Search

Objective: Native Hawaiians (NH) represent a unique population where socioeconomic factors have contributed to higher incidence rates of obesity and related comorbidities than in the general population resulting in substantial prescription medication costs. Studies demonstrate that laparoscopic Roux-en-y gastric bypass (LRYGB) surgery results in significant weight loss, improvement of comorbidities, and decreased costs for prescription medications in Caucasians. This study aimed to analyze the effects of LRYGB surgery on Native Hawaiians and their prescription drug costs., Methods: Demographics, baseline body mass index (BMI), comorbidities, preoperative, and postoperative data were analyzed for NH patients who underwent LRYGB between January 2004 and April 2009. Medication costs were determined using the online pharmacy . Generic drugs were selected when appropriate, while vitamins and nutritional supplements were not included in this study., Results: Fifty (14 Men, 36 women) NH patients had sufficient data and follow-up for analysis. Average preoperative BMI was 49 kg/m(2), while at one year follow-up it decreased to 33 kg/m(2) (P<.001). This correlates to an average of 61% excess body weight lost (P<.001). The average number of prescription medications decreased from 3.5/patient preoperatively to 1.1/patient at one year (P<.001), equating to a monthly cost savings of US $195.8/patient (P<.001)., Conclusions: LRYGB provided substantial weight loss for morbidly obese NH patients, resulting in significantly less prescription medication use and substantial cost savings. Thus, bariatric surgery for weight management has the potential to improve the overall well-being and lower the financial burden of medical care in socioeconomically disadvantaged communities such as the NH.

Living-renal transplant (LRT) is the most effective treatment for endstage renal disease (ESRD), and innovative strategies to increase donation are needed. We reviewed our ethnically/culturally diverse program to identify factors that contribute to donors' decision to participate. Records of 110 LRT (related:unrelated = 66:44) and respective donors (1999-2005) were reviewed for demographics, outcome, education, employment, language, religion, and motivation. One and 5-year graft survival were 98.2% and 92% respectively. Mean donor age was 41.1 yrs with Men:Women = 62:48 and similar ethnicity to recipients. Donors tended to be married (65.5%), educated (31.8% -- high school, 58.1% -- additional education/degree), employed (84.4%), religious (55.9%) and English-speaking (73.8%). Successful donors were motivated: 54% traveled from off-island, and 10.9% had prior acts of altruism. Proper referral, identification & education of donors, and individual motivation of potential donors are key factors required for LRT. Continued efforts to overcome educational/language/cultural barriers are necessary to assist patients in finding donors and increasing LRT.