A healthcare workforce reflective of the population is essential to improving access and quality, yet students from low socioeconomic and underrepresented backgrounds continue to face barriers to entry. Early exposure and mentorship programs are critical strategies to address these gaps. We evaluated the Horizons Mentoring Program, a novel multilevel pipeline model that integrates medical students, undergraduates, and predominantly low-income, Black high school students from local communities into mentoring families across two consecutive cohorts. All families concurrently participated in monthly sessions over the course of an academic year, focusing on clinical skills, college preparation, and healthcare career exploration. Among both cohorts A and B, nearly all of the respondents reported satisfaction with this program, formation of mentorship networks, and understanding of healthcare careers. In Cohort B, the proportion of high school students reporting no mentors in healthcare significantly decreased from 62.9% to 29.6% (p = .003). Participants also reported significantly greater understanding of healthcare career pathways (p = .016) and increased confidence in achieving these careers (p = .041), while interest in healthcare careers remained consistently high. These findings demonstrate that a multilevel, family-based mentorship model is feasible, scalable, and associated with improved mentorship and career preparedness, supporting its potential as a valid framework.
{"title":"Building a scalable, multilevel healthcare pipeline program through structured mentoring families: perceptions and outcomes from two cohorts","authors":"Zeeyong Kwong, Evan Patel, Chandrahaas Kona, Kanisha Bahierathan, Lauren Rodio, Shannon Morrison, James Bena, Monica Yepes-Rios","doi":"10.1016/j.jnma.2026.06.003","DOIUrl":"10.1016/j.jnma.2026.06.003","url":null,"abstract":"<div><div>A healthcare workforce reflective of the population is essential to improving access and quality, yet students from low socioeconomic and underrepresented backgrounds continue to face barriers to entry. Early exposure and mentorship programs are critical strategies to address these gaps. We evaluated the Horizons Mentoring Program, a novel multilevel pipeline model that integrates medical students, undergraduates, and predominantly low-income, Black high school students from local communities into mentoring families across two consecutive cohorts. All families concurrently participated in monthly sessions over the course of an academic year, focusing on clinical skills, college preparation, and healthcare career exploration. Among both cohorts A and B, nearly all of the respondents reported satisfaction with this program, formation of mentorship networks, and understanding of healthcare careers. In Cohort B, the proportion of high school students reporting no mentors in healthcare significantly decreased from 62.9% to 29.6% (<em>p </em>= .003). Participants also reported significantly greater understanding of healthcare career pathways (<em>p </em>= .016) and increased confidence in achieving these careers (<em>p </em>= .041), while interest in healthcare careers remained consistently high. These findings demonstrate that a multilevel, family-based mentorship model is feasible, scalable, and associated with improved mentorship and career preparedness, supporting its potential as a valid framework.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 4","pages":"Pages 707-715"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148451182","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}
Atrial fibrillation (AF) and heart failure (HF) frequently coexist, with each condition exacerbating the other through complex haemodynamic and structural interactions. While the prognostic influence of AF in HF is well-established in high-income settings, data from sub-Saharan Africa remain scarce. The objective of the study is to examine the prevalence, clinical correlates, and one-year outcomes associated with AF among Nigerian patients with chronic HF.
Methods
This was a pragmatic, real-life, prospective observational cohort study. It was conducted at the Cardiology Unit of the Department of Medicine of the University College Hospital, Ibadan, Nigeria, which is a tertiary hospital. A total of 1040 adults with clinically and echocardiographically confirmed chronic HF were enrolled. The participants were followed up for 12 months.
The primary outcome was all-cause mortality, while the secondary outcomes were hospital admissions and a composite of deaths and admissions.
Results
Atrial fibrillation (AF) was present in 136 patients (13.1%) at baseline. Patients with AF were significantly older than those without AF (63.8 ± 14.2 vs. 55.7 ± 15.7 years, P < 0.001) and had lower mean systolic blood pressure (114.9 ± 22.2 vs. 121.2 ± 24.5 mmHg, P = 0.007). The distribution of heart failure subtypes by left ventricular ejection fraction did not differ significantly between AF and non-AF groups (HFrEF 39.7% vs. 42.4%, HFmrEF 31.0% vs. 26.8%, HFpEF 29.3% vs. 30.7%, P = 0.811). Mitral and tricuspid regurgitation were more prevalent among patients with AF. At one-year follow-up, mortality was higher among patients with AF (22.8%vs. 17.7%), but this was not statistically significant (p = 0.20). Rehospitalisation occurred in 5.1% of patients with AF compared with 4.2% of those in sinus rhythm (p = 0.881).
Conclusions
AF affected roughly one in eight Nigerian patients with CHF and was linked to older age, lower blood pressure, and greater valvular dysfunction. Although AF was not an independent predictor of the composite outcome, patients with AF exhibited numerically higher event rates.
{"title":"Atrial fibrillation in chronic heart failure: prevalence and one-year outcome in the Ibadan chronic heart failure project","authors":"Chukwuemeka Louis Anyikwa, Caroline Anuli Nwamadiegesi, Olanike Allison Orimolade, Omokorede Oluwafikunmi Ademowo-Olusanya, Chidinma Martha Ogah, Akinyemi Aje, Oladimeji Muritala Adebayo, Adewale Ismahil Badru, Abiodun Moshood Adeoye, Adewole Adesoji Adebiyi, Olulola Olutoyin Oladapo, Okechukwu Samuel Ogah","doi":"10.1016/j.jnma.2026.05.004","DOIUrl":"10.1016/j.jnma.2026.05.004","url":null,"abstract":"<div><h3>Background</h3><div>Atrial fibrillation (AF) and heart failure (HF) frequently coexist, with each condition exacerbating the other through complex haemodynamic and structural interactions. While the prognostic influence of AF in HF is well-established in high-income settings, data from sub-Saharan Africa remain scarce. The objective of the study is to examine the prevalence, clinical correlates, and one-year outcomes associated with AF among Nigerian patients with chronic HF.</div></div><div><h3>Methods</h3><div>This was a pragmatic, real-life, prospective observational cohort study. It was conducted at the Cardiology Unit of the Department of Medicine of the University College Hospital, Ibadan, Nigeria, which is a tertiary hospital. A total of 1040 adults with clinically and echocardiographically confirmed chronic HF were enrolled. The participants were followed up for 12 months.</div><div>The primary outcome was all-cause mortality, while the secondary outcomes were hospital admissions and a composite of deaths and admissions.</div></div><div><h3>Results</h3><div>Atrial fibrillation (AF) was present in 136 patients (13.1%) at baseline. Patients with AF were significantly older than those without AF (63.8 ± 14.2 vs. 55.7 ± 15.7 years, <em>P </em>< 0.001) and had lower mean systolic blood pressure (114.9 ± 22.2 vs. 121.2 ± 24.5 mmHg, <em>P </em>= 0.007). The distribution of heart failure subtypes by left ventricular ejection fraction did not differ significantly between AF and non-AF groups (HFrEF 39.7% vs. 42.4%, HFmrEF 31.0% vs. 26.8%, HFpEF 29.3% vs. 30.7%, <em>P </em>= 0.811). Mitral and tricuspid regurgitation were more prevalent among patients with AF. At one-year follow-up, mortality was higher among patients with AF (22.8%vs. 17.7%), but this was not statistically significant (<em>p </em>= 0.20). Rehospitalisation occurred in 5.1% of patients with AF compared with 4.2% of those in sinus rhythm (<em>p </em>= 0.881).</div></div><div><h3>Conclusions</h3><div>AF affected roughly one in eight Nigerian patients with CHF and was linked to older age, lower blood pressure, and greater valvular dysfunction. Although AF was not an independent predictor of the composite outcome, patients with AF exhibited numerically higher event rates.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 4","pages":"Pages 684-695"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240889","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: 2026-07-19DOI: 10.1016/j.jnma.2026.06.016
Gianna Giacomotto, Ricardo Antillon, Esmeralda Trejo, Gerardo Moreno, Gregg J. Gold, Jennifer M. Lucero
Despite the documented benefits of a diverse physician workforce, significant barriers continue to limit some students' success within the clinical clerkship phase of their medical education. These students may experience unintended bias in grading and assessment that can limit their access to future opportunities. Anti-bias training is one strategy used to address these shortcomings in the assessment process. However, anti-bias training has been shown to be ineffective, resented by participants, and can even result in the opposite of its intended effects. Innovative training strategies to support equitable student success are therefore critical. Here we present the lessons learned from implementing a pilot medical education training program for clerkship directors to avoid these issues.
To reduce unintended assessment bias students face during their clinical clerkships, a fall seminar for clerkship directors was designed and implemented at the UCLA David Geffen School of Medicine (DGSOM). These directors participated in ten monthly Zoom sessions and one culminating four-hour in-person seminar on the UCLA campus in August 2024. Psychological topics related to bias, such as intergroup dynamics, ingroup favoritism, and social dominance theory, were openly discussed with and among the faculty. To enable continuous improvement, a pre-, mid-year, and post-evaluation was administered to participants to capture participants' perceptions of the effectiveness of the training, materials, and the program.
Mid-year evaluations found the Zoom sessions ineffective at increasing participants' understanding of anti-bias constructs and led to negative perceptions and resistance to the training. The transition to an in-person seminar was made accordingly. The seminar yielded much higher satisfaction, negligible resistance, and much higher perceived comprehension rates than the online format. The clerkship directors' post-seminar evaluations greatly increased across all measures. It appears that having a social psychologist co-lead an in-person seminar with a leading DGSOM physician, along with other changes, was critical to the success of the in-person seminar.
{"title":"Lessons learned from the David Geffen school of medicine-UCLA clinical clerkship psychology of bias seminar","authors":"Gianna Giacomotto, Ricardo Antillon, Esmeralda Trejo, Gerardo Moreno, Gregg J. Gold, Jennifer M. Lucero","doi":"10.1016/j.jnma.2026.06.016","DOIUrl":"10.1016/j.jnma.2026.06.016","url":null,"abstract":"<div><div>Despite the documented benefits of a diverse physician workforce, significant barriers continue to limit some students' success within the clinical clerkship phase of their medical education. These students may experience unintended bias in grading and assessment that can limit their access to future opportunities. Anti-bias training is one strategy used to address these shortcomings in the assessment process. However, anti-bias training has been shown to be ineffective, resented by participants, and can even result in the opposite of its intended effects. Innovative training strategies to support equitable student success are therefore critical. Here we present the lessons learned from implementing a pilot medical education training program for clerkship directors to avoid these issues.</div><div>To reduce unintended assessment bias students face during their clinical clerkships, a fall seminar for clerkship directors was designed and implemented at the UCLA David Geffen School of Medicine (DGSOM). These directors participated in ten monthly Zoom sessions and one culminating four-hour in-person seminar on the UCLA campus in August 2024. Psychological topics related to bias, such as intergroup dynamics, ingroup favoritism, and social dominance theory, were openly discussed with and among the faculty. To enable continuous improvement, a pre-, mid-year, and post-evaluation was administered to participants to capture participants' perceptions of the effectiveness of the training, materials, and the program.</div><div>Mid-year evaluations found the Zoom sessions ineffective at increasing participants' understanding of anti-bias constructs and led to negative perceptions and resistance to the training. The transition to an in-person seminar was made accordingly. The seminar yielded much higher satisfaction, negligible resistance, and much higher perceived comprehension rates than the online format. The clerkship directors' post-seminar evaluations greatly increased across all measures. It appears that having a social psychologist co-lead an in-person seminar with a leading DGSOM physician, along with other changes, was critical to the success of the in-person seminar.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 4","pages":"Pages 770-776"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148498612","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 : 2026-06-01Epub Date: 2026-04-09DOI: 10.1016/j.jnma.2026.03.007
Abdulla Amir , Manroop Minhas , Elizabeth Beyene , Chukwudalu Ononenyi , Mrinalini Deverapalli , Miriam Michael
Background: Lactic acidosis is a life-threatening condition associated with high morbidity and mortality. Micronutrient deficiencies, particularly of thiamine and vitamin C, may exacerbate metabolic dysfunction in critically ill patients. While these vitamins are often empirically administered, evidence regarding their clinical impact in lactic acidosis remains limited. We aimed to assess the association between thiamine and vitamin C supplementation and clinical outcomes in hospitalized patients with lactic acidosis.
Methods: A retrospective analysis was conducted using the TriNetX Global Collaborative Network. Adult patients hospitalized with lactic acidosis were identified based on diagnostic codes and laboratory criteria. Patients were categorized according to receipt of both thiamine and vitamin C during hospitalization versus no supplementation. Propensity score matching (1:1) was performed to balance baseline characteristics, including age, sex, chronic kidney disease, and diabetes mellitus. Outcomes assessed within 30 days included resolution of acidosis, all-cause mortality, preserved ejection fraction, and emergency room utilization. Effect estimates were reported as risk ratios with 95% confidence intervals, and time-to-event analyses were performed using Kaplan–Meier analysis.
Results: After matching, each cohort included 95,358 patients. Resolution of acidosis occurred in 65.2% of supplemented patients versus 57.5% of controls (RR 1.13, 95% CI: 1.13–1.14, p
Conclusion: Thiamine and vitamin C supplementation was associated with improved resolution of acidosis and higher EF but unexpectedly correlated with increased mortality and ER visits. These results may reflect confounding by indication, as more severely ill patients likely received supplementation. Randomized controlled trials are warranted to clarify causality and guide clinical practice.
{"title":"Thiamine and vitamin C supplementation in lactic acidosis: A propensity-matched analysis of clinical outcomes","authors":"Abdulla Amir , Manroop Minhas , Elizabeth Beyene , Chukwudalu Ononenyi , Mrinalini Deverapalli , Miriam Michael","doi":"10.1016/j.jnma.2026.03.007","DOIUrl":"10.1016/j.jnma.2026.03.007","url":null,"abstract":"<div><div>Background: Lactic acidosis is a life-threatening condition associated with high morbidity and mortality. Micronutrient deficiencies, particularly of thiamine and vitamin C, may exacerbate metabolic dysfunction in critically ill patients. While these vitamins are often empirically administered, evidence regarding their clinical impact in lactic acidosis remains limited. We aimed to assess the association between thiamine and vitamin C supplementation and clinical outcomes in hospitalized patients with lactic acidosis.</div><div>Methods: A retrospective analysis was conducted using the TriNetX Global Collaborative Network. Adult patients hospitalized with lactic acidosis were identified based on diagnostic codes and laboratory criteria. Patients were categorized according to receipt of both thiamine and vitamin C during hospitalization versus no supplementation. Propensity score matching (1:1) was performed to balance baseline characteristics, including age, sex, chronic kidney disease, and diabetes mellitus. Outcomes assessed within 30 days included resolution of acidosis, all-cause mortality, preserved ejection fraction, and emergency room utilization. Effect estimates were reported as risk ratios with 95% confidence intervals, and time-to-event analyses were performed using Kaplan–Meier analysis.</div><div>Results: After matching, each cohort included 95,358 patients. Resolution of acidosis occurred in 65.2% of supplemented patients versus 57.5% of controls (RR 1.13, 95% CI: 1.13–1.14, p</div><div>Conclusion: Thiamine and vitamin C supplementation was associated with improved resolution of acidosis and higher EF but unexpectedly correlated with increased mortality and ER visits. These results may reflect confounding by indication, as more severely ill patients likely received supplementation. Randomized controlled trials are warranted to clarify causality and guide clinical practice.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 3","pages":"Pages 519-524"},"PeriodicalIF":2.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147648190","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}
Infective gastroenteritis remains an important cause of gastrointestinal-related mortality in the United States despite medical advances. Antibiotic resistance, increasing immunosuppression, and population aging may contribute to its burden, yet long-term national mortality trends and disparities are incompletely defined.
Methods
CDC WONDER multiple cause of death data from 1999–2023 were analyzed for U.S. adults aged ≥25 years. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated. Joinpoint Regression v5.2.0 estimated annual percent changes (APCs) with 95 % confidence intervals (p ≤ 0.05), stratified by sex, race and ethnicity, region, urbanization, and age group.
Results
From 1999–2023, 304,378 deaths were attributed to infective gastroenteritis. AAMR increased from 1.5 in 1999 to 7.7 in 2010, then declined to 5.0 in 2023. Mortality rose sharply during 1999–2005 (APC=23.4; p < 0.001) and declined thereafter (APC=−4.0; p = 0.008). Males had higher overall mortality compared to females (5.40 and 5.29, respectively), while females showed steeper increases and declines (AAPC for females' and males': 5.92; p < 0.05 and 5.28; p < 0.05, respectively). Non-Hispanic (NH) American Indians had the highest AAMR (6.42), followed by NH Whites (5.62), NH Blacks (4.81), Hispanics (3.93), and NH Asians (2.33). The Northeast showed the highest regional burden (5.89); urban rates slightly exceeded rural rates (5.39 and 5.23, respectively), and adults aged ≥85 years consistently had the highest mortality (23.22). State-wise AAMR ranged between Hawaii to Rhode Island (2.19 to 10.32).
Conclusion
Significant demographic and geographic disparities persist, highlighting the need for targeted, equity-focused prevention strategies to reduce preventable deaths across vulnerable populations.
背景：尽管医学进步，感染性肠胃炎仍然是美国胃肠道相关死亡的一个重要原因。抗生素耐药性、免疫抑制增强和人口老龄化可能会加重其负担，但长期的全国死亡率趋势和差异尚未完全确定。方法：分析1999-2023年美国年龄≥25岁成人的CDC WONDER多原因死亡数据。计算了每10万人的年龄调整死亡率（AAMRs）。Joinpoint Regression v5.2.0以95% %的置信区间（p ≤ 0.05）估计年度百分比变化（APCs），按性别、种族和民族、地区、城市化和年龄组分层。结果：1999-2023年，304,378例死亡归因于感染性肠胃炎。AAMR从1999年的1.5上升到2010年的7.7，然后下降到2023年的5.0。1999-2005年期间死亡率急剧上升（APC=23.4; p ）结论：显著的人口和地理差异仍然存在，突出表明需要制定有针对性的、注重公平的预防战略，以减少弱势群体中可预防的死亡。
{"title":"Temporal and demographic trends in infective gastroenteritis-related mortality among U.S. adults: A 25-year nationwide analysis (1999-2023)","authors":"Dinesh Kumar , Tabia Shujaat , Inza Saif , Areej Javeid , Bakhtawar Haseeb , Rayyan Nabi , Rajesh Kumar , Kantash Kumar","doi":"10.1016/j.jnma.2026.03.006","DOIUrl":"10.1016/j.jnma.2026.03.006","url":null,"abstract":"<div><h3>Background</h3><div>Infective gastroenteritis remains an important cause of gastrointestinal-related mortality in the United States despite medical advances. Antibiotic resistance, increasing immunosuppression, and population aging may contribute to its burden, yet long-term national mortality trends and disparities are incompletely defined.</div></div><div><h3>Methods</h3><div>CDC WONDER multiple cause of death data from 1999–2023 were analyzed for U.S. adults aged ≥25 years. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated. Joinpoint Regression v5.2.0 estimated annual percent changes (APCs) with 95 % confidence intervals (<em>p</em> ≤ 0.05), stratified by sex, race and ethnicity, region, urbanization, and age group.</div></div><div><h3>Results</h3><div>From 1999–2023, 304,378 deaths were attributed to infective gastroenteritis. AAMR increased from 1.5 in 1999 to 7.7 in 2010, then declined to 5.0 in 2023. Mortality rose sharply during 1999–2005 (APC=23.4; <em>p</em> < 0.001) and declined thereafter (APC=−4.0; <em>p</em> = 0.008). Males had higher overall mortality compared to females (5.40 and 5.29, respectively), while females showed steeper increases and declines (AAPC for females' and males': 5.92; <em>p</em> < 0.05 and 5.28; <em>p</em> < 0.05, respectively). Non-Hispanic (NH) American Indians had the highest AAMR (6.42), followed by NH Whites (5.62), NH Blacks (4.81), Hispanics (3.93), and NH Asians (2.33). The Northeast showed the highest regional burden (5.89); urban rates slightly exceeded rural rates (5.39 and 5.23, respectively), and adults aged ≥85 years consistently had the highest mortality (23.22). State-wise AAMR ranged between Hawaii to Rhode Island (2.19 to 10.32).</div></div><div><h3>Conclusion</h3><div>Significant demographic and geographic disparities persist, highlighting the need for targeted, equity-focused prevention strategies to reduce preventable deaths across vulnerable populations.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 3","pages":"Pages 505-518"},"PeriodicalIF":2.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147725400","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}
Atrial fibrillation (AF) is a common arrhythmia that is a potent independent risk factor for stroke. The incidence of AF increases with age, and most affected people have underlying cardiac disease. This study aimed to describe the risk factors for AF in Nigeria.
Methods
This was a hospital-based case-controlled study. The cases were adult male and female clinic attendees aged 18 years and above who had 12-lead ECG-diagnosed atrial fibrillation. They were age- and sex-matched with clinic attendees who were free of AF. A uniform case report form was used for data collection for the cases and controls. These included: socio-demographic, clinical history, cardiovascular risk factors and co-morbidities, symptoms and signs, laboratory, 12-lead ECG, and echocardiography data.
Results
The mean age of the cases was 63.57 ± 4.59 years, while that of the control group was 63.21 ± 14.29 years. There were 114 and 101 males and females in each group. There were similarities in the socio-demographic characteristics. The pulse rate was significantly higher in the cases, but the blood pressure was significantly lower. Family history of CVD, cardiomyopathy, hypertension, myocardial infarction, congenital heart disease, rheumatic heart disease, and stroke were significantly more common in cases than in controls. The cases had lower packed cell volume, serum sodium, estimated glomerular filtration rate, plasma glucose, total cholesterol, low-density lipoprotein cholesterol, and triglyceride; as well as larger atria, thinner walls, and larger left ventricular internal dimensions. The independent risk factors associated with AF in the study were: left atrial dimension-aOR-6.49, 95% CI-2.05-20.51, p=0.001; left ventricular internal dimension in diastole-aOR=3.13, 95%CI, 1.03-9.52, p=0.044, eGFR-aOR-0.93, 95% CI-0.89-0.97, 0.001; total cholesterol- aOR=1.02, 95%CI, 1.00-1.03, p=0.044 and, HDL cholesterol aOR=0.94, 95%CI, 0.91-0.98, p=0.001
Conclusion
The study identified left atrial dimension, left ventricular internal dimension in diastole, eGFR, total cholesterol, and HDL cholesterol as the independent predictors of AF. Stroke rates were also high in the AF population. Modification of these risk factors at the population level will prevent or delay the onset of AF. Appropriate management of AF cases, especially with anti-coagulation, will also prevent or reduce stroke incidences in them.
{"title":"Risk factors for atrial fibrillation in Ibadan, Nigeria: A case-controlled study","authors":"Okechukwu Samuel Ogah , Olanike Allison Orimolade , Chima Uzoma Akunwata , Chukwuemeka Louis. Anyikwa , Chidinma Martha. Ogah , Gloria Oluwakorede Alao , Joshua O Akinyemi , Oladimeji Muritala Adebayo , Akinyemi Aje , Adewole Adebiyi , Olulola Olutoyin Oladapo , Mayowa Ojo Owolabi , Wuraola Adebola Shokunbi , Ayodele Olajide Falase","doi":"10.1016/j.jnma.2026.03.013","DOIUrl":"10.1016/j.jnma.2026.03.013","url":null,"abstract":"<div><h3>Background</h3><div>Atrial fibrillation (AF) is a common arrhythmia that is a potent independent risk factor for stroke. The incidence of AF increases with age, and most affected people have underlying cardiac disease. This study aimed to describe the risk factors for AF in Nigeria.</div></div><div><h3>Methods</h3><div>This was a hospital-based case-controlled study. The cases were adult male and female clinic attendees aged 18 years and above who had 12-lead ECG-diagnosed atrial fibrillation. They were age- and sex-matched with clinic attendees who were free of AF. A uniform case report form was used for data collection for the cases and controls. These included: socio-demographic, clinical history, cardiovascular risk factors and co-morbidities, symptoms and signs, laboratory, 12-lead ECG, and echocardiography data.</div></div><div><h3>Results</h3><div>The mean age of the cases was 63.57 ± 4.59 years, while that of the control group was 63.21 ± 14.29 years. There were 114 and 101 males and females in each group. There were similarities in the socio-demographic characteristics. The pulse rate was significantly higher in the cases, but the blood pressure was significantly lower. Family history of CVD, cardiomyopathy, hypertension, myocardial infarction, congenital heart disease, rheumatic heart disease, and stroke were significantly more common in cases than in controls. The cases had lower packed cell volume, serum sodium, estimated glomerular filtration rate, plasma glucose, total cholesterol, low-density lipoprotein cholesterol, and triglyceride; as well as larger atria, thinner walls, and larger left ventricular internal dimensions. The independent risk factors associated with AF in the study were: left atrial dimension-aOR-6.49, 95% CI-2.05-20.51, p=0.001; left ventricular internal dimension in diastole-aOR=3.13, 95%CI, 1.03-9.52, p=0.044, eGFR-aOR-0.93, 95% CI-0.89-0.97, 0.001; total cholesterol- aOR=1.02, 95%CI, 1.00-1.03, p=0.044 and, HDL cholesterol aOR=0.94, 95%CI, 0.91-0.98, p=0.001</div></div><div><h3>Conclusion</h3><div>The study identified left atrial dimension, left ventricular internal dimension in diastole, eGFR, total cholesterol, and HDL cholesterol as the independent predictors of AF. Stroke rates were also high in the AF population. Modification of these risk factors at the population level will prevent or delay the onset of AF. Appropriate management of AF cases, especially with anti-coagulation, will also prevent or reduce stroke incidences in them.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 3","pages":"Pages 546-558"},"PeriodicalIF":2.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147950658","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 : 2026-06-01Epub Date: 2026-04-29DOI: 10.1016/j.jnma.2026.03.011
Joseph C. Rumenapp , Favour Oladipupo , Daniel Sanchez , Myrtis Sullivan , Jamal Turner , Mildred MG Olivier
Community engagement programs offer medical students opportunities to develop leadership skills and apply health equity principles. This study explored medical students’ perceptions of leadership development and diversity, equity, and inclusion after volunteering in a mini medical school (MMS) program. Between 2023 and 2024, four focus groups with eleven medical students examined perceptions of leadership growth and community impact through volunteering in an MMS program for 4th–6th graders in North Chicago. Thematic coding revealed three leadership development themes, with character development as the most dominant. Respondents reported enhanced problem-solving skills, deeper engagement with health inequities, and a strong motivation to “give back” by expanding opportunities for underrepresented in medicine (URiM) students. MMS programs not only cultivate leadership skills but also strengthen pathways for URiM students to explore medical careers. These programs complement formal curricula, reinforcing medical students’ commitment to socially conscious practice.
{"title":"Medical student perspectives of leadership development in community engagement","authors":"Joseph C. Rumenapp , Favour Oladipupo , Daniel Sanchez , Myrtis Sullivan , Jamal Turner , Mildred MG Olivier","doi":"10.1016/j.jnma.2026.03.011","DOIUrl":"10.1016/j.jnma.2026.03.011","url":null,"abstract":"<div><div>Community engagement programs offer medical students opportunities to develop leadership skills and apply health equity principles. This study explored medical students’ perceptions of leadership development and diversity, equity, and inclusion after volunteering in a mini medical school (MMS) program. Between 2023 and 2024, four focus groups with eleven medical students examined perceptions of leadership growth and community impact through volunteering in an MMS program for 4th–6th graders in North Chicago. Thematic coding revealed three leadership development themes, with character development as the most dominant. Respondents reported enhanced problem-solving skills, deeper engagement with health inequities, and a strong motivation to “give back” by expanding opportunities for underrepresented in medicine (URiM) students. MMS programs not only cultivate leadership skills but also strengthen pathways for URiM students to explore medical careers. These programs complement formal curricula, reinforcing medical students’ commitment to socially conscious practice.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 3","pages":"Pages 411-421"},"PeriodicalIF":2.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147825583","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 : 2026-06-01Epub Date: 2026-03-09DOI: 10.1016/j.jnma.2026.02.006
Abdulmoein Eid Al-Agha , Shatha Jafar Abukammas
Congenital adrenal hyperplasia (CAH) is an autosomal recessive disorder, most commonly due to 21-hydroxylase deficiency caused by mutations in the CYP21A2 gene. This review summarizes the epidemiology, genetic spectrum, clinical presentation, and management of CAH in Saudi Arabia. Literature review indicates that the incidence of CAH in the Kingdom is substantially higher than global estimates, mainly due to high consanguinity rates. Newborn screening has enhanced early detection, enabling timely initiation of glucocorticoid and mineralocorticoid therapy. However, long-term challenges include poor adherence, growth abnormalities, obesity, and iatrogenic Cushingoid features. Data on genotype phenotype correlation and long-term outcomes remain limited. Establishing national registries, improving access to genetic counseling, and developing individualized treatment protocols are essential to optimize lifelong outcomes.
{"title":"Congenital adrenal hyperplasia in Saudi Arabia: Epidemiology, genetic mutations, and evolving management strategies","authors":"Abdulmoein Eid Al-Agha , Shatha Jafar Abukammas","doi":"10.1016/j.jnma.2026.02.006","DOIUrl":"10.1016/j.jnma.2026.02.006","url":null,"abstract":"<div><div>Congenital adrenal hyperplasia (CAH) is an autosomal recessive disorder, most commonly due to 21-hydroxylase deficiency caused by mutations in the CYP21A2 gene. This review summarizes the epidemiology, genetic spectrum, clinical presentation, and management of CAH in Saudi Arabia. Literature review indicates that the incidence of CAH in the Kingdom is substantially higher than global estimates, mainly due to high consanguinity rates. Newborn screening has enhanced early detection, enabling timely initiation of glucocorticoid and mineralocorticoid therapy. However, long-term challenges include poor adherence, growth abnormalities, obesity, and iatrogenic Cushingoid features. Data on genotype phenotype correlation and long-term outcomes remain limited. Establishing national registries, improving access to genetic counseling, and developing individualized treatment protocols are essential to optimize lifelong outcomes.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 3","pages":"Pages 451-457"},"PeriodicalIF":2.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438989","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}
Artificial intelligence (AI) is increasingly reshaping modern healthcare by introducing innovative approaches to diagnosis, treatment planning, patient monitoring, and health system management. This review examines how AI is being integrated into clinical practice and evaluates its influence on improving health outcomes while supporting improvements in health care accessibility and quality. Based on an in-depth analysis of peer-reviewed literature, reports, and case studies, the review covers key areas such as AI-driven diagnostic tools, drug discovery processes, healthcare management systems, and telemedicine applications. The findings indicate that AI technologies, particularly deep learning and artificial neural networks, have enhanced diagnostic accuracy and accelerated clinical decision-making. Predictive algorithms now assist in early disease detection and optimized resource allocation, while virtual health assistants and advanced image analysis systems contribute to improved patient engagement and faster identification of medical conditions. Innovations such as NVIDIA Clara and the MyBreastAI Suite demonstrate tangible improvements in imaging efficiency and diagnostic precision. However, the incorporation of AI into routine healthcare practice is not without obstacles. Challenges include the complexity of integrating AI systems into established clinical workflows, the dependence on large and diverse datasets for effective model training, and significant ethical concerns. Data privacy risks linked to electronic health records and continuous monitoring, along with algorithmic bias arising from non-representative datasets, may intensify existing healthcare inequalities. Furthermore, limited transparency in AI decision-making processes raises concerns regarding accountability, clinical reliability, and patient safety, ultimately affecting trust among healthcare professionals, patients, and health system leaders. While AI holds strong potential to reduce costs, enhance efficiency, and personalize patient care, its widespread adoption remains limited by technical, ethical, and regulatory constraints. The future success of AI in healthcare depends on the development of explainable and ethically aligned systems, stronger interoperability, improved clinician training, and the implementation of privacy-preserving approaches such as federated learning. Overall, this review underscores the need to move beyond evaluating AI performance alone and to focus more on its seamless integration into everyday clinical practice, ensuring that advancements translate into equitable, accessible, and patient-centered healthcare delivery.
{"title":"Harnessing artificial intelligence in healthcare: Advancing diagnosis, treatment, and patient-centered care","authors":"Amiya Das , Deepshi Arora , Geeta Deswal , Ajmer Singh Grewal , Shilpi Bansal","doi":"10.1016/j.jnma.2026.02.007","DOIUrl":"10.1016/j.jnma.2026.02.007","url":null,"abstract":"<div><div>Artificial intelligence (AI) is increasingly reshaping modern healthcare by introducing innovative approaches to diagnosis, treatment planning, patient monitoring, and health system management. This review examines how AI is being integrated into clinical practice and evaluates its influence on improving health outcomes while supporting improvements in health care accessibility and quality. Based on an in-depth analysis of peer-reviewed literature, reports, and case studies, the review covers key areas such as AI-driven diagnostic tools, drug discovery processes, healthcare management systems, and telemedicine applications. The findings indicate that AI technologies, particularly deep learning and artificial neural networks, have enhanced diagnostic accuracy and accelerated clinical decision-making. Predictive algorithms now assist in early disease detection and optimized resource allocation, while virtual health assistants and advanced image analysis systems contribute to improved patient engagement and faster identification of medical conditions. Innovations such as NVIDIA Clara and the MyBreastAI Suite demonstrate tangible improvements in imaging efficiency and diagnostic precision. However, the incorporation of AI into routine healthcare practice is not without obstacles. Challenges include the complexity of integrating AI systems into established clinical workflows, the dependence on large and diverse datasets for effective model training, and significant ethical concerns. Data privacy risks linked to electronic health records and continuous monitoring, along with algorithmic bias arising from non-representative datasets, may intensify existing healthcare inequalities. Furthermore, limited transparency in AI decision-making processes raises concerns regarding accountability, clinical reliability, and patient safety, ultimately affecting trust among healthcare professionals, patients, and health system leaders. While AI holds strong potential to reduce costs, enhance efficiency, and personalize patient care, its widespread adoption remains limited by technical, ethical, and regulatory constraints. The future success of AI in healthcare depends on the development of explainable and ethically aligned systems, stronger interoperability, improved clinician training, and the implementation of privacy-preserving approaches such as federated learning. Overall, this review underscores the need to move beyond evaluating AI performance alone and to focus more on its seamless integration into everyday clinical practice, ensuring that advancements translate into equitable, accessible, and patient-centered healthcare delivery.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 3","pages":"Pages 463-488"},"PeriodicalIF":2.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147464680","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}
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality among patients with type 2 diabetes mellitus (T2DM). Advanced age and poor glycemic control are recognized risk factors, yet data from low-resource settings remain limited. This study aimed to identify predictors of Composite cardiovascular events among adults with T2DM in central Ethiopia.
Methods
We conducted a five-year retrospective cohort study from January 1, 2020, to December 31, 2025, including 7280 adult T2DM patients receiving follow-up at selected hospitals in central Ethiopia. Patients with type 1 diabetes, gestational diabetes, end-stage organ failure, or incomplete records were excluded. Data on sociodemographics, clinical characteristics, laboratory values, medication use, and cardiovascular outcomes were extracted from medical records. Composite cardiovascular events included myocardial infarction, stroke, unstable angina, or heart failure. Cox proportional hazards regression was used to identify independent predictors of cardiovascular events.
Results
The mean age of participants was 48.7 ± 12.6 years, and 59 % were male. Thirty years with in the study period of 5 years was a maximum follow up time, a median follow up time were 14 year and 7 month, and a minimum follow up time were 2nd visit after (three month) the diagnosis of type two DM. Over the study period, 2475 patients (34.1 %) developed cardiovascular events, corresponding to an incidence rate of 339.9 per 1000 person-years. Median time to event was 18.3 years. Multivariable Cox regression analysis showed that advanced age significantly increased the hazard of cardiovascular events (AHR 4.5; 95 % CI: 2.06–6.7). Elevated HGB-A1C (≥7 %) was associated with a threefold higher risk (AHR 3.02; 95 % CI: 2.25–5.09), and triglyceride ≥150 mg/dL also predicted increased risk (AHR 3.72; 95 % CI: 2.2–5.42).
Conclusion
Advanced age, poor glycemic control, and hypertriglyceridemia were independent predictors of Composite cardiovascular events among adults with T2DM in central Ethiopia. These findings underscore the need for early risk stratification, aggressive management of hyperglycemia and dyslipidemia, and targeted interventions for older patients to reduce the cardiovascular burden in resource-limited settings.
{"title":"A multi-site analysis of advanced age and elevated glucose predicting composite cardiovascular events in patients with type II diabetes mellitus in Central Ethiopia: A five-year retrospective cohort study","authors":"Sintayehu Samuel Lorato , Dawit Alemu Lema , Temesgen Mamo , Mitiku Desalegn , Gediwon Gebrehiwot , Selman Reshad , Yisehak Wolde , Shamil Eanga Helill , Zekarias Markos , Abas Ali Hussen","doi":"10.1016/j.jnma.2026.02.005","DOIUrl":"10.1016/j.jnma.2026.02.005","url":null,"abstract":"<div><h3>Background</h3><div>Cardiovascular disease (CVD) is the leading cause of morbidity and mortality among patients with type 2 diabetes mellitus (T2DM). Advanced age and poor glycemic control are recognized risk factors, yet data from low-resource settings remain limited. This study aimed to identify predictors of Composite cardiovascular events among adults with T2DM in central Ethiopia.</div></div><div><h3>Methods</h3><div>We conducted a five-year retrospective cohort study from January 1, 2020, to December 31, 2025, including 7280 adult T2DM patients receiving follow-up at selected hospitals in central Ethiopia. Patients with type 1 diabetes, gestational diabetes, end-stage organ failure, or incomplete records were excluded. Data on sociodemographics, clinical characteristics, laboratory values, medication use, and cardiovascular outcomes were extracted from medical records. Composite cardiovascular events included myocardial infarction, stroke, unstable angina, or heart failure. Cox proportional hazards regression was used to identify independent predictors of cardiovascular events.</div></div><div><h3>Results</h3><div>The mean age of participants was 48.7 ± 12.6 years, and 59 % were male. Thirty years with in the study period of 5 years was a maximum follow up time, a median follow up time were 14 year and 7 month, and a minimum follow up time were 2nd visit after (three month) the diagnosis of type two DM. Over the study period, 2475 patients (34.1 %) developed cardiovascular events, corresponding to an incidence rate of 339.9 per 1000 person-years. Median time to event was 18.3 years. Multivariable Cox regression analysis showed that advanced age significantly increased the hazard of cardiovascular events (AHR 4.5; 95 % CI: 2.06–6.7). Elevated HGB-A1C (≥7 %) was associated with a threefold higher risk (AHR 3.02; 95 % CI: 2.25–5.09), and triglyceride ≥150 mg/dL also predicted increased risk (AHR 3.72; 95 % CI: 2.2–5.42).</div></div><div><h3>Conclusion</h3><div>Advanced age, poor glycemic control, and hypertriglyceridemia were independent predictors of Composite cardiovascular events among adults with T2DM in central Ethiopia. These findings underscore the need for early risk stratification, aggressive management of hyperglycemia and dyslipidemia, and targeted interventions for older patients to reduce the cardiovascular burden in resource-limited settings.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 3","pages":"Pages 400-410"},"PeriodicalIF":2.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147370955","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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