Journal of the National Medical Association最新文献

{"title":"Hidden Infections, Hidden Risks: Unveiling the Connection beatingetween Chlamydia & Preeclampsia","authors":"Azure B. Erskine BS, Nurupa Ramkissoon BS, Austin Eakinyemi, Samrawit Zinabu MS, Miriam Michael MD","doi":"10.1016/j.jnma.2025.08.047","DOIUrl":"10.1016/j.jnma.2025.08.047","url":null,"abstract":"<div><h3>Background</h3><div>Preeclampsia is a leading cause of maternal and perinatal morbidity and mortality, characterized by new-onset hypertension and organ dysfunction after 20 weeks of gestation. While its pathophysiology involves abnormal placental development, endothelial dysfunction, and systemic inflammation, emerging evidence suggests that infections, particularly Chlamydia trachomatis, may contribute to its development. Chlamydia trachomatis is a common sexually transmitted infection (STI) that is often asymptomatic but can cause chronic inflammation and vascular damage, which are also key mechanisms in preeclampsia.</div><div>Understanding the potential link between Chlamydia infection and preeclampsia could improve early detection and prevention strategies for high-risk populations.</div></div><div><h3>Methods</h3><div>This study utilized a cohort analysis to compare the incidence of preeclampsia in women with a history of Chlamydia trachomatis infection versus those without. Two cohorts were defined based on medical records: women with documented Chlamydia infection (Cohort 1) and a control group without any history of Chlamydia infection. Propensity score matching was used to balance baseline characteristics between the groups. Statistical analyses included risk ratio, odds ratio, Kaplan-Meier survival analysis, and propensity-matched comparisons to assess the association between Chlamydia infection and preeclampsia risk.</div></div><div><h3>Results</h3><div>The findings revealed a small but statistically significant increase in the absolute risk of preeclampsia among women with a history of Chlamydia infection. While the overall increase in risk was modest, the data indicated that women with Chlamydia had a higher frequency of preeclampsia events compared to the control group. Although the Kaplan-Meier survival analysis showed no significant difference in the timing of preeclampsia onset, the increased number of instances suggests that prior Chlamydia infection may influence the severity or recurrence of the condition. These results highlight a potential physiological connection between Chlamydia-related inflammation and endothelial dysfunction, key factors in the development of preeclampsia.</div></div><div><h3>Conclusions</h3><div>The study supports the hypothesis that Chlamydia trachomatis infection may be a contributing factor in preeclampsia through its impact on inflammation, vascular health, and immune response during pregnancy. Given the high prevalence of Chlamydia, even a small increase in preeclampsia risk could have significant public health implications. These findings suggest that routine STI screening and early treatment could serve as a preventative measure against pregnancy complications, particularly in high-risk populations with limited healthcare access. Further research is needed to explore the biological mechanisms underlying this association and to evaluate whether targeted screening and intervention strat","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Page 24"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989864","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":"Access and Outcomes of CAR-T Cell Therapy in Relapsed/Refractory Multiple Myeloma by Race","authors":"Marcus Selles ,&nbsp;Shebli Atrash ,&nbsp;Peter Voorhees","doi":"10.1016/j.jnma.2025.08.095","DOIUrl":"10.1016/j.jnma.2025.08.095","url":null,"abstract":"<div><h3>Background</h3><div>Multiple myeloma (MM) is a plasma cell malignancy with disproportionately high incidence and mortality among Black patients. Recent advances in CAR-T cell therapies, particularly idecabtagene vicleucel (ide-cel) and ciltacabtagene autoleucel (cilta-cel), have revolutionized treatment for MM. However, administration and supportive care of CAR T cell therapy is complex and disparities in access and outcomes remain poorly characterized in real-world settings.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of 101 patients with relapsed/refractory MM (RRMM) treated with CAR-T therapy at Levine Cancer Institute. Baseline patient demographics, treatment and disease characteristics, toxicity, and outcomes were analyzed, with a focus on racial differences.</div></div><div><h3>Results</h3><div>Median age was 66 years; 58% were male. The cohort was 78% White, 21% Black, and 1% Asian. Black patients comprised 21% of CAR-T recipients, significantly lower than their representation among all MM patients at the center (31%, p = 0.0277). CRS occurred in 79% of patients (86% Black, 77% White). ICANS occurred in 21% of patients (24% Black, 20% White). Neutrophil counts were lower at day 90 for Black vs White patients (median 1.32 vs 2.5 × 106 / L). Infections occurred in 33% of Black and 34% of White patients. MRD negativity was achieved in 86% of Black and 80% of White patients. 6-month progression-free survival was 90% and 82% for Black and non-Black patients, respectively (p = 0.8). The hazard ratio for overall survival between Black and non-Black patients was 1.07 (p = 0.9).</div></div><div><h3>Conclusion</h3><div>CAR-T therapy yielded similar efficacy and safety outcomes across racial groups. However, Black patients were significantly underrepresented among recipients, despite comparable clinical benefit. These findings highlight the urgent need to address structural and institutional barriers limiting CAR-T access for Black patients with RRMM</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 52-53"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989868","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":"Hospitalists' Perspective on Goals of Care Discussion on Racially and Ethnically Diverse Patients","authors":"Amanda E. Dowden MD","doi":"10.1016/j.jnma.2025.08.033","DOIUrl":"10.1016/j.jnma.2025.08.033","url":null,"abstract":"<div><h3>Background</h3><div>Previous literature has shown that patients of racial and ethnic diverse backgrounds are less likely to be engaged in goals of care discussions during hospitalization. The objective of this study is to shed light on barriers to addressing goals of care in this vulnerable population.</div></div><div><h3>Methods</h3><div>All hospitalists at a major tertiary center were surveyed. Study data were collected using REDCap electronic data capture tools. This needs assessment will be performed via an anonymous and voluntary survey of hospitalists. Descriptive statistics and Chi test will be used for analysis.</div><div>Data records consist of Anonymous survey responses from hospitalists. Questions will include barriers and facilitators to discussing Goals of Care with patients of diverse racial and ethnic backgrounds as well as hospitalist perceptive on current recommendations to improve these discussions in this population. Part 1 of the study assesses hospitalist confidence in carrying Goals of Care conversations. Part 2 of the study assesses hospitalists barriers to goals of care discussions amongst patients of ethnic and racial backgrounds. Part 3 assessing how practical hospitalists feel GOC conversations are in their clinical practice.</div></div><div><h3>Results</h3><div>The data shows that the number of hospitalists who feel very and extremely confident having G.O.C discussions with patient’s drops significantly when talking to non- English speaking patients from 67% to 19%. There is a similar trend when discussing life support from 81% to 19%. Additionally, 52% state that language is a moderate to extreme barrier to GOC Discussions with patients. Of interest, only 4% state that race and ethnicity is a moderate barrier to GOC discussions and 11% state that spirituality or religion is a barrier to GOC discussions. Additionally, when asking about integrating the recommended questioning to underserved/diverse populations 48% felt that it would not be realistic in clinical practice.</div></div><div><h3>Conclusion</h3><div>The data suggests that looking forward it is necessary for us to eliminate disparities in end of life care. Additionally, it is the goal to use this data to create a curriculum for hospitalists centered around Goals of Care and Advanced Care planning.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Page 16"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989938","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":"Implementing a Health Equity Grading System into Obstetrics and Gynecology","authors":"Aleah R. Booker BA,&nbsp;Alexander Z Wang BS,&nbsp;J. Michael Millis MD,&nbsp;Ted A. Skolarus MD, MPH,&nbsp;Jana Richards MD,&nbsp;Chelsea Dorsey MD","doi":"10.1016/j.jnma.2025.08.049","DOIUrl":"10.1016/j.jnma.2025.08.049","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Maternal morbidity and mortality rates in the United States have risen, disproportionately affecting women of color across all income and education levels. While factors like hypertension and diabetes are often cited, they fail to account for the broader impact of structural inequities, including implicit bias and racism. The persistence of these trends indicates systemic contributors to these poor outcomes.&lt;/div&gt;&lt;div&gt;To date, few provider case review tools effectively capture the impact of health inequity on patient complications. Traditional health equity teaching in medical education is largely didactic and does not address real-time clinical decision-making. Case review formats, like Morbidity and Mortality (M&amp;M) conferences, focus on patient outcomes but overlook the role of health inequities in complications.&lt;/div&gt;&lt;div&gt;The uChicago Health Inequity Classification System (CHI-CS) was developed in the Department of Surgery as a structured framework to implement health equity into M&amp;M case discussions. Building on prior implementation, this study sought to assess CHI-CS’s effectiveness in Obstetrics and Gynecology and examine its generalizability to other medical specialties.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;CHI-CS was implemented into OBGYN M&amp;M conferences for 6 months. Residents reported deidentified M&amp;M data to determine the frequency of bias-or-access related complications.&lt;/div&gt;&lt;div&gt;A pre-intervention survey was administered to assess participants’ beliefs, recognition, discussion and understanding of bias and access. After six months, a post-intervention survey was distributed to evaluate CHI-CS’s impact on clinical practice and participant’s understanding of health equity.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The pre-intervention survey was distributed to 29 residents and 82 faculty members in the department of Obstetrics and Gynecology. Among them, 54 participants completed the survey (48.6% response rate). Of the 54 participants, 68% were faculty (n=37) and 31% were residents (n=17).&lt;/div&gt;&lt;div&gt;On the pre-intervention survey, residents reported stronger beliefs and greater confidence recognizing bias’s contribution to complications compared to faculty. Participants indicated greater understanding of access issues.&lt;/div&gt;&lt;div&gt;During the study period, 21 cases were presented at monthly M&amp;M conferences. Bias or access contributed to 57% of cases presented during the study.&lt;/div&gt;&lt;div&gt;The post-intervention survey was distributed to 30 residents and 83 faculty in the department. Preliminary results from the post- intervention survey indicate increased recognition, understanding, and discussion of bias and access. Participants reported having more conversations about bias and access since implementation, indicating an improvement in care delivery. Additionally, nearly half of respondents stated that they have changed their clinical practice to address bias and access, aiming to improve pati","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 25-26"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989962","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":"Seasonal Trends in Sinusitis-related Cerebral Abscess","authors":"Laura E. Ramirez BS,&nbsp;Alexander K. Foyt BS,&nbsp;Jordon Grube DO","doi":"10.1016/j.jnma.2025.08.067","DOIUrl":"10.1016/j.jnma.2025.08.067","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Sinus infections, if left untreated, can spread to the brain, leading to life-threatening complications such as cerebral abscesses. While previous research has established a correlation between seasonality and the incidence, presentation, and clinical course of sinusitis, as well as its progression to conditions like orbital cellulitis, the relationship between seasonality and the development of sinusitis- related cerebral abscesses remains inadequately explored. Understanding potential seasonal variations in disease progression is critical, as it may have implications for early diagnosis, risk stratification, and targeted public health interventions. This study leverages data from the National Emergency Department Sample (NEDS) to investigate whether a seasonal association exists between sinusitis-related cerebral abscesses and to identify key factors that may influence this relationship. By analyzing large-scale national data, this research aims to provide new insights into the temporal patterns and risk factors associated with this severe complication, ultimately contributing to improved clinical decision-making and preventive strategies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Patients diagnosed with sinusitis-related cerebral abscesses between 2018 and 2021 were identified using the National Emergency Department Sample (NEDS) database. To assess potential seasonal and demographic variations, patients were categorized based on age groups, geographic region, and month of presentation. Statistical analyses were conducted to evaluate differences across these groups. Chi-square tests were utilized to compare categorical variables, and a significance threshold of p ≤ 0.05 was applied to determine statistical significance.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 645 cases met the inclusion criteria for this study. Statistical analysis demonstrated a significant correlation between the overall number of sinusitis-related cerebral abscess cases and the month of presentation (p = 0.02). Further subgroup analysis revealed notable seasonal patterns in specific demographics. A significant association was observed in adult cases overall by month (p = 0.005), as well as in regional analyses, with adult cases in the Northeast showing a significant seasonal trend (p = 0.014) and adult cases in the South also exhibiting a significant monthly variation (p = 0.007).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Despite advancements in antibiotic therapy and imaging modalities that have contributed to a decline in the overall incidence of sinusitis-related cerebral abscesses, this condition remains a serious medical concern, particularly in regions with limited healthcare access and diagnostic capabilities. The findings of this study indicate a significant correlation between seasonality and the incidence of sinusitis-related cerebral abscesses, suggesting that environmental or seasonal factors may play a role in disease progressio","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 35-36"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989963","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":"Anti-Thyroglobulin Antibody in Differentiated Thyroid Cancer: Predictors and Outcomes","authors":"Matthew D. Leeder MD, BSc,&nbsp;Aishwarya R Krishnan MD,&nbsp;Andrew Day MSc, BSc,&nbsp;Sara Awad MD,&nbsp;Joshua Lakoff MD","doi":"10.1016/j.jnma.2025.08.027","DOIUrl":"10.1016/j.jnma.2025.08.027","url":null,"abstract":"<div><h3>Objective</h3><div>Thyroglobulin (Tg) is a biomarker used to monitor for persistent or recurrent disease (PRD) in differentiated thyroid cancer (DTC). 25% of DTC patients have positive antithyroglobulin antibodies which interfere with Tg measurements. We aim to understand what risk factors are associated with TgAb-positivity and how TgAb can aid in disease monitoring.</div></div><div><h3>Methods</h3><div>We retrospectively studied 329 adult DTC patients with documented TgAb values who underwent total thyroidectomy. Using a proportional hazards model, we examined the association between potential risk factors and TgAb-positivity. Using a Cox model for time-dependent covariates, we evaluated the relationship between TgAb-positivity and PRD.</div></div><div><h3>Results</h3><div>Lymphocytic thyroiditis (LT) (HR = 2.28 [CI 1.55-3.33]), stage &gt; 1 (p = 0.009), family history of thyroid cancer (HR = 2.27 [CI 1.02-5.05]), and age at diagnosis (HR = 0.98 [CI 0.97-1.00]) were associated with TgAb-positivity. TgAb-positivity was associated with increased PRD risk (HR=2.8 [CI 1.5-5.3]). However, LT was associated with decreased PRD risk (HR = 0.39, [CI 0.17-0.92]). When compared to combined undetectable Tg and negative TgAb, combined detectable Tg and positive TgAb had a higher hazard of PRD than detectable Tg or positive TgAb alone (HR = 29.6 [CI 6.3-138.1] vs. HR = 11.8 [CI 2.8-50.2] vs. HR = 11.9 [CI 2.4-58.8]), although this was statistically insignificant.</div></div><div><h3>Conclusions</h3><div>LT, stage &gt; 1, family history of thyroid cancer, and younger age were associated with TgAb-positivity. While TgAb- positivity is associated with increased PRD risk, patients with LT had a lower PRD risk. PRD risk may be higher in patients with combined positive TgAb and detectable Tg.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 12-13"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144988786","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":"Evaluation of Control Arm Quality in Recent Radiation Oncology Randomized Clinical Trials","authors":"Ifeanyi O Ekpunobi BS,&nbsp;Laura E Flores MD, PhD,&nbsp;Reshma Jagsi MD, DPhil,&nbsp;Shearwood McClelland III MD","doi":"10.1016/j.jnma.2025.08.072","DOIUrl":"10.1016/j.jnma.2025.08.072","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Randomized controlled trials (RCTs) are designed to provide the highest levels of evidence for clinical practice; consequently, RCTs are the mainstay for creating guidelines and approving new treatments. It is ethically essential for patients assigned to the control arm in RCTs to receive standard-of-care treatment. This serves to protect patients, optimize adequate treatment, and ensures that RCT findings are compared to current standard-of-care therapy – an ethical imperative of RCT design and implementation. Oncologic medical trials investigating new systemic agents for cancer have a high proportion of RCTs with inadequate control arms (PMID 31046071). It is unknown whether this finding is prevalent in oncologic trials investigating radiation therapy (RT) for cancer.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We identified registered clinical trials investigating RT in patients with cancer over the past decade. ClinicalTrials.gov was queried for RT as the intervention and cancer and other related terms as the condition between 1/1/13 and 1/1/23. Exclusion criteria included trials with incomplete status or non-oncologic indications. Trials were categorized by indication/primary disease site, first posted date, investigational arm, control arm, and sponsor/collaborator. Each control arm was analyzed, and the standard of care was determined according to National Comprehensive Cancer Center Network (NCCN) guidelines at the time of first posting.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 508 interventional studies with results registered on ClinicalTrials.gov were included. Of these, 360 single-arm studies were excluded. 116 studies investigating a treatment other than RT were excluded. 20 studies that were not completed were excluded. The remaining 12 studies were included in the final analysis. Of the included trials, 2 each investigated RT usage in central nervous system, prostate, head and neck, and breast disease sites, and 1 each for lung, hepatobiliary, rectal, and bone disease sites. A majority of the trials were industry-funded (83%), and over 2/3 of studies took place in the United States (75%). 100% of the trials were found to have an adequate control arm per the corresponding NCCN.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;100% of oncologic RCTs investigating radiation therapy for cancer were found to have an adequate control arm. This finding contrasts with medical oncology trials, which have been shown to have a high proportion of RCTs with inadequate control arms. This disparity highlights the importance of designing oncologic RCTs with adequate control arms, which is crucial for providing the highest level of evidence to guide optimal clinical practice and ensure the safety of patients. These findings suggest that adequate control arm treatments are feasible to achieve in trial design, emphasizing both the need for continued focus on improving the quality of ethical oncologic research trials and a possib","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 37-38"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989417","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":"HIV-Positive ESRD Patients: A Decade Comparison of Femur and Hip Fracture Risk (2004-2013 vs. 2014-2023)","authors":"Keleb S. Mehari BS,&nbsp;Damon Ross BS,&nbsp;Justin Morrison BS,&nbsp;Ryan Mitchell BS","doi":"10.1016/j.jnma.2025.08.062","DOIUrl":"10.1016/j.jnma.2025.08.062","url":null,"abstract":"<div><h3>Introduction</h3><div>HIV-positive patients with end-stage renal disease (ESRD) are at significantly increased risk for hip and femur fractures due to a combination of accelerated bone loss from both HIV and antiretroviral therapy (ART), particularly tenofovir disoproxil fumarate (TDF), which is known to reduce bone mineral density (BMD). Despite improvements in ART leading to longer life expectancy, prolonged exposure to these medications has raised concerns about earlier-onset osteoporosis and fractures in younger patients. This study evaluates trends in the incidence and prevalence of hip and femur fractures in HIV-positive ESRD patients across two decades (2004– 2013 vs. 2014–2023), with a specific focus on demographic differences in age, sex, and race.</div></div><div><h3>Methods</h3><div>This retrospective cohort study utilized data from the TriNetX database, which included 728,161 HIV-positive ESRD patients on ART from 2004 to 2023. The primary outcomes of interest were femur and hip fractures. Data on age, sex, and race were analyzed, and Poisson regression along with Chi-square tests were used to compare fracture rates between the two time periods (2004–2013 vs. 2014–2023).</div></div><div><h3>Results</h3><div>Femur fractures increased by 71% in incidence (1.52% to 2.61%) and 127% in prevalence (1.67% to 3.80%). Hip fractures showed a 184% rise in incidence (0.64% to 1.82%) and 248% in prevalence (0.69% to 2.40%). Significant increases in fracture rates were observed in younger age groups, particularly the 20–24 years group. Women experienced a larger increase in fracture rates (incidence 112%, prevalence 160%) compared to men. Racial disparities were evident, with Asians showing a notable rise in fracture incidence in the 2014–2023 period.</div></div><div><h3>Conclusion</h3><div>The incidence and prevalence of femur and hip fractures in HIV-positive ESRD patients have significantly increased over the past two decades. This rise is particularly notable in younger adults, women, and racial minorities, emphasizing a critical need for proactive measures to address bone health in this population. The findings suggest that fractures are occurring earlier, which highlights the importance of early osteoporosis screening, particularly for individuals on long-term ART. Given the severe consequences of fractures, including increased morbidity, mortality, and healthcare burden, early intervention strategies, such as DXA screening must be prioritized. These results underscore the urgent need for targeted fracture prevention, tailored interventions, and equitable healthcare strategies to mitigate bone health risks in HIV-positive ESRD patients.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 32-33"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989594","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 Role of GLP-1 Receptor Agonists (e.g., Ozempic) in Decreasing Disparities in Diabetes and Obesity Care: A Systematic Review of Efficacy, Access, and Public Health Equity Implications","authors":"Monika Panwar MPA","doi":"10.1016/j.jnma.2025.08.017","DOIUrl":"10.1016/j.jnma.2025.08.017","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), such as semaglutide (Ozempic), have revolutionized the management of type 2 diabetes and obesity, with benefits beyond glycemic control, including weight loss and cardiovascular protection. Access to these drugs, despite their efficacy, is unequal, with marginalized populations facing considerable barriers in the way of cost, lack of insurance, and geographic disparities. This systematic review seeks to evaluate the efficacy, safety, and equity implications of using GLP-1 RAs in treating diabetes and obesity and propose means by which access can be enhanced.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Systematic searching was carried out in Embase, PubMed, Cochrane Library, and clinical trial registers using the terms “GLP-1 receptor agonists,” “semaglutide,” “diabetes,” “obesity,” “health disparities,” and “access.” Only randomized controlled trials (RCTs), observation studies, and systematic reviews from the last seven years (2018-2024) were included. Data extraction followed PRISMA guidelines, and the risk of bias was assessed with the Cochrane Risk of Bias Tool and Newcastle-Ottawa Scale. Meta- analyses were performed to pool data on weight loss and glycemic control.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The result shows that of 1,235 records identified, 45 studies met the inclusion criteria. Semaglutide demonstrated better effect, such as average HbA1c reduction -1.5% (95% KI: -1.7 to -1.3) and 12.4% (95% CI: 11.8 to 13.0), with other GLP -1 RAS and traditional treatments better than conventional treatments. Reduction in cardiovascular risk was significant, with a 26% reduction in larger side effects in cardiovascular events (HR: 0.74; 95% CI: 0.68 to 0.81). Safety profiles were favorable; gastrointestinal side effects were the most common but generally mild. However, access inequalities were evident: black and Latin American patients had 40% less probability of getting GLP -1 RAS and were 50% smaller manufacturers in rural areas. Innovative strategies such as telehealth models and policy intervention promised to improve access, with an increase of 30% in telecommunications tips.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;GLP-1 RAS, especially Semaglutide, is very effective and safe for handling diabetes and overweight. However, there are still many inequalities in access, which affect individuals in racial/ethnic minorities, poor and rural communities. The disruption of these barriers by telehealth, policy reform, and community-based services is paramount for health equity. The focus of this review is that equal access to GLP-1 RAs is a national public health priority. Insurance expansion, drug cost decreases, and expansion of telehealth and community-based services are paramount steps in closing gaps and improving outcomes in individuals with diabetes and obesity. A national public health priority must be equal access to GLP-1 RAs to improve outcomes and close gaps ","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Page 6"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989730","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":"Evaluating Best-Practice-Advisors at Mitigating Ethnic disparities in Low-Dose-Aspirin Recommendation for Pre-Eclampsia","authors":"Elisabeth N. Adkins MD, MBA,&nbsp;Etoi Garrison MD, PhD,&nbsp;Melissa S. Wong MD, MHDS,&nbsp;Mulubrhan F. Mogos PhD, MSc, FAHA","doi":"10.1016/j.jnma.2025.08.046","DOIUrl":"10.1016/j.jnma.2025.08.046","url":null,"abstract":"<div><h3>Introduction</h3><div>Preeclampsia significantly contributes to adverse maternal and fetal outcomes. The American College of Obstetricians and Gynecologists (ACOG) recommends low-dose aspirin (LDA) for high-risk women to prevent preeclampsia. Despite this, significant racial/ethnic disparities exist in LDA utilization. Electronic Best Practice Alerts (eBPAs) may improve compliance with LDA recommendations. This study evaluates whether an eBPA implementation mitigated racial/ethnic disparities in LDA prescribing and preeclampsia incidence in an urban academic medical center.</div></div><div><h3>Methods</h3><div>A retrospective cohort of 15,216 pregnant women, categorized into four groups (White, Black, Other, and Missing), was analyzed before and after eBPA implementation. Preeclampsia incidence and LDA prescription rates were stratified by gestational age, race, and preeclampsia risk categories. Rao-Scott Chi-Square and logistic regression analyses were conducted to assess changes in LDA prescribing and preeclampsia rates.</div></div><div><h3>Results</h3><div>Post-eBPA, LDA prescription rates increased significantly across all risk categories, particularly among Black women (p &lt; .0001). White women showed a significant reduction in preeclampsia incidence post-eBPA (p &lt; .0001), while Black women had the highest preeclampsia risk and showed no significant reduction in risk post-eBPA (p = 0.1964). Racial disparities in LDA uptake and preeclampsia risk remained, with Black women experiencing persistently higher risk compared to other racial groups. The eBPA had a modest overall effect on reducing preeclampsia incidence (p = 0.0479).</div></div><div><h3>Conclusion</h3><div>While eBPA implementation increased LDA prescribing, it did not substantially mitigate racial/ethnic disparities in preeclampsia risk, particularly among Black women. Further strategies are needed to address these persistent disparities and ensure equitable health outcomes.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 23-24"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989860","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}