Journal of the National Medical Association最新文献

{"title":"Systemic sclerosis and scleroderma renal crisis in African American patients.","authors":"Riti Kotamarti, Kevin V Hackshaw","doi":"10.1016/j.jnma.2025.04.006","DOIUrl":"https://doi.org/10.1016/j.jnma.2025.04.006","url":null,"abstract":"<p><p>Scleroderma, or systemic sclerosis (SSc) is an autoimmune fibrosing disease that encompasses a range of clinical presentations and severities. Prior investigations have shown that African Americans exhibit nearly twice the incidence of disease compared to non-African American patients, and overall worse outcomes. ³² This is particularly evident when analyzing scleroderma renal crisis, a feared complication of SSc which is 3.5 times prevalent in the African American community compared to non-A.A. ⁵ Although the exact etiology is not fully understood, associations between ethnicity, pathogenesis, and complexities of disease have been investigated, illuminating an interplay between genetics, environmental and social triggers in the development of disease.</p>","PeriodicalId":94375,"journal":{"name":"Journal of the National Medical Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144083134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in cancer incidence and mortality in the United States (1999-2021): A retrospective cohort study of health disparities and regional variations.","authors":"Bayuh Asmamaw Hailu","doi":"10.1016/j.jnma.2025.04.007","DOIUrl":"https://doi.org/10.1016/j.jnma.2025.04.007","url":null,"abstract":"<p><strong>Objective: </strong>Analyze cancer incidence and mortality in the U.S. 1999-2021, focusing on variations by sex, race, cancer type, and state. The study aims to identify disparities in cancer rates and highlight regions and populations most affected, to inform public health policies and interventions.</p><p><strong>Methods: </strong>Age-adjusted rates were analyzed by race, cancer type, sex, and state. Bayesian statistical techniques were employed for accurate trend estimation, and cancer hotspots were identified using the Getis-Ord Gi* statistic. Joinpoint regression was used to estimate the Average Annual Percent Change (AAPC) in cancer rates. The analysis was conducted using R.</p><p><strong>Results: </strong>The overall trend was noted reduction in aggregate cancer rate (AAPC =-0.007) and mortality (AAPC =-0.004). Regional and racial disparities are still prevalent with outcomes showing that Kentucky, West Virginia, and Mississippi have the highest prevalence of both. Cancer incidence was reduced most significantly among Black or African American individuals (AAPC=-0.008) and mortality in (AAPC=-0.021) but their rates are still higher. Hotspot analyses identified high cancer incidence and mortality clusters, particularly in the Midwestern and Southern regions of the United States.</p><p><strong>Discussion: </strong>The implications arising from these results suggest that focused public health campaigns need to be directed toward cancer, smoking, and access to care services for effective health promotion. These findings therefore call for innovative public health measures to reduce the burden of cancer and disparity in the future. More sophisticated studies of the social, environmental, and genetic causes of these trends are required to improve the efficacy of cancer control.</p>","PeriodicalId":94375,"journal":{"name":"Journal of the National Medical Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of race and socioeconomic disparities on the short-term efficacy of bevacizumab for macular edema secondary to retinal vein occlusion.","authors":"Minali Prasad, Deniz Goodman, Pawarissara Osathanugrah, Nayan Sanjiv, Xuejing Chen, Steven Ness, Nicole H Siegel, Manju L Subramanian","doi":"10.1016/j.jnma.2025.04.001","DOIUrl":"https://doi.org/10.1016/j.jnma.2025.04.001","url":null,"abstract":"<p><strong>Purpose: </strong>Anti-VEGF injections are often used for the treatment of macular edema from retinal vein occlusions (RVO). Variable response to intravitreal bevacizumab has been reported for treatment of diabetic macular edema (DME) between racial and ethnic groups. We examined potential variances in treatment response to bevacizumab by race and socioeconomic status among patients with macular edema secondary to RVO in this retrospective study.</p><p><strong>Methods: </strong>Intravitreal anti-VEGF naïve patients aged over 18 who received at least one intravitreal bevacizumab injection for central or branch RVO were included. Data were collected before treatment, 1-3 months after the first injection (n = 150 eyes of 148 patients), and 1-3 months after 3 injections (n = 99 eyes of 98 patients). Primary outcome measures were percentage of patients with visual acuity (VA) improvement (defined as >0.1 on the logarithm of minimum angle of resolution scale), reduction in central macular thickness (CMT), and reduction in total macular volume (TMV). Participant addresses were used to calculate Area Deprivation Index (ADI) and were categorized into low disadvantage (state ADI decile from 1 to 5) or high disadvantage (state ADI decile from 6 to 10) cohorts. Odds of VA improvement were analyzed via multivariate logistic regression and mean change in CMT and TMV were analyzed via multivariate linear regression to compare treatment responses among the two ADI cohorts and between Black or African American and White participants after one and three injections.</p><p><strong>Results: </strong>There were no significant differences in the odds of VA improvement (1-injection: OR=1.24, p = 0.60; 3-injection: OR=2.17, p = 0.23), percent reduction in CMT (1-injection: -31.2 vs -27.5, p = 0.98; 3-injection: -16.2 vs -32.7, p = 0.11), and percent reduction in TMV (1-injection: -15.5 vs -18.7, p = 0.44; 3-injection: -11.6 vs-15.4, p = 0.60) after controlling for demographic and clinical factors. There were no significant differences in the odds of VA improvement, percent reduction in CMT, and percent reduction in TMV between ADI cohorts (p > 0.05).</p><p><strong>Conclusions: </strong>The absence of significant differences in treatment response amongst race groups is congruent with existing literature on RVO outcomes, however, it contrasts our findings in diabetic macular edema which did show differences in treatment response between race groups. There were also no significant differences in treatment by socioeconomic status.</p>","PeriodicalId":94375,"journal":{"name":"Journal of the National Medical Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"General surgery leadership demographics are associated with trainee diversity.","authors":"Alejandro Chiodo Ortiz, Nathalia Castillo, Mihir Tandon, Juan Ortiz, Yang Yu, Meng-Hao Li, Krithika Shrinivas, David Ford, Naoru Koizumi, Jorge Ortiz","doi":"10.1016/j.jnma.2025.04.008","DOIUrl":"https://doi.org/10.1016/j.jnma.2025.04.008","url":null,"abstract":"","PeriodicalId":94375,"journal":{"name":"Journal of the National Medical Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of NIH funding and program reputation score on research output and residency matches in neurosurgery: A bibliometrics analysis.","authors":"Kyril L Cole, Ashley Carter, Clayton Rawson, Sam Tenhoeve, Cody Orton, Maryam Zeinali, Michael Karsy","doi":"10.1016/j.jnma.2025.03.002","DOIUrl":"https://doi.org/10.1016/j.jnma.2025.03.002","url":null,"abstract":"<p><p>The neurosurgery residency applicant selection process is complex, with peer-reviewed publications (PRP) recently becoming a key focus. While PRP may significantly impact applicant matching, equitable opportunities for research may vary for students. We aimed to evaluate the impact of NIH funding and program reputation score on applicants' ability to match into top neurosurgery residency programs. Successfully matched PGY1 neurosurgery applicants in the 2022-2023 cycle were evaluated. PRP, Blue Ridge Institute for Medical Research (BRIMR) medical school and residency NIH-funding ranking, and residency Doximity reputation score were evaluated. PGY1 residents (n = 235, 73% male) included 84% MDs, 1.0% DO, 10% MD/PhD, and 5% IMGs. Thirty-one (13.2%) superpublishers (> 25 PRPs) were identified (93.5% male) and had a higher number of non-MD degrees (32.3% vs. 13.3%, p = 0.007). Matching into a top 20 NIH-ranked residency program was associated with completion of a top 20 NIH-medical program (OR = 2.70, p = 0.015), superpublisher status (OR = 2.87, p = 0.024), and affiliation with a top 40 NIH-ranked neurosurgery program (OR = 3.44, p < 0.001). Matching into a top 40 reputation program was predicted by being a superpublisher (≥ 25 publications; OR = 2.66, p = 0.04) and attending a medical school with an affiliated top 40 reputation neurosurgery program (OR = 4.85, p < 0.001). PRP has become a large focus in determining a candidate's competitiveness for top neurosurgery residency programs. Our results clarify the factors impacting PRP, including the importance of NIH funding and the neurosurgery department's reputation. These results highlight both best practices for training residents and potential disadvantages some medical school candidates may have from lower-ranked programs or limited research opportunities. Further studies are warranted to evaluate the impact of these factors on the equity of neurosurgery residency candidates.</p>","PeriodicalId":94375,"journal":{"name":"Journal of the National Medical Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combating racism in medical education: Problems, definitions, principles and practical steps.","authors":"Joshua E Lewis, Lornee C Pride, Maame A Effirim, Adedamola Ashade, Raven Hollis, Kafayat Oyejide, Wei-Chen Lee","doi":"10.1016/j.jnma.2025.02.002","DOIUrl":"https://doi.org/10.1016/j.jnma.2025.02.002","url":null,"abstract":"<p><p>Racism remains a significant issue in the medical field, profoundly affecting minority medical students. These students face unique challenges - including microaggressions, implicit biases, systemic barriers, and overt discrimination - impacting their education, mental health, career trajectories, and ability to provide compassionate care. Despite some progress, structural obstacles and underrepresentation persist, highlighting the need for systemic changes. This viewpoint paper explores definitions, principles, and practical steps for fostering antiracist cultures within medical education. It emphasizes the importance of developing self-advocacy, building support networks, and practicing continuous learning for minority students, while advocating for institutional strategies such as creating inclusive spaces, mentorship programs, curriculum reform, and financial support. By combining personal resilience with unwavering institutional support, medical education can move towards true equity and inclusion, ensuring that all students can thrive and contribute to a more equitable healthcare system.</p>","PeriodicalId":94375,"journal":{"name":"Journal of the National Medical Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143675145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Underrepresented in medicine resident physician distribution by race, gender, and specialty trends from 2013-2019.","authors":"Joshua Ellis, Alden Landry, Leeanne Fagan, Payton Cabrera, Andrew Marshall, Ryan Burke, Nicole Dubosh","doi":"10.1016/j.jnma.2025.03.003","DOIUrl":"https://doi.org/10.1016/j.jnma.2025.03.003","url":null,"abstract":"<p><strong>Importance: </strong>While significant racial disparities in the physician workforce have existed for decades, recent attention on this mismatch and the current sociopolitical climate have led to an increase in recruitment efforts of Underrepresented in Medicine (URiM) physicians by residency programs. The effect of these efforts on URiM distribution across residency programs has not yet been comprehensively studied.</p><p><strong>Objective: </strong>To describe the distribution of URiM residents across the top 20 most populous medical and surgical specialties by race and gender as well as trends observed from 2013 to 2019.</p><p><strong>Design: </strong>Multicenter, retrospective cross sectional analysis Setting: US residency programs Participants: All first-year residents matching in the 20 most populous specialties as documented in the Association of American Medical Colleges (AAMC) Data Resource Books during the study period.</p><p><strong>Main outcomes: </strong>The primary outcome of this study was to describe the percentages of URiM resident physicians in the US by race and gender, as defined by the AAMC during the study period. Secondary outcomes include an analysis of URiM race and gender distribution as well as URiM distribution in competitive vs noncompetitive specialties, surgical vs nonsurgical specialties, and primary care specialties.</p><p><strong>Results: </strong>From 2013-2019, there were 228,645 entries by 211,356 first-year residents to the top 20 most populous specialties. In total, 15.2% of entries were URiM residents. Forty-six percent of applicants identified as female. All but two specialties studied had an increase in URiM representation. No specialty had greater than 4% increase in URiM representation. In 2019, there were differences in specialty representation when individual race and gender categories within URiM were considered. The URiM percentages were as follows in specialty subtypes: surgical (16%) vs nonsurgical (16.4%) and competitive (12.3%) vs noncompetitive (18.2%). The top 3 specialities with the highest percentage of URiM residents were primary care specialties.</p><p><strong>Conclusion: </strong>Despite the increase in recruitment efforts for URiM applicants at the residency level, there was only a slight change in total URiM distribution by specialty over the study time period. Individual race categories and gender had an impact on the distribution of residents in the most recent year.</p>","PeriodicalId":94375,"journal":{"name":"Journal of the National Medical Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing African American representation in plastic surgery.","authors":"Joshua E Lewis, Wei-Chen Lee","doi":"10.1016/j.jnma.2025.01.009","DOIUrl":"https://doi.org/10.1016/j.jnma.2025.01.009","url":null,"abstract":"<p><p>Plastic surgery is a specialty crucial for addressing the needs of diverse patient, yet it faces significant underrepresentation of African Americans, especially in academic leadership. This imbalance persists throughout medical education, training, and professional advancement. Dr. Arthur L. Garnes, the first board-certified African American plastic surgeon, overcame profound challenges, inspiring subsequent generations. Notable figures like Dr. Camille Cash and Dr. Steven Williams further exemplify resilience in the face of barriers. Mentorship emerges as pivotal, fostering diversity and inclusion within plastic surgery. Initiatives promoting mentorship, financial support, and recruitment are essential to rectifying disparities, ensuring equitable representation, and improving access to care for minority patients.</p>","PeriodicalId":94375,"journal":{"name":"Journal of the National Medical Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A critical awareness approach to cluster hiring for academic inclusion.","authors":"Sierra Carter, Emmanuella Asabor, Grace Packard, Margaux Kenwood, Ayana Jordan, Rachel A Ross","doi":"10.1016/j.jnma.2025.02.001","DOIUrl":"https://doi.org/10.1016/j.jnma.2025.02.001","url":null,"abstract":"<p><p>Minoritized groups experience interpersonal, structural, and systemic marginalization that is also perpetuated within academic institutions. This marginalization produces barriers that exclude racial/ethnic minoritized groups within academic medicine from career opportunities and advancement. Racial/ethnic minoritized faculty are often expected to take on additional labor to serve the diversity needs of the program and/or institution that are often unrecognized or undervalued in the tenure or promotion process or detract from additional responsibilities. The unique needs resulting from multiple intersecting identities must be considered when planning initiatives to support minoritized groups in academia. This is detrimental to medicine as it limits innovation, perpetuates health disparities, and prevents the recruitment of scholars/physicians that are representative of the diversity within the U.S. population. Cluster hiring is a newer initiative adopted by many institutions; recently supported by funding from the National Institutes of Health (NIH) to improve diversity and inclusion of racial/ethnic minoritized groups. Here we discuss the elements of the cluster hire process and how they might be particularly relevant to intersectional inclusion and structural change of academic institutions, while also highlighting potential limitations to broad adoption. We conclude with recommendations for the potential need for integration of more culturally informed cluster hiring practices that can be made at the departmental, institutional and national level to positively impact the hiring, retention and advancement of faculty from marginalized populations.</p>","PeriodicalId":94375,"journal":{"name":"Journal of the National Medical Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hydrus stent removal for delayed cystoid macular edema: Two cases.","authors":"Daniel Laroche, Alissa Belzie, Idaima Calderon","doi":"10.1016/j.jnma.2024.12.001","DOIUrl":"https://doi.org/10.1016/j.jnma.2024.12.001","url":null,"abstract":"","PeriodicalId":94375,"journal":{"name":"Journal of the National Medical Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143470333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}