The Ahalaya case management model was designed to provide culturally sensitive services to HIV-positive American Indians (AI), Alaska Natives (AN), and Native Hawaiians (NH). This program started in 1991 and expanded across the country in 1994. The evaluation plan included a client satisfaction survey, along with focus groups and key informant interviews. Of the 389 active clients enrolled, 132 responded to the anonymous 35-item questionnaire. Responses were favorable regarding benefits of the programs. Self-reported quality of life changes after enrollment also were significantly improved (Wilcoxon Signed Rank Test: T=6.87, p=.000; n=131). Qualitative data highlighted other important issues. Social relationships-with staff, community, and family-were critical to client welfare, as a source of both strength and fear. While AI/AN/NH case management programs have been shown effective, services need to expand, and they have to facilitate resolutions to problems in clients social relationships.
Comparisons of cancer survival in Canadian and US metropolitan areas have shown consistent Canadian advantages. This study tests a health insurance hypothesis by comparing cancer survival in Toronto, Ontario, and Honolulu, Hawaii.
Ontario and Hawaii registries provided a total of 9190 and 2895 cancer cases (breast and prostate, 1986-1990, followed until 1996). Socioeconomic data for each person's residence at the time of diagnosis were taken from population censuses.
Socioeconomic status and cancer survival were directly associated in the US cohort, but not in the Canadian cohort. Compared with similar patients in Honolulu, residents of low-income areas in Toronto experienced 5-year survival advantages for breast and prostate cancer. In support of the health insurance hypothesis, between-country differences were smaller than those observed with other state samples and the Canadian advantage was larger among younger women.
Hawaii seems to provide better cancer care than many other states, but patients in Toronto still enjoy a significant survival advantage. Although Hawaii's employer-mandated health insurance coverage seems an effective step toward providing equitable health care, even better care could be expected with a universally accessible, single-payer system.
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Total alkalinity (AT) is an important parameter for describing the marine inorganic carbon system and understanding the effects of atmospheric CO2 on the oceans. Measurements of AT are limited, however, because of the laborious process of collecting and analyzing samples. In this work we evaluate the performance of an autonomous instrument for high temporal resolution measurements of seawater AT. The Submersible Autonomous Moored Instrument for alkalinity (SAMI-alk) uses a novel tracer monitored titration method where a colorimetric pH indicator quantifies both pH and relative volumes of sample and titrant, circumventing the need for gravimetric or volumetric measurements. The SAMI-alk performance was validated in the laboratory and in situ during two field studies. Overall in situ accuracy was -2.2 ± 13.1 µmol kg(-1) (n = 86), on the basis of comparison to discrete samples. Precision on duplicate analyses of a carbonate standard was ±4.7 µmol kg(-1) (n = 22). This prototype instrument can measure in situ AT hourly for one month, limited by consumption of reagent and standard solutions.
Little is known about breast cancer screening practices or predictors of age-specific screening for Samoan women.
Through systematic, random sampling procedures, we identified and interviewed 720 adult (> or =30 years) Samoan women residing in American Samoa, Hawaii, and Los Angeles. Multivariate logistic regressions were performed to determine independent predictors for recent age-specific screening.
Only 55.6% of women (> or =30 years) had ever had a CBE and 32.9% of women (> or =40 years) had ever had a mammogram. Furthermore, only 24.4 and 22.4% of Samoan women (> or =40 years) residing in Hawaii and Los Angeles, respectively, had an age-specific mammogram within the prior year. Independent predictors of age-specific CBE screening included age, education, health insurance, ambulatory visit, and being a resident of Hawaii or Los Angeles; those for mammography included ambulatory visit and awareness of screening guidelines.
Population-based estimates of age-specific breast cancer screening among Samoan women are lower than the national objectives and those reported for other minorities. Targeted efforts that address doctor-patient communication on preventive behavior, improved access to health care services (especially in American Samoa), and focused educational awareness programs are needed to improve the dismal screening rates observed in this indigenous population.
The frequency and form of the middle trigonid crest (MTC) in lower permanent molars is reported for 1,131 dental casts of Bushman (San), Bantu, Solomons, Hawaiians, Pima, Eskimo, Navajo, Chinese, and American whites. The MTC occurs most often on the first molar. We found very little intra-trait variation, so observations were scored on a present-absent basis. The MTC is most frequent in the African samples and rare in those of the other populations. Two reference plaques can be obtained to add to the existing series in the ASU dental anthropology system.
In 2000, cancer health indicators for Native Hawaiians were worse than those of other ethnic groups in Hawai'i, and Native Hawaiians were under-represented in research endeavors. To build capacity to reduce cancer health disparities, 'Imi Hale applied principles of community-based participatory research (CBPR) and empowerment theory. Strategies included: 1) engaging Native Hawaiians in defining cancer priorities; 2) developing culturally appropriate processes and products; 3) supplementing primary and secondary cancer prevention activities; 4) offering skills training and technical assistance; and 5) providing an infrastructure to support culturally appropriate research. Between 2000 and 2005, 'Imi Hale involved more than 8000 Native Hawaiians in education, training, and primary and secondary prevention activities; developed 24 culturally tailored educational products (brochures, curricula, and self-help kits); secured $1.1 million in additional program and research funds; trained 98 indigenous researchers, 79 of whom worked on research projects; and engaged more than 3000 other Native Hawaiians as research participants and advisors. Evidence of empowerment was seen in increased individual competence, enhanced community capacity and participation, reduced barriers, and improved supports to address cancer in Hawaiian communities. Operationalizing CBPR and empowerment requires a commitment to involving as many people as possible, addressing community priorities, following cultural protocol, developing and transferring skills, and supporting an infrastructure to reduce barriers and build supports to sustain change. This approach is time consuming, but necessary for building competence and capacity, especially in indigenous and minority communities. Cancer 2006. (c) 2006 American Cancer Society.
Little is known about the cancer control needs of American Samoans. This report provides some of the first data on cancer incidence among American Samoans in Hawaii.
The Hawaii Tumor Registry, a Surveillance, Epidemiology, and End Results population-based, active cancer surveillance program, provided archival data on American Samoans residing in Hawaii and on those referred to Hawaii for diagnosis and treatment from the U.S. Territory of American Samoa.
In American Samoan males, the more commonly encountered cancers included cancer of the lung, prostate, stomach and liver, and leukemia. In American Samoans females, breast carcinoma was most frequent, followed by cancer of the corpus uteri, cervix uteri and thyroid, and leukemia. Females were more likely than males to receive a diagnosis of cancer at an early age: 34.5% of females and 19.9% of males with cancer were diagnosed when they were between the ages of 0 and 44 years. Males were more likely than females to be diagnosed with cancer after metastasis had occurred (45% vs. 33.9%). Compared with other Polynesians (i.e., Western Samoans and Hawaiians), American Samoan males have a relatively higher frequency of lung, prostate, thyroid, and liver cancers and a lower frequency of colon and rectum cancers. American Samoan females, compared with other Polynesians, have a higher frequency of leukemia and corpus uteri, thyroid, and pancreatic cancers and a lower frequency of colon and rectum cancers.
The data provide baseline information that has important public health and research implications for cancer control programs for this population.
Variations in cancer incidence among whites in 1973-77 in 8 geographic areas of the Pacific Basin were compared. Substantial differences were found for the occurrences of lung cancer, cancer of the corpus uteri, and malignant melanoma. White women living in New Zealand and Australia had the lowest risk of developing lung cancer, whereas white men living in the western United States had the highest risk. Cancer of the corpus uteri occurred more commonly in the western United States than elsewhere in the Pacific Basin. Geographic areas located closest to the equator experienced the highest incidence of malignant melanoma. In all areas, the incidence rates of cancers of the lung and corpus uteri and malignant melanoma increased significantly between 1960-66 and 1973-77; after the mid-1970s, rates of cancer of the corpus uteri declined. The incidence of stomach cancer decreased in all areas. Although cervical cancer decreased in incidence over time for most women, it increased noticeably in young women. The incidence of breast cancer also rose during the 17-year period. In at least 1 geographic area, the observed increases in breast cancer incidence were confined to women under age 40.