Pub Date : 2026-08-01Epub Date: 2026-05-22DOI: 10.1016/j.jnma.2026.03.008
Muhammed Y. Idris, Mary Beth Chalk
Clinical artificial intelligence (AI) and machine learning (ML) have advanced rapidly, yet few systems achieve sustained use in routine clinical care. This innovation–practice gap reflects not a lack of model performance, but persistent failures in validation, governance, and trust when AI is deployed in real-world clinical environments. Models that perform well retrospectively often degrade prospectively, misalign with local workflows, or are ultimately abandoned, with current responses relying on people- and process-centric mechanisms such as expert review, bespoke validation, and discretionary governance. These approaches are slow, fragile, and difficult to scale, making trust the primary bottleneck to adoption. We argue for a shift toward trust by design, in which trust is treated as a system property rather than a judgment conferred by individuals or committees. We describe how trusted systems, including privacy-enhancing compute, trusted execution environments, and trusted research environments, embed enforceable guarantees around data use, auditability, and reproducibility. By operationalizing trust through infrastructure, these systems enable scalable local validation, reduce duplicated effort, and support more equitable and durable deployment of clinical AI/ML.
{"title":"Trust by design: Crossing the chasm between clinical AI/ML innovation and practice","authors":"Muhammed Y. Idris, Mary Beth Chalk","doi":"10.1016/j.jnma.2026.03.008","DOIUrl":"10.1016/j.jnma.2026.03.008","url":null,"abstract":"<div><div>Clinical artificial intelligence (AI) and machine learning (ML) have advanced rapidly, yet few systems achieve sustained use in routine clinical care. This innovation–practice gap reflects not a lack of model performance, but persistent failures in validation, governance, and trust when AI is deployed in real-world clinical environments. Models that perform well retrospectively often degrade prospectively, misalign with local workflows, or are ultimately abandoned, with current responses relying on people- and process-centric mechanisms such as expert review, bespoke validation, and discretionary governance. These approaches are slow, fragile, and difficult to scale, making trust the primary bottleneck to adoption. We argue for a shift toward trust by design, in which trust is treated as a system property rather than a judgment conferred by individuals or committees. We describe how trusted systems, including privacy-enhancing compute, trusted execution environments, and trusted research environments, embed enforceable guarantees around data use, auditability, and reproducibility. By operationalizing trust through infrastructure, these systems enable scalable local validation, reduce duplicated effort, and support more equitable and durable deployment of clinical AI/ML.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 4","pages":"Pages 780-788"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148008329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-08-01Epub Date: 2026-06-02DOI: 10.1016/j.jnma.2026.05.001
Rakasa Pattanaik, Adam Cohen, Mary Ehlenbach, Kajal Khanna, Heidi Kloster, Laurel Scheinfeld, Uchechi Oddiri
Background/purpose
Burnout, elevated psychological distress, and reduced flourishing undermine the well-being of physician trainees and may ultimately compromise patient care. Exposure to ethno-racial trauma (ERT) can disrupt trainees’ personal and professional identity formation and impede their learning experiences. This scoping review aims to synthesize the existing literature on how ERT affects the well-being of medical trainees.
Methods
This review was conducted according to JBI methodology. A literature search of six bibliographic databases and one grey literature source was conducted in August 2023, and updated in June 2024, without time restriction applied. All English language studies conducted in the US that assessed the impact of ERT on physicians and/or physician trainees were included.
Results
Of the 4656 manuscripts identified for initial screening, 534 studies underwent full-text review, and 92 studies met inclusion criteria, with 45 studies focused on physician trainees alone and 18 focused on both physicians and physician trainees. Included studies were published between 1987 and 2024, with the majority of quantitative (49%) or qualitative (30%) methodology. Most frequently reported forms of ERT experienced by physician trainees included microaggressions, discrimination, implicit bias, invisibility, lack of belonging, devaluation of works, and disrespectful actions. Faculty, peers, patients, other practitioners and staff, community members, and medical school administrators were identified as sources of ERT. ERT was most often associated with burnout, isolation, and stress, and negatively impacted confidence, emotions, learning experience, and mental health. ERT impacted all domains of PERMA in this literature review.
Conclusion
Current literature indicates that ERT has profound negative effects on physician trainees’ well-being, contributing to burnout, psychological distress, and diminished sense of belonging. These impacts erode professional identity, hinder learning, and threaten long-term career satisfaction. Prospective, interventional studies are needed to further delineate the effects of ERT on trainees’ well-being and inform strategies to mitigate these effects.
{"title":"Ethno-racial trauma and well-being in medical education: A scoping review of U.S. physician trainees and medical students","authors":"Rakasa Pattanaik, Adam Cohen, Mary Ehlenbach, Kajal Khanna, Heidi Kloster, Laurel Scheinfeld, Uchechi Oddiri","doi":"10.1016/j.jnma.2026.05.001","DOIUrl":"10.1016/j.jnma.2026.05.001","url":null,"abstract":"<div><h3>Background/purpose</h3><div>Burnout, elevated psychological distress, and reduced flourishing undermine the well-being of physician trainees and may ultimately compromise patient care. Exposure to ethno-racial trauma (ERT) can disrupt trainees’ personal and professional identity formation and impede their learning experiences. This scoping review aims to synthesize the existing literature on how ERT affects the well-being of medical trainees.</div></div><div><h3>Methods</h3><div>This review was conducted according to JBI methodology. A literature search of six bibliographic databases and one grey literature source was conducted in August 2023, and updated in June 2024, without time restriction applied. All English language studies conducted in the US that assessed the impact of ERT on physicians and/or physician trainees were included.</div></div><div><h3>Results</h3><div>Of the 4656 manuscripts identified for initial screening, 534 studies underwent full-text review, and 92 studies met inclusion criteria, with 45 studies focused on physician trainees alone and 18 focused on both physicians and physician trainees. Included studies were published between 1987 and 2024, with the majority of quantitative (49%) or qualitative (30%) methodology. Most frequently reported forms of ERT experienced by physician trainees included microaggressions, discrimination, implicit bias, invisibility, lack of belonging, devaluation of works, and disrespectful actions. Faculty, peers, patients, other practitioners and staff, community members, and medical school administrators were identified as sources of ERT. ERT was most often associated with burnout, isolation, and stress, and negatively impacted confidence, emotions, learning experience, and mental health. ERT impacted all domains of PERMA in this literature review.</div></div><div><h3>Conclusion</h3><div>Current literature indicates that ERT has profound negative effects on physician trainees’ well-being, contributing to burnout, psychological distress, and diminished sense of belonging. These impacts erode professional identity, hinder learning, and threaten long-term career satisfaction. Prospective, interventional studies are needed to further delineate the effects of ERT on trainees’ well-being and inform strategies to mitigate these effects.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 4","pages":"Pages 581-625"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148152784","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}
Pub Date : 2026-08-01Epub Date: 2026-07-11DOI: 10.1016/j.jnma.2026.06.010
Rohan Rattan, Ruth X. Wang, Lena Chu, Genevieve Kaunitz
Dermatologic diagnosis is fundamentally visual, yet minimally melanated skin has historically predominated in educational imagery used for medical training. The limited representation of brown and black skin in dermatologic preclinical education may contribute to delayed recognition of disease and reduced diagnosis confidence among trainees and physicians caring for patients with skin of color. Promoting visual equity within medical student preclinical education therefore represents an important step toward improving health outcomes in patients of color. In this cross-sectional study, preclinical dermatology and rheumatology teaching materials at the University of California, San Diego were systematically examined using a standardized image-based protocol. Clinical images were classified according to the Massey-Martin New Immigrant Survey Skin Color Scale and collapsed into three analytic groups: Light/White, Medium/Brown, and Dark/Black. These groups were further analyzed by instructional week and disease category. Across 507 clinical images, lighter skin tones predominated: light/white (n = 304, 60%), medium/brown (n = 147, 29%), and dark/black (n = 56, 11%), a distribution that deviated significantly from equal representation (χ² = 186.26, p < 0.001). Disease-level stratification revealed underrepresentation of dark/black skin tones across all analyzed disease categories. These findings highlight persistent gaps in skin tone diversity within preclinical curricula and demonstrate the feasibility of a standardized, reproducible framework for evaluating visual representation in dermatologic education. Establishing scalable equity audits across medical schools may enable institutional benchmarking and ultimately contribute to more equitable dermatologic diagnosis and care.
{"title":"Skin tone representation in preclinical dermatology education: A cross-sectional curricular audit","authors":"Rohan Rattan, Ruth X. Wang, Lena Chu, Genevieve Kaunitz","doi":"10.1016/j.jnma.2026.06.010","DOIUrl":"10.1016/j.jnma.2026.06.010","url":null,"abstract":"<div><div>Dermatologic diagnosis is fundamentally visual, yet minimally melanated skin has historically predominated in educational imagery used for medical training. The limited representation of brown and black skin in dermatologic preclinical education may contribute to delayed recognition of disease and reduced diagnosis confidence among trainees and physicians caring for patients with skin of color. Promoting visual equity within medical student preclinical education therefore represents an important step toward improving health outcomes in patients of color. In this cross-sectional study, preclinical dermatology and rheumatology teaching materials at the University of California, San Diego were systematically examined using a standardized image-based protocol. Clinical images were classified according to the Massey-Martin New Immigrant Survey Skin Color Scale and collapsed into three analytic groups: Light/White, Medium/Brown, and Dark/Black. These groups were further analyzed by instructional week and disease category. Across 507 clinical images, lighter skin tones predominated: light/white (<em>n</em> = 304, 60%), medium/brown (<em>n</em> = 147, 29%), and dark/black (<em>n</em> = 56, 11%), a distribution that deviated significantly from equal representation (χ² = 186.26, <em>p</em> < 0.001). Disease-level stratification revealed underrepresentation of dark/black skin tones across all analyzed disease categories. These findings highlight persistent gaps in skin tone diversity within preclinical curricula and demonstrate the feasibility of a standardized, reproducible framework for evaluating visual representation in dermatologic education. Establishing scalable equity audits across medical schools may enable institutional benchmarking and ultimately contribute to more equitable dermatologic diagnosis and care.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 4","pages":"Pages 749-755"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-08-01Epub Date: 2026-05-18DOI: 10.1016/j.jnma.2026.05.005
Michelle Knecht, Dilys Schoorman, Maria Mejia
Despite the widespread integration of cultural competence training into undergraduate medical education (UME) curricula over the past two decades, health disparities persist for African American patients. While such training may improve provider attitudes and patient satisfaction, evidence linking it to measurable health outcomes remains limited. This perspective examines how culturally relevant pedagogy (CRP), originally developed by Gloria Ladson-Billings for K–12 education, can be meaningfully adapted to medical education by analyzing successful healthcare interventions for African American patients through this lens. By focusing on CRP principles, including identity, social relationships, and conceptions of knowledge, this article explores how medical educators can better prepare students to serve African American patients through more culturally grounded, community based, and critically engaged training.
{"title":"From classrooms to clinics: Applying culturally relevant pedagogy to train physicians who serve African American patients","authors":"Michelle Knecht, Dilys Schoorman, Maria Mejia","doi":"10.1016/j.jnma.2026.05.005","DOIUrl":"10.1016/j.jnma.2026.05.005","url":null,"abstract":"<div><div>Despite the widespread integration of cultural competence training into undergraduate medical education (UME) curricula over the past two decades, health disparities persist for African American patients. While such training may improve provider attitudes and patient satisfaction, evidence linking it to measurable health outcomes remains limited. This perspective examines how culturally relevant pedagogy (CRP), originally developed by Gloria Ladson-Billings for K–12 education, can be meaningfully adapted to medical education by analyzing successful healthcare interventions for African American patients through this lens. By focusing on CRP principles, including identity, social relationships, and conceptions of knowledge, this article explores how medical educators can better prepare students to serve African American patients through more culturally grounded, community based, and critically engaged training.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 4","pages":"Pages 764-769"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147978106","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}
Pub Date : 2026-08-01Epub Date: 2026-05-08DOI: 10.1016/j.jnma.2026.05.006
Areesha Sabir, Timothy P. Rugile, Helen E. Pope, Keith C. Ferdinand
<div><h3>Background</h3><div>Medicaid serves as the cornerstone of healthcare access for low-income and medically complex individuals in the United States. H.R.1, also known as the One Big Beautiful Bill Act, introduces sweeping federal Medicaid reforms, including $1 trillion in cuts, mandatory 80-hour monthly work requirements, and $35 co-pays per clinical service, that threaten to disenroll millions of beneficiaries. The implications of these changes for structurally vulnerable populations and student-run free clinics (SRFCs) remain poorly understood.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cross-sectional study of adults (≥19) with active Medicaid coverage seen at Tulane University School of Medicine SRFCs from 2017–2025 using the TuPACT registry. Chronic illness burden (diabetes, hypertension, coronary artery disease [CAD], human immunodeficiency virus [HIV], hepatitis C virus [HCV], chronic obstructive pulmonary disease [COPD], cancer, and asthma) and structural risk factors (homelessness, history of incarceration, less than a high school education, and psychiatric illness) were identified. Patients were classified into four groups: ≥1 chronic condition, ≥2 structural risk factors, overlap (≥1 chronic condition + ≥2 structural risk factors), and neither. Outcomes included cost- or insurance-related barriers to care, primary-care physician (PCP) access, and chronic medication use. χ² tests and logistic regression were used for comparisons.</div></div><div><h3>Results</h3><div>Among 1173 Medicaid-insured adults (mean age 43.4 ± 12.8 years), 47.9% had ≥1 chronic condition, 47.1% had ≥2 structural risk factors, and 23.7% met criteria for both (overlap group). Patients in the overlap group had significantly higher odds of reporting cost- or insurance-related barriers to care compared to all other groups (adjusted odds ratio [aOR] 3.11, 95% CI 1.48–6.53, p = 0.0027). Primary care access differed by group (p = 0.005), with 28.1% of overlap patients reporting no PCP, compared with 25.6% in the chronic condition group, 30.8% in the structural risk group, and 35.3% in the neither group; this association was not significant after adjustment. Chronic medication use demonstrated the greatest gradient across groups: 70.5% of overlap patients were taking ≥1 chronic disease medication, compared with 67.1% in the chronic condition group, 60.0% in the structural risk group, and 29.4% in the neither group (p < 0.0001). In adjusted analysis, overlap patients had higher odds of chronic medication use compared to all other groups (aOR 2.75, 95% CI 2.07–3.69). These findings indicate that individuals facing both chronic illness and structural vulnerability already experience substantial financial and access barriers that would likely be exacerbated by the work requirements and cost-sharing provisions outlined in H.R.1.</div></div><div><h3>Conclusions</h3><div>Patients at the intersection of medical complexity and structural vulnerabili
背景：医疗补助是美国低收入和医疗复杂人群获得医疗保健的基石。H.R.1，也被称为“一个大美丽法案”，引入了全面的联邦医疗补助改革，包括削减1万亿美元，强制性每月80小时的工作要求，以及每次临床服务35美元的自付费用，这可能会使数百万受益人退出。这些变化对结构上的弱势群体和学生经营的免费诊所（SRFCs）的影响仍然知之甚少。方法：我们使用TuPACT注册表对杜兰大学医学院srfc 2017-2025年积极享受医疗补助的成年人（≥19岁）进行了回顾性横断面研究。慢性疾病负担（糖尿病、高血压、冠心病、人类免疫缺陷病毒（HIV）、丙型肝炎病毒（HCV）、慢性阻塞性肺疾病（COPD）、癌症和哮喘）和结构性风险因素（无家可归、监禁史、高中以下文化程度和精神疾病）被确定。患者分为四组：≥1个慢性疾病、≥2个结构性危险因素、重叠（≥1个慢性疾病 + ≥2个结构性危险因素）和均无。结果包括与费用或保险相关的护理障碍、初级保健医生（PCP）的获取和慢性药物使用。采用χ 2检验和逻辑回归进行比较。结果：1173名参保成人（平均年龄43.4 ± 12.8岁）中，47.9%患有≥1种慢性疾病，47.1%患有≥2种结构性危险因素，23.7%两者均符合（重叠组）。与所有其他组相比，重叠组患者报告成本或保险相关的护理障碍的几率显著更高（调整后的优势比[aOR] 3.11, 95% CI 1.48-6.53, p = 0.0027）。初级保健可及性因组而异（p = 0.005），28.1%的重叠患者报告无PCP，而慢性疾病组为25.6%，结构风险组为30.8%，两组均为35.3%；调整后，这种相关性不显著。慢性药物使用在两组间表现出最大的梯度：70.5%的重叠患者服用≥1种慢性疾病药物，而慢性疾病组为67.1%，结构风险组为60.0%，两组均为29.4% （p ）。处于医疗复杂性和结构脆弱性交叉点的患者代表了医疗补助人口中最不能遵守工作要求和最容易受到与成本相关的护理逃避的部分。即使有积极的医疗补助覆盖，许多人已经面临财务障碍和支离破碎的护理。因此，H.R.1法案的实施将不成比例地使那些最依赖医疗补助的人退出医保，进一步破坏社保体系的稳定。要保护医疗补助计划的作用，就不能将其视为一种与就业相关的特权，而是一种公共卫生公平的工具。对于经历过无家可归、精神疾病或监禁史的个人来说，工作要求和共同支付不是激励工具，而是生存的障碍。保持对这些群体的持续覆盖是公共卫生的当务之急。如果没有深思熟虑的保障措施，《人力资源法案》可能会扩大医疗补助计划旨在消除的不平等。
{"title":"Medicaid work requirements and cost-sharing under H.R.1: Implications for structurally vulnerable and medically complex populations in New Orleans","authors":"Areesha Sabir, Timothy P. Rugile, Helen E. Pope, Keith C. Ferdinand","doi":"10.1016/j.jnma.2026.05.006","DOIUrl":"10.1016/j.jnma.2026.05.006","url":null,"abstract":"<div><h3>Background</h3><div>Medicaid serves as the cornerstone of healthcare access for low-income and medically complex individuals in the United States. H.R.1, also known as the One Big Beautiful Bill Act, introduces sweeping federal Medicaid reforms, including $1 trillion in cuts, mandatory 80-hour monthly work requirements, and $35 co-pays per clinical service, that threaten to disenroll millions of beneficiaries. The implications of these changes for structurally vulnerable populations and student-run free clinics (SRFCs) remain poorly understood.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cross-sectional study of adults (≥19) with active Medicaid coverage seen at Tulane University School of Medicine SRFCs from 2017–2025 using the TuPACT registry. Chronic illness burden (diabetes, hypertension, coronary artery disease [CAD], human immunodeficiency virus [HIV], hepatitis C virus [HCV], chronic obstructive pulmonary disease [COPD], cancer, and asthma) and structural risk factors (homelessness, history of incarceration, less than a high school education, and psychiatric illness) were identified. Patients were classified into four groups: ≥1 chronic condition, ≥2 structural risk factors, overlap (≥1 chronic condition + ≥2 structural risk factors), and neither. Outcomes included cost- or insurance-related barriers to care, primary-care physician (PCP) access, and chronic medication use. χ² tests and logistic regression were used for comparisons.</div></div><div><h3>Results</h3><div>Among 1173 Medicaid-insured adults (mean age 43.4 ± 12.8 years), 47.9% had ≥1 chronic condition, 47.1% had ≥2 structural risk factors, and 23.7% met criteria for both (overlap group). Patients in the overlap group had significantly higher odds of reporting cost- or insurance-related barriers to care compared to all other groups (adjusted odds ratio [aOR] 3.11, 95% CI 1.48–6.53, p = 0.0027). Primary care access differed by group (p = 0.005), with 28.1% of overlap patients reporting no PCP, compared with 25.6% in the chronic condition group, 30.8% in the structural risk group, and 35.3% in the neither group; this association was not significant after adjustment. Chronic medication use demonstrated the greatest gradient across groups: 70.5% of overlap patients were taking ≥1 chronic disease medication, compared with 67.1% in the chronic condition group, 60.0% in the structural risk group, and 29.4% in the neither group (p < 0.0001). In adjusted analysis, overlap patients had higher odds of chronic medication use compared to all other groups (aOR 2.75, 95% CI 2.07–3.69). These findings indicate that individuals facing both chronic illness and structural vulnerability already experience substantial financial and access barriers that would likely be exacerbated by the work requirements and cost-sharing provisions outlined in H.R.1.</div></div><div><h3>Conclusions</h3><div>Patients at the intersection of medical complexity and structural vulnerabili","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 4","pages":"Pages 696-706"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148019885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-08-01Epub Date: 2026-05-27DOI: 10.1016/j.jnma.2026.05.003
Rishika Yadav, Keith C. Ferdinand
The “One Big Beautiful Bill Act,” a federal bill that will significantly reduce Medicaid funding, raises concerns about its downstream healthcare effects in the United States. Medicaid has served as a vital source of insurance coverage and has historically benefited many minoritized groups. The expansion of Medicaid eligibility under the Affordable Care Act in 2010 resulted in meaningful reductions in uninsured rates and improvements in access to care. The proposed policy changes are expected to cause millions of Americans to lose coverage, worsening existing inequities and destabilizing the healthcare system. This short communication examines the importance of Medicaid in promoting equitable access to healthcare, synthesizes current evidence on coverage disparities, and discusses the potential public health implications of the planned large-scale funding reductions. Protecting Medicaid coverage is essential to advancing health equity and preventing the widening of disparities in the United States.
“一个大美丽法案”是一项联邦法案，将大幅削减医疗补助计划的资金，这引发了人们对其对美国下游医疗保健影响的担忧。医疗补助一直是保险覆盖的重要来源，历史上许多少数民族群体受益。2010年《平价医疗法案》（Affordable Care Act）扩大了医疗补助计划的适用范围，大幅降低了未参保率，改善了获得医疗服务的机会。拟议中的政策变化预计将导致数百万美国人失去保险，加剧现有的不平等，并破坏医疗体系的稳定。这篇简短的报告考察了医疗补助在促进公平获得医疗保健方面的重要性，综合了目前关于覆盖差距的证据，并讨论了计划中的大规模资金削减对公共卫生的潜在影响。保护医疗补助覆盖范围对于促进美国医疗公平和防止差距扩大至关重要。
{"title":"Cuts to medicaid and the affordable care act: Negative consequences for the black community","authors":"Rishika Yadav, Keith C. Ferdinand","doi":"10.1016/j.jnma.2026.05.003","DOIUrl":"10.1016/j.jnma.2026.05.003","url":null,"abstract":"<div><div>The “One Big Beautiful Bill Act,” a federal bill that will significantly reduce Medicaid funding, raises concerns about its downstream healthcare effects in the United States. Medicaid has served as a vital source of insurance coverage and has historically benefited many minoritized groups. The expansion of Medicaid eligibility under the Affordable Care Act in 2010 resulted in meaningful reductions in uninsured rates and improvements in access to care. The proposed policy changes are expected to cause millions of Americans to lose coverage, worsening existing inequities and destabilizing the healthcare system. This short communication examines the importance of Medicaid in promoting equitable access to healthcare, synthesizes current evidence on coverage disparities, and discusses the potential public health implications of the planned large-scale funding reductions. Protecting Medicaid coverage is essential to advancing health equity and preventing the widening of disparities in the United States.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 4","pages":"Pages 744-748"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148045386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-08-01Epub Date: 2026-06-04DOI: 10.1016/j.jnma.2026.05.007
Joseph C. Rumenapp, Favour Oladipupo, Daniel Sanchez, Myrtis Sullivan, Jamal Turner, Mildred MG Olivier
{"title":"Corrigendum to ``Medical student perspectives of leadership development in community engagement'' [In Press]","authors":"Joseph C. Rumenapp, Favour Oladipupo, Daniel Sanchez, Myrtis Sullivan, Jamal Turner, Mildred MG Olivier","doi":"10.1016/j.jnma.2026.05.007","DOIUrl":"10.1016/j.jnma.2026.05.007","url":null,"abstract":"","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 4","pages":"Page 817"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148159618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-08-01Epub Date: 2026-05-14DOI: 10.1016/j.jnma.2026.05.002
Okechukwu S. Ogah, Ejiroghene M. Umuerri, Julia Hahnle, Nicholas A. Fitchat, Franklin E. Obiekwe, Chukwuagoziem S. Onuigbo, Chidinma M. Ogah, Boluwatife D. Elusiyan, Dimeji Olawuyi, Christabel Uche-Orji, Oluwabunmi Ajala, Boma Oyan, Adeola T. Adedokun, Olanike A. Orimolade, Omokorede O. Ademowo-Olusanya, Julius C. Mwita, Chukwuemeka L. Anyikwa, Casmir E. Amadi, Dike B. Ojji, Mahmoud U. Sani, Karen Sliwa
In sub-Saharan Africa (SSA), the cardiovascular system can be significantly impacted by infections and infestations with the heart being a target of several neglected tropical diseases as well as some latent parasitic infections which may become reactivated in cases of immunosuppression, such as in individuals with HIV/AIDS.
The African environment may provide a milieu for the existence and propagation of some of these infections with poor environmental hygiene, inadequate sanitation, substandard housing, and overcrowding contributing to the development and spread of infections, further exacerbating cardiovascular complications. The etiopathogenesis and clinical presentations of these infections are generally due to either direct cardiac involvement or a broader systemic illness with sequelae that can affect the pericardium, myocardium, and endocardium, as well as the blood vessels supplying the heart. Some parasitic infections, such as schistosomiasis, can cause pulmonary hypertension.
While these infections are prevalent in many African countries, it is difficult to provide an exact estimate of cardiovascular involvement as there is a lack of extensive research specifically focused on the cardiac complications in the continent. Prompt detection of cardiac involvement is crucial to improve prognosis thus, future directions on the use of more sophisticated imaging (i.e., cardiac magnetic resonance imaging) may help in the early diagnosis of cardiovascular involvement.
This paper therefore, offers a comprehensive review of the interplay between infectious diseases, infestations, neglected tropical diseases, and cardiovascular diseases in SSA. It emphasizes the complex interplay between these factors and the implications for public health and medical management in the region, which are compounded by limited healthcare resources and the high prevalence of co-infections.
{"title":"The intersection of infectious diseases and cardiovascular disease in Africa: A narrative review","authors":"Okechukwu S. Ogah, Ejiroghene M. Umuerri, Julia Hahnle, Nicholas A. Fitchat, Franklin E. Obiekwe, Chukwuagoziem S. Onuigbo, Chidinma M. Ogah, Boluwatife D. Elusiyan, Dimeji Olawuyi, Christabel Uche-Orji, Oluwabunmi Ajala, Boma Oyan, Adeola T. Adedokun, Olanike A. Orimolade, Omokorede O. Ademowo-Olusanya, Julius C. Mwita, Chukwuemeka L. Anyikwa, Casmir E. Amadi, Dike B. Ojji, Mahmoud U. Sani, Karen Sliwa","doi":"10.1016/j.jnma.2026.05.002","DOIUrl":"10.1016/j.jnma.2026.05.002","url":null,"abstract":"<div><div>In sub-Saharan Africa (SSA), the cardiovascular system can be significantly impacted by infections and infestations with the heart being a target of several neglected tropical diseases as well as some latent parasitic infections which may become reactivated in cases of immunosuppression, such as in individuals with HIV/AIDS.</div><div>The African environment may provide a milieu for the existence and propagation of some of these infections with poor environmental hygiene, inadequate sanitation, substandard housing, and overcrowding contributing to the development and spread of infections, further exacerbating cardiovascular complications. The etiopathogenesis and clinical presentations of these infections are generally due to either direct cardiac involvement or a broader systemic illness with sequelae that can affect the pericardium, myocardium, and endocardium, as well as the blood vessels supplying the heart. Some parasitic infections, such as schistosomiasis, can cause pulmonary hypertension.</div><div>While these infections are prevalent in many African countries, it is difficult to provide an exact estimate of cardiovascular involvement as there is a lack of extensive research specifically focused on the cardiac complications in the continent. Prompt detection of cardiac involvement is crucial to improve prognosis thus, future directions on the use of more sophisticated imaging (i.e., cardiac magnetic resonance imaging) may help in the early diagnosis of cardiovascular involvement.</div><div>This paper therefore, offers a comprehensive review of the interplay between infectious diseases, infestations, neglected tropical diseases, and cardiovascular diseases in SSA. It emphasizes the complex interplay between these factors and the implications for public health and medical management in the region, which are compounded by limited healthcare resources and the high prevalence of co-infections.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 4","pages":"Pages 626-638"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148255348","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}
Pub Date : 2026-08-01Epub Date: 2026-07-01DOI: 10.1016/j.jnma.2026.06.002
Michael A. Neri, Maria E. Theodorou
Infectious mononucleosis has frequently been associated with splenic pathology, most significantly splenic rupture, but splenic infarction has been reported as a rare complication. Our case describes a 24-year-old male with a mononucleosis-like illness but with a negative heterophile antibody (Monospot), who later returned with left upper quadrant pain and was diagnosed with splenic infarct on contrast computed tomography. His Epstein-Barr Virus polymerase chain reaction returned positive, and workup for an underlying hematologic cause of thromboembolism was negative. This report draws attention to the complication of splenic infarct in infectious mononucleosis, the importance of searching for causes of hypercoagulability, malignancy and patent foramen ovale, and the need for further guidance on optimal management.
{"title":"Splenic infarct in a patient with heterophile antibody negative/epstein-barr virus PCR positive infectious mononucleosis","authors":"Michael A. Neri, Maria E. Theodorou","doi":"10.1016/j.jnma.2026.06.002","DOIUrl":"10.1016/j.jnma.2026.06.002","url":null,"abstract":"<div><div>Infectious mononucleosis has frequently been associated with splenic pathology, most significantly splenic rupture, but splenic infarction has been reported as a rare complication. Our case describes a 24-year-old male with a mononucleosis-like illness but with a negative heterophile antibody (Monospot), who later returned with left upper quadrant pain and was diagnosed with splenic infarct on contrast computed tomography. His Epstein-Barr Virus polymerase chain reaction returned positive, and workup for an underlying hematologic cause of thromboembolism was negative. This report draws attention to the complication of splenic infarct in infectious mononucleosis, the importance of searching for causes of hypercoagulability, malignancy and patent foramen ovale, and the need for further guidance on optimal management.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 4","pages":"Pages 777-779"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148451209","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}
Pub Date : 2026-08-01Epub Date: 2026-05-14DOI: 10.1016/j.jnma.2026.04.005
Muhammad Shaheer Bin Faheem, Syed Tawassul Hassan, Syed Atta Ur Rafe, Faheem Feroze, Syeda Lyba Onaiz
Background
Lung cancer is the leading cause of death worldwide, and about 40% to 70% of lung cancer patients have chronic obstructive pulmonary disease (COPD). The aim of this study is to analyze lung cancer and COPD-related mortality trends among older adults in the U.S. and to assess shifts in trends across different divisions of demographics and geographics.
Methods
We assessed CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiology Research) death certificates on which both lung cancer and COPD were listed as either underlying or contributing cause of death from 1999 to 2024. Age-adjusted mortality rates (AAMRs) per 100,000 and annual percent changes (APCs) were calculated and measured across different demographic and geographic subdivisions.
Results
Overall, 582,373 deaths were recorded with AAMR declining from 58.7 in 1999 to 43.8 in 2024, showing significant falls between 2006–2018 (APC -1.96*; p < 0.05) and later from 2021 to 2024 (APC -2.66*; p < 0.05). Males (68.1) persistently had higher AAMRs than females (41.1). From races/ ethnicities, the highest AAMR was reported in NH whites (58.3), while non-metropolitan areas (67.2) and the region of the Midwest (60.8) represented the highest rates among geographics.
Conclusion
Although AAMR declined from 1999 to 2024, significant disparities persist, highlighting the need for targeted interventions and resource distributions among males, NH Whites, and non-metropolitan areas in the U.S.
背景：肺癌是世界范围内死亡的主要原因，约40%至70%的肺癌患者患有慢性阻塞性肺疾病（COPD）。本研究的目的是分析美国老年人肺癌和copd相关的死亡率趋势，并评估不同人口统计和地理区域的趋势变化。方法：我们评估了CDC WONDER（疾病控制和预防中心流行病学研究广泛在线数据）死亡证明，其中肺癌和COPD被列为1999年至2024年死亡的潜在或促成原因。计算和测量了不同人口和地理细分的每10万人年龄调整死亡率（AAMRs）和年百分比变化（APCs）。结果：共有582,373例死亡，其中AAMR从1999年的58.7下降到2024年的43.8,2006-2018年显著下降（APC -1.96*; p ）结论：尽管1999年至2024年AAMR下降，但显著差异仍然存在，突出了在美国男性、NH白人和非大都市地区进行有针对性的干预和资源分配的必要性
{"title":"Trends in lung cancer- and chronic obstructive pulmonary disease (COPD)-related mortality among older adults in the United States, 1999–2024: A CDC WONDER database analysis","authors":"Muhammad Shaheer Bin Faheem, Syed Tawassul Hassan, Syed Atta Ur Rafe, Faheem Feroze, Syeda Lyba Onaiz","doi":"10.1016/j.jnma.2026.04.005","DOIUrl":"10.1016/j.jnma.2026.04.005","url":null,"abstract":"<div><h3>Background</h3><div>Lung cancer is the leading cause of death worldwide, and about 40% to 70% of lung cancer patients have chronic obstructive pulmonary disease (COPD). The aim of this study is to analyze lung cancer and COPD-related mortality trends among older adults in the U.S. and to assess shifts in trends across different divisions of demographics and geographics.</div></div><div><h3>Methods</h3><div>We assessed CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiology Research) death certificates on which both lung cancer and COPD were listed as either underlying or contributing cause of death from 1999 to 2024. Age-adjusted mortality rates (AAMRs) per 100,000 and annual percent changes (APCs) were calculated and measured across different demographic and geographic subdivisions.</div></div><div><h3>Results</h3><div>Overall, 582,373 deaths were recorded with AAMR declining from 58.7 in 1999 to 43.8 in 2024, showing significant falls between 2006–2018 (APC -1.96*; p < 0.05) and later from 2021 to 2024 (APC -2.66*; p < 0.05). Males (68.1) persistently had higher AAMRs than females (41.1). From races/ ethnicities, the highest AAMR was reported in NH whites (58.3), while non-metropolitan areas (67.2) and the region of the Midwest (60.8) represented the highest rates among geographics.</div></div><div><h3>Conclusion</h3><div>Although AAMR declined from 1999 to 2024, significant disparities persist, highlighting the need for targeted interventions and resource distributions among males, NH Whites, and non-metropolitan areas in the U.S.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 4","pages":"Pages 664-672"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147944322","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}
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