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The beacon of hope program: Co-creating effective, measurable solutions for health equity 希望灯塔计划:共同创造有效、可衡量的健康公平解决方案。
IF 2.5 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-01 DOI: 10.1016/j.jnma.2024.09.002
Priscilla Pemu , Celia Maxwell , Rajbir Singh , Jaydutt Vadgama , Shahanaz Arjumand , Linda Armstrong
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引用次数: 0
Updates in pharmacotherapy of obesity 肥胖症药物疗法的最新进展。
IF 2.5 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-01 DOI: 10.1016/j.jnma.2024.09.004
Amie A. Ogunsakin , Tomilola I. Olakunde , Moses D. Fehintola , Ifeoluwa Malmberg , Akinwale Olakunde , Ayotunde O. Dokun
Obesity is now recognized as a chronic, progressive condition requiring early intervention and long-term management to achieve health benefits and improve metabolic risk factors. The main objective of obesity pharmacotherapy is weight loss and weight loss maintenance. There is increasing acceptance of anti-obesity medications as an adjunct to lifestyle modifications and/or surgery. In recent years there has been an evolution in management approach and pharmacologic options for treatment. As a result, there is increased focus on the efficacy and safety of these agents. We provide a historical perspective, review of recent studies on anti-obesity medication outcomes showing efficacy, potential side effects and promising therapies in development.
肥胖症现已被认为是一种慢性、进行性疾病,需要早期干预和长期管理,以实现健康效益并改善代谢风险因素。肥胖症药物治疗的主要目标是减轻体重和维持体重。越来越多的人接受将抗肥胖药物作为改变生活方式和/或手术治疗的辅助手段。近年来,肥胖症的管理方法和药物治疗方案不断发展。因此,人们越来越关注这些药物的疗效和安全性。我们将从历史的角度回顾抗肥胖药物的疗效、潜在的副作用以及正在开发的有前景的疗法。
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引用次数: 0
Managing hypertension in African Americans with heart failure: A guide for the primary care clinician 非裔美国人心力衰竭的高血压管理:初级保健临床医生指南:短标题:黑人心力衰竭患者的高血压
IF 2.5 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-01 DOI: 10.1016/j.jnma.2023.11.004
Bria Rice , Lydia Mbatidde , Oludamilola Oluleye , Anekwe Onwuanyi , Demilade Adedinsewo
Hypertension is the predominant risk factor for cardiovascular disease related morbidity and mortality among Black adults in the United States. It contributes significantly to the development of heart failure and increases the risk of death following heart failure diagnosis. It is also a leading predisposing factor for hypertensive disorders of pregnancy and peripartum cardiomyopathy in Black women. As such, all stakeholders including health care providers, particularly primary care clinicians (including physicians and advanced practice providers), patients, and communities must be aware of the consequences of uncontrolled hypertension among Black adults. Appropriate treatment strategies should be identified and implemented to ensure timely and effective blood pressure management among Black individuals, particularly those with, and at risk for heart failure.
高血压是美国黑人成人心血管疾病相关发病率和死亡率的主要危险因素。它有助于心力衰竭的发展,并增加心力衰竭诊断后的死亡风险。它也是黑人妇女妊娠期高血压疾病和围产期心肌病的主要诱发因素。因此,包括卫生保健提供者在内的所有利益相关者,特别是初级保健临床医生(包括医生和高级实践提供者)、患者和社区必须意识到黑人成年人高血压不受控制的后果。应确定并实施适当的治疗策略,以确保黑人,特别是那些有心力衰竭和有心力衰竭风险的黑人,及时有效地进行血压管理。
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引用次数: 0
Special Issue on Cardiovascular Health in African-Americans and More 非裔美国人及更多人的心血管健康特刊。
IF 2.5 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-01 DOI: 10.1016/j.jnma.2024.10.004
Marie L. Borum MD, EdD, MPH, MACP, FACG, AGAF, FRCP (Editor-In-Chief, Journal of the National Medical Association)
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引用次数: 0
Top five considerations for improving outcomes in black patients with heart failure: A guide for primary care clinicians 改善黑人心力衰竭患者预后的五大考虑因素:初级保健临床医生指南
IF 2.5 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-01 DOI: 10.1016/j.jnma.2023.11.008
JaNae’ Richard , Jacob Sama , Anekwe Onwuanyi , Onyedika J. Ilonze
Black patients develop heart failure at younger ages and have worse outcomes such as higher mortality rates compared to other racial and ethnic groups in the United States. Despite significant recent improvements in heart failure medical therapy, these worse outcomes have persisted. Multiple reasons have been provided to explain the situation, including but not limited to higher baseline cluster of cardiovascular risk factors amongst Black patients, inadequate use of heart failure guideline directed medical therapy and delayed referral for advanced heart failure therapies and interventions. Strategic interventions considering social and structural determinants of health, addressing structural inequalities/ bias, implementation of quality improvement programs, early diagnosis and prevention are critically needed to bridge the racial/ ethnic disparities gap and improve longevity of Black patients with heart failure. In this review, we propose evidence-based solutions that provide a framework for the primary care physician addressing these challenges to engender equity in treatment allocation and improve outcomes for all patients with heart failure.
与美国其他种族和族裔相比,黑人患者在更年轻的时候就会出现心力衰竭,结果也更糟,比如死亡率更高。尽管最近心力衰竭的医学治疗有了显著的进步,但这些较差的结果仍然存在。提供了多种原因来解释这种情况,包括但不限于黑人患者心血管风险因素的基线群集较高,不充分使用心力衰竭指南指导的药物治疗以及延迟转诊晚期心力衰竭治疗和干预措施。考虑到健康的社会和结构决定因素、解决结构性不平等/偏见、实施质量改进方案、早期诊断和预防的战略干预措施对于弥合种族/民族差距和提高黑人心力衰竭患者的寿命至关重要。在这篇综述中,我们提出了基于证据的解决方案,为初级保健医生解决这些挑战提供了一个框架,以实现治疗分配的公平性,并改善所有心力衰竭患者的预后。
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引用次数: 0
Addressing racial differences in the management of atrial fibrillation: Focus on black patients 解决房颤管理的种族差异:关注黑人患者
IF 2.5 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-01 DOI: 10.1016/j.jnma.2023.11.007
Hakeem Ayinde , Favour Markson , Ugonna Kevin Ogbenna , Larry Jackson II
Atrial fibrillation (AF) is the most common sustained arrhythmia, affecting between 3 and 6 million people in the United States. It is associated with a reduced quality of life and increased risk of stroke, cognitive decline, heart failure and death. Black patients have a lower prevalence of AF than White patients but are more likely to suffer worse outcomes with the disease. It is important that stakeholders understand the disproportionate burden of disease and management gaps that exists among Black patients living with AF. Appropriate treatments, including aggressive risk factor control, early referral to cardiovascular specialists and improving healthcare access may bridge some of the gaps in management and improve outcomes.
心房颤动(AF)是最常见的持续性心律失常,在美国有3-6百万患者。它会降低生活质量,增加中风、认知能力下降、心力衰竭和死亡的风险。黑人患者的房颤患病率低于白人患者,但更有可能遭受更糟糕的后果。重要的是,利益相关者了解黑人房颤患者中存在的不成比例的疾病负担和管理差距。适当的治疗,包括积极的风险因素控制,早期转诊到心血管专家和改善医疗保健可弥合管理方面的一些差距并改善结果。
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引用次数: 0
Leonidas H. Berry Health Equity Research Award - ACG Announcement Leonidas H. Berry 健康公平研究奖 - ACG 公告
IF 2.5 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-01 DOI: 10.1016/j.jnma.2024.10.011
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引用次数: 0
Impact of Etonogestrel-releasing contraceptive implant use in cisgender women with Sickle cell disease 在患有镰状细胞病的顺性别妇女中使用炔诺酮释放避孕植入物的影响。
IF 2.5 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-01 DOI: 10.1016/j.jnma.2024.09.003
Milena Bastos Brito , Andrea Queiroz Vilas Boas , Anelise Maria Nicolau Silva , Flávia Pimentel Miranda , Carolina Brabec Barreto Matos , Oziemile Silva Santos , Tais Paiva da Costa

Background

Sickle cell disease is a hereditary hemolytic anemia that exposes women to increased health risks especially in pregnancy, with serious implications for the woman and fetus. Acute pain episodes can occur multiple times per month and result in reduction of quality of life and disruption of her life.

Objective

To assess the clinical, including pain and metabolic parameters of women with sickle cell disease using etonogestrel-releasing contraceptive implants.

Methods

Women with sickle cell disease, aged 18–40 years, with reports of pain crises in the preceding 3 months were included and followed up for 12 months. Blood samples were collected to evaluate the blood count, reticulocytes, liver profile (alkaline phosphatase, gamma-glutamyl transferase, alanine aminotransferase, aspartate aminotransferase, and total bilirubin and its fractions), lipid profile, and lactate dehydrogenase levels before and 6 and 12 months after implant insertion. The following clinical variables were analyzed every 3 months: bleeding pattern, blood pressure, weight, body mass index, pain intensity (assessed using a visual analogic scale (VAS) from 0 to 10), and frequency of pain crises.

Results

Twenty-three women completed the study. There were no differences in laboratory variables between baseline and 6 and 12 months after implant insertion. Similarly, clinical variables did not differ, except for pain intensity (VAS pre-insertion = 8 vs. VAS 12 months post insertion = 4; p = 0.005) and frequency of pain crises (pre-insertion = 6 vs. 12 days/month post insertion = 0; p = 0.000).

Conclusions

Etonogestrel-releasing contraceptive implants were associated with a reduction in the intensity and frequency of pain crises in women with sickle cell disease. Moreover, it was safety among these population due to no changes in laboratory parameters during the first 12 months of use.
背景:镰状细胞病是一种遗传性溶血性贫血:镰状细胞病是一种遗传性溶血性贫血,会增加妇女的健康风险,尤其是在怀孕期间,对妇女和胎儿都有严重影响。急性疼痛每月可发作多次,导致生活质量下降和生活中断:评估使用依托孕酮释放避孕植入物的镰状细胞病患者的临床指标,包括疼痛和代谢指标:方法:纳入年龄在 18-40 岁之间、在过去 3 个月中有疼痛危机报告的镰状细胞病患者,并对其进行为期 12 个月的随访。采集血样以评估植入前、植入后 6 个月和 12 个月的血细胞计数、网状细胞、肝功能(碱性磷酸酶、γ-谷氨酰转移酶、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、总胆红素及其组分)、血脂、乳酸脱氢酶水平。每 3 个月对以下临床变量进行分析:出血模式、血压、体重、体重指数、疼痛强度(使用 0 至 10 的视觉类比量表(VAS)进行评估)以及疼痛危机的频率:结果:23 名妇女完成了研究。实验室变量在基线与植入后 6 个月和 12 个月之间没有差异。同样,除了疼痛强度(植入前 VAS = 8 vs. 植入后 12 个月 VAS = 4;p = 0.005)和疼痛危机频率(植入前 = 6 vs. 植入后 12 天/月 = 0;p = 0.000)外,其他临床变量也没有差异:埃托孕酮释放避孕植入物可降低镰状细胞病妇女疼痛危机的强度和频率。此外,由于在使用的前 12 个月中实验室参数没有发生变化,因此在这些人群中使用伊托孕素释放避孕植入剂是安全的。
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引用次数: 0
Life's essential eight as targets for cardiometabolic risk reduction among non-Hispanic black adults: A primary care approach 非西班牙裔黑人成人降低心脏代谢风险的生命基本八项指标:初级保健方法
IF 2.5 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-01 DOI: 10.1016/j.jnma.2023.11.003
Ebubechukwu Ezeh , Onyedika Ilonze , Maddie Perdoncin , Archana Ramalingam , Gurleen Kaur , Bisher Mustafa , Samson Teka , Keith C. Ferdinand
Cardiovascular diseases remain the leading cause of death in the United States. Several studies have shown racial disparities in the cardiovascular outcomes. When compared to their Non-Hispanic White (NHW) counterparts, non-Hispanic Black (NHB) individuals have higher prevalence of cardiovascular risk factors and thus, increased mortality from atherosclerotic cardiovascular diseases. This is evidenced by lower scoring in the indices of the American Heart Association's Life Essential 8 among NHB individuals. NHB individuals score lower in blood pressure, blood lipids, nicotine exposure, sleep, physical activity level, glycemic control, weight, and diet when compared to NHW individuals. Measures to improve these indices at the primary care level may potentially hold the key in mitigating the health care disparities in cardiovascular health experienced by NHB individuals.
在美国,心血管疾病仍然是导致死亡的主要原因。几项研究表明,心血管疾病的结果存在种族差异。与非西班牙裔白人(NHW)相比,非西班牙裔黑人(NHB)具有更高的心血管危险因素患病率,因此,动脉粥样硬化性心血管疾病的死亡率增加。NHB人群在美国心脏协会的生命基本8指数中得分较低,证明了这一点。与NHW个体相比,NHB个体在血压、血脂、尼古丁暴露、睡眠、身体活动水平、血糖控制、体重和饮食方面得分较低。在初级保健水平改善这些指标的措施可能是减轻NHB个体心血管健康方面的卫生保健差异的关键。
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引用次数: 0
Relationship between race, income-level, and Cardiovascular Disease 种族、收入水平与心血管疾病之间的关系
IF 2.5 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-01 DOI: 10.1016/j.jnma.2024.07.115
Khawaja M. Talha , Eisha Waqar , Heather M. Johnson , Michael D. Shapiro , Vijay Nambi , Salim S. Virani , Anurag Mehta , Khurram Nasir , Michael E. Hall , Dmitry Abramov , Abdul Mannan Khan Minhas

Aim

To study the prevalence of cardiovascular disease (CVD) and associated risk factors among different races/ethnicities across different income groups.

Methods

This retrospective analysis included data from the National Health and Nutrition Examination Survey from 2005-2018. Adults >20 years who identified as non-Hispanic (NH) White, NH Black, or Hispanic were included. Family income-to-poverty ratio (PIR) was calculated by dividing family income by poverty guidelines specific to the survey year and divided into four quartiles. Weighted logistic regression was performed to estimate adjusted odds ratios to determine association of race/ethnicity and CVD in each PIR quartile. Models were adjusted for age, sex, race, health insurance, marital status, citizenship status, education level, and PIR.

Results

We included 31,884 adults that corresponded to ∼191.3 million weighted, nationally representative participants. Of these, 8,009, 7,967, 7,944, and 7,964 participants belonged to 1st, 2nd, 3rd, and 4th quartiles, respectively. The prevalence of diabetes mellitus (DM), hypertension, coronary artery disease (CAD), congestive heart failure (CHF), and stroke decreased with each successive PIR quartile. NH Black participants had higher prevalence odds of DM, hypertension, obesity, CHF, and stroke compared to NH White participants. The difference in prevalence odds between NH White adults and NH Black adults was greater for obesity (p-interaction=0.002), DM (p-interaction=0.027), and stroke (p-interaction=0.053) in the 4th PIR quartile (highest income) compared to the 1st PIR quartile (lowest income).

Conclusion

Racial and ethnic disparities in the risk of CVD persists across income levels, with a greater difference in prevalence of select CVD and risk factors between NH Black and NH White participants in the highest income quartile compared to the lowest income quartile.
研究不同收入群体中不同种族/族裔的心血管疾病(CVD)患病率及相关风险因素。这项回顾性分析包括 2005-2018 年国家健康与营养调查的数据。研究对象包括年龄大于 20 岁的非西班牙裔(NH)白人、NH 黑人或西班牙裔成年人。家庭收入与贫困比率(PIR)的计算方法是将家庭收入除以调查年份的贫困准则,并分为四个四分位数。采用加权逻辑回归法估算调整后的几率比,以确定每个 PIR 四分位数中种族/人种与心血管疾病的关系。模型根据年龄、性别、种族、医疗保险、婚姻状况、公民身份、教育水平和 PIR 进行了调整。我们纳入了 31,884 名成年人,相当于 1.913 亿名具有全国代表性的加权参与者。其中,8009 人、7967 人、7944 人和 7964 人分别属于 1、2、3 和 4 四分位数。糖尿病 (DM)、高血压、冠状动脉疾病 (CAD)、充血性心力衰竭 (CHF) 和中风的患病率随着 PIR 四分位数的增加而降低。与新罕布什尔州的白人参与者相比,新罕布什尔州的黑人参与者患糖尿病、高血压、肥胖症、冠心病和中风的几率更高。在肥胖症(p-交互作用=0.002)、糖尿病(p-交互作用=0.027)和中风(p-交互作用=0.053)方面,与 PIR 四分位数 1(收入最低)相比,PIR 四分位数 4(收入最高)的新罕布什尔州白人成人和新罕布什尔州黑人成人之间的患病几率差异更大。在不同收入水平的人群中,心血管疾病风险的种族和民族差异依然存在,与最低收入四分位数相比,最高收入四分位数的北卡罗来纳州黑人和北卡罗来纳州白人参与者在某些心血管疾病和风险因素的患病率上差异更大。
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引用次数: 0
期刊
Journal of the National Medical Association
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