Journal of the National Medical Association最新文献

{"title":"Comparative Analysis: Operative versus Non-Operative Management of Acute-Pediatric Monteggia Fractures","authors":"Lakin S. Hatcher BA,&nbsp;Vidushan Nadarajah MD,&nbsp;Anh Le BA,&nbsp;Ryan Garay BA,&nbsp;Sarah Dance BA,&nbsp;Sean Tabaie MD","doi":"10.1016/j.jnma.2025.08.059","DOIUrl":"10.1016/j.jnma.2025.08.059","url":null,"abstract":"<div><h3>Background</h3><div>The management of acute pediatric Monteggia fractures, characterized by a fracture of the ulna with associated radial head dislocation, remains a challenging aspect of pediatric orthopedic care. The primary debate centers around the efficacy of operative versus non-operative treatments. This systematic review aims to provide a comprehensive comparison of these approaches, focusing particularly on the outcomes and effectiveness of intramedullary fixation versus plate fixation within operative treatments.</div></div><div><h3>Methods</h3><div>A systematic review was conducted following PRISMA guidelines, involving an extensive search of databases including PubMed, Embase, and Cochrane Library up to May 2024. Studies included in the review had to meet specific criteria: they had to involve pediatric patients (age &lt;18 years) with acute Monteggia fractures, compare operative to non-operative management, and report on outcomes such as complication rates, recovery of range of motion (ROM), and need for further interventions. Data extraction covered study characteristics, participant demographics, fracture patterns, intervention details, and outcomes. Quality assessment of the included studies was performed using the MINORS (Methodological Index for Non-Randomized Studies) tool.</div></div><div><h3>Results</h3><div>A total of 24 studies were included in the qualitative synthesis, with 15 studies providing quantitative data for meta-analysis. The non- operative approach, typically involving closed reduction and casting, was found to be effective for certain fracture patterns but required close monitoring due to the risk of redislocation, especially in Bado Type III and IV fractures. Studies highlighted that non-operative treatment had a comparable outcome to surgical management when careful follow-up was ensured.</div><div>In contrast, surgical management showed a higher initial success rate, with intramedullary fixation (IMF) being preferred for its minimally invasive nature and reliable stabilization. IMF was associated with fewer immediate complications, such as infection and nerve injury, and allowed for early mobilization. Plate fixation, while less commonly used, provided superior outcomes in complex fractures, particularly in maintaining reduction and promoting bone healing. This method was noted for its robustness in cases with high angular deformities or comminution.</div><div>Key predictors of treatment success included the type and degree of fracture angulation, timing of intervention (with earlier treatment yielding better outcomes), and the presence of associated injuries or comorbidities. The review found that patients undergoing operative treatment had a faster return to full ROM and lower rates of redislocation. However, surgical management also came with risks such as hardware complications and the need for subsequent surgical removal in cases of IMF.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 30-31"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989582","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 Health Disparities and Health Equity Issues in Internal Medicine: Highlighting the intersection between environmental justice and health equity.","authors":"Eric T. Jones PhD (candidate)","doi":"10.1016/j.jnma.2025.08.084","DOIUrl":"10.1016/j.jnma.2025.08.084","url":null,"abstract":"<div><h3>Introduction</h3><div>In 2019, the American Public Health Association (APHA) released a <span><span>policy brief</span><svg><path></path></svg></span> titled “Addressing Environmental Justice to Achieve Health Equity,” highlighting the interplay between race, environmental toxins, and health disparities. However, opposing arguments have suggested that health disparities are solely a byproduct of individual behaviors or genetic differences. While the APHA brief addressed these counterpoints, a <span><span>recent study</span><svg><path></path></svg></span> illustrated that some physicians still hold these beliefs. Other physicians have argued that environmental racism should be regarded as a <span><span>secondary diagnosis</span><svg><path></path></svg></span> for populations disproportionately exposed to air pollution. This argument warrants further exploration because Black people are exposed to the highest levels of air pollution and have experienced the most air pollution-related deaths, according to a <span><span>study</span><svg><path></path></svg></span> by Stanford medicine researchers.</div></div><div><h3>Discussion</h3><div>Based on this evidence, the oral presentation will share interdisciplinary research from a dissertation project that analyzes the lived experience of Black residents who lived near U.S. Steel’s Clairton Coke Works. Residents who live near this coke plant are exposed to the highest levels of air pollution within the Pittsburgh metropolitan area and the nation. Furthermore, the project illustrates how disproportionate exposure to air pollution impacts residents’ quality of life and exacerbates health inequity. Therefore, the presentation aims to emphasize the importance of environmental justice concerning health disparities and health equity issues in internal medicine. The presenter is a PhD Candidate in Africana Studies whose research focuses on the interplay between race, the environment, and health.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Page 45"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Prostaglandin Administration on Cesarean Delivery Rates","authors":"Brooke Malone BS, MS,&nbsp;Kelly Muller BS,&nbsp;Angelina Lam BS,&nbsp;Daniel Novak PhD,&nbsp;Brenda Ross-Shelton MD","doi":"10.1016/j.jnma.2025.08.048","DOIUrl":"10.1016/j.jnma.2025.08.048","url":null,"abstract":"<div><h3>Introduction</h3><div>Induction of labor (IOL) is a common obstetric procedure that has significantly increased in recent years, reaching a rate of 27.1% in the United States in 2020. IOL stimulates labor onset using mechanical or pharmacological methods, with prostaglandin analogues like misoprostol and dinoprostone commonly used for cervical ripening. These drugs aim to achieve vaginal delivery, but there is a lack of predictive models to determine successful induction. This study investigates whether prostaglandin analogues reduce cesarean section rates in singleton. Our hypothesis is that prostaglandin analogues lead to less cesarean deliveries in patients with singleton uncomplicated pregnancies, with the null hypothesis being that the drugs do not lead to any differences.</div></div><div><h3>Methods</h3><div>This retrospective cohort study utilized the TriNetX platform, a global network of electronic health records, to compare the likelihood of cesarean section in patients receiving misoprostol or dinoprostone within 24 hours of induction. Patients were identified using CPT and procedure codes for vaginal delivery, full-term, uncomplicated pregnancies, and drug exposure records for misoprostol (RxNorm 42331) and dinoprostone (RxNorm 3748).</div><div>Inclusion criteria included females aged 18-45 who received misoprostol or dinoprostone within three days of delivery and had delivery outcomes documented within the same hospitalization. Exclusion criteria were pre existing uterine anomalies, prior cesarean section, multiple gestations, or pregnancy complications like preeclampsia and gestational diabetes. Propensity score matching (PSM) was used to balance covariates such as maternal age, BMI, race, and comorbidities (e.g., hypertension, diabetes). The primary outcome was cesarean section delivery.</div></div><div><h3>Results</h3><div>After propensity score matching, two cohorts were created: 364,291 patients who received prostaglandin analogs and 364,291 controls. The group receiving prostaglandin analogues had a slightly higher likelihood of cesarean section (1.105%) compared to the control group (0.848%) (OR = 0.765, p&lt;0.0001).</div></div><div><h3>Conclusion</h3><div>This study suggests that prostaglandin analog administration is associated with an increased likelihood of cesarean delivery. While the findings align with some studies, they also contrast with others in the existing literature. These conflicting results underscore the need for further research to optimize labor induction strategies and improve maternal and fetal outcomes.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 24-25"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989504","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":"Quality of Preeclampsia Videos on TikTok: A Social Media Analysis","authors":"Monica D. Hill MPH,&nbsp;Kandis M.J. Fox BS,&nbsp;Olivia Y. Gardiner MS,&nbsp;Angel G.A. Prempeh BS,&nbsp;Alane M. Laws-Barker MD","doi":"10.1016/j.jnma.2025.08.052","DOIUrl":"10.1016/j.jnma.2025.08.052","url":null,"abstract":"<div><h3>Introduction</h3><div>Preeclampsia is a hypertensive disorder of pregnancy. It leads to severe maternal and neonatal complications, including fetal growth restriction, preterm birth, and maternal death. Affecting approximately 1 in 25 pregnancies worldwide, timely detection and education are crucial for improved birthing outcomes. With over a billion active users, TikTok is a rapidly growing social media platform for information dissemination. As health professionals consider using TikTok to share health content, concerns about the accuracy and quality of information have emerged. While previous studies have assessed health content on platforms like YouTube and Instagram, no studies have specifically evaluated preeclampsia-related videos on TikTok. This study aims to evaluate the accuracy, clarity, and comprehensiveness of preeclampsia-related content on TikTok.</div></div><div><h3>Methods</h3><div>This study is a cross-section content analysis of publicly available preeclampsia-related videos on TikTok. Using the APIFY TikTok extractor, we retrieved all relevant videos on November 13, 2024 based on hashtags and captions containing “preeclampsia,” “toxemia,” or “pregnancy hypertension.” The extracted videos were collected in an Excel sheet with all relevant data such as uploader type, content type, and engagement metrics. Our exclusion criteria were applied and the Excel sheet was updated as such. Two independent reviewers assessed quality using the Modified DISCERN tool, JAMA benchmark, and Global Quality Score. The ACOG bulletin on preeclampsia served as the gold standard for content veracity.</div></div><div><h3>Results</h3><div>A total of 147 videos met the inclusion criteria. Most were uploaded by non-medical individuals (64.63%), followed by OB/GYNs (14.97%), healthcare non-physicians (14.97%), and other physicians (5.44%). The most common content types were personal experiences (59.86%) and educational videos (35.37%). Videos uploaded by OB/GYNs had the highest mean quality scores (Modified Discern Tool= 2.32, GQS= 3.45, and JAMA= 1.39), followed by healthcare non-physicians (Modified Discern Tool= 1.64, GQS= 3.18, and JAMA= 1.30). Non-medical individuals had the lowest quality (Modified Discern Tool= 0.36, GQS= 1.78, and JAMA= 0.98). When assessed by content, educational videos had higher quality scores than personal experience videos (Modified Discern Tool= 1.79 vs 0.32, GQS= 3.16 vs 1.72, and JAMA= 1.26 vs 0.99). Statistically significant differences were found between uploader type and quality scores with healthcare professionals producing higher-quality content than non-medical individuals (P&lt;0.019).</div><div>Similarly, educational videos were significantly higher in quality than personal experience videos (P&lt;0.000). Interestingly, lower-quality videos had greater engagement (i.e., likes, comments, shares, views) than higher-quality videos (P&lt;0.04).</div></div><div><h3>Conclusion</h3><div>The quality of preeclampsia","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 26-27"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989663","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":"Good Science in Compliance: Optimizing Remote Clinical Trial Management: A Multi-Site Analysis of Virtual Monitoring Implementation","authors":"Mary C. Blake MS, DrPH (in progress)","doi":"10.1016/j.jnma.2025.08.011","DOIUrl":"10.1016/j.jnma.2025.08.011","url":null,"abstract":"<div><h3>Introduction</h3><div>The COVID-19 pandemic accelerated the adoption of remote clinical trial monitoring, yet standardized protocols for virtual oversight remain inconsistent across research sites. This study evaluates the effectiveness of a hybrid monitoring approach implemented across multiple research centers, focusing on data quality, protocol adherence, and resource utilization.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted across 12 research sites from 2021-2024, examining clinical trials that utilized both traditional on-site and remote monitoring approaches. Data was collected from three primary sources: electronic data capture systems, monitoring visit reports, and site performance metrics. Key performance indicators included protocol deviation rates, query resolution time, and data entry completion rates. Statistical analysis was performed using SPSS and Python, with significance set at p&lt;0.05.</div></div><div><h3>Results</h3><div>Remote monitoring implementation resulted in a 32% reduction in monitoring-related costs while maintaining data quality standards. Sites utilizing the hybrid approach demonstrated comparable protocol adherence rates to traditional monitoring (98.2% vs. 97.8%, p=0.67). Query resolution time improved by 45% (mean 3.2 days vs. 5.8 days, p&lt;0.001) with the implementation of virtual monitoring tools. Site staff reported increased satisfaction with flexible monitoring schedules (satisfaction score 4.2/5 vs. 3.6/5, p&lt;0.01).</div><div>However, technology infrastructure limitations at 25% of sites necessitated additional support and training.</div></div><div><h3>Conclusion</h3><div>The implementation of remote monitoring strategies demonstrates significant potential for improving clinical trial efficiency while maintaining quality standards. These findings suggest that a hybrid monitoring approach can effectively support clinical trial oversight while reducing operational costs and improving staff satisfaction. Future research should focus on standardizing remote monitoring protocols and addressing technology infrastructure challenges across diverse research settings.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Page 2"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989656","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":"START-CART: Study on Timing and Referral Trends for CAR-T Therapy: Examining Racialized Trends in the Timing of CAR-T Therapy Initiation in Multiple Myeloma","authors":"Elisabeth White BS,&nbsp;Dr. Brandon Blue MD","doi":"10.1016/j.jnma.2025.08.097","DOIUrl":"10.1016/j.jnma.2025.08.097","url":null,"abstract":"<div><h3>Background</h3><div>CAR-T cell therapy offers transformative outcomes for patients with relapsed/refractory multiple myeloma. However, equitable access to this advanced treatment remains a critical challenge. Black patients are disproportionately affected by multiple myeloma yet remain underrepresented among those receiving novel therapies. Delays in CAR-T referral may reflect systemic inequities contributing to disparities in treatment outcomes.</div></div><div><h3>Objective</h3><div>To evaluate the timing and treatment burden preceding CAR-T referral among patients with multiple myeloma, with a specific focus on identifying racial disparities in referral patterns.</div></div><div><h3>Methods</h3><div>This retrospective chart review includes adult patients diagnosed with multiple myeloma and evaluated for CAR-T therapy at Moffitt Cancer Center between January 2022 and December 2023. Variables collected include demographic characteristics (age, sex, race), myeloma subtype, date of diagnosis, date of referral, CAR-T readiness status, and the number of treatment lines received prior to referral or evaluation. Descriptive statistics and comparative analyses will be used to assess differences across racial and demographic groups. Multivariable regression models will be employed to adjust for potential confounders such as age, disease subtype, and comorbidities.</div></div><div><h3>Preliminary Status</h3><div>Data collection is ongoing. Initial analyses are focused on characterizing the cohort and quantifying the average number of therapy lines received before CAR-T referral. Early trends are being explored across key categories, including race, age, and myeloma subtype, though no statistically significant findings have yet been observed.</div></div><div><h3>Conclusion</h3><div>This study aims to clarify whether racial disparities exist in the timing and treatment burden associated with CAR-T referral in multiple myeloma. Findings will inform future interventions to promote earlier and more equitable access to novel therapies among historically underserved populations.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 53-54"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989870","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":"Doses of Disparity: Gaps in the Management of Crohn’s Disease","authors":"Sean J.L. Parker BS, FA,&nbsp;Ryan A. Mitchell BS,&nbsp;Samrawit Zinabu MD,&nbsp;Miriam Michael MD","doi":"10.1016/j.jnma.2025.08.030","DOIUrl":"10.1016/j.jnma.2025.08.030","url":null,"abstract":"<div><h3>Introduction</h3><div>Crohn’s Disease (CD) is a chronic inflammatory bowel disease commonly treated with biologics (e.g., infliximab, adalimumab), immunomodulators (e.g., azathioprine, methotrexate), aminosalicylates (e.g. mesalamine), corticosteroids or, when severe, surgical intervention. While studies suggest that African Americans have a lower incidence of CD than European Americans, the incidence of CD is on the rise among African American populations, with these patients often presenting with more severe disease at diagnosis. Socioeconomic barriers, provider bias, and healthcare disparities may contribute. This study examines whether African American patients are more or less likely to receive biologics or immunomodulators before surgery compared to European American patients.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using the TriNetX Global Network, a de-identified electronic health record-based database, encompassing 33,802 patients from 140 healthcare organizations. CD patients were identified using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Two cohorts were defined based on ethnic identification— European American and African American—and were matched 1:1 using propensity score matching for age, sex, comorbidities, literacy and socioeconomic factors. Baseline data were extracted from the 12 months preceding the index event, with the data spanning a period of 20 years. The primary outcomes were the proportions of patients prescribed traditional corticosteroids, aminosalicylates, immunomodulators, or biologics as determined by RxNorm codes. Group differences were evaluated using Z-tests and Kaplan–Meier survival analysis.</div></div><div><h3>Results</h3><div>After matching, each cohort comprised 33,802 patients with comparable demographics (mean age 40.5 ± 18.3 years; 58.4% female, 41.6% male). While African American patients had higher corticosteroid utilization when compared to European Americans (40.8% vs 37%), notable differences emerged in the other treatment modalities. African American patients had lower utilization rates of aminosalicylates (13.4% vs 14.3%) immunomodulators (8.9% vs 11.3%), and biologics (16.7% vs 17.8%). All the results were statistically significant.</div></div><div><h3>Conclusion</h3><div><strong>.</strong>These findings reveal meaningful disparities in therapeutic treatment patterns of CD despite established guidelines for standard of care. The observed differences in non-surgical approaches may contribute to divergent long-term outcomes, potentially leading to higher rates of surgical intervention in African American patients. This illustrates the need for further studies to investigate whether these discrepancies lead to higher rates of surgical intervention in African American patients and underscores the importance of early pharmacological interventions to ensure equitable care across ethnic groups in the","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Page 14"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144988789","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":"Clinical Outcomes and Racial Disparities in NSTEMI Patients with Concomitant Diabetic Ketoacidosis: A National Inpatient Analysis","authors":"Unwam Jumbo MD.,&nbsp;Gift Akpama MD.","doi":"10.1016/j.jnma.2025.08.085","DOIUrl":"10.1016/j.jnma.2025.08.085","url":null,"abstract":"<div><h3>Background</h3><div>Diabetic ketoacidosis (DKA) may complicate acute cardiovascular events, including Non-ST Elevation Myocardial Infarction (NSTEMI). This study evaluated whether a secondary diagnosis of DKA affects clinical outcomes in hospitalized NSTEMI patients.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort analysis using the National Inpatient Sample (2016–2020). Multivariate logistic regression adjusted for comorbidities to assess the impact of DKA on outcomes. Primary endpoints were in-hospital mortality, length of stay and total hospital charge; secondary outcomes included cardiogenic shock, acute heart failure, and cardiac arrest.</div></div><div><h3>Results</h3><div>Among 2,141,719 NSTEMI patients, 942,474 had a secondary diagnosis of DKA. Compared to those without DKA, these patients had lower adjusted odds of mortality (AOR 0.69; 95% CI, 0.66–0.72; <em>p</em> &lt; 0.001) and shorter hospital stays (−0.35 days; <em>p</em> &lt; 0.001). They were more likely to receive left heart catheterization (AOR 1.35) and early intervention. Odds of cardiac arrest (AOR 0.83), cardiogenic shock (AOR 0.87), and acute heart failure (AOR 0.75) were also lower, despite higher hospitalization costs (+$3,573; <em>p</em> &lt; 0.001).</div><div>Racial disparities were also evident in this study. Asian patients had higher mortality than White patients (AOR 1.29; 95% CI, 1.15–1.44; <em>p</em> &lt; 0.001) while Non-Hispanic Black patients had lower mortality (AOR 0.89; 95% CI, 0.83–0.95; <em>p</em> = 0.001). Minoritized groups also had lower rates of left heart catheterization and early intervention.</div></div><div><h3>Conclusion</h3><div>Contrary to expectations, NSTEMI patients with DKA had lower mortality and fewer complications, possibly due to timely intervention and metabolic optimization. Racial disparities in outcomes and procedure use highlight the need for equitable access to cardiovascular care.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 45-46"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989954","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":"Distressed Communities Index and Utilization of Total-Hip Replacement in Maryland","authors":"Nadia O. Hackett BS,&nbsp;Oluwasegun Akinyemi MD, MS, PhD,&nbsp;Rolanda Willacy MD,&nbsp;Damon Ross BS,&nbsp;Lucia Guo BS,&nbsp;Tegshjargal Baasansukh BS,&nbsp;Lakin Hatcher BA,&nbsp;Michael Joly MD","doi":"10.1016/j.jnma.2025.08.061","DOIUrl":"10.1016/j.jnma.2025.08.061","url":null,"abstract":"<div><h3>Background</h3><div>Neighborhood socioeconomic status (nSES) is a critical determinant of healthcare access and outcomes. The Distressed Communities Index (DCI) is a composite measure of economic well-being, yet its association with orthopedic surgical utilization remains unclear.</div></div><div><h3>Objective</h3><div>This study examines the relationship between DCI and the utilization of total hip replacement (THR) in Maryland, as well as its impact on post-surgical outcomes, including prolonged hospital stay and readmission rates.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis using the Maryland State Inpatient Database (2016–2020). Adults aged 18 to 90 years undergoing THR were included. Multiple imputation was employed to address missing data, and logistic regression models were used to assess the association between DCI and THR utilization, extended hospital stay, and 30-day readmission rates. Models were adjusted for demographic and clinical covariates.</div></div><div><h3>Results</h3><div>Among the 61,228 THR cases, the majority were White (74.2%) and female (58.9%), with a mean age of 72.5 ± 14.2 years. Individuals from the most socioeconomically distressed neighborhoods were significantly less likely to undergo THR compared to those from more affluent areas (OR=0.89, 95% CI 0.86- 0.92, p &lt;0.001). Additionally, patients from highly distressed communities had a higher likelihood of experiencing prolonged hospital stays post-surgery (OR=1.13, 95% CI 1.04- 1.23, p=0.04). However, no significant association was found between DCI and 30-day readmission rates following THR.</div></div><div><h3>Conclusion</h3><div>Our findings suggest that socioeconomic disadvantage, as captured by the DCI, is associated with disparities in THR utilization and post-surgical hospital stay in Maryland.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Page 32"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989593","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":"Exploring Firearm Safety Barriers among Black American Firearm Owners","authors":"Evan V. Goldstein PhD, MPP,&nbsp;Aryanna Sanger BA","doi":"10.1016/j.jnma.2025.08.015","DOIUrl":"10.1016/j.jnma.2025.08.015","url":null,"abstract":"<div><h3>Introduction</h3><div>Suicide rates are rising among Black Americans (i.e., increasing 39.9% from 5.01 deaths/100,000 persons in 2009 to 7.51 deaths/100,000 persons in 2020), while firearm-related homicide rates increased by 75.8% among Black Americans over the same period. Complicating suicide prevention efforts, 1 in every 2 suicide deaths among Black adults involve firearms, the most lethal suicide method. Lethal means counseling (LMC) may help physicians prevent firearm-related deaths and injuries. LMC incorporates counseling strategies to help limit access to firearms in times of crisis, including dialogue on safe firearm storage options in the home. However, studies evaluating LMC have not included perspectives from racially/ethnically diverse communities. This gap is problematic because different populations experience different barriers to practicing firearm safety, and LMC depends on understanding patients’ firearm safety barriers. Our objective was to gather feedback from Black adult firearm owners on (1) why they keep firearms in the home and (2) barriers preventing safe firearm storage in their homes.</div></div><div><h3>Methods</h3><div>Insights were collected through in-depth semi-structured interviews with n=15 Black adults (age 18+) in the U.S. who have access to firearms in their homes. Open-ended questions focused on eliciting information on interviewees’ history with firearms, rationale for keeping firearms in their homes, and perceived barriers to discussing firearm safety with clinicians. Participants were purposively recruited through study advertising and postings, word-of-mouth referrals, and organizations (e.g., gun ranges/National African American Gun Association). Interview data were analyzed at a semantic level using rapid qualitative analysis. We completed an episode profile for each transcribed interview to deductively organize relevant information by topics aligned with our interview guide. We aggregated our findings in matrix format to generate preliminary themes in the responses to each topic.</div></div><div><h3>Results</h3><div>Participants were 40 years old on average. 67% were male. 10 states and all U.S. Census Regions were represented. Theme 1: Most interviewees were introduced to firearms at an early age, often by their fathers, and learned how to handle firearms safely. Theme 2: Most interviewees kept firearms in their homes to protect themselves, their families, and their property. The perceived need for protection through firearm ownership was repeatedly a response to fear of experiencing racial violence, racism, or prejudice. Theme 3: Interviewees discussed both a lack of firearm safety knowledge and limited access to firearm safety knowledge in Black communities as causing barriers to safe firearm practices in the home. Theme 4: Despite not asking about children during the interviews, when asked about barriers to maintaining firearm safety in their homes, interviewees repeatedly and spontaneou","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 4-5"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989728","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}