Journal of the National Medical Association最新文献

{"title":"Effect of antioxidant and statin supplementation on endothelial function and cardiovascular markers among people with HIV in Nigeria: A protocol for a randomised controlled trial","authors":"Anas Ismail ,&nbsp;Faisal S. Dankishiya ,&nbsp;Abbas Rabiu Muhammad ,&nbsp;Dr Ruqayya Nasir Sani ,&nbsp;Aisha M. Nalado ,&nbsp;Dr Zainab Uba Ibrahim ,&nbsp;Dr Umar Sharif Abdussalam ,&nbsp;Dr Umar Faruk Abdullahi ,&nbsp;Dr Rabiu Ibrahim Jalo ,&nbsp;Mahmoud U. Sani ,&nbsp;Muktar H. Aliyu","doi":"10.1016/j.jnma.2025.11.008","DOIUrl":"10.1016/j.jnma.2025.11.008","url":null,"abstract":"<div><h3>Objectives</h3><div>People living with HIV face a heightened risk of cardiovascular disease, with endothelial dysfunction playing a critical role in its development. While antioxidants and statins have shown promise in improving endothelial function and reducing cardiovascular risk, their long-term effect on HIV-positive individuals remain unclear. This study aims to assess the individual and combined effects of antioxidant and statin supplementation on endothelial function and cardiovascular markers in Nigerian HIV patients.</div></div><div><h3>Methods</h3><div>This randomised, double-blind, placebo-controlled trial will be conducted on 100 participants, with 25 in each of the four groups: antioxidant supplementation, statin supplementation, combined antioxidant and statin supplementation and placebo. The primary outcomes include endothelial function (assessed by brachial artery flow-mediated dilation), blood pressure, and pulse rate, and serum levels of LDL cholesterol, HDL cholesterol, total cholesterol, triglycerides, and inflammatory markers (highly sensitive-C-reactive protein). The data collection entails the baseline and follow-up assessments at 1,3 and 6 months. Blood samples will be collected to measure cardiovascular markers. Endothelial function will be assessed using brachial artery flow-medial dilatation Statistical analysis will follow intention-to-treat principles. Group differences will be assessed using ANOVA or Kruskal-Wallis test for continuous variables and Chi-square or McNemar test for categorical variables, while multivariable regression models will be used to adjust for confounding.</div></div><div><h3>Conclusion</h3><div>The study is hypothesized to provide evidence of the efficacy of antioxidant and statin supplementation in improving endothelial function and cardiovascular health in Nigerian HIV patients. If successful, this could inform guidelines and interventions to reduce cardiovascular risk in this population.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 1","pages":"Pages 133-140"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145673463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A biochemical study of estrogen receptor beta and oxidative stress in females with ovarian cancer","authors":"Ali M.A. Al-Kufaishi ,&nbsp;Noor J.T. Al-Musawi","doi":"10.1016/j.jnma.2025.10.004","DOIUrl":"10.1016/j.jnma.2025.10.004","url":null,"abstract":"<div><h3>Objectives</h3><div>The study includes the interpretation of hormonal disturbances resulting from the activation of Beta estrogen receptors, which leads to increased oxidative stress and its relationship to the development1and spread of ovarian1cancer in perimenopause women compared to healthy women.</div></div><div><h3>Methods</h3><div>Blood samples were collected from (12) perimenopause women with ovarian cancer immediately after diagnosis to be compared with (45) healthy women. Estrogen receptor beta and some hormones were assessed using ELISA and miniVIDAS, while spectrophotometric methods were used to evaluate variables associated with oxidative stress.</div></div><div><h3>Results</h3><div>The results show a significant increase in the values of estrogen receptors beta for women with ovarian cancer (48.4±3.18) ng/mL compared to healthy women (36.20±2.44) ng/mL. Also, a significant increase was remark in the values of each estrogen, progesterone, DHEA-s, testosterone, AMH, and total oxidant status. In contrast, a significant1decrease in the concentrations of total antioxidant capacity. The results also show a positive1correlation between1the values of total oxidants and the hormones studied, compared to the negative correlation with total antioxidants.</div></div><div><h3>Conclusion</h3><div>The significant increase in the values of beta-estrogen receptors as well as the estrogen hormone that may be derived from adipose tissue in women with ovarian cancer in the perimenopause stage has multiple effects, for example, causing disturbances in some hormones such as progesterone, DHEA-s, testosterone, and AMH. These hormonal disturbances resulting from granulosa cell tumors (GCTs) play a role in increasing the metabolic rate and thus increasing the oxidative stress of the cells.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 1","pages":"Pages 56-63"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145454501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A risk prediction model for cervical cancer in adults: A study based on the national health interview survey (NHIS) 2019–2023","authors":"Yuxin Ruan ,&nbsp;Xia Liu ,&nbsp;Yiying Li ,&nbsp;Ailan Fu ,&nbsp;Zheng Chen ,&nbsp;Feifeng Lin","doi":"10.1016/j.jnma.2025.10.003","DOIUrl":"10.1016/j.jnma.2025.10.003","url":null,"abstract":"<div><h3>Background/Objectives</h3><div>Cervical cancer (CC) seriously threatens women's health. Precisely identifying its risk factors and constructing a reliable prediction model are of utmost importance for reducing the risks of both its occurrence and mortality. This study was precisely carried out based on such a need. This study aims to analyse the association between variables and cervical cancer, construct an effective risk prediction model, and evaluate its performance, thereby providing a basis for cervical cancer risk assessment and prevention.</div></div><div><h3>Methods</h3><div>Using data from the US NHIS from 2019 to 2023, we analysed the association between 13 variables and cervical cancer, screened key classification variables using machine learning algorithms, and constructed a predictive model based on these variables. We then plotted nomograms, ROC curves, calibration curves, and decision curves to evaluate the model's performance.</div></div><div><h3>Results</h3><div>Four of the 13 variables were significantly correlated with CC (<em>P</em> &lt; 0.001). Among the 38 categorical variables, the machine learning algorithm identified seven key variables. The nomogram constructed based on these variables demonstrated good predictive ability, with an AUC of 0.82, high accuracy in distinguishing CC patients from non-patients, calibration curves confirming its accuracy, and decision curves showing a net benefit greater than 0.</div></div><div><h3>Conclusions</h3><div>In this study, key factors related to CC were screened out through machine learning, and an effective nomogram risk prediction model was constructed. It provided valuable insights for the risk assessment, prevention, and personalized intervention of CC, thus contributing to better clinical management of CC.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 1","pages":"Pages 45-55"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the relationship between trends in racial residential segregation and trends in racial mortality rate disparities on the state level in the United States","authors":"Leighla Dergham ,&nbsp;Michael Siegel","doi":"10.1016/j.jnma.2025.10.005","DOIUrl":"10.1016/j.jnma.2025.10.005","url":null,"abstract":"<div><div>Racial residential segregation has been shown to contribute to racial disparities in many health outcomes in the United States. However, it is unclear whether changes in segregation also impact changes in these disparities. This paper examines the association between changes in residential segregation at the state-level over four decades (1980–2020) and coinciding changes in the non-Hispanic Black vs. non-Hispanic White racial disparity in mortality rates for those under 65 across a wide range of health outcomes between the years 2002 and 2017. Annual, age- adjusted, race/ethnicity-specific death rates among people under 65 years of age were obtained from CDC Wonder, and segregation indices were calculated using data from the United States Census Bureau’s Decennial Censuses. The connection between baseline segregation levels and changes in those levels and trends in racial health disparities within a state were investigated using latent trajectory analysis. The trajectory analysis resulted in a three-group model, in which trajectory Groups 1 and 2 (64% of states) exhibited decreasing trends in the ratios of Black to White death rates over the specified period. In contrast, Group 3 (36% of states) began with the highest baseline racial disparity in death rates in 2002 and experienced the most constant disparity over time. Heightened initial baseline levels of racial segregation and a lack of progress in diminishing segregation over time were significantly linked to increased racial disparities in mortality rates, both at baseline and in subsequent years. This provides new evidence that changes in segregation are related to trends in racial health disparities in mortality rates over time at the state level.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 1","pages":"Pages 64-76"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146098688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Charting the use of inclusive language in medical school diversity mission statements: A national study","authors":"Jared Stowers ,&nbsp;Aditi Mahajan ,&nbsp;Khaleel Atkinson ,&nbsp;Laura Malmut","doi":"10.1016/j.jnma.2025.10.006","DOIUrl":"10.1016/j.jnma.2025.10.006","url":null,"abstract":"<div><h3>Background &amp; objectives</h3><div>Improving medical student diversity continues to be a challenge and a priority for medical schools. Mission statements that address diversity, equity, and inclusion are an initial step in recruiting a diverse student body. This study explores the use of inclusive language, as defined by key demographic variables, in diversity mission statements published on US medical school websites.</div></div><div><h3>Methods</h3><div>Diversity mission statements of 158 MD-granting and 41 DO-granting medical schools were examined from March to May 2024. Statements were coded for the presence of inclusive language based on the following demographic variables: race, ethnicity, socioeconomic status, sex, sexual orientation or gender identity, ability or disability, and age. Differences in the use of inclusive language between MD-granting and DO-granting institutions and between public and private institutions were calculated.</div></div><div><h3>Results</h3><div>169 diversity mission statements were located for 134 (85 %) MD-granting and 35 (85 %) DO-granting institutions. Inclusive language describing race, ethnicity, socioeconomic status, sex, sexual orientation or gender identity, ability or disability, and/or age was noted in 105 (62 %) diversity mission statements. In comparison, 64 (38 %) diversity mission statements recognized diversity without explicitly referencing the terms above. No significant difference was observed in the use of inclusive terms between MD-granting and DO-granting institutions or between public and private institutions.</div></div><div><h3>Conclusions</h3><div>Most medical schools published diversity mission statements, and a majority contained inclusive language. A minority of medical schools did not have a locatable diversity mission statement but included language supporting diversity, equity, and inclusion in their general mission statements.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 1","pages":"Pages 77-82"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145552372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physician referral is associated with recruitment, motivation, and adherence in an exercise intervention study for older adults","authors":"Rachel Holden ,&nbsp;Amanda N. Szabo-Reed ,&nbsp;Amber Watts ,&nbsp;Jonathan Clutton ,&nbsp;Katrina Finley ,&nbsp;Sharon Fitzgerald Wolff ,&nbsp;Jeffrey M. Burns","doi":"10.1016/j.jnma.2025.11.002","DOIUrl":"10.1016/j.jnma.2025.11.002","url":null,"abstract":"<div><h3>Objective</h3><div>The LEAP! Rx study was a 12-month randomized controlled trial investigating the effects of supervised exercise and education. This paper is a secondary-data analysis exploring differences in recruitment, motivation, adherence, and retention between physician-referred and self-referred participants.</div></div><div><h3>Methods</h3><div>219 total healthy, older adult participants (72.79 ± 4.83 years), 118 physician-referred and 101 self-referred, were randomized into a structured exercise and education for Alzheimer’s Disease prevention ((<em>n</em> = 110, i.e., LEAP! Rx) or a waitlist control group (<em>n</em> = 109). Demographics and patterns in recruitment, motivations for participation, adherence, and retention related to age, gender, race, ethnicity, or education were examined between the physician-referred and self-referred groups.</div></div><div><h3>Results</h3><div>We observed a significant difference in race, but not sex, between the two referral methods. Specifically, the physician-referred group had a higher proportion of African American participants. Attendance to education classes was similar for both referral types. However, self-referred participants had better adherence to the exercise prescription and were also less likely to withdraw from the study. A higher number of physician-referred participants withdrew due to COVID-19 or were lost to follow-up, likely due to the timing of their recruitment into the study. Motivations for participation were not significantly different by referral source however, a trend with recognition was associated with physician referral and study withdrawal.</div></div><div><h3>Conclusions</h3><div>Findings suggest that physician referrals can enhance the racial diversity of research participants. The lower adherence in the physician-referred group was likely due to the pandemic's influence on enrollment, highlighting the need for further research on the relationship between recruitment source, motivations, and adherence.</div></div><div><h3>Trial registration</h3><div>NCT03253341</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 1","pages":"Pages 103-112"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Client satisfaction with family planning services and associated factors in public health facilities of West Belessa, Ethiopia, 2022: A cross-sectional study","authors":"Wudiye Shumie Alemu ,&nbsp;Melkamu Tamir ,&nbsp;Terefe Derso ,&nbsp;Getachew Yitayew Tarekegn ,&nbsp;Tilaye Arega Moges ,&nbsp;Sisay Sitotaw Anberbr ,&nbsp;Temesgen Dessie Mengistu ,&nbsp;Fisseha Nigussie Dagnew","doi":"10.1016/j.jnma.2025.10.001","DOIUrl":"10.1016/j.jnma.2025.10.001","url":null,"abstract":"<div><h3>Background</h3><div>Reproductive health services and the family planning service are affected by the satisfaction of the client with health care professionals, which shows the quality of service provided. To improve family planning service utilization and lessen its detrimental effects on the health care system, it is necessary to identify factors that influence service satisfaction, requiring routine and ongoing efforts. Thus, this study aimed to assess family planning services satisfaction and associated factors among family planning service users in West Belessa district, Northwest Ethiopia, 2022.</div></div><div><h3>Methods</h3><div>Facility-based cross-sectional and mixed-method study design was conducted from Jun to July 2022. The sampling technique utilized was systematic random sampling to choose 567 study participants, who were then interviewed with structured questionnaires. On the other hand, 12 in-depth interviews were accompanied by using a semi-structured interview. The data were cleaned, coded, and entered using EPI-Data version 4.6 and then exported and analyzed using SPSS Version 25 statistical software. A multivariable binary logistic regression model was fitted to identify factors associated with client satisfaction. Variables with a p-value less than 0.05 at a 95% confidence interval were considered significant.</div></div><div><h3>Result</h3><div>In this study, the overall client satisfaction with family planning services was found to be 53.6% (95% CI (49.5 - 57.7)). Multiple logistic regression showed that being urban in residence [AOR = 2.22(95% CI: 1.35-3.66), P = 0.002], daily labor [AOR = 0.41 (95% CI: 0.18-0.91), P = 0.02], students [AOR = 0.08 (95% CI: 0.01-0.69), P = 0.02], difficult discussion with the provider [AOR = 0.30 (95% CI: 0.11-0.88), P = 0.02], waiting time less than 30 minutes [AOR = 3.56 (95% CI: 1.55-8.15), P = 0.003], privacy maintained during procedure and examination [AOR = 2.27 (95% CI: 1.33-3.86), P = 0.003], and receiving preferred FP method [AOR = 3.04 (95% CI: 1.42-6.51), P = &lt; 0.001] have shown a significant association with family planning service client satisfaction.</div></div><div><h3>Conclusion</h3><div>The overall client satisfaction with family planning services was low. Urban residence, daily labor, student status, waiting time under 30 minutes, provider discussion, preferred technique, and privacy during procedure and examination were strongly associated with client satisfaction of family planning services.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 1","pages":"Pages 19-33"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145524802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changing the world for world changers: medical learners’ socioecological perspective of medical student supports","authors":"Michael Denning ,&nbsp;T’yasah Walser","doi":"10.1016/j.jnma.2025.11.016","DOIUrl":"10.1016/j.jnma.2025.11.016","url":null,"abstract":"","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 1","pages":"Pages 9-12"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Skin tone representation on United States medical school websites: A cross-sectional content analysis","authors":"Michelle Timmons ,&nbsp;Mai Hatazaki ,&nbsp;Sarah Isaac ,&nbsp;Antonia Oladipo ,&nbsp;Mekbib Gemeda ,&nbsp;Jennifer Zepf","doi":"10.1016/j.jnma.2025.11.004","DOIUrl":"10.1016/j.jnma.2025.11.004","url":null,"abstract":"<div><h3>Background</h3><div>In the United States, certain racial and ethnic groups are systemically underrepresented in the physician workforce. This underrepresentation perpetuates health disparities among corresponding underserved populations. On medical residency websites, representation has a demonstrated impact on applicant and matriculant demographics. However, visual representation on American medical school websites has not previously been independently studied.</div></div><div><h3>Methods</h3><div>A cross-sectional content analysis of all United States medical school websites (n=192) was conducted, including up to nine images per school (n=1042). Skin tone was evaluated using the 10-point Massey-Martin scale. Institutional characteristics (e.g. location, tuition, and proportion of students from groups underrepresented in medicine or URiM) were collected when included in school-level applicant-facing data.</div></div><div><h3>Results</h3><div>Individuals of darker skin tones were represented in a lower proportion of images on medical school websites (r=-0.94). Most images represented multiple skin tones. Of images that depicted only one skin tone (n=403), the majority (80%, n=322) depicted lighter skin-toned individuals only. Schools located in urban environments were more likely to represent darker skin tones in images on their websites (<em>t</em>(233)=2.90, <em>p</em>=0.004). Other applicant facing metrics (e.g. tuition, program-reported URiM proportions) were not significantly associated with visual representation.</div></div><div><h3>Conclusions</h3><div>United States medical schools underrepresent darker skin tones in images on their websites. This may signal exclusion to applicants from marginalized backgrounds, influencing recruitment and perceptions of belonging in this population. Medical schools have a responsibility to critically assess whether their online imagery aligns with their commitments to equity and inclusion.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 1","pages":"Pages 125-132"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145673421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pancreatic cancer can be scary, hospice care isn’t","authors":"David E. Myles","doi":"10.1016/j.jnma.2025.11.011","DOIUrl":"10.1016/j.jnma.2025.11.011","url":null,"abstract":"<div><div>A personal vignette highlights how a mother and physician/son came to the decision to discontinue chemotherapy for pancreatic cancer and transition to home hospice care set in the larger context of the higher risk of pancreatic cancer faced by African Americans.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 1","pages":"Pages 2-3"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644350","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}