Journal of the National Medical Association最新文献

{"title":"Try not to think about food: An association between fasting, binge eating and food cravings","authors":"Jônatas de Oliveira ,&nbsp;João Ferro ,&nbsp;Victor Hugo Dantas Guimarães ,&nbsp;Felipe Quinto da Luz","doi":"10.1016/j.jnma.2024.09.005","DOIUrl":"10.1016/j.jnma.2024.09.005","url":null,"abstract":"<div><h3>Background</h3><div>When individuals follow a diet or limit their food intake, they activate cognitive restraint, which is defined as a mental effort to restrict dietary behavior with the goal of losing weight. As an example, fasting has also been associated with the recruitment of cognitive restraint, but further research is needed to fully understand its underlying mechanisms.</div></div><div><h3>Aims</h3><div>The aim of this study was to examine the relationship between the duration of fasting and disordered eating, such as food cravings, binge eating, and potential changes in eating habits.</div></div><div><h3>Methods</h3><div>An online survey was conducted among 853 first-semester university students to investigate their fasting practices and frequency over a three-month period prior to data collection. Participants who were on diets were excluded (n=214). After controlling the sample for biases, a comparison was made between 89 fasters and 369 non-fasters. The study compared levels of cognitive restraint, binge eating, food cravings, and consumption of ‘forbidden’ foods. A Poisson model was used to examine the association between hours of fasting and disordered eating traits. In the context of this study, the rate ratio was used to examine the relationship between fasting hours and disordered eating characteristics, such as binge eating and food cravings.</div></div><div><h3>Results</h3><div>The study found that fasters experienced an increase in food cravings and binge eating. However, fasters consumed fewer bread slices than non-fasters. The rate ratio of fasting hours practiced is 115% higher among binge eaters (RR 2.15; CI95% 1.70-2.73) compared to those who did not binge. The rate ratio of fasting hours is 29% higher in participants with moderate binge eating (RR 1.29; CI95% 1.05-1.59), increasing to 140% (RR 2.40; CI95% 1.86-3.11) in people with severe binge eating. As for food cravings (state), the rate ratio was 2% higher (RR 1.02; CI 95% 1.01-1.03) for each increase in the unit of the scale.</div></div><div><h3>Conclusions</h3><div>Our study has indicated that fasting is positively associated with increased levels of binge eating and food cravings.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 5","pages":"Pages 588-599"},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142485018","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 socioeconomic disparities in the treatment of unruptured intracranial aneurysms: A county hospital experience","authors":"Taylor Smith ,&nbsp;Kelley Wormmeester ,&nbsp;John Attia ,&nbsp;Mesha Martinez ,&nbsp;Nicolas Useche ,&nbsp;Juan Tejada","doi":"10.1016/j.jnma.2024.07.008","DOIUrl":"10.1016/j.jnma.2024.07.008","url":null,"abstract":"<div><h3>Background</h3><p>With increasing prevalence of unruptured intracranial aneurysms (UIAs), there is a need to provide appropriate management. Several studies have suggested that minorities in the United States have limited access to non-invasive imaging leading to increased presentation of aneurysmal subarachnoid hemorrhages (aSAHs). Given our medical institution's commitment to ensuring racial equality within our health care system, we chose to analyze our practice to assess the utilization of care provided by our neuroendovascular team. We hypothesized that given our diverse neuroendovascular care team along with our dedication to equity in healthcare, that we would find no difference in care provided to minority patients versus white patients who presented with UIAs.</p></div><div><h3>Methods</h3><p>We conducted a retrospective electronic medical record-based review of all patients with UIAs (<em>n</em> = 140) between September 2010 and June 2022 treated at a county hospital. Data regarding age at the time of treatment, gender, race, insurance type and aneurysm location were obtained.</p></div><div><h3>Results</h3><p>Of the 140 patients that underwent treatment, 54 % of patients were from the Black/Hispanic group and 46 % were from the white/non-Hispanic group. Commercial/private insurance was more common among White/NonHispanic patients (57.7 % vs 51.4 %) whereas Medicaid or uninsured status was more common among Black/Hispanic patients (25.7 % vs 15.4 %), although these differences were not statistically significant.</p></div><div><h3>Conclusion</h3><p>Building a diverse neuroendovascular physician team with intentionality to equity in healthcare, and providing appropriate funding and resources to facilities used by marginalized populations, such as safety-net institutions, can mitigate minority patients’ limited access to intracranial aneurysmal care.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Pages 410-414"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141862013","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":"Disparities in Advanced Care Planning: Exploring Factors, Outcomes, and Equity","authors":"Toni-Ann J'nelle Lewis Degrees MD, MPH,&nbsp;Fatiah Joseph MD,&nbsp;Michael E. Kaiser MD, MPH,&nbsp;Gabriella J. Phillip MD,&nbsp;Joshua Green DPM,&nbsp;Francin Alexis MD,&nbsp;Louis Mudannayake MD,&nbsp;Anna Goehring MD,&nbsp;Kwesi Blackman MD, MBA,&nbsp;David Conner MD, MPH,&nbsp;William M. Briggs PhD","doi":"10.1016/j.jnma.2024.07.050","DOIUrl":"10.1016/j.jnma.2024.07.050","url":null,"abstract":"<div><h3>Purpose</h3><p>ACP is pivotal in patient care. It emphasizes respecting an individual's values, preferences, and goals in decision-making. Although ACP is beneficial to patients and families, disparities persist, particularly among marginalized groups. We undertook this study to assess these disparities between ACP among patients of various groups and evaluate the relationship between these factors on shared-decision making.</p></div><div><h3>Methods</h3><p>A retrospective cohort analysis collected data from a single facility spanning March to September 2023, focusing on palliative care encounters. Data were categorized by demographics (race, age, gender) and factors affecting patient and family decisions, including religion, marital status, diagnosis, and ultimate choices (DNR/DNI, comfort-measures, hospice). We examined these variables through logistic regression models, chi-square tests, and F-tests (p &lt; 0.05) to uncover potential correlations with advanced care planning.</p></div><div><h3>Results</h3><p>End-stage dementia patients showed a significant association with the likelihood and probability of undergoing ACP. Patients opting for comfort-directed care, DNR/DNI, and hospice care correlated significantly with ACP. Interestingly, there was no statistically significant association (p-value &gt;0.05) between race, gender, marital status, religion, or age and the likelihood of undergoing ACP.</p></div><div><h3>Conclusion</h3><p>Our results diverge from past trends, showing diminished rates of ACP completion among specific ethnic and religious demographics. One potential rationale is the integration of social workers within our facility, actively engaging in ACP with patients. This approach facilitates early interventions and ensures comprehensive patient services across both outpatient and inpatient settings. Overcoming obstacles to ACP conversations and embracing diverse perspectives is essential to achieving equitable and compassionate end-of-life care.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 433"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089193","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 & Socioeconomic Disparities in Patients with B-Cell Prolymphocytic Leukemia","authors":"Kingsley Chinonyerem Nnawuba MD,&nbsp;Samantha Robinson PhD,&nbsp;Obed Asare Hanna Jensen MD, PhD","doi":"10.1016/j.jnma.2024.07.057","DOIUrl":"10.1016/j.jnma.2024.07.057","url":null,"abstract":"<div><h3>Background</h3><p>Leukemia refers to blood cell cancers that originates from the bone marrow. The prolymphocytic leukemia (PLL) subtype consists of the T-Cell prolymphocytic leukemia(T-PLL) and rarer B-Cell prolymphocytic leukemia(B-PLL) variant. B-PLL is harder to treat owing to cytogenetic abnormalities like MYC rearrangement and TP53 mutations. There have been limited studies about this disease, especially outcomes among different patient demographics.</p></div><div><h3>Methods</h3><p>The National Cancer Institute's Surveillance, Epidemiology, and End-Result (SEER) registry research database 17(2000 -2020) was used to explore and compare the outcomes for B-PLL in adult &amp; Adolescent and Young Adult (AYA) patients. Univariate &amp; multivariate analyses were performed to assess prognostic outcomes. A p-value &lt;0.05 was considered statistically significant.</p></div><div><h3>Results</h3><p>A total of 608 deidentified patients were sampled (375 males and 233 females). Race and ethnicity was categorized to Hispanic &amp; non-Hispanic. The non-Hispanic patients were further subdivided into White, Black, Asian, and Pacific Islanders. Socioeconomic status was associated with urban vs rural dwelling. Significant racial/ethnic differences (p&lt;0.01) were seen in patients for this cancer type with regard to age group and living status. Specifically, there were significantly more Hispanic (all races) patients that were younger i.e., AYA than other racial/ethnic groups (p=.002). Additionally, non-Hispanic Black and White patients were more likely to die from B-PLL compared to other racial/ethnic groups (p=.007).</p></div><div><h3>Discussion</h3><p>Interesting differences were observed in the age, socioeconomic status, geographical area, and survival status among different race groups with B-PLL. Further research is warranted to characterize the demographic variables that may impact cancer care and survival.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 436"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089201","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":"A Comparative Analysis of Large Language Model Accuracy for Image-Based Hair Disease Identification in Diverse Skin Tones","authors":"Willow D. Pastard MS ,&nbsp;Willow Pastard MS ,&nbsp;Zane Sejdiu BS ,&nbsp;Alexis Arza BS ,&nbsp;James Cross MBA ,&nbsp;Razmig Garabet BS ,&nbsp;Anna Chacon MD ,&nbsp;Ellen N. Pritchett MD","doi":"10.1016/j.jnma.2024.07.035","DOIUrl":"10.1016/j.jnma.2024.07.035","url":null,"abstract":"<div><h3>Purpose</h3><p>The rapid integration of artificial intelligence (AI) in dermatology shows promise for support of clinical practice and democratization of diagnosis access. Significant limitations and ethical concerns persist, however. Despite growing research into AI's effectiveness in identifying skin conditions, fewer studies have explored its ability to accurately diagnose hair disorders.</p></div><div><h3>Methods</h3><p>This study explores the capacity of the large language model (LLM) ChatGPT to correctly identify alopecia areata, androgenetic alopecia, traction alopecia, and central centrifugal cicatricial alopecia across a range of skin tones. Utilizing the Monk Skin Tone Scale, images of hair disorders were sorted into lighter (Monk Scale 1-5) and darker (Monk Scale 6-10) categories. Images were sourced from publicly accessible databases.</p></div><div><h3>Results</h3><p>Our analysis revealed significant differences in diagnosis rates. ChatGPT was more likely to correctly identify disease in lighter skin, notably for alopecia areata (p&lt;.001) and androgenetic alopecia (p=.003). This trend was also seen in overall diagnosis rates (p&lt;.001). Interestingly, the program repeatedly incorrectly identified 24.48% of all hair conditions in dark skin as traction alopecia. Additionally, while initially this study sought to explore ChatGPT's ability to diagnose common nail disorders across skin tones this could not be completed due to the insufficient availability of images depicting nail disorders in darker skin.</p></div><div><h3>Conclusion</h3><p>These findings highlight some of the limitations of LLMs in accurate diagnosis of diseases of the hair and nails. It emphasizes potential implications for the performance of artificial intelligence trained on dermatologic databases with limited representation.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 426"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089246","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":"Effect of Tobacco and E-Cigarette-Related Social Media Content on Youth","authors":"Daniel P Ashley MPA, BSc (Hons),&nbsp;Brienna N. Rutherford BS,&nbsp;Carmen C.W. Lim BS,&nbsp;Brandon Cheng BS,&nbsp;Tianze Sun BS,&nbsp;Gigi Vu BS,&nbsp;Benjamin Johnson BS,&nbsp;Jack Chung BS,&nbsp;Sandy Huang BS,&nbsp;Janni Leung PhD,&nbsp;Daniel Stjepanović PhD,&nbsp;Jason P. Connor PhD,&nbsp;Gary C.K. Chan PhD","doi":"10.1016/j.jnma.2024.07.023","DOIUrl":"10.1016/j.jnma.2024.07.023","url":null,"abstract":"<div><h3>Introduction</h3><p>E-cigarette and tobacco-related content on social media has been linked to various mechanisms of increased e-cigarette and tobacco use. This study aimed to synthesis the association between exposure to e-cigarette and tobacco-related content and youth behaviors and attitudes.</p></div><div><h3>Methods</h3><p>A comprehensive search was conducted as part of a larger study on social media and recreational substance use. Studies published post-2004 reporting effect estimates for exposure or engagement with e-cigarette or tobacco content on social media and behavior or attitude outcomes were included.</p></div><div><h3>Results</h3><p>32 studies (N = 274,283, 9-25 years) were included. Meta-analyses revealed significant associations between engagement with tobacco content and use, to content and never users’ risk and exposure to e-cigarette content and use. There was no observed relationship between exposure to tobacco content and ever users’ risk perceptions. Qualitative synthesis found significant associations between tobacco exposure and increased current use and pro-tobacco attitudes; e-cigarette exposure and increased susceptibility and reduced risk perceptions; tobacco engagement and increased susceptibility; e-cigarette engagement and increased use; dual exposure and increased susceptibility; and dual engagement and increased dual use. Mixed findings were identified for the influence of e-cigarette exposure on attitudes, tobacco exposure on susceptibility, dual exposure on dual use behaviors, and dual engagement on dual susceptibility.</p></div><div><h3>Conclusion</h3><p>Exposure to and engagement with content depicting e-cigarette or tobacco products may significantly influence the behaviors and attitudes of youth. Policies should continue to monitor the potential implications of interactions with this content and implementing strategies to reduce the impact of this content.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 420"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142087000","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":"Time to diagnosis and treatment of emergent postpartum hypertensive disorders","authors":"Gabrielle J. Ezell MS,&nbsp;Nicolina Smith DO/MBA/MCSR,&nbsp;D'Angela S. Pitts MD,&nbsp;Mary Codon MSN,&nbsp;Katherine Joyce MD/MPH,&nbsp;John Joseph MD","doi":"10.1016/j.jnma.2024.07.074","DOIUrl":"10.1016/j.jnma.2024.07.074","url":null,"abstract":"<div><h3>Objective</h3><p>Approximately 12% of postpartum patients seek treatment in the emergency department (ED). Hypertensive disorders are commonly seen during this time. This study assessed time to diagnosis and treatment of hypertensive disorders in postpartum patients with the hope to improve care through quality improvement.</p></div><div><h3>Study Design</h3><p>This is a retrospective study in metro-Detroit analyzing patients with hypertension in the ED from postpartum day 2 through 28. Primary outcomes included average time elapsed between severe range blood pressure (BP) readings to administration of antihypertensives and magnesium sulfate. Secondary outcomes included the presence of diagnostic laboratory testing, for classifying hypertensive disorders.</p></div><div><h3>Results</h3><p>Our cohort included 430 postpartum patients. The average time elapsed between the first severe BP reading and antihypertensive administration was 189 minutes for Black patients and 370 minutes for White patients. 72% received a complete blood count, 66% received creatinine and liver profile labs, and 4% had urine protein ordered. 15 patients (4.03%) with severe range BP received correct magnesium sulfate dosing. No statistically significant differences in time elapsed between severe BP readings to administration of antihypertensives, lab workup or administration of magnesium sulfate between racial groups were found.</p></div><div><h3>Conclusion</h3><p>Areas for improvement include the timeliness of administration of antihypertensive medications after severe range BP readings and ordering essential laboratory tests to classify the disorder. Fortunately, our institution did not demonstrate disparities of care with Black patients, despite existing literature. Moving forward, a targeted quality improvement plan will be implemented to address identified areas of concern.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Pages 443-444"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142087546","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":"Process Improvement of Lipid Screening at Walter Reed PCMH","authors":"Brandon J. Neal MD,&nbsp;Samantha Hanciles MD,&nbsp;Henry Goetzman MD,&nbsp;Wendy Hoffner MD,&nbsp;Wanda Foxx MD","doi":"10.1016/j.jnma.2024.07.067","DOIUrl":"10.1016/j.jnma.2024.07.067","url":null,"abstract":"<div><h3>Purpose</h3><p>In 2008, The American Academy of Pediatrics (AAP) released guidelines supporting universal lipid screenings for children between the ages of 9 and 11 years old with the goal of accomplishing earlier detection of children who may be at risk of developing cardiovascular issues. A review of our current practice at Walter Reed National Military Medical Center found that only 17% of children ages 9-11 years old had lipid screenings, showing missed opportunities for early intervention.</p></div><div><h3>Methods</h3><p>This project aimed to improve the lipid screening process with the implementation of countermeasures amongst a target population of children ages 9-11 in our pediatric clinic. Utilizing the CarePoint database, baseline data was gathered for the target population of children who were enrolled in the Walter Reed PCMH in September 2023. Countermeasures focused on addressing inconsistent recommendations from providers, lack of a lipid screening prompt in standard intake paperwork, and lack of patient/parent awareness.</p></div><div><h3>Results</h3><p>Re-evaluation of CarePoint data after countermeasures implementation revealed an increase in the percentage of children aged 9-11 years old with lipid screening performed from 17% to 19%. Factors affecting the lack of change may include late introduction of countermeasures, incomplete acceptance of guidelines, and difficulty for families to get labs drawn at our crowded outpatient laboratory.</p></div><div><h3>Conclusions</h3><p>Implementation of a multifaceted approach to increase education and awareness of lipid screening in the Walter Reed PCMH may improve adherence to the current AAP lipid screening guidelines. However, with our limited data we are not yet seeing substantial change.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 440"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142087555","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":"Hidradenitis Suppurativa and Vulvar Lichen Sclerosus: a Case Series","authors":"Sydney A. Martin BA,&nbsp;Julia M. Riley MD,&nbsp;Kelsey S. Flood MD","doi":"10.1016/j.jnma.2024.07.039","DOIUrl":"10.1016/j.jnma.2024.07.039","url":null,"abstract":"<div><h3>Purpose</h3><p>Hidradenitis Suppurativa (HS) is a chronic inflammatory skin disease associated with many cutaneous comorbidities, including acne, dissecting cellulitis of the scalp, pilonidal cysts, and pyoderma gangrenosum (1-4). Although there is a plethora of literature on HS comorbidities, the association between HS and vulvar lichen sclerosus (VLS) needs further investigation. To date, two cases have been reported of HS and VLS in Caucasian women in their 4th to 6th decade of life (5). This study describes a series of 27 women with HS and VLS.</p></div><div><h3>Methods</h3><p>Retrospective review of 27 female patients diagnosed with HS, identified by ICD-10 code L73.2, and comorbid VLS, identified by ICD-10 code L90.0, who presented to Northwestern Dermatology between October 2015 - December 2023. Demographic variables of age, sex, and race were extracted for all included patients.</p></div><div><h3>Results</h3><p>Out of 27 female patients, 74.1% identified as white, 7.4% identified as black, and 18.5% declined to respond. The mean age was 57.1 years old (SD 17.2). All patients were either diagnosed with HS first (15/27) or HS and VLS simultaneously (12/27). For the 15 patients diagnosed with HS first, the average time between HS and VLS diagnosis was 25.1 months (2.09 years).</p></div><div><h3>Conclusion</h3><p>We present a cohort of patients with HS and VLS, two chronic inflammatory conditions that often present unique challenges in diagnosis and management. Providers caring for patients with HS may consider screening for VLS. This is especially pertinent as both diseases are associated with an increased risk of cutaneous squamous cell carcinoma (6-7).</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Pages 427-428"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089119","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":"Examining the Impact of the Affordable Care Act on Access to Care For Black Men and White Men: Implications for Policy and Practice","authors":"Okechuku K. Enyia MPH, DrPH","doi":"10.1016/j.jnma.2024.07.047","DOIUrl":"10.1016/j.jnma.2024.07.047","url":null,"abstract":"<div><h3>Introduction</h3><p>Black men experience poor health outcomes across a spectrum of chronic medical conditions and co-morbidities that ultimately lead to lower quality of life and premature death. Lack of access to medical care is one of many factors that contributes to these poor outcomes. This study examines the impact of the Patient Protection and Affordable Care Act of 2010 (ACA) on Black men's access to care compared to White men ages 18-64; and proposes strategies to help address any inequities. The ACA undergirds this study because it includes several provisions that are specifically meant to help address racial and ethnic health disparities and improve health outcomes.</p></div><div><h3>Methods</h3><p>This study took a longitudinal approach by examining access to care among non-Hispanic Black men and non-Hispanic White men ages 18-64 from 2011-2019. Using a publicly available secondary data source, the Medical Expenditure Panel Survey (MEPS), a descriptive and multi-variate analysis was conducted to examine the relationship between race, sociodemographic characteristics, and two indicators of health care access (insurance status and usual source of care).</p></div><div><h3>Results</h3><p>The analysis found that the ACA decreased the proportions of non-Hispanic Black men and non-Hispanic White men who were uninsured after 2014 by nearly 50%; however, racial disparities persisted. Other key findings are as follows: 1) race was a significant predictor of being uninsured, with non-Hispanic Black men having 30% greater odds than non-Hispanic White men of being uninsured and 2) non-Hispanic Black men had 25% lower odds than non-Hispanic White men of having a usual source of care.</p></div><div><h3>Conclusion</h3><p>Specific policy recommendations proposed include: 1) develop pathways to coverage for states that have yet to adopt Medicaid expansion and 2) use a multilevel approach to expand the proportion of men with a usual source of care that includes: a) disseminating educational messages to improve men's awareness of the value of having a regular source of care and b) facilitating health care delivery and payment reforms that incentivize health care institutions to increase the number of Black men who are meaningfully engaged with a regular source of care.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 431"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089157","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}