Increased time between diagnosis and surgery in slipped capital femoral epiphysis results in increased radiographic deformity.

PURPOSE: Previous work has examined the impact of delay of diagnosis in slipped capital femoral epiphysis (SCFE) but not the impact of delay in treatment after radiographic diagnosis. Due to requirements for long distance transportation from less developed regions for many of our patients, our hospital was able to study variation in time between diagnosis and surgery for SCFE, as related to slip severity. METHODS: This is a retrospective review of patients treated for SCFE between 2005 and 2014 at a tertiary care paediatric hospital. Demographics, time between diagnosis and surgery, radiographic deformity (Southwick angle), postoperative complications and need for further surgery were variables of interest. Statistical analysis included Pearson and Spearman rank correlations and chi-squared tests. RESULTS: The study sample included 147 hips (119 patients). Mean time between radiographic diagnosis and surgery was 20.9 days (sd 46, 0 to 321). The mean Southwick angle (SA) at the time of surgery was 31.9˚ (sd 19.6˚, 1° to 83˚). There was a significant relationship between increased delay and increased SA (0.34, p < 0.001). Increased SA was correlated with need for future significant surgery (0.27, p < 0.01).Patients from less-developed regions, with barriers to timely care, had moderate and severe deformity (SA) (p < 0.01), and required significant further surgery more often than SCFE patients from the local population (p < 0.01). CONCLUSION: The unique referral environment of our hospital provided an opportunity to examine traditional recommendations for treating SCFE promptly after radiographic diagnosis. Delay in treatment is correlated with increased radiographic deformity. LEVEL OF EVIDENCE: III.

Equivalencies regarding the measurement and constructs of self-esteem and major life events in an Asian/Pacific islander sample.

Construct, scalar, and functional measurement equivalencies of the Rosenberg Self-Esteem Scale (RSES) and Major Life Events checklist (MLE) and the constructs assessed were investigated across groups differentiated on Hawaiian/part-Hawaiian and non-Hawaiian (e.g., Caucasian, Filipino, Hispanic, Japanese, and mixed/2 or more) ethnicity and gender. Initial results from maximum likelihood factoring with promax rotation showed that RSES negatively worded Item 5 loaded with the positively worded Items 1, 2, 4, 6, and 7 on 1 of 2 factors for Hawaiian/part-Hawaiian female participants. Similarly, negatively worded Item 8 and the same positively worded items comprised 1 of 2 factors for non-Hawaiian male participants. For the other 2 Ethnicity x Gender groups, factors were respectively comprised of the 5 positively and 5 negatively worded RSES items. Construct equivalence or simple (2-factor) structure underlying the RSES was indicated across the 4 groups after Items 5 and 8 were excluded from a subsequent factoring procedure. Simple structure showed that Factor 1 comprised the positively worded Items 1, 2, 4, 6, and 7, and the remaining negatively worded Items 3, 9, and 10 loaded on Factor 2. Scalar equivalence of the self-esteem and major life events measures was supported by the statistical nonsignificance of the Major Life Events x Ethnicity x Gender interaction effect in multiple regression models. The consistency in the absolute size and direction of the intercorrelations between overall self-esteem, self-esteem Factors 1 and 2, and major life events variables indicated the functional equivalence of respective measures and constructs assessed. Measurement equivalency findings concerning the RSES and MLE, the constructs measured, and their utility versus caution against their use in multiethnic studies were discussed.

Risk and protective factors related to native Hawaiian adolescent alcohol use.

The present study examined protective and risk factors in the prediction of alcohol use for Hawaiian and non-Hawaiian (i.e. Caucasian, Japanese, Filipino, 'other') adolescents. Comparable rates of approximately 25% were found for both the Hawaiian and non-Hawaiian samples regarding sometimes drinking too much alcohol. However, Hawaiians reported a statistically significantly higher rate (3.7%) of taking 'a drink in the morning to steady my nerves or to get rid of a hangover' than non-Hawaiians (1.3%). The reason for this is unknown but might indicate a higher rate of dependent alcohol use. The overall results supported the traditional model of protective and risk factors predicting alcohol use (R(2) > 15.0%), with relatively few differences found between the two ethnic groups. Further research is needed in assessing possibly unique cultural variables such as Hawaiian acculturation.

Sociocultural and community factors influencing the use of Native Hawaiian healers and healing practices among adolescents in Hawai'i.

Recently, there has been much emphasis placed on both alternative approaches to health care and the provision of culturally competent care. Despite these trends, few studies have examined the use of alternative therapies on the part of adolescents. Even fewer studies have been done focusing on traditional Hawaiian approaches to health care. This is essential, especially in Hawai'i, where Hawaiians have not attained health parity with other majority ethnic populations, despite significant efforts and funding to achieve this end. This study examines the sociocultural and community factors influencing the use of traditional Native Hawaiian healers and healing practices by adolescents in Hawai'i. The Hawaiian High Schools Health Survey was administered at five high schools on three islands in Hawai'i during the 1993-1994 school year. The sample included 1,321 high school students who preferred either an allopathic or alternative practitioner. Ethnicity, gender, community access, healer preference, health status, level of education, and health insurance status were used to predict healer use and participation in healing practices. Community access and healer preference predicted both healer use and participation in native healing practices. Mental health predicted healer use (i.e., seeing a Native Hawaiian healer in the past six months), but did not predict taking part in native healing practices, such as ho'oponopono and lomilomi. Hawaiian ethnicity, female gender, and a measure of health insurance predicted participation in native healing practices, but not healer use. These results suggest that native healing practices and traditional healers are being used in Native Hawaiian communities and this is perhaps not due to a lack of health insurance. Given the general separation between Western and Native Hawaiian health services, traditional healing practices should be made available in Native Hawaiian communities to see whether a collaboration between Western practitioners and traditional healers can have a greater positive impact on the health of Native Hawaiians, particularly for adolescents.

Prediction of anxiety disorders using the state-trait anxiety inventory for multiethnic adolescents.

The purpose of this study was to determine the validity of the State-Trait Anxiety Inventory (STAI) in predicting DSM-III-R anxiety disorders based on the Diagnostic Interview Schedule for Children (DISC, Version 2.3) and using Asian/Pacific Islander adolescents. An overall prevalence rate of 9.19% for generalized anxiety disorder, overanxious disorder, or social phobia was consistent with past studies. As hypothesized, STAI negatively worded (i.e., Factor 2) items were better predictors than positively stated (i.e., Factor 1) items. The STAI State mean was a better predictor of concurrent DISC anxiety disorders as compared to STAI State Factors I or 2. In contrast, the STAI Trait Factor 2 (negatively worded) composite was the best predictor for nonconcurrent DISC anxiety disorders as compared to STAI Trait Factor 1 or the overall STAI Trait subscale. Satisfactory predictive-validity values were obtained when using the STAI State mean and Trait Factor 2 composite. Implications of these findings are discussed, including using the STAI as a screening measure for ethnically diverse adolescents.

Prediction of DISC substance abuse and dependency for ethnically diverse adolescents.

PURPOSE: This study examines the validity of selected items from the Substance Abuse Subtle Screening Inventory-Adolescent (SASSI-A) version in predicting Diagnostic Interview Schedule for Children (DISC version 2.3) Substance abuse and dependency (SA/D) for Native Hawaiian (i.e., indigenous people of the Hawaiian Islands) and non-Hawaiian adolescents (youth without any Native Hawaiian indigenous ancestry). METHODS: 542 students were randomly selected from the larger sample to participate in the DISC administration. Demographic information, SASSI-A scores, and DISC diagnoses were obtained for each student. Univariate and multiple logistic regressions were performed in the prediction of DISC SA/D. RESULTS: SASSI-A Factor 1, consisting of three items measuring substance use, was found to have the best utility, accounting for 18.1% of the variance, in predicting DISC SA/D. IMPLICATIONS: These results support selected SASSI-A items in screening for SA/D for Native Hawaiian and non-Hawaiian adolescents in Hawaii as compared to other community-based screening instruments for other populations.

Sociocultural factors influencing adolescent preference and use of native Hawaiian healers.

OBJECTIVE: Few studies have examined the use of alternative therapies among adolescents. This study examines the predictors of Native Hawaiian healer preference in the treatment of physical or emotional problems as well as the predictors of healer use. DESIGN: This study is a longitudinal cross-sectional design. SETTING: The survey was conducted in five high schools in Hawai'i. PARTICIPANTS: 1,322 high school students selected preference for and/or use of allopathic or alternative practitioners. MAIN OUTCOME MEASURES: Grade level, gender, ethnicity and cultural identity were used to predict healer preference. Healer preference, socioeconomic status and health status were used to predict healer use. RESULTS: Identification with the Hawaiian culture was the strongest predictor of healer preference for both Hawaiian and non-Hawaiian adolescents. Mental health was also predictive of healer preference for non-Hawaiians. Healer use by Native Hawaiian adolescents was also predicted by Hawaiian cultural identity. Gender, grade level, and socioeconomic variables were not predictive of healer preference or use. CONCLUSION: Cultural identity plays a significant role in the preference and use of alternative practitioners, especially for minority adolescent populations.

Alcohol use in Hawaii.

This article provides a review of the existing literature on alcohol use in Hawaii (i.e., epidemiology, reasons for use, associated problems, and intervention) and offers clinical implications of the findings and suggestions for further areas of research. In general, Caucasians, Hawaiians, younger Filipinos, males, adolescents, young adults, and those with lower educational attainment were found to be at higher risk. Overall, Hawaii's rates were either comparable or lower than those for the entire United States. Factors associated with different rates of alcohol use included accessibility, ability to resist offers, parent use and sanctions, peer influence and use, attitudes and beliefs (e.g., perceived normal drinking, dangerousness), religious affiliation, social occasions, and school intervention. Variable rates and trends in help-seeking behaviors, treatment admissions, and treatment utilization reflected the socio-cultural diversity in Hawaii. Perceived effectiveness of different treatments were generally consistent across ethnic groups, but did not necessarily represent actual efficacy. There is a clear need for additional prevention, screening, and intervention programs in Hawaii, including socio-culturally appropriate ones, as well as a need for further research.

Differences in State-Trait Anxiety Inventory scores for ethnically diverse adolescents in Hawaii.

This study examined the association between anxiety and 5 predictor variables: ethnicity (Caucasian, Native Hawaiian/part Hawaiian, Japanese, other), gender, grade level (9-12th), main wage earners' educational level, and State-Trait Anxiety Inventory (STAI; C. D. Spielberger, R. L. Gorsuch, & R. E. Lushene, 1970) factors for a diverse group of students. Hawaiian students were found to have significantly higher levels of anxiety than Japanese students; however, ethnicity was not a significant predictor when gender, grade level, and main wage earners' education were statistically held constant. An interaction between ethnicity and STAI factor scores indicated an atypical pattern for Caucasians. Female students scored significantly higher than male students, and main wage earners' education predicted amount of anxiety. In general, these 2 associations remained significant when ethnicity and grade level were held constant. An interaction between gender and STAI factor scores indicated that the difference between female and male students was relatively larger for positively (as opposed to negatively) worded State items and for negatively (as opposed to positively) worded Trait items. Overall, the findings suggested that apparent ethnic differences in anxiety levels may be due to causal variables related to other sociodemographic variables. Factor scores in the form of positively versus negatively worded items should be considered an important variable; using only a global STAI composite as a measure of anxiety will mask the differential effects of the STAI factor scores. Further research is needed to determine the generalizability of these findings to other groups and to provide knowledge on direct causal variables that may account for a greater percentage of variance.

Psychometric properties of the Hawaiian Culture Scale--Adolescent Version.

This article reports on the psychometric properties of a newly constructed Hawaiian Culture Scale--Adolescent Version. A total of 2,272 Native Hawaiian and 1,170 non-Hawaiian adolescents were administered this 50-item inventory that measures the source of learning the Hawaiian way of life, how much Hawaiian beliefs are valued and important to maintain, how much non-Hawaiian beliefs are valued, Hawaiian blood quantum, and specific cultural traditions (seven subscales = Lifestyles, Customs. Activities, Folklore, Causes-Locations, Causes-Access, and Language Proficiency). The results strongly supported the internal consistency and validity of the measures for both the Hawaiian and non-Hawaiian groups. On the basis of the demographic data, partial support was offered for cross-cultural theories of ethnic identity. More consistent support was found for multiculturalism in Hawai'i's adolescents. Further research is needed to link these measures with indicators of psychological adjustment (e.g., depression, anxiety, substance use).

Cultural identification and attempted suicide in Native Hawaiian adolescents.

OBJECTIVES: To determine rates of lifetime suicide attempts in a community sample of Native Hawaiian adolescents and determine the contribution of Hawaiian cultural affiliation, socioeconomic status, and psychiatric symptoms as risk factors for suicide. METHOD: High school students were surveyed in the state of Hawaii for lifetime suicide attempts, Hawaiian cultural affiliation, socioeconomic status, and symptoms of depression, substance abuse, aggression, and anxiety. Multiple logistic regressions were used on 3,094 subjects to develop prediction models for lifetime suicide attempts. RESULTS: Native Hawaiian adolescents had significantly higher rates of suicide attempts (12.9%) than other adolescents in Hawaii (9.6%). Hawaiian cultural affiliation rather than ethnicity was uniquely predictive of suicide attempts. Logistic regression indicated that depression, substance abuse, grade level, Hawaiian cultural affiliation, and main wage earner's education best predicted suicide attempts in Native Hawaiian adolescents, while depression, substance abuse, and aggression predicted suicide attempts in non-Hawaiians. CONCLUSIONS: Native Hawaiian adolescents have higher rates of attempted suicide than non-Hawaiian adolescents. Strong Hawaiian cultural affiliation rather than ethnicity is a risk factor for attempted suicide.

Psychometric properties of the state-trait anxiety inventory for Asian/Pacific-islander adolescents.

Anxiety disorders are said to be universal across all cultures and recent reviews have found relatively high prevalence rates across different countries. However, the experience and interpretation of anxiety are strongly influenced by cultural factors. Demonstrating cross-cultural equivalence of measures of anxiety is essential to assure that comparisons between cultures will result in meaningful interpretations. Despite the State-Trait Anxiety Inventory being the most researched of anxiety measures from a cross-cultural basis, there is a lack of empirical studies on the psychometric properties of the STAI with adolescent Asian/Pacific Islanders. The present study examined the STAI using a large sample of ethnically diverse high school students in Hawaii. In general, a four-factor model (State-Anxiety Absent, State-Anxiety Present, Trait-Anxiety Absent, and Trait-Anxiety Present) provided the best fit based on a series of confirmatory factor analyses. Indicators of internal consistency supported the reliability of the factors and subscales, and the inter-factor correlations reflected positively on the concurrent validity of the different STAI factor and subscale measures. This study suggested cautious use and interpretation of one particular item (Trait Item 14 = I try to avoid facing a crisis or difficulty ), and cautious application of the STAI to Filipino adolescents (particularly Filipino males). Domains for further research are discussed.

Prediction of major depression and dysthymia from CES-D scores among ethnic minority adolescents.

OBJECTIVE: The Native Hawaiian Mental Health Research Development Program is an epidemiological longitudinal study of adolescents residing in Hawaii. This article examines the utility of the Center for Epidemiologic Studies-Depression Scale (CES-D) for predicting DSM-III-R diagnoses of major depression (MD) and dysthymic disorder (DD) and investigates whether prediction differs by gender and ethnicity. METHOD: Diagnostic Interview Schedule for Children interviews were conducted with 556 adolescents randomly selected from among more than 7,000 students who had completed the CES-D. RESULTS: Six-month prevalence rates were as follows: MD = 8.5%, DD = 4.7%, either (MDDD) = 9.9%. Prevalence rates were significantly higher among females, but after CES-D scores were accounted for, gender no longer predicted depression in most analyses. When a cutoff score of 16 was used, classification accuracy was lower for Native Hawaiians than non-Hawaiians. However, after group differences in gender and grade level were accounted for, the predictive validity of the CES-D did not differ by ethnicity. CES-D factor 1 scores identified MD, DD, and MDDD about as well as the total score or all three factors together. CONCLUSIONS: These results support the validity of the CES-D for screening for depression among adolescents of Native Hawaiian and other minority backgrounds.

Psychiatric symptoms in offspring of within vs. across racial/ethnic marriages.

A large number of adolescents of interracial ancestry (parents comprising various combinations of African-American, American Indian/Alaska Native, European-American, Chinese, Filipino, Hispanic, Japanese, Korean, Puerto Rican, Samoan, and Tongan ancestry) were contrasted with a monoracial European-American sample in the degree to which they reported symptoms of depression, anxiety, conduct disorder/aggression, and substance abuse. The adolescents of interracial ancestry were subdivided into three groups in terms of parental ancestry: both parents of interracial ancestry, one parent of interracial and the other of monoracial ancestry, and both parents of monoracial but different ancestries. The interracial ancestry groups did not differ significantly from one another or from the European American sample in terms of symptom scores.

Radiotherapeutic management of an orocutaneous defect with a balloon-retaining stent.

Maxillary resection defects have traditionally been technically difficult to treat with conventional radiation therapy. The irregular contours of the defect lead to an uneven distribution of the radiation doses. The potential to undertreat defects of microscopic involvement may leave residual disease. Tissue morbidity is high at isolated "hot spots" or at locations of excessive dose distribution. The use of a water-filled balloon bolus in conjunction with a balloon-retaining stent can significantly improve treatment efficacy and decrease tissue morbidity. This article describes a technique for the fabrication of a balloon-retaining stent for an orocutaneous defect.