Whites and (2) Micronesians vs. Japanese Americans. Participants were practicing OB-GYNs in Hawai'i. The study was conducted online and included survey questions on demographic and physician practice characteristics in addition to IATs. The primary outcome was the mean IAT D score. Associations between IAT D scores and demographic and practice characteristics were also analyzed. RESULTS: Of the 49 OB-GYNs, 38 (77.6%) were female, mean age was 40 years, 29.5% were Japanese, 22.7% were White, and none were from a Micronesian ethnic group. The mean IAT D score in the Micronesian vs. White condition (N = 29) was 0.181, (SD: 0.465, p < 0.05) for the Attitude IAT and 0.197 (SD: 0.427; p < 0.05) for the Stereotype IAT. CONCLUSION: The findings from this pilot suggest a slight degree of implicit bias favoring Whites over Micronesians within this sample of OB-GYNs and warrant a larger investigation into implicit biases toward this unique and understudied Pacific Islander population.

Sex comparisons in neuropsychological functioning and reported symptoms following a sports-related concussion among high school athletes.

The aim of this study was to compare the neuropsychological functioning and symptoms of female and male high school athletes following a single concussion during the school year. The baseline test scores of the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) of 309 concussed athletes (169 females, 221 males) in varied sports were obtained. After a sport-related concussion, the athletes were re-administered the ImPACT, on the average, 7.25 days after the injury. MANCOVA compared the ImPACT baseline scores, post-concussion scores, and baseline-to-post-concussion changes of the female and male athletes, with p set at 0.01. The only significant sex comparison found females performing better on baseline visual motor speed (p < 0.001). Otherwise, no sex differences were found in baseline test scores, post-concussion scores, and baseline-to-post-concussion changes. The findings tentatively suggest that there are insignificant sex differences in the consequences of sport-related concussion after a week post-injury. Future studies on sex comparisons after a concussion are needed focusing on the acute and sub-acute phases of the recovery period.

Racial/Ethnic Disparities in Intensive Care Admissions in a Pregnant and Postpartum Population, Hawai'i, 2012-2017.

OBJECTIVE: Maternal morbidity and mortality is a global concern despite advances in medical care and technology and improved economic resources of nations worldwide. The primary objective of our study was to describe racial/ethnic disparities in severe maternal morbidity by using admission to an intensive care unit (ICU) as a marker. The secondary objective was to evaluate associations between patient characteristics, including obstetric outcomes, and severe maternal morbidity. METHODS: This retrospective cohort study used a large inpatient database to identify pregnancy and postpartum hospitalizations in Hawai'i from January 2012 through September 2017. We evaluated associations between sociodemographic and clinical characteristics and race/ethnicity by using χ2 tests. We used multivariable logistic regression to assess associations between race/ethnicity and ICU admission. We used a post hoc analysis to assess associations between ICU admission and obstetric outcomes by race/ethnicity. RESULTS: After adjustment, we found a significantly higher ICU admission rate among Asian (adjusted odds ratio [aOR] = 1.30; 95% CI, 1.04-1.62; P = .02), Filipino (aOR = 1.45; 95% CI, 1.17-1.79; P < .001), and Native Hawaiian/Other Pacific Islander (aOR = 1.39; 95% CI, 1.15-1.68; P < .001) women compared with non-Hispanic White women. Multiple clinical characteristics and outcomes were associated with ICU admission, such as preexisting chronic conditions and pregnancy-induced hypertensive disorders. CONCLUSION: We found that severe maternal morbidity represented by ICU admission is higher among Asian, Filipino, and Native Hawaiian/Other Pacific Islander women than among non-Hispanic White women in Hawai'i. Our findings reemphasize the need for health care providers to be vigilant in caring for members of racial/ethnic minority groups and managing their comorbidities.

Genetic risk factors associated with gestational diabetes in a multi-ethnic population.

AIMS: Genome-wide association studies have shown an increased risk of type-2-diabetes (T2DM) in patients who carry single nucleotide polymorphisms in several genes. We investigated whether the same gene loci confer a risk for gestational diabetes mellitus (GDM) in women from Hawaii, and in particular, Pacific Islander and Filipino populations. METHODS: Blood was collected from 291 women with GDM and 734 matched non-diabetic controls (Pacific Islanders: 71 GDM, 197 non-diabetic controls; Filipinos: 162 GDM, 395 controls; Japanese: 58 GDM, 142 controls). Maternal DNA was used to genotype and show allele frequencies of 25 different SNPs mapped to 18 different loci. RESULTS: After adjusting for age, BMI, parity and gravidity by multivariable logistic regression, several SNPs showed significant associations with GDM and were ethnicity specific. In particular, SNPs rs1113132 (EXT2), rs1111875 (HHEX), rs2237892 (KCNQ1), rs2237895 (KCNQ1), rs10830963 (MTNR1B) and rs13266634 (SLC30A8) showed significant associations with GDM in Filipinos. For Japanese, SNPs rs4402960 (IGFBP2) and rs2237892 (KCNQ1) were significantly associated with GDM. For Pacific Islanders, SNPs rs10830963 (MTNR1B) and rs13266634 (SLC30A8) showed significant associations with GDM. Individually, none of the SNPs showed a consistent association with GDM across all three investigated ethnicities. CONCLUSION: Several SNPs associated with T2DM are found to confer increased risk for GDM in a multiethnic cohort in Hawaii.

Disparities in Potentially Preventable Emergency Department Visits for Children with Asthma among Asian Americans, Pacific Islanders, and Whites in Hawai'i.

The cost burdens of potentially preventable emergency department visits for pediatric asthma were estimated for Asian Americans, Pacific Islanders, and Whites using Hawai'i statewide 2015-2016 data. The cost burden of the 3234 preventable emergency department visits over the study period was over $1.9 million. Native Hawaiians had the largest proportion (36.5%) of all preventable emergency department visits and accounted for the highest costs for the two years at $709,698. After adjusting for other factors, costs for preventable pediatric-asthma-related emergency department visits differed significantly by age, insurance provider, and island of residency. Reducing potentially preventable emergency department visits would not only improve health disparities among Native Hawaiians compared to other racial or ethnic populations in Hawai'i, but could also generate cost savings for public and private insurance payers.

A Cultural Dance Program Improves Hypertension Control and Cardiovascular Disease Risk in Native Hawaiians: A Randomized Controlled Trial.

BACKGROUND: Native Hawaiians have higher hypertension (HTN) and cardiovascular disease (CVD) rates than non-Hispanic whites, calling for culturally responsive interventions to close this gap. PURPOSE: We tested the effects of a 6-month behavioral intervention, a cultural dance program based on hula (the customary dance of Hawai'i), for improving blood pressure (BP) and CVD risk among Native Hawaiians with uncontrolled HTN. METHODS: In a randomized controlled trial, we tested the effects of the hula-based intervention among 263 Native Hawaiians with uncontrolled HTN (systolic ≥ 140 or ≥ 130 mmHg if diabetes) and no CVD at enrollment. All participants received a brief culturally tailored heart health education before random assignment to the hula-based intervention (n = 131) or the education-only waitlist control (n = 132). Intervention received hula lessons and group-based activities for 6 months. Control received only 1-week education through 6 months. RESULTS: Intervention yielded greater reductions in systolic (-15.3 mmHg) and diastolic (-6.4 mmHg) BP than control (-11.8 and -2.6 mmHg, respectively) from baseline to 6 months (p < .05). At 6 months, 43% of intervention participants compared to 21% of controls achieved a HTN stage <130/80 mmHg (p < .001). The 10-year CVD risk reduction was two times greater for the intervention group than the control group based on the Framingham Risk Score calculator. All improvements for intervention participants were maintained at 12 months. CONCLUSIONS: This trial represents one of the few rigorously conducted examinations of an Indigenous practice leveraged for health promotion, with implications for other ethnic populations.

Invalid Baseline Testing with ImPACT: Does Sandbagging Occur with High School Athletes?

The aim of this large-scale research was to determine the frequency of valid, invalid, and sandbagging results in ImPACT baseline testing of high school athletes. This retrospective study identified valid, invalid (identified by five embedded Invalidity Indicators), and sandbagging (identified by three "red flags") results in the ImPACT baseline test scores of 6,346 high school athletes. In addition, the ImPACT postconcussion scores of 266 athletes who sustained a concussion during the school year were evaluated to compare the baseline-to-postconcussion changes of valid versus a combined group of invalid and sandbagging scorers. There were 3,299 (51.99%) athletes who had valid baseline scores, 269 (4.24%) had invalid scores, and 3,009 (47.42%) had sandbagging scores. (There were 231 who obtained both invalidity and sandbagging scores.) The overall difference in baseline-to-postconcussion changes between the valid scorers and the combined group of invalid and sandbagging scorers was statistically significant. The high rate of athletes who had invalid and sandbagging scores raised concern that the underperformance of baseline testing occurs more commonly than is probably realized by those who utilize computerized neuropsychological testing with high school athletes. Accordingly, efforts are needed to improve test administration procedures so that maximal attention and effort can be maintained among the test takers. In the meantime, increased caution is called for in employing the baseline-to-postconcussion paradigm when return-to-play decisions are made.