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  • Faculty helps build China's first global health curriculum

    Posted Feb 5, 2019 at 2:30pm

    China is facing an increasing demand for health professionals with a background in global health issues, and University of Hawaiʻi at Mānoa Professor Yuanan Lu is working to help Chinese universities meet this demand for a highly-trained public health workforce.

    Recently Lu, of the Office of Public Health Studies at the Myron B. Thompson School of Social Work, collaborated with global healthexperts on a project to create the first global health bachelor curriculum in China. The new program at Wuhan University can be used as a guide for other institutions that want to develop similar programs.

    “We wanted to create a curriculum that will provide students with a strong background in understanding and addressing global health issues, such as food security and maternal-child health,” Lu said. “We wanted the students of this program to graduate and be prepared to become health professionals with international and intercultural competencies.” Lu and his colleagues published a paper outlining the new curriculum in BMJ Open.

    Expanding collaborative efforts in China

    In a separate project, Lu worked with collaborators at Fudan University to test drinking water in the city of Shaoxing for chemicals called nitrosamines, which are linked with cancer and stillbirths. Shaoxing is a developing, middle-sized city located in the Yangtze River Delta.

    Researchers found that the levels of some nitrosamines exceeded the levels allowed in U.S. drinking water by the Environmental Protection Agency. The findings show that there is an urgent need to improve nitrosamine regulations in China, the researchers wrote in their study, published in December in Environmental Science and Pollution Research.

    Building a thriving public health exchange program with China

    Both projects stemmed from a thriving international exchange program between UH Mānoa’s Office of Public Health Studies and several schools of public health and traditional Chinese medicine in China. Lu is the chair of the program.

    As China’s economy continues to grow, health issues and health inequality have quickly become challenges for the country, Lu says. Since the exchange program began in 2007, 22 faculty members and 39 students from UH Mānoa’s Public Health have gone to China, and more than 200 faculty members and students have come to UH Mānoa from Wuhan University, Nanchang University and Fudan University.

    The program has resulted in more than 100 published research papers over 12 years.

    “Global health education programs are common in universities in many highly-developed countries today, and now China is working to establish a better health care education system,” Lu said. “This system will help the country to address health issues and conduct research to provide evidence for policy-making decisions.”

  • Chuukese People in Hawai‘i Commonly Experience Racial Discrimination, UH Public Health Research Finds

    Posted Jan 10, 2019 at 7:05am

    Chuukese people face many barriers to accessing medical care in Hawaiʻi, and now a new study shows that many Chuukese may experience racial discrimination, leading to poor access to appropriate healthcare.

    The study also found that Chuukese people face other barriers including miscommunication with providers. They endure insensitive remarks when trying to access services, and face great difficulties navigating the healthcare system due to the differences between the US and Chuukese systems.

    "This study highlights the importance of addressing racial discrimination, cultural beliefs, and community assets when working towards health and healthcare equity for the Chuukese," said Megan Kiyomi Inada, DrPH, the lead researcher on the study. Dr. Inada, formerly with UH Public Health, now works at Kokua Kalihi Valley Comprehensive Family Services, a federally-qualified health center in Kalihi.

    For the study, Dr. Inada interviewed nine Chuukese community members in Hawaiʻi and eight healthcare providers, including physicians, interpreters, and community health workers who provide health services to Chuukese people. The researchers then analyzed transcripts of the interviews.

    Results showed that almost all of the Chuukese community members in the study said that they or someone they know had received poor care or heard rude remarks from providers. Several providers in the study reported that they had witnessed colleagues discriminating against Chuukese patients.

    The participants also reported that aside from racial discrimination, other barriers that prevent Chuukese people from getting the health care they need include a lack of appropriate healthcare coverage, financial resources, health literacy, and access to food and transportation.

    In Chuuk, patients do not need to make appointments, nor do they need to pay to see providers. When they come to Hawai‘i, inadequate insurance coverage becomes a barrier.  Many migrants who come to the US from Micronesia are not able to fully participate in government programs such as Medicaid.

    For those with limited English, this is compounded by communication barriers. Although some providers have interpreters available, Chuukese culture includes a general reluctance to discuss health problems with a person who is not a family member. Also, the prospect of seeing several physicians at different locations can quickly become overwhelming.

    Still, the researchers reported that the study participants identified several solutions. Building trust with Chuukese community and educating patients on navigating the healthcare system, as well as educating providers about the Chuukese history and culture could help to reduce the barriers, they said.

    “Mistaken assumptions and harmful stereotypes could be overcome by working to build stronger patient-provider relationships, mutual understanding, and respect,” notes Dr. Inada.

    The study will be published in the January 2019 issue of the journal Social Medicine. Inada's co-authors included Kathryn L. Braun, DrPH, the director of UH Public Health, and Tetine Sentell, PhD, an associate professor with UH Public Health. Co-authors also included Parkey Mwarike, of the College of Micronesia in the Federated States of Micronesia, Kevin Cassel, DrPH, of the University of Hawai‘i Cancer Center, Randy Compton, JD, of the  William S. Richardson School of Law, and Seiji Yamada, MD, MPH, of the John A. Burns School of Medicine.

  • To prevent chronic disease in Hawai‘i, researchers look to Albania

    Posted Jan 9, 2019 at 6:15am

    In Albanian, “Si je?” means “How are you?” Public health researchers at the University of Hawaiʻi at Mānoa asked exactly that question of an innovative new health program in Albania. Their analysis shows how one country is making progress toward a goal of preventing chronic diseases like diabetes and heart disease on a national level. Their findings hold lessons for other locations, including Hawaiʻi.

    A global effort is underway to prevent chronic diseases, rather than focus on treating people once they become ill. Toward this goal, the small European country of Albania launched an innovative health program in 2015, called “Si je?” which encourages middle-age adults to go to their local community health center every year for a free check-up. The program is aimed at shifting healthcare resources toward disease prevention through personal contact with primary healthcare providers.

    “Right now, there is a growing understanding worldwide that in order for a nation to be healthy, it has to have a health system that aims to prevent chronic diseases, not just treat patients once they are sick,” said Tetine Sentell, lead author of the study and an associate professor with UH Mānoa Office of Public Health Studies in the Myron B. Thompson School of Social Work. “Our new study shows that the Si Je? program is working—it is building a culture of prevention and health in Albania.”

    Study results and challenges

    Researchers analyzed the screening database created from this program and conducted interviews with 15 health center directors. Results showed that about 270,000 people got a checkup during the program’s first year, which is more than a quarter of the number of people who were eligible. The program also successfully strengthened links between communities and health centers and had higher-than-expected participation rates in rural communities. As in Hawaiʻi, family members were important motivators to getting check-ups and screening.

    But challenges remain. The researchers noted a need for greater participation among some groups. For example, men had lower participation than women.

    Building a culture of prevention

    The study found that Albania, like Hawaiʻi, seeks to build a culture of prevention that will reduce health inequities by increasing patient-centered relationships with clinicians and the healthcare system and by diversifying the primary healthcare workforce to meet community needs.

    “Lessons can be learned by studying country-wide transformative programs such as Si Je? that extend far beyond Albania,” said Catherine M. Pirkle, assistant professor of public health and a co-author of the study.

    “For example, the activities to reinforce community-clinical linkages resemble similar efforts in Hawaiʻi, which may help us here as we seek to strengthen the relationships and bridges between our primary care centers with the communities they serve,” Pirkle said.

    The study was published online November 30 in Prevention Science and is a collaborative outcome from Sentell’s Fulbright Specialist program stay in Tirana, Albania in January 2017.

  • Public Health Undergrads' Hard Work Pays Off with Successful Undergrad Summit

    Posted Dec 6, 2018 at 11:18am

    After months of data collection, analysis, and thinking critically about public health issues, more than 50 undergraduate public health students put their hard work on display on Thursday in the Public Health Undergraduate Summit.

    The bi-annual event drew students and faculty members from all over the UH campus, as well as alumni and public health community members, who came to see the students' posters exhibited at the Biomed building.

    "This semester's summit was a huge success," said Denise Nelson-Hurwitz, assistant professor and chair of the public health undergraduate program. "These projects from our undergraduate students make a valuable contribution to the public health community and to research being conducted here in Hawaiʻi."

    The students' projects spanned all aspects of public health, and many projects focused on the health of Native Hawaiians or other Indigenous peoples. Leila Chang's project explored the relationships between globalization and changes in the diet of Samoans, and Cherry Yamane's project looked at ways to reduce health disparities in Indigenous populations using interventions that are based on culture.

    In one project, which dealt directly with health at UH Mānoa, Pua Yang conducted an assessment of mosquito breeding sites on campus. Mosquito larvae were found most often in littered coffee cups, which accumulate standing water. So, something as simple as reducing litter could prevent the spread of mosquito-born infections on campus.

    Prevention was a popular theme with other students as well, with a project on preventing cardiovascular disease from Kelly Knowles, a project on preventing breast cancer by Nathalie Lozano, and one on preventing diabetes by Haleigh Romero.

    Some students presented their literature reviews, an early step of completing a project, and are slated to present their completed projects at the next Public Health Undergraduate Summit in May 2019. Julia Andaya presented her literature review on promoting oral health education in kids, and Charlene Mikee Nguyen presented her early findings on promoting breastfeeding for expectant women.  

    "Student capstone projects make a difference in the way we understand the public health issues facing our communities," Nelson-Hurwitz said. These capstone projects are completed over three semesters of coursework, where students first familiarize themselves with a public health topic, then work to address it under the mentorship of a community-based or research faculty advisor, then finally link their field experiences and academic learning into a final paper and poster presentation.  

    “The projects show that our students are truly well-prepared to enter the public health workforce in Hawaiʻi or go on to graduate school,” Nelson-Hurwitz said. "It is always exciting to see where our students go next with their work."

    The Bachelor of Arts in Public Health at the University of Hawaiʻi at Mānoa is a new and exciting undergraduate degree program, preparing students for careers in multiple professional pathways in public health. High school students applying to the University of Hawai‘i at Mānoa may declare Public Health as their major upon entry. For further information about the program, contact the Undergraduate Advisor at phadvise@hawaii.edu.

  • Study of uterine ruptures in West Africa supports health-system improvement

    Posted Nov 14, 2018 at 8:23am

    Tearing of the uterus is a serious complication in pregnancy that can lead to bleeding, shock and even death. Uterine rupture is very rare in the United States but is more common in low-income nations. A study from University of Hawaiʻi at Mānoa public health researchers that examined data from two countries in West Africa shows that women whose labor slows down or stops altogether, resulting in the need to be transferred to a higher-level hospital, are at increased risk of uterine rupture.

    Researchers led by Rebecca Delafield, a PhD student with the Office of Public Health Studies in the Myron B. Thompson School of Social Work, looked at data from the medical records of nearly 85,000 women who gave birth over the course of one year in Senegal and Mali. The researchers found that 569 of the women had suffered a uterine rupture while giving birth.

    “The fact that uterine rupture is so rare in high-income nations demonstrates that it is largely preventable,” said Delafield. “We wanted to find out what increases the risk of suffering a uterine rupture for women. A better understanding of the factors involved could point to ways to prevent this outcome and possibly save lives.”

    Obstructed labor strong predictor of uterine rupture

    The data showed that the likelihood of a woman experiencing a uterine rupture increased with the number of times she had given birth. Women in the sample who had given birth five or more times were nearly eight times more likely to suffer a uterine rupture compared with women who had given birth once.

    But the strongest single factor that influenced a woman’s risk of uterine rupture was “obstructed labor,” meaning that her labor had slowed down or stopped.

    “We were not surprised to see obstructed labor was a strong predictor of uterine rupture,” Delafield said. “But what this study also shows is that, in addition to obstetric factors, health system factors increase the likelihood of uterine rupture in this population.”

    The women in the study who had obstructed labor and were transferred to a higher-level hospital were 46 times more likely to experience a uterine rupture compared with women who did not have obstructed labor and did not need to be referred to the higher-level hospitals.

    Findings support health-system improvements

    Said Delafield, “Our findings suggest that women would benefit from improvements in the health systems in these settings. By improving the quality of care at the smaller, local hospitals or by transferring patients with obstructed labor more quickly, women might receive the care they need in time to prevent uterine rupture.”

    The study was published November 1 in the journal BMC Pregnancy and Childbirth. Delafield’s co-authors include Catherine Pirkle, an assistant professor with the UH Office of Public Health Studies, and Alexandre Dumont, a researcher at the Research Institute for Development in Marseille, France.

  • Happiness, health missing from measuring nation's well-being

    Posted Nov 5, 2018 at 6:37am

    Imagine that you had to choose between living your life with only the goods available in the 1950s (say goodbye to your cell phone), or living with only the health outcomes of that time (you’d live 11 years less, on average). Which would you pick?

    Most people would choose the latter, which is why, in a paper published in The BMJ medical journal, the point is made that investments in improving a country’s public health should not be overshadowed by obsession over gross domestic product (GDP).

    GDP represents the value of all goods and services produced in a country within one year. It does not include any measure of non-economic conditions, such as the quality of schools or the environment, or length of people’s lives.

    “GDP undervalues the true worth of human health,” says Victoria Fan, lead author and assistant professor in the Office of Public Health Services in the Myron B. Thompson School of Social Work at the University of Hawaiʻi at Mānoa. “There are other measures that can provide a fuller picture of the value of investing in health.”

    Although GDP is often cited by political leaders and economists as the definitive measurement of well-being, it falls far short of capturing the value of human life.

    “GDP can tell us whether the economy is growing, but it doesn’t tell us anything about how healthy and safe people are in their day-to-day lives,” said Fan. “Being healthy and safe, and living in a fair and equitable society, are important components of people’s freedom to live their lives how they truly want to.”

    Other measurements better illustrate the value of health, said Fan, citing “value of life years” (VLYs) or the estimate of how much people value living longer. The question offering a choice between material goods and longer life was posed by Yale economist William Nordhaus as one way to measure VLYs.

    “We think that GDP should be used alongside other indicators of progress, such as life expectancy, which captures other aspects of well-being,” said Fan.

  • Gun Violence A Defining Public Health Issue

    Posted Oct 29, 2018 at 2:36pm

    MPH (HPM) student Katey Peck wrote an editorial in Civil Beat https://www.civilbeat.org/2018/10/gun-violence-a-defining-public-health-issue/

  • Start of new relationship is important time for HIV prevention

    Posted Oct 22, 2018 at 10:30am

    For same-sex male couples, the first few months of a new relationship are a crucial time to communicate about sexual health and HIV prevention, according to new findings from public health researchers at the University of Hawaiʻi at Mānoa. The research may ultimately help to lower new HIVinfections for this group.

    For the study, same-sex male couples were sought through advertising on Facebook. A total of 722 men (representing 361 couples) were enrolled in the study, and completed a questionnaire asking about the timing of when they first discussed their HIV status, had sex without a condom, and if and when they had reached an agreement about whether or not they would have sex with anyone else.

    The results showed that more than half of the men had talked about their HIV status on the first day of their relationship, and more than 80 percent had talked about it during the first two weeks. The results also showed that about one quarter of the men reported having sex without a condom on the first day of their relationship, and about 60 percent reported doing so during the first three months. However, there were some differences based on the men’s and couples’ HIV-status.

    “In our study, we wanted to look at same-sex males couples and determine, within their relationships, when they start having conversations about their HIV status, when they start having sex without a condom, and deciding what kind of relationship they want,” said Jason Mitchell, lead author of the study and an assistant professor with the UH Mānoa Office of Public Health Studies in the Myron B. Thompson School of Social Work. “Knowing this timeline could give the public health research community ideas for ways to intervene to help improve HIV prevention efforts for same-sex male couples in the U.S. and abroad.”

    Research shows that men who have sex with men (a group that includes men who are gay, bisexual, questioning their sexual identity or orientation, or heterosexual but having sexual encounters with other men) have elevated rates of HIV infection. Epidemiological estimates from other studies indicate that between 33 to 66 percent of men who have sex with men acquire HIV while in a same-sex relationship, and that this risk is attributed to the sexual behaviors they engage in with their primary partner.

    “The new findings suggest that many couples find it important to communicate about their HIV status before they first engage in sex without a condom,” Mitchell said. The new data provide researchers with a good summary of the timing of when these events occur within same-sex male couple relationships, he said.

    Mitchell and his research team secured funding from the National Institute of Mental Health via an R21 grant, which is intended to encourage exploratory/developmental research. Their goal is to apply these findings toward the development of a web-based “decision aid” aimed at helping same-sex male couples in new relationships create a plan on how best to reduce their risk for HIV. The researchers will also test this decision aid to determine whether couples find it useful and effective.

    The new study was published on October 8 in The Journal of Sex Research. Mitchell’s co-authors on the study include Yan Yan Wu, an assistant professor of public health at UH, and Kristi E. Gamarel, an assistant professor with the University of Michigan School of Public Health.

  • Health declines are more rapid in older women with urinary incontinence

    Posted Oct 22, 2018 at 10:28am

    As women age, their ability to get around affects their quality of life. A new study shows that older women’s physical functioning declines more rapidly if they develop urinary incontinence, according to public health researchers at the University of Hawaiʻi at Mānoa.

    Catherine Pirkle and Yan Yan Wu, both assistant professors in the Office of Public Health Studies in the Myron B. Thompson School of Social Work, collaborated with researchers in Brazil, Colombia and Canada to recruit approximately 900 women in their sixties and seventies from those three countries plus Albania. About 25 percent of women over age 60 experience urinary incontinence.

    Study participants completed a short test of physical functioning, which included measuring the speed of their usual walking pace, checking their balance and testing how fast they could stand up from a chair. The women also completed a questionnaire about their health, which included a query about whether they had experienced any leakage of urine in the past week. After two years, the women repeated the physical functioning test.

    Pirkle said the researchers were surprised by how much physical function had decreased over a two-year period in women who had reported experiencing urine leakage at the study’s start.

    “The loss of physical function in this group was quite large and happened very rapidly,” said Pirkle. “We know that, as women age, they tend to experience more functional limitations and disability than men do. But the reasons for this gender gap are not clear.”

    Cycle of incontinence and decreasing physical activity

    Wu said one supposition is that women who experience incontinence start to engage in less physical activity out of fear of losing urine. This could lead to a vicious cycle, as a reduction in physical activity leads to worsening incontinence and overall health.

    But it’s possible that other factors, such as giving birth to many children, may contribute to both urinary incontinence and a physical performance decline. Pirkle and Wu said the next step for the research team is to look at whether women’s reproductive lives, such as the number of children they have and their history of gynecological or obstetric problems, influence their risk of incontinence, as well as other health outcomes of importance to older women.

    The study was published in the September 2018 Journal of Aging and Health. Pirkle and Wu’s collaborators on the study include Luana Caroline de Assunção Cortez Corrêa and Saionara Maria Aires da Câmara of the Federal University of Rio Grande do Norte in Brazil; Afshin Vafaei of Lakehead University in Canada; and Carmen-Lucia Curcio of Universidad de Caldas in Colombia.

  • Researchers encourage more farmers' markets to accept SNAP debit cards

    Posted Sep 26, 2018 at 8:39am

    The heaps of fresh vegetables and tropical fruits stacked high on tables at local farmers’ markets could be a boon to the health of Hawaiʻi families. But in many cases, those who could benefit most from the healthy fare may be missing out, according to a new study led by public health researchers at the University of Hawaiʻi at Mānoa.

    Opal Vanessa Buchthal, an assistant professor with the UH Office of Public Health Studies, led team members who mapped out farmers’ markets on Oʻahu using a geographic information system spatial analysis. The researchers then looked at which farmers’ markets were equipped to accept debit cards through the state’s Supplemental Nutrition Assistance Program (SNAP), and the number of people with SNAP benefits in nearby neighborhoods.

    They found that, while 75 percent of low-income families on Oʻahu live near a farmers’ market, only nine of the 55 markets accept SNAP debit cards.

    “People with limited resources tend to have higher rates of chronic diseases, and also may have a difficult time finding affordable, healthy food close to where they live,” Buchthal said. “Farmers’ markets are a great way to increase access to food, but there is one more step that’s needed to help families: to equip the markets to accept SNAP debit cards.”

    The researchers calculated that if farmers’ markets in just six specific neighborhoods were to start accepting the debit cards, two-thirds of Oʻahu‘s SNAP participants would benefit. The six neighborhoods include five locations in urban Honolulu (Liliha, Downtown/Fort Street, Lower Makiki/Punchbowl, Ala Moana/Rycroft and Mōiliʻili/McCully), and one location on the (Pōkaʻicoast Bay/Lualualei Beach Park).

    “Equipping these six markets to accept SNAP cards would substantially improve access to healthy foods for the county’s low-income residents,” Buchthal said.

    The study was published August 29 in Public Health Nutrition. Buchthal’s co-authors on the study were Denise Nelson-Hurwitz, who is also an assistant professor with the UH Office of Public Health Studies; Grace Wolff, a graduate student with the UH Department of Urban and Regional Planning; and Daniela Kittinger and Danielle Schaeffner at the state Department of Health.

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