Principal investigator and Office of Public Health Studies Associate Professor Tetine Sentell, says, “We were interested in patient perspectives on the role of housing as contributing to their potentially preventable hospitalization.”
Said Michelle Quensell, MPH '15, lead author of the study and a UH public health graduate, “We talked to 90 patients, and almost 25 percent reported a housing-related issue as a major factor in hospitalization. About half of these patients were homeless, noting the high cost of housing in Hawaiʻi.”
“Patients said it was hard to care for their diabetes or heart disease when they were living without amenities such as refrigeration, running water, a stove or a safe place to store medications,” added Sentell. “Patients also mentioned challenges of following diet plans when canned goods were the only available foods at the shelters and food banks.”
Several major health providers in Hawaiʻi have recently created innovative new programs to address social determinants, including housing, within the health care setting to improve health care quality and reduce health care costs. This research strongly supports these efforts.
Other investigators include Kathryn Braun, UH Public Health, Deborah Taira, Daniel K. Inouye College of Pharmacy at UH Hilo, and Todd Seto, Queen’s Medical Center.
Congratulations to the 2017 UH Mānoa Awardees from our very own Public Health program ‘ohana - doctoral student, Mapuana, and assistant professor, Denise Nelson-Hurwitz!
Dr. Nelson-Hurwitz received the Frances Davis Award for Excellence in Undergraduate Teaching. She was selected because of her incredible work developing and teaching the BA in public health.
Mapuana Antonio won the Student Excellence in Research Award for her studies of Native Hawaiian physical and mental health resilience. Mapuana graduated in May 2017 with her DrPH and is now teaching at Leeward Community College.
Assistant Professor Catherine Pirkle (Health Policy and Management) has been selected as a Fulbright Specialist by the J. William Fulbright Council for International Exchange of Scholars. She will collaborate with faculty at the College of Health Sciences of Trairí (FACISA), which is a rural satellite campus of the Federal University of Rio Grande do Norte in Northeast, Brazil.
Dr. Pirkle will be working on FACISA’s health system and research capacity to address issues such as reproductive and sexual health including early pregnancy, sexually transmitted diseases and violence against women. She will lead teacher training and participate in short-term lecturing and seminars.
Dr. Pirkle has a long history of working in underserved global settings including West Africa and Arctic regions. She has strong, long-term international connections to research teams around the globe with which to link faculty and staff at FACISA. She will help prepare students to address critical public health needs and to attract more local and international students.
As a Fulbright Specialist, Dr. Pirkle will also be considered for additional future overseas assignments that require her unique expertise during the next three years.
BeneFISHiary, an app created in part by University of Hawaiʻi at Mānoa Office of Public Health Studies Assistant Professor Catherine Pirkle, provides location-specific data and the risks and benefits of Bermudian fish species. Pirkle worked in close collaboration with Philippe Rouja of the Ocean and Human Health Research Programme in Bermuda and Tidjane Tall of HUACTIVE.
App users can search or browse fish and get detailed information about the mercury concentrations and nutrients such as selenium and omega-3 fatty acids in that particular species. The app also provides information about the sustainability of local and imported fish, as well as which lower mercury level fish can substitute for their higher relatives.
The BeneFISHiary app was recognized with a 2016 International Association for Ecology and Health Small Grant Award. The app is in a beta version with plans for scale-up to other communities and enhanced features including updated fish inventories.
The app was developed following a study on the consumption of fish by pregnant women in Bermuda and the effectiveness of public health messaging on mercury in fish. The study, “Examining the Impact of a Public Health Message on Fish Consumption in Bermuda” was published in PLOS One. It found that public health messaging warning of the dangers of mercury exposure from consumption of certain fish appeared to be effective, but adjustments needed to be made to promote consumption of healthy and sustainable fish with lower mercury levels. The BeneFISHiary app was created to help consumers make those adjustments, as well as healthcare providers who counsel pregnant women.
The data for the app was collected in Bermuda, however, with additional funding, Pirkle sees the potential to expand the use of the app to Hawaiʻi and other coastal communities with strong ties to their local environments.
BeneFISHiary is available for free at the iTunes store and the Google Play store.
Assistant Professor Victoria Fan, Associate Professor Timothy Halliday and Bradley Chen investigated infant and child mortality in after the 2010 earthquake in Haiti. Their study “The impact of internal displacement on child mortality in post-earthquake Haiti: a difference-in-differences analysis” was published in the International Journal for Equity in Health.
The study found that births from camp households had higher infant mortality and child mortality than those not living in camps. These odds are higher despite better access to food, water, bed net use, mosquito spraying and vaccines among camp households. Efforts are needed to identify vulnerable populations to provide targeted assistance in post-disaster relief.
“The data indicates that those living in camps are getting several key health services, but the services may not be of adequate quality to reduce child mortality,” said Fan. “We also found that those who did not or could not move, either to camps or elsewhere, are quite vulnerable as well. These populations are the literally ‘left behind.’”
“In carrying out disaster relief, providing a lot of materials and supplies to camps is not sufficient,” said Chen. “Despite better access to food, water and vaccines, kids in camps are still having worse health than other migrant and displaced households. Those reasons need to be better understood.”
In a newly published World Health Organization report, “The Health Workforce in India,” co-author University of Hawaiʻi at Mānoa Assistant Professor Victoria Y. Fan has brought attention to the level of education and medical qualifications of physicians and other healthcare providers in India. Fan and co-author Oxford University Professor Sudhir Anand’s 104-page book includes a three-page summary of key findings.
“The monograph examines the distribution, patterns and inequalities of the health workforce in India by education, gender and urban-rural stratum,” says Fan. “The report also lists the districts that lack any qualified nurses and qualified dentists, which may be useful for policymakers who wish to address these significant disparities that affect access to healthcare services.”
News articles published in India on the study:
WHO report sounds alarm on ‘doctors’ in India, The Hindu, July 18, 2016
Under-educated doctors, rural-urban divide and a stark gender gap. WHO study's shocking data on Indian healthcare, India Today, July 18, 2016
Assistant Professor Catherine Pirkle is the primary author of “Managing mercury exposure in northern Canadian communities,” which was published in the Canadian Medical Association Journal. The journal is ranked in the top 10 medical journals in the world.
The review provides guidance for healthcare providers on the effects of mercury exposure and how to manage it in patients who consume diets high in fish and marine animals. Mercury exposure is common in communities in Canada’s north, especially in indigenous peoples who consume fish and other wild food with high mercury content, yet current clinical guidelines are not adequate for this population.
“Communities that frequently consume predatory fish and/or marine mammals have elevated mercury exposure,” said Pirkle. “It is important for clinicians to be clear on the potential risks, the complexity of the underlying epidemiological data and how to approach, in a culturally sensitive manner, communities where mercury exposure may be a concern.”
Dangers of mercury exposure
Mercury exposure in pregnant women can have multiple effects in children, affecting brain development. In adults, mercury poisoning can cause vision changes, numbness in extremities, muscle weakness, cognitive changes and even death. Symptoms of mercury poisoning are often difficult to detect and vary between people, requiring diagnosis by a toxicologist or neurologist.
The Nunavik Child Development Study, conducted by Université Laval Professor Gina Muckle, which for nearly 20 years has been following a cohort of children recruited before birth, found blood mercury concentrations above the Canadian guidance value in 16.9 percent of school-aged children. In another study of Inuit women aged 18–39 in northern Quebec, 53.3 percent had blood levels above the guidance value; the average in Canadians is 2.2 percent (Canadian Health Measures Survey).
Mercury levels influenced by location
Mercury levels vary widely in wild foods and are influenced by location, according to Melanie Lemire, professor with the Department of Social and Preventive Medicine at Laval. To help healthcare providers recommend appropriate consumption levels, the authors have included tables with consumption guidelines and blood mercury levels and information on how to test.
“The principles and suggestions in this paper apply directly to practitioners working in northern Canadian communities, where wild foods are important dietary components,” said Pirkle. “They are more broadly applicable to practitioners working with patients or in communities with high fish consumption.”
The authors caution that there should be a balance between appropriate consumption and overconsumption of wild foods with mercury; if physicians recommend complete avoidance, people may not have enough nutritious food to eat.
“Mercury exposure is one of many health concerns facing northern Canadian communities,” write the authors. “Counseling to reduce exposure must recognize and address wider food security issues and nutritional challenges, or it will unlikely be effective.”
The Spring 2016 OPHS Undergraduate Summit was a success. This event was a poster presentation of project proposals from 4-5pm and final projects from 5-6pm for their Applied Learning Experience (a BA Public Health degree requirement).
There were 56 students presenting in total (38 proposals and 18 final projects), including 18 students graduating later this month and 16 Honors students.
Please join us as our undergraduate students present their Applied Learning Experience (APLE) project posters at the OPHS Undergraduate Summit on Thursday, April 28. This event will be held in the Biomedical Sciences Building, D-Courtyard from 4:00-5:00 PM (proposal project posters) and 5:00-6:00 PM (final project posters).
