Journal of the National Medical Association最新文献

{"title":"Trends in cancer incidence and mortality in the United States (1999-2021): A retrospective cohort study of health disparities and regional variations","authors":"Bayuh Asmamaw Hailu","doi":"10.1016/j.jnma.2025.04.007","DOIUrl":"10.1016/j.jnma.2025.04.007","url":null,"abstract":"<div><h3>Objective</h3><div>Analyze cancer incidence and mortality in the U.S. 1999-2021, focusing on variations by sex, race, cancer type, and state. The study aims to identify disparities in cancer rates and highlight regions and populations most affected, to inform public health policies and interventions.</div></div><div><h3>Methods</h3><div>Age-adjusted rates were analyzed by race, cancer type, sex, and state. Bayesian statistical techniques were employed for accurate trend estimation, and cancer hotspots were identified using the Getis-Ord Gi* statistic. Joinpoint regression was used to estimate the Average Annual Percent Change (AAPC) in cancer rates. The analysis was conducted using R.</div></div><div><h3>Results</h3><div>The overall trend was noted reduction in aggregate cancer rate (AAPC =−0.007) and mortality (AAPC =−0.004). Regional and racial disparities are still prevalent with outcomes showing that Kentucky, West Virginia, and Mississippi have the highest prevalence of both. Cancer incidence was reduced most significantly among Black or African American individuals (AAPC=−0.008) and mortality in (AAPC=−0.021) but their rates are still higher. Hotspot analyses identified high cancer incidence and mortality clusters, particularly in the Midwestern and Southern regions of the United States.</div></div><div><h3>Discussion</h3><div>The implications arising from these results suggest that focused public health campaigns need to be directed toward cancer, smoking, and access to care services for effective health promotion. These findings therefore call for innovative public health measures to reduce the burden of cancer and disparity in the future. More sophisticated studies of the social, environmental, and genetic causes of these trends are required to improve the efficacy of cancer control.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 3","pages":"Pages 185-192"},"PeriodicalIF":2.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From conference to career: Tracing medical pathways of Stanford university’s minority medical alliance (SUMMA) premedical conference alumni","authors":"Aneysis D. Gonzalez-Suarez ,&nbsp;Emily Moya ,&nbsp;Felipe D. Perez ,&nbsp;Mark Gutierrez ,&nbsp;Reena P. Thomas","doi":"10.1016/j.jnma.2025.05.001","DOIUrl":"10.1016/j.jnma.2025.05.001","url":null,"abstract":"<div><div>Despite the growing diversity of the U.S. population, racial and ethnic minorities remain underrepresented in healthcare professions, perpetuating health disparities. This study evaluates the effectiveness of the Stanford University’s Minority Medical Alliance (SUMMA) Premedical Conference in addressing these challenges. We conducted a survey of 238 former conference attendees from 2018 to 2023 to assess the conference’s impact on their educational and career trajectories in medicine. The survey examined demographic variables, post-graduate intentions, and perceptions of the conference’s impact using a 5-point Likert scale. 85% of survey respondents identified as first-generation medical students, with significant representation from Hispanic/Latino (30.67%), Black/African-American (20.17%), and Asian (21.43%) backgrounds. 44% applied to medical school post-conference, and 74% aspired to or were enrolled in medical school. Chi-square tests revealed that 43.75% of Black/African-American and 37.67% of Hispanic/Latino respondents applied to medical school, compared to 28.57% of Asian respondents (χ²=10.72, p=0.030), and that 56.25% of economically disadvantaged students applied to medical school compared to 30.91% of those not disadvantaged (χ²=16.99, p=0.001). Logistic regression highlighted that first-generation and economically-disadvantaged students had higher odds of applying to medical school (OR=4.84, p=0.005; OR=9.94, p&lt;0.001). Likert scale responses showed that 81.9% of respondents agreed that the conference increased their confidence in navigating medical school applications and 68.2% agreed that it increased their confidence in seeking advisors. By sharing the effectiveness of the SUMMA conference in supporting minority students, we provide a learning opportunity by which other institutions may engage their communities to increase diversity in healthcare education.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 3","pages":"Pages 208-221"},"PeriodicalIF":2.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic sclerosis and scleroderma renal crisis in African American patients","authors":"Riti Kotamarti ,&nbsp;Kevin V. Hackshaw","doi":"10.1016/j.jnma.2025.04.006","DOIUrl":"10.1016/j.jnma.2025.04.006","url":null,"abstract":"<div><div>Scleroderma, or systemic sclerosis (SSc) is an autoimmune fibrosing disease that encompasses a range of clinical presentations and severities. Prior investigations have shown that African Americans exhibit nearly twice the incidence of disease compared to non-African American patients, and overall worse outcomes. ³² This is particularly evident when analyzing scleroderma renal crisis, a feared complication of SSc which is 3.5 times prevalent in the African American community compared to non-A.A. ⁵ Although the exact etiology is not fully understood, associations between ethnicity, pathogenesis, and complexities of disease have been investigated, illuminating an interplay between genetics, environmental and social triggers in the development of disease.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 3","pages":"Pages 179-184"},"PeriodicalIF":2.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144083134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"General surgery leadership demographics are associated with trainee diversity","authors":"Alejandro Chiodo Ortiz ,&nbsp;Nathalia Castillo ,&nbsp;Mihir Tandon ,&nbsp;Juan Ortiz ,&nbsp;Yang Yu ,&nbsp;Meng-Hao Li ,&nbsp;Krithika Shrinivas ,&nbsp;David Ford ,&nbsp;Naoru Koizumi ,&nbsp;Jorge Ortiz","doi":"10.1016/j.jnma.2025.04.008","DOIUrl":"10.1016/j.jnma.2025.04.008","url":null,"abstract":"","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 3","pages":"Pages 193-200"},"PeriodicalIF":2.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary healthcare utilization patterns among sickle cell disease patients in tribal India: A multi-centric study","authors":"Shaily B. Surti ,&nbsp;Shubhangi Patel ,&nbsp;Yogita Sharma ,&nbsp;Parikipandla Sridevi ,&nbsp;Deepa Bhat ,&nbsp;Jatin Sarmah ,&nbsp;Manoranjan Ranjit ,&nbsp;Madhusmita Bal ,&nbsp;Bontha V. Babu","doi":"10.1016/j.jnma.2025.04.004","DOIUrl":"10.1016/j.jnma.2025.04.004","url":null,"abstract":"<div><h3>Background</h3><div>Prevention and management of chronic diseases have been integrated into the primary healthcare system in recent years. However, due to the social, cultural and geographical barriers, patients of one of such chronic illnesses, viz., sickle cell disease (SCD) have poor utilization and access to healthcare services. Hence, this study explored the utilization of outpatient services by SCD patients and associated factors in five SCD-endemic tribal districts of India.</div></div><div><h3>Methods</h3><div>This cross-sectional quantitative study was conducted on 263 SCD patients or their caregivers and 263 corresponding controls recruited from 5 SCD endemic districts. Data on utilizing outpatient services and health system-related characteristics were collected using a pretested questionnaire. Multiple logistic regression was conducted to explore the association between utilization of outpatient services and independent variables.</div></div><div><h3>Results</h3><div>About 80% of the patients reported the public healthcare system as a regular source of healthcare. 86% of the patients and 65% of the controls or their families visited primary health centres (PHCs) in the past year. More than two-thirds of the patients (67.7%) and more than half of the controls (50.6%) didn’t face any problems accessing PHC services. Patients with 6–10 years of schooling (adjusted odds ratio (AOR)=0.45), annual family income of USD 480 to USD 720 (AOR=0.41) and more than USD 720 (AOR=0.35), &gt;15 kilometres of distance to PHCs (AOR=0.32) are less likely to visit PHCs.</div></div><div><h3>Conclusion</h3><div>The primary healthcare system was a regular source of medical care for the majority of the population, and utilization of outpatient services at PHCs was high in our study. Hence, this study emphasizes strengthening screening and management of SCD right from the primary healthcare level so that the healthcare needs of SCD patients can be met for the continuum of care.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 3","pages":"Pages 158-169"},"PeriodicalIF":2.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Health Outcomes","authors":"Marie L. Borum MD, EdD, MPH, MACP, FACG, AGAF, FRCP","doi":"10.1016/j.jnma.2025.06.002","DOIUrl":"10.1016/j.jnma.2025.06.002","url":null,"abstract":"","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 3","pages":"Page 157"},"PeriodicalIF":2.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144307149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of knowledge of breast cancer risk factors and practice of breast self-examination among students at CSJM university, Kanpur","authors":"Tanisha Anand ,&nbsp;Priya Mishra ,&nbsp;Mahima Saxena ,&nbsp;Umra Naeem ,&nbsp;Anushka Jauhari ,&nbsp;Himanshi Chauhan ,&nbsp;Santosh Kumar Yadav ,&nbsp;Pankaj Kumar ,&nbsp;Dheeraj Kumar","doi":"10.1016/j.jnma.2025.04.005","DOIUrl":"10.1016/j.jnma.2025.04.005","url":null,"abstract":"<div><div>Breast cancer is still one of the leading malignancies among women in the world and accounts for 19-34 % of all cancers in India. This cross-sectional study was conducted to evaluate the knowledge of risk factors of breast cancer and the practice of BSE among students at CSJM University, Kanpur. A structured online questionnaire was used to collect data from 375 participants, including undergraduate, postgraduate, and PhD students, as well as faculty members. The study revealed a moderate awareness of breast cancer risk factors such as family history (62.7 %) and radiation exposure (50.4 %), while it was lower for lifestyle-related risks like smoking (44.3 %). Only 36.3 % of the participants practiced BSE monthly, and barriers included a lack of knowledge (51.2 %), forgetfulness (24 %), and fear (14.9 %). Online tutorials (51.5 %) and interactive workshops (41.9 %) emerged as preferred educational materials. The findings indicate wide knowledge gaps and practice gaps; hence, there is an urgent need for educational intervention and curricular reforms, along with increased awareness programs, in improving breast health literacy and related preventive behaviors.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 3","pages":"Pages 170-178"},"PeriodicalIF":2.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144087426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Personal reflections on race-based medicine: narrative analysis of a case study using a situated lens","authors":"Breanna Thompson ,&nbsp;Rasheda J. Vereen ,&nbsp;Torie C. Plowden ,&nbsp;Monica A. Lutgendorf","doi":"10.1016/j.jnma.2025.04.009","DOIUrl":"10.1016/j.jnma.2025.04.009","url":null,"abstract":"<div><h3>Background</h3><div>Race-based medicine was initially established to risk-stratify patients using algorithms based on biological similarities. This generalized form of medicine resulted in harmful practices and health inequities. Although race-based medicine has received increasing attention as a harmful practice contributing to structural and systemic racism in medicine, the individual patient perspective remains relatively under-studied, particularly in obstetrics. This qualitative case study uses a situated lens to explore the individual experience and perspective of race-based medicine in perinatal care.</div></div><div><h3>Methods</h3><div>This was an institutional review board approved qualitative study utilizing semi-structured interviews as part of a larger study investigating the birth experiences of military beneficiaries. The interview was recorded and transcribed with data inductively analyzed using narrative analysis with positioning theory to identify positions and lived experiences during the individual's care experiences.</div></div><div><h3>Results</h3><div>Narrative analysis yielded the following themes: (1) self-identity; (2) reinforcing racial sensitivity; (3) health individualization; (4) internal conflict with external perception and honesty; (5) trust and respect; (6) resisting negative influence and press/stories; (7) intellectualization; and (8) fear vs. empowerment for personalized birth wishes. Each theme represented valid concerns patients may experience with race-based medicine in a healthcare setting.</div></div><div><h3>Conclusions</h3><div>The application of race-based medicine during prenatal care may harm the relationship between pregnant individuals and clinicians, leading to an overall negative experience and erosion of trust in the healthcare system. Implementing personalized race-conscious healthcare rather than race-based medicine is essential to improving patient-doctor relationships by building trust and eliminating unnecessary medical practices.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 3","pages":"Pages 201-207"},"PeriodicalIF":2.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of NIH funding and program reputation score on research output and residency matches in neurosurgery: A bibliometrics analysis","authors":"Kyril L. Cole ,&nbsp;Ashley Carter ,&nbsp;Clayton Rawson ,&nbsp;Sam Tenhoeve ,&nbsp;Cody Orton ,&nbsp;Maryam Zeinali ,&nbsp;Michael Karsy","doi":"10.1016/j.jnma.2025.03.002","DOIUrl":"10.1016/j.jnma.2025.03.002","url":null,"abstract":"<div><div>The neurosurgery residency applicant selection process is complex, with peer-reviewed publications (PRP) recently becoming a key focus. While PRP may significantly impact applicant matching, equitable opportunities for research may vary for students. We aimed to evaluate the impact of NIH funding and program reputation score on applicants’ ability to match into top neurosurgery residency programs. Successfully matched PGY1 neurosurgery applicants in the 2022-2023 cycle were evaluated. PRP, Blue Ridge Institute for Medical Research (BRIMR) medical school and residency NIH-funding ranking, and residency Doximity reputation score were evaluated. PGY1 residents (n = 235, 73% male) included 84% MDs, 1.0% DO, 10% MD/PhD, and 5% IMGs. Thirty-one (13.2%) superpublishers (&gt; 25 PRPs) were identified (93.5% male) and had a higher number of non-MD degrees (32.3% vs. 13.3%, <em>p</em> = 0.007). Matching into a top 20 NIH-ranked residency program was associated with completion of a top 20 NIH-medical program (OR = 2.70, <em>p</em> = 0.015), superpublisher status (OR = 2.87, <em>p</em> = 0.024), and affiliation with a top 40 NIH-ranked neurosurgery program (OR = 3.44, <em>p</em> &lt; 0.001). Matching into a top 40 reputation program was predicted by being a superpublisher (≥ 25 publications; OR = 2.66, <em>p</em> = 0.04) and attending a medical school with an affiliated top 40 reputation neurosurgery program (OR = 4.85, <em>p</em> &lt; 0.001). PRP has become a large focus in determining a candidate's competitiveness for top neurosurgery residency programs. Our results clarify the factors impacting PRP, including the importance of NIH funding and the neurosurgery department's reputation. These results highlight both best practices for training residents and potential disadvantages some medical school candidates may have from lower-ranked programs or limited research opportunities. Further studies are warranted to evaluate the impact of these factors on the equity of neurosurgery residency candidates.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 2","pages":"Pages 115-122"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of race and socioeconomic disparities on the short-term efficacy of bevacizumab for macular edema secondary to retinal vein occlusion","authors":"Minali Prasad ,&nbsp;Deniz Goodman ,&nbsp;Pawarissara Osathanugrah ,&nbsp;Nayan Sanjiv ,&nbsp;Xuejing Chen ,&nbsp;Steven Ness ,&nbsp;Nicole H. Siegel ,&nbsp;Manju L. Subramanian","doi":"10.1016/j.jnma.2025.04.001","DOIUrl":"10.1016/j.jnma.2025.04.001","url":null,"abstract":"<div><h3>Purpose</h3><div>Anti-VEGF injections are often used for the treatment of macular edema from retinal vein occlusions (RVO). Variable response to intravitreal bevacizumab has been reported for treatment of diabetic macular edema (DME) between racial and ethnic groups. We examined potential variances in treatment response to bevacizumab by race and socioeconomic status among patients with macular edema secondary to RVO in this retrospective study.</div></div><div><h3>Methods</h3><div>Intravitreal anti-VEGF naïve patients aged over 18 who received at least one intravitreal bevacizumab injection for central or branch RVO were included. Data were collected before treatment, 1–3 months after the first injection (<em>n</em> = 150 eyes of 148 patients), and 1–3 months after 3 injections (<em>n</em> = 99 eyes of 98 patients). Primary outcome measures were percentage of patients with visual acuity (VA) improvement (defined as &gt;0.1 on the logarithm of minimum angle of resolution scale), reduction in central macular thickness (CMT), and reduction in total macular volume (TMV). Participant addresses were used to calculate Area Deprivation Index (ADI) and were categorized into low disadvantage (state ADI decile from 1 to 5) or high disadvantage (state ADI decile from 6 to 10) cohorts. Odds of VA improvement were analyzed via multivariate logistic regression and mean change in CMT and TMV were analyzed via multivariate linear regression to compare treatment responses among the two ADI cohorts and between Black or African American and White participants after one and three injections.</div></div><div><h3>Results</h3><div>There were no significant differences in the odds of VA improvement (1-injection: OR=1.24, <em>p</em> = 0.60; 3-injection: OR=2.17, <em>p</em> = 0.23), percent reduction in CMT (1-injection: −31.2 vs −27.5, <em>p</em> = 0.98; 3-injection: −16.2 vs −32.7, <em>p</em> = 0.11), and percent reduction in TMV (1-injection: −15.5 vs −18.7, <em>p</em> = 0.44; 3-injection: −11.6 vs-15.4, <em>p</em> = 0.60) after controlling for demographic and clinical factors. There were no significant differences in the odds of VA improvement, percent reduction in CMT, and percent reduction in TMV between ADI cohorts (<em>p</em> &gt; 0.05).</div></div><div><h3>Conclusions</h3><div>The absence of significant differences in treatment response amongst race groups is congruent with existing literature on RVO outcomes, however, it contrasts our findings in diabetic macular edema which did show differences in treatment response between race groups. There were also no significant differences in treatment by socioeconomic status.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 2","pages":"Pages 132-139"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}