Journal of the National Medical Association最新文献

{"title":"Addressing Health Equity with a Focus on Education, Health Concerns across Specialties and Clinical Trial Enrollment","authors":"Marie L. Borum MD, EdD, MPH, MACP, FACG, AGAF, FRCP","doi":"10.1016/j.jnma.2025.07.015","DOIUrl":"10.1016/j.jnma.2025.07.015","url":null,"abstract":"","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 4","pages":"Page 224"},"PeriodicalIF":2.3,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144722057","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 urgent need to address residency attrition rates among black physicians in internal medicine","authors":"Devaun Reid ,&nbsp;Monica Khadka","doi":"10.1016/j.jnma.2025.06.006","DOIUrl":"10.1016/j.jnma.2025.06.006","url":null,"abstract":"<div><div>This review examines the critical issue of residency attrition among Black physicians in internal medicine, highlighting systemic inequities and unconscious bias within training programs. Analysis of data from 2011 to 2019 shows that Black residents represent only 4.2 % of the internal medicine workforce and face disproportionately high rates of withdrawal and dismissal. The review synthesizes current literature to identify contributing factors such as subjective evaluations, inadequate mentorship, and pervasive racial bias. It proposes targeted interventions including structured one-on-one mentoring, objective and double-evaluation systems, robust feedback mechanisms, and comprehensive bias training for faculty. Implementing these strategies is essential for creating a more inclusive residency environment and advancing healthcare equity.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 5","pages":"Pages 301-303"},"PeriodicalIF":2.3,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719326","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":"Racial disparities in outcomes after lymphedema surgery: A call for equitable care","authors":"Felix J. Klimitz ,&nbsp;Stav Brown ,&nbsp;Sam Boroumand ,&nbsp;Thomas Schaschinger ,&nbsp;Leonard Knoedler ,&nbsp;Adriana C. Panayi ,&nbsp;Fortunay Diatta ,&nbsp;Martin Kauke-Navarro ,&nbsp;Kamal Addagatla","doi":"10.1016/j.jnma.2025.07.011","DOIUrl":"10.1016/j.jnma.2025.07.011","url":null,"abstract":"","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 5","pages":"Pages 296-300"},"PeriodicalIF":2.3,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719325","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":"Beyond hair loss: Exploring the psychiatric burden of alopecia areata in a large cohort","authors":"Ayana Crawl-Bey ,&nbsp;Jerome Watts ,&nbsp;Jaide Cotton ,&nbsp;Uchechi Nwaneri ,&nbsp;Samrawit Zinabu ,&nbsp;Mekdem Bisrat ,&nbsp;Elizabeth Beyene ,&nbsp;Ellen Pritchett ,&nbsp;Miriam Michael","doi":"10.1016/j.jnma.2025.07.008","DOIUrl":"10.1016/j.jnma.2025.07.008","url":null,"abstract":"<div><h3>Background</h3><div>Alopecia areata is a non-scarring autoimmune condition that causes hair loss and is increasingly linked to mental health disorders. This study examined the incidence of psychiatric conditions among patients newly diagnosed with alopecia areata and explored demographic differences in psychiatric outcomes.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted using the TriNetX Global Collaborative Network. A total of 97,925 patients with a new diagnosis of alopecia areata were identified using diagnostic codes. After exclusions, 91,302 patients were included in the final analysis. Over a one-year follow-up period, the incidence of depression, anxiety, schizophrenia, obsessive-compulsive disorder, and adjustment disorders was assessed. Survival analysis and risk calculations were performed, and demographic data were analyzed to identify disparities.</div></div><div><h3>Results</h3><div>Mental health conditions were common in patients with alopecia areata. Anxiety was the most frequent psychiatric diagnosis, affecting 3.1 % of patients, followed by depression at 1.6 %. Adjustment disorders, schizophrenia, and obsessive-compulsive disorder were less common but still present. Patients diagnosed with these conditions experienced repeated episodes, with the highest average episodes per patient seen in those with depression, followed by anxiety. Kaplan-Meier survival analysis showed high probabilities of remaining free from psychiatric conditions during the study period. The average age of patients was 49 years, and 72.06 percent were female. The racial distribution was predominantly White (58.24 %), followed by Black or African American (16.85 %), with other racial groups represented in smaller proportions.</div></div><div><h3>Conclusion</h3><div>Patients with alopecia areata face a substantial mental health burden, highlighting the need for integrated medical and psychological care.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 5","pages":"Pages 335-340"},"PeriodicalIF":2.3,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719321","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":"Unequal healing: Racial differences in hypertrophic scarring following burn injuries","authors":"Derek Nuamah ,&nbsp;Jarrell B. Patterson ,&nbsp;Joshua E. Lewis ,&nbsp;Ertha Sefu Omba ,&nbsp;Olivia Anga ,&nbsp;Blanche Neige ,&nbsp;Raven J. Hollis ,&nbsp;Ernst Nicarnord","doi":"10.1016/j.jnma.2025.07.004","DOIUrl":"10.1016/j.jnma.2025.07.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Hypertrophic scarring is a common complication of burn injuries, and its incidence and treatment outcomes vary among racial groups. The motivation for this study was to further understand the disparities in hypertrophic scar formation that exist amongst different racial groups. This study aimed to address the gaps by investigating disparities in hypertrophic scar formation among African American, Asian, and White patients one year after burn injury.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using the TriNetX Research Network, a federated database of de-identified electronic health records from over 116 million patients across 112 healthcare organizations (HCOs) as of August 28, 2024. Patients were stratified by race. Propensity score matching adjusted for age, gender, and burn severity. Hypertrophic scarring was assessed at one, six, and twelve months. Relative risk ratio was calculated using White patients as the reference cohort. Statistical significance was deemed <em>p</em> &lt; 0.05.</div></div><div><h3>Results</h3><div>We identified 633,708 adult burn patients (≥18 years) treated between 2013 and 2023. African American, Asian, and Native Hawaiian patients had significantly higher risks of hypertrophic scarring compared to White patients (<em>p</em> &lt; 0.05). At six months and one-year, similar trends persisted across racial groups. Among the 46,893 patients with hypertrophic scarring, 63.06 % were White, 13.50 % Black, 2.47 % Asian, 0.55 % Native Hawaiian, and 0.54 % American Indian. Interestingly, Native Hawaiians demonstrated a decreased risk in specific subgroup analyses (<em>p</em> &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>Significant racial disparities exist in hypertrophic scarring incidence following burn injury. African American, Asian, and Native Hawaiian patients are at elevated risk compared to White patients. Further research is needed to develop equitable prevention and treatment strategies for high-risk patient populations.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 5","pages":"Pages 315-322"},"PeriodicalIF":2.3,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719327","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":"Racial and gender disparities in HPV vaccination: Implications for reducing head and neck cancer","authors":"Kamdili Ogbutor ,&nbsp;Elijah McMillan ,&nbsp;Nurupa Ramkissoon ,&nbsp;Rawan Elkomi ,&nbsp;Da’Jhai Monroe ,&nbsp;Samrawit Zinabu ,&nbsp;Ahmed Ali ,&nbsp;Huda Gasmelseed ,&nbsp;Miriam Michael","doi":"10.1016/j.jnma.2025.07.001","DOIUrl":"10.1016/j.jnma.2025.07.001","url":null,"abstract":"<div><h3>Objective</h3><div>Head and neck cancer caused by human papillomavirus (HPV) is a rare form of cancer that disproportionately impacts males more than their female counterparts (11.4 per 1000,000 compared to females 3.0 per 1000,000). Despite the introduction of vaccination for HPV there has still been an increase in incidence within the past 20 years. This study investigates disparities in HPV vaccination rate and head and neck cancer amongst gender and various racial groups within Washington, DC and Maryland.</div></div><div><h3>Methods</h3><div>Retrospective cross-sectional study of patients vaccinated for HPV from January 2014 to December 2020. Epic EMR Slicer Dicer tool analysis of 5.8 million de-identified patients via University of Maryland clinical database. Vaccination rates and head and neck cancer incidence were compared between respective gender and racial subgroups over a 6-year period.</div></div><div><h3>Results</h3><div>Females had significantly higher vaccination rates than males (58.1 % vs 41.9 %). Black females were the most vaccinated subgroup (27.6 %), while white males were the least vaccinated (16.8 %). Among vaccinated individuals, 0.13 % developed head and neck cancer. Of this percentage, there was a disproportionate representation of black females, accounting for 46.7 % of head and neck cancer cases despite having the highest vaccination rates.</div></div><div><h3>Conclusion</h3><div>Despite persistent vaccination efforts, we see an unexplained high incidence of head and neck cancer affecting black females. Targeted interventions are essential to improving health outcomes in this population.</div></div><div><h3>Level of Evidence</h3><div>3</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 5","pages":"Pages 311-314"},"PeriodicalIF":2.3,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719324","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":"What black doctors know that AI can’t: Confronting algorithmic bias and structural racism in modern medicine","authors":"Luis Emilio Gomez","doi":"10.1016/j.jnma.2025.07.009","DOIUrl":"10.1016/j.jnma.2025.07.009","url":null,"abstract":"","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 5","pages":"Pages 294-295"},"PeriodicalIF":2.3,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719328","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":"Factors influencing willingness to utilize the emergency department when experiencing sickle cell disease pain crises","authors":"Elizabeth A. Ibiloye ,&nbsp;Ayobami A. Aiyeolemi ,&nbsp;Jamie C. Barner ,&nbsp;Carolyn M. Brown ,&nbsp;Hyeun Ah Kang ,&nbsp;Benita A. Bamgbade","doi":"10.1016/j.jnma.2025.07.007","DOIUrl":"10.1016/j.jnma.2025.07.007","url":null,"abstract":"<div><h3>Background</h3><div>The emergency department (ED) is essential for treating sickle cell disease (SCD) pain crises. However, there is limited understanding of factors influencing intentions to seek ED care during these crises. Guided by the Theory of Planned Behavior (TPB), this study aimed to determine factors influencing willingness to use the ED among individuals with SCD during pain crises.</div></div><div><h3>Methods</h3><div>A national web-based cross-sectional survey was conducted among adults (≥ 18 years) with SCD who had visited the ED for pain crises. The survey assessed direct and indirect TPB constructs (willingness, attitude, subjective norm, and perceived behavioral control), as well as additional variables such as stigma, prior ED experience, and sociodemographic and personal characteristics. Participants were recruited through a Texas-based SCD advocacy group and a national platform that enables patients to share their disease experiences with external stakeholders. Descriptive statistics and hierarchical regression analyses were used to address the study aim.</div></div><div><h3>Results</h3><div>A total of 259 responses were received, of which 114 were included in the analysis. The TPB model explained 61 % of the variance in willingness (R²=0.610, <em>p</em> &lt; 0.0001). Direct attitude toward going to the ED (β=0.50, <em>p</em> &lt; 0.0001) and frequency of previous ED visits (β=0.57, <em>p</em> = 0.0005) were the only significant predictors of willingness while controlling for sociodemographic and personal characteristics. The addition of stigma and prior ED experiences did not significantly improve the predictive utility of the TPB model.</div></div><div><h3>Conclusion</h3><div>Findings support the utility of the TPB in predicting willingness to use the ED among individuals with SCD during pain crises. Intervention strategies aimed at addressing patient attitudes may enhance willingness to use the ED during pain crises as well as the overall ED experience of individuals with SCD.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 5","pages":"Pages 323-334"},"PeriodicalIF":2.3,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144710457","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":"Marcelle lapicque (1873-1960): The first black female European neuroscientist?","authors":"Alison Christy ,&nbsp;Manon Auffret ,&nbsp;Jean-Gaël Barbara ,&nbsp;Alexis Simpkins","doi":"10.1016/j.jnma.2025.07.010","DOIUrl":"10.1016/j.jnma.2025.07.010","url":null,"abstract":"<div><div>Marcelle Lapicque (1873-1960), a contemporary of Solomon Carter Fuller, was a neuroscientist who studied the electrophysiology of the neuromuscular junction at the Sorbonne in Paris. Though award-winning, extensively published and an enthusiastic mentor of women, she was written about almost exclusively in French in her lifetime, and her name has been forgotten in favor of her husband, Louis Lapicque (1866–1952), known for the integrate-and-fire model of the action potential. Although little was written about Marcelle’s ethnicity, her father, Severiano de Heredia, was a Cuban of African heritage – a mixed-race politician elected president of the Paris City Council, today written about as the “first Black mayor of Paris.” It is unclear if the discrimination Marcelle faced was purely due to gender, or whether her mixed African and Cuban heritage played a role as well.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 5","pages":"Pages 341-346"},"PeriodicalIF":2.3,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700884","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":"Objective quantification of trabecular meshwork pigmentation and correlation to primary open-angle glaucoma disease severity","authors":"Daniel Laroche ,&nbsp;Brian Grodecki ,&nbsp;Chester NG","doi":"10.1016/j.jnma.2025.06.008","DOIUrl":"10.1016/j.jnma.2025.06.008","url":null,"abstract":"<div><h3>Purpose</h3><div>In this study, we further evaluated a unique early biomarker that has been demonstrated to be correlated with primary open-angle glaucoma in a pilot study. This novel biomarker correlated an increased ratio of pigmentation in the inferior trabecular meshwork (TM) compared to the superior TM with a greater degree of visual field loss in a small subset of patients. We evaluated this association in a larger group of patients.</div></div><div><h3>Methods</h3><div>This is a retrospective single-center analysis of Black and Afro-Latino patients that make up the local New York inner-city community of Advanced Eyecare of New York in Queens Village and Harlem, New York City with a diagnosis of primary open-angle glaucoma. We reviewed 335 consecutive glaucoma and glaucoma suspect patients with imaging of the TM via the GS-1 gonioscope. The degree of pigmentation was then quantified using ImageJ software to measure the ratio of pigmentation in the superior to inferior TM. We then created a ratio based on these superior to inferior TM measurements for each patient and compared this ratio to the patient’s mean deviation of the visual field.</div></div><div><h3>Results</h3><div>Results from 529 eyes in 335 patients demonstrated a positive correlation between the superior-inferior ratio (SIR) of pigmentation and visual field loss. The greater the degree of pigmentation asymmetry between the superior and inferior angle, the greater the extent of visual field deterioration. There was also a positive correlation between the SIR and age.</div></div><div><h3>Conclusion</h3><div>In a larger cohort of patients with glaucoma or glaucoma suspects, on TM pigment assessment with Image J, there was a positive correlation between SIR and worsening visual field mean deviation. Further research is required to evaluate a greater number of normal patients, glaucoma suspects, and glaucoma patients. Further research is also necessary to produce automated TM images and to develop automated assessment of TM pigment density with artificial intelligence to compare with other clinical factors such as age, IOP, OCT, and retinal nerve fiber layer thickness. Since the TM is where damage initially occurs to cause glaucoma, this can potentially lead to earlier detection before IOP elevation and retinal ganglion cell loss.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 5","pages":"Pages 304-310"},"PeriodicalIF":2.3,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692984","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}