Journal of the National Medical Association最新文献

{"title":"Treating Intractable Nausea and Vomiting in Cerebellar and Medullary Stroke","authors":"Taimur Khalid BS,&nbsp;Ryan Parto MD,&nbsp;John Varras MD, FACP","doi":"10.1016/j.jnma.2024.07.070","DOIUrl":"10.1016/j.jnma.2024.07.070","url":null,"abstract":"<div><h3>Purpose</h3><p>Cerebellar and medullary strokes are relatively rare, comprising only 1-4% of all cerebral infarctions [1–3]. Common symptoms include dizziness or vertigo, nausea, vomiting, and gait disturbance, with nausea and vomiting occurring &gt; 50% of the time [4]. Despite the frequency of these symptoms, there is scarce literature on successful treatment regimens.</p></div><div><h3>Methods</h3><p>We report the case of a 48 year old male with history of diabetes mellitus II who presented with 10-days of nausea, vomiting, and rightsided weakness / paresthesias. MRI brain revealed infarcts in the inferomedial right cerebellum and posterior right medulla brainstem. Initial management of nausea and vomiting with ondansetron 4mg q6h and metoclopramide 10mg q8h proved ineffective.</p><p>Metoclopramide was discontinued and ondansetron increased to 8mg q8h. However, symptoms persisted followed by the development of hiccups. A more aggressive treatment plan was opted for, including chlorpromazine 25mg q4h for hiccups and prochlorperazine 10mg q6h for nausea. The patient saw marked improvement and was discharged on ondansetron 8mg q8h, prochlorperazine 10mg q6h, amitriptyline 25mg nightly, and a scopolamine patch every 3 days.</p></div><div><h3>Results</h3><p>On the patient's one week follow up in the resident clinic, the patient reported almost full resolution of nausea and vomiting.</p></div><div><h3>Conclusion</h3><p>Cerebellar and medullary infarcts may frequently present with nonspecific symptoms including intractable nausea and vomiting. Management is complex and may be confounded by underlying conditions with similar presentations. Implementation of successful treatment regimens may greatly expedite recovery and mitigate extraneous workup and expenses. This report details a successful option for treatment.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Pages 441-442"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142087543","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":"Associations between Intrauterine Exposure to Malaria and Childhood Neurodevelopment","authors":"Daniel P Ashley MPA, BSc (Hons),&nbsp;Samudragupta Bora PhD","doi":"10.1016/j.jnma.2024.07.068","DOIUrl":"10.1016/j.jnma.2024.07.068","url":null,"abstract":"<div><h3>Introduction</h3><p>The financial cost of mental illness in low- and middle-income countries in 2010 was estimated to be $870 billion USD, with this number expected to double by 2030. There is mounting evidence supporting a link between malaria in pregnancy (MIP) and adverse birth outcomes. However, substantial evidence verifying the impact of MIP on neurocognitive function in offspring is lacking. This viewpoint will discuss the burden of MIP globally and explore current literature linking MIP and neurodevelopmental outcomes.</p></div><div><h3>Methods</h3><p>Through an extensive database search, this narrative review summarized 66 references from the existing literature, which demonstrates a significant association between intrauterine exposure to malaria and adverse childhood neurodevelopment.</p></div><div><h3>Results</h3><p>Malaria incidence is on the rise in many countries and preventative measures not only improve the health outcomes for mother and infant but also potentially reduce the long-term economic burden on countries globally. Much attention has been focused on the effects of malaria on maternal health and birth outcomes, but foetal neurodevelopment is now emerging as an important risk factor. This review highlights the potential risk for neurodevelopmental delay in those children exposed to malaria infection in utero and consequently millions of children may not be meeting their developmental potential.</p></div><div><h3>Conclusion</h3><p>Treating MIP as a preventable risk factor for childhood neurocognitive and adult neuropsychiatric disorders could have overwhelming health and financial implications. Ideally, a shift from global health priorities focused on lifelong treatment and rehabilitation to disease prevention is necessary to combat the adverse outcomes from malaria infection.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 441"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142087557","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":"Malaria and typhoid fever co-infection: disease severity and immune response","authors":"Ange Maxime TCHOUTANG BS,&nbsp;MacDonald BIN Eric,&nbsp;Severin Donald Kamdem,&nbsp;Marie Chrisitne NKUNO,&nbsp;NGUM Lesly NGUM,&nbsp;Arnauld Tepa,&nbsp;Palmer MASUMBE NETONGO","doi":"10.1016/j.jnma.2024.07.086","DOIUrl":"10.1016/j.jnma.2024.07.086","url":null,"abstract":"<div><h3>Introduction</h3><p>Malaria and Typhoid fever are significant diseases in many parts of the world, especially in the tropics and fever is a common sign. Prominent markers for early diagnosis and better comprehension of this pathological association and immunity are vital to reduce mortality, drug resistance and for clinical purposes. We sought to explore the profile of severity, oxidative stress, and inflammatory markers during malaria and typhoid fever co-infection.</p></div><div><h3>Methods</h3><p>From a cross-sectional study, 81 malaria and/or typhoid fever-positive patients from 288 fever patients were selected. Malaria was diagnosed using a Rapid diagnostic test and microscopy while typhoid fever was diagnosed using a Rapid typhoid test and Widal. Severity, stress level and inflammatory responses were evaluated by hematological analysis using full blood count, erythropoietin, cortisol, IL-10, IL-4 and IFN-γ through ELISA, superoxide dismutase and Catalase activities by spectrophotometer. Data were analysed using SPPS 26 and PRISM 9 software.</p></div><div><h3>Results</h3><p>Co-infected patients present significant alterations of red blood cell lines such as thrombocytopenia and anaemia. We founded also a significant increase of stress marker cortisol, IFN-γ and IFN-γ/IL-10 ratio compared to other groups, a decrease in anti-oxidant activities and an alteration of erythropoietin production. The levels of IL-10 and IL-4 were higher during mono-infections.</p></div><div><h3>Conclusion</h3><p>Co-infected subjects show changes in hematological parameters. The presence of malaria and typhoid fever results in a significant increase in stress, alterations in erythropoietin production, anti-oxidants and TH1- cytokine dominance. These findings allow for better management by the clinicians of these infections in the tropics.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 449"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142088121","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":"Underlying Viral Etiology in Behcet's Disease: A Systematic Review","authors":"Victoria A.O. Ayodele BA,&nbsp;Ayomide Akinsooto MS,&nbsp;Raphaela Tchani BS,&nbsp;Pavela Bambekova MD,&nbsp;Sandra Osswald MD","doi":"10.1016/j.jnma.2024.07.040","DOIUrl":"10.1016/j.jnma.2024.07.040","url":null,"abstract":"<div><h3>Introduction</h3><p>Bechet's disease is a rare auto-inflammatory systemic vasculitis characterized by recurrent oral and genital ulcerations, chronic uveitis, and vasculitis affecting arteries and veins of all sizes. Left untreated, it can lead to more severe complications such as stroke and blindness. Behcet's disease primarily affects individuals who are in their 20s to 40s, however the cause of the condition is still unknown. Additionally, there is a higher prevalence in Middle Eastern, Asian, and Mediterranean patients, suggesting a possible association with genetic predisposition and environmental influences. Other studies have indicated viral infection may play a role in the pathogenesis of Behcet's disease.</p></div><div><h3>Methods</h3><p>Articles in English were identified from January 1960 through March 2024 using PubMed and SCOPUS, adhering to the updated 2020 standards of the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statement. Search terms were ‘Bechet's disease’ and ‘case report’. Relevant abstracts were retrieved and assessed for inclusion by three reviewers.</p></div><div><h3>Results</h3><p>Out of 1127 studies identified, 467 met inclusion criteria. 73% of the studies (343) did not report/assess the viral status of the patient. Of the 124 studies that did report viral status, 9.7 % of patients (12) were found to be positive for one or more viruses. The most common virus identified was cytomegalovirus (CMV), which was positive in 3 patients.</p></div><div><h3>Conclusion</h3><p>Behcet's disease, though rare, remains poorly understood. Advancements in understanding its etiology and risk factors could lead to improved treatments and patient oues.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 428"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089120","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":"New Instrument for Adverse Childhood Experiences in HIV-Positive Zambian Children","authors":"Ruth N Agwaze BS, BA,&nbsp;Mwemba Milimo MS,&nbsp;Patil Gauri BA,&nbsp;Shahid Mohammed Mehdi BA,&nbsp;G Mbewe Esau MS,&nbsp;P Kabundula Pelekelo MS,&nbsp;Mwanza-Kabaghe Sylvia MS,&nbsp;R Bearden David MD","doi":"10.1016/j.jnma.2024.07.045","DOIUrl":"10.1016/j.jnma.2024.07.045","url":null,"abstract":"<div><h3>Purpose</h3><p>Adverse childhood experiences (ACE) drive a variety of poor health outcomes, including anxiety, depression, and cognitive impairment. Little is known about the impact of ACE in HIV-positive children in Sub-Saharan Africa. We sought to develop and validate a culturally-sensitive instrument to evaluate ACE in HIV-positive Zambian children.</p></div><div><h3>Methods</h3><p>This was a prospective mixed-methods study within HIV-Associated Neurocognitive Disorders in Zambia (HANDZ), a longitudinal cohort study of children with HIV in Zambia, Africa. Qualitative interviews with families and community experts were conducted to generate a battery of questions for Adverse Life Experiences in Zambia (ALEZ) in three domains: violence exposure, serious illness, and family stressors. Standardized NIH Toolbox neuropsychological batteries of sadness, fearfulness, depression and anxiety were administered annually. The World Health Organization Adverse Childhood Experiences International Questionnaire (ACEIQ) was administered for comparison. Face, convergent and content validity were assessed using multivariate linear regression analyses.</p></div><div><h3>Results</h3><p>The baseline sample consisted of 331 HIV-positive, 208 HIV-exposed uninfected (HEU) and 75 HIV-unexposed uninfected (HUU) children. Interviews and linear regression analyses between ALEZ and ACE-IQ established face, content, and criterion validity. HIV-positive children experienced increased average NIH-Toolbox sadness and fearful emotion, but there were no significant differences in prevalence of depression and anxiety among all groups. ALEZ z-scores were more positively-correlated to sadness and fearful emotion than ACE-IQ z-scores.</p></div><div><h3>Conclusion</h3><p>ALEZ was the first instrument designed to measure ACE in Sub-Saharan Africa with appropriate face, content, and construct validity. Further studies are needed to establish ALEZ reliability predictive validity.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 430"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089125","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 Ethnic Disparities in Helicopter Transport Utilization in Severely Injury Children","authors":"Christian Mpody MD, PhD, MBA,&nbsp;Joseph D. Tobias MD,&nbsp;Olubukola O. Nafiu MD","doi":"10.1016/j.jnma.2024.07.049","DOIUrl":"10.1016/j.jnma.2024.07.049","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;p&gt;In the United States, trauma is a leading cause of pediatric mortality. In severe injury, every second counts towards maximizing survival, an urgency encapsulated in the concept of the 'Golden Hour.' In this context, helicopter air ambulances is as a vital component of the emergency medical services system, reducing the time to definitive care for severely injured patients. However, persisting racial and ethnic disparities in trauma outcomes in the US raise questions about whether non-clinical factors, such as race or ethnicity, influence the deployment of life saving interventions, such as air transport for severely injured children. In this study, we evaluated whether there is a racial or ethnic disparity in the risk-adjusted use of helicopter ambulance following severe pediatric trauma. We also evaluated whether the gaps in helicopter utilization between children of different races and ethnicity have begun to narrow or widen over time.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;We conducted a population-based, 1:1 propensity-score matched, retrospective cohort study using data from the National Trauma Data Bank (NTDB) between 2017 and 2022. Our cohort included 42,812children (15) and had and emergency department disposition to the operating room or the ICU at level I or II trauma centers. Our primary outcome was the risk-adjusted transport mode comparing racial/ethnic groups (helicopter ambulance vs. ground ambulance). We used linear risk and log-binomial regression models and summarized the results as adjusted relative risk (RRadj), absolute risk difference (RDadj) along with their 95% confidence intervals (CIs). To account for clinical characteristics that could influence the decision to use helicopter transport, the propensity score models controlled for age, sex, hospital teaching status, American College of Surgeons verification level, state designation, hospital bed size, patient's primary insurance, injury intentionality, injury mechanism, chronic complex condition, body region, injury severity score, EMS reported Glasgow coma scale, heart rate and systolic blood pressure, and a distance indicator between injury site and receiving hospital.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Result&lt;/h3&gt;&lt;p&gt;Helicopter transport was associated with a lower mortality risk compared to ground transport (RRadj: 0.86, 95%CI: 0.79 to 0.93, P-value &lt; 0.001). Despite the mortality benefits of helicopter utilization, non-Hispanic Black children were 50% relative less likely to be air transported, compared to Non-Hispanic White children (20.0% vs. 33.6%, RDadj: -20.0%, 95% CI: -22.0 to -18.0, P-value &lt; 0.001). Similarly, Non-Hispanic Others (24.7% vs. 33.6%, RDadj: -11.0%, 95% CI: -14.0 to -8.0%, P-value &lt; 0.001), and Hispanics (24.0% vs. 33.6%, RDadj: -11.0%, 95% CI: -13.0 to -10.0%, P-value &lt; 0.001) were both less likely to be air transported compared to Non-Hispanic White children—Figure 1. We found no statistical evidence of narrowing of the dispar","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Pages 432-433"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089159","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":"Addressing Disparities in Cardiovascular Disease, Cancer, COVID and HIV","authors":"Marie L. Borum MD, EdD, MPH, MACP, FACG, AGAF, FRCP","doi":"10.1016/j.jnma.2024.07.010","DOIUrl":"10.1016/j.jnma.2024.07.010","url":null,"abstract":"","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Pages 323-324"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089164","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":"Investigating the Accuracy of Obstetric-Related Educational Material Disseminated Through Social Media","authors":"Ogechukwu S. Anwaegbu BS,&nbsp;Smiti Gandhi BS,&nbsp;Gengi E. Kleto BS,&nbsp;Mitaire Erhieyovew BS,&nbsp;Deniz Isikkent MD,&nbsp;Rovnat Babazade MD","doi":"10.1016/j.jnma.2024.07.015","DOIUrl":"10.1016/j.jnma.2024.07.015","url":null,"abstract":"<div><h3>Introduction</h3><p>In recent times, healthcare providers have leveraged Instagram to share insights into their medical specialty, providing educational content to the public in a format distinct from traditional medical norms. However, the medical domain on Instagram lacks the same level of regulation, potentially resulting in the dissemination of inaccurate information3, impacting patient experiences and health outcomes. Our study aims to evaluate the quality and accuracy of obstetric anesthesia-related content on Instagram.</p></div><div><h3>Methods</h3><p>A search Instagram posts for #Epidural, #EpiduralAnalgesia, #ObAnesthesiologist and #ObstetricAnesthesia was conducted. Engagement metrics were used to quantify post content reach. Medical education videos were assessed for accuracy and PEMAT-A/V to evaluate understandability and actionability.</p></div><div><h3>Results</h3><p>A total of 80 Instagram posts were analyzed, revealing a predominant focus on Medical Education(46%), followed by Provider Lifestyle(21%), Advertisement(16%), Research Articles(8%), Patient Experience(5%), and Medical Illustration(4%). In medical education content, 69% of posts were completely accurate, 28% were partially accurate or potentially misleading, and 3% were entirely inaccurate. When comparing video posts to picture posts: among video posts, 50% accurate information, 42% partially accurate or incomplete information, and 7% were entirely inaccurate. In contrast, picture posts demonstrated higher accuracy rates, with 81% being accurate, 19% partially accurate or potentially misleading, and none being inaccurate.</p></div><div><h3>Conclusion</h3><p>Our analysis illustrates diverse obstetric anesthesia-related content on Instagram. Future research should assess accuracy variations among different obstetric healthcare provider types on social media and provide strategies for healthcare providers to improve engagement, maintain accuracy, and navigate time constraints when sharing medical information.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 416"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089172","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":"Segmental Analysis of Racial and Ethnic Diversity in the Pipeline to Anesthesiology Fellowship from 2012-2022","authors":"Candice S Dyce BA,&nbsp;Megan Darrell B.A.,&nbsp;Mill Etienne M.D., MPH, FAAES, FAAN","doi":"10.1016/j.jnma.2024.07.016","DOIUrl":"10.1016/j.jnma.2024.07.016","url":null,"abstract":"<div><h3>Purpose</h3><p>Racial and ethnic minorities have historically experienced inequities in pain assessment and analgesia delivery, as well as worse perioperative outcomes. An equally diverse physician workforce is necessary to care for the needs of this population. Despite ACGME's interest in prioritizing expansion and support of a diverse workforce, the percentage of URiM Anesthesiology trainees is lagging behind the demographic shift in the US.</p></div><div><h3>Methods</h3><p>We extracted data from the Accreditation Council for Graduate Medical Education (ACGME) graduate medical education Data Resource Book from 2012 to 2022. We performed a Chi-squared analysis of the demographic data of Anesthesiology residents and subspecialty fellows by race and ethnicity then compared to US census demographics &amp; AAMC Matriculant Data File.</p></div><div><h3>Results</h3><p>Asian residents and fellows are overrepresented in nearly all categories, ie. Anesthesiology residency, Pediatric Anesthesia, Pain Medicine, Adult Cardiothoracic Anesthesia, Critical Care Medicine, and Colon &amp; Rectal Surgery fellowship (all pp&lt;0.001). Black, Hispanic, and Native American doctors are all underrepresented in Anesthesiology residency programs (p&lt;0.001). At the fellowship level, Black candidates are underrepresented in Adult Cardiothoracic Anesthesia (p&lt;.01), Pain Medicine (p&lt;0.001), Pediatric Anesthesia (p&lt;.05), and Critical Care (p&lt;.001). Hispanic candidates are underrepresented in nearly all subspecialty programs: Colon &amp; Rectal surgery (p&lt;.001), Critical Care (p&lt;.001), Obstetric Anesthesia (p&lt;.05), Pediatric Anesthesia (p&lt;.05), Pain Medicine (p&lt;0.001), and Adult Cardiothoracic (p&lt;.001).</p></div><div><h3>Conclusion</h3><p>The onus now lies with academic medical institutions to cultivate diversity by recruiting and retaining URiM trainees so that the field can better reflect the population and bridge the gap to healthcare equity.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 417"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089173","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":"Suicide-related mortality in cardiovascular disease in the United States from 1999 to 2019","authors":"Kenyon Agrons ,&nbsp;Vijay Nambi ,&nbsp;Ramiro Salas ,&nbsp;Abdul Mannan Khan Minhas","doi":"10.1016/j.jnma.2024.07.001","DOIUrl":"10.1016/j.jnma.2024.07.001","url":null,"abstract":"<div><h3>Introduction</h3><p>Research has shown chronic diseases can be associated with suicide but there is limited data on suicide in cardiovascular disease (CVD). Given the substantial psychosocial, financial, quality of life, and health impact of CVD, we aimed to study suicide-related mortality in CVD.</p></div><div><h3>Methods</h3><p>We used Center for Disease Control Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) to access Multiple Cause of Death data from 1999 to 2019. Suicide and CVD related deaths in patients ≥ 25 years were identified. Proportionate suicide-related mortality (PSrM) was calculated as suicide-related deaths (listed with CVD) divided by all CVD-related deaths (irrespective of suicide) and reported as PSrM per 100,000 CVD-related deaths. Joinpoint regression was used to examine trend changes using annual percentage change (APC) overall and by sex, race/ethnicity, disease subtype, and age.</p></div><div><h3>Results</h3><p>Overall, PSrM in CVD increased from 62.8 in 1999 to 90.5 in 2019. The PSrM increased from 1999 to 2002 with an associated APC of 6.2 (95 % CI, 0.0 to 12.7), remained stable from 2002 to 2005, increased from 2005 to 2013 with an APC of 4.8 (95 % CI, 3.4 to 6.3), and decreased from 2013 to 2019 with an APC of -2.1 (95 % CI, -3.6 to -0.5). Among racial/ethnic groups, PSrM was highest in non-hispanic (NH) White (103.8), then Hispanic or Latino (63.6), and then NH Black or African American individuals (29.2). PSrM was highest in the 25–39 years age group (858), then 40–54 years (382.8), 55–69 years (146.2), 70–84 years (55.9), and then 85+ (17). PSrM initially increased in men with APC (3.1 until 2013), women (4.1 until 2014), NH White individuals (3.9 until 2013), Hispanic or Latino (3.5 until 2014), ages 40–54 years (2.9 until 2013), 55–69 years (6.0 until 2013), then stabilized or decreased. AAMR increased in NH Black or AA individuals APC (1.0) and 25–39 years APC (1.4) from 1999 to 2019.</p></div><div><h3>Conclusion</h3><p>PSrM in CVD peaked in the early 2010s, with varying differences across sex, racial/ethnic, and age groups. Further research is needed to understand disparities and develop preventive strategies.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Pages 378-389"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141891488","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}