Journal of the National Medical Association最新文献

Introduction

Social Determinants of Health (SDOH) are conditions in environments where people live, learn, work, play, worship, and age that affect a wide range of health, functional, and quality-of-life outcomes and risks, contributing to health disparities and inequities. Several agencies endorse the importance of SDOH, but limited data is available on effective teaching tools for incorporating SDOH into Graduate Medical Education (GME). We developed a case-based curriculum to increase comfort of trainees and faculty in identifying, researching, and educating on SDOH, and utilized it to promote and assess commitment to clinical practice change.

Methods

Kern's six-step methodology guided development of the curricular framework. A selected resident-faculty pair reviewed a subspecialtyspecific case through the lens of an assigned SDOH domain using evidence-based medicine. The pair created an interactive learning module to discuss the case, review evidence, investigate whether the standard of care addresses the SDOH domain, and provide a relevant clinical toolkit item.

Results

Pre-curriculum assessments showed gaps between resident-perceived SDOH education frequency and staff comfort with SDOH education. Qualitative feedback demonstrated that the curriculum improved resident-perceived education and comfort of faculty in educating on subspecialty-specific SDOH. Nearly 50 commitment-to-clinical practice change goals were created.

Conclusion

Integrated SDOH instruction in GME is a priority, but residents report insufficient instruction and faculty feel ill-equipped to provide such education. Our case-based SDOH curriculum presents a dynamic, sustainable, and clinically relevant solution to bridge both gaps and a unique opportunity for programs to reimagine SDOH education and foster a cadre of healthcare professionals equipped to deliver SDOH-competent care.

Purpose

Inflammation is widely recognized for its significant association with major adverse cardiovascular events (MACE). Our study aims to evaluate this relationship and predictive efficacy using the Systemic Inflammation Response Index (SIRI).

Method

In our study, we analyzed 9,450 adults aged 18 years and older from NHANES 2017-2018. We evaluated inflammatory status using the Systemic Inflammation Response Index (SIRI) and conducted ROC analysis to determine its predictive ability. Additionally, we employed three logistic regression models to assess the association of SIRI with Major Adverse Cardiovascular Events (MACE). The first model considered SIRI alone, the second model combined SIRI with hs-CRP and ferritin, and the third model included additional factors such as age, gender, race, education, asthma, diabetes, hypertension, and estimated glomerular filtration rate.

Result

ROC analysis was used to determine the SIRI cut-off points for predicting non-fatal myocardial infarction, stroke, angina, and heart failure, yielding values of 1.1195 (AUC=0.639, 95% CI: 0.606-0.672), 1.0594 (AUC=0.583, 95% CI: 0.549-0.616), 0.9882 (AUC=0.524, 95% CI: 0.506-0.543), and 1.1074 (AUC=0.646, 95% CI: 0.607-0.685), respectively. Despite various influencing factors in Model 3, SIRI showed significant associations with each MACE. These events included myocardial infarction (AOR=1.979, 95% CI: 1.537-2.548), stroke (AOR=1.399, 95% CI: 1.093-1.790), angina (AOR=1.979, 95% CI: 1.537-2.548), and heart failure (AOR=2.586, 95% CI: 1.742-3.837).

Conclusion

SIRI shows strong associations with all outcomes but only predicts non-fatal MI and heart failure. Despite this limitation, its cost-effectiveness and accessibility indicate potential as an early screening tool for improving risk assessment and intervention in high-risk individuals.

Youth exposed to community violence and neighborhood stressors report devastating mental health consequences. Black youth are at greater risk and experience community violence at rates higher than other youth populations. An underexplored mental health consequence is anxiety sensitivity, the fear of experiencing anxiety-related symptoms, which contributes to maladaptive coping strategies and the development and severity of other mental health problems. This study utilized structural equation modeling (SEM) to examine socio-ecological risk and protective factors associated with community violence exposure and anxiety sensitivity among low-income Black youth. Survey data are from a sample of 320 Black youth residing in public and subsidized housing in a Northeastern city in the United States. Results indicated that neighborhood risk, parenting behaviors, and exposure to delinquent peers were indirectly associated with anxiety sensitivity, which occurred through community violence exposure. Additionally, neighborhood risks had direct effects on anxiety sensitivity. Results point to the need to incorporate social and environmental factors in interventions addressing anxiety sensitivity among Black youth in urban communities.

Background

Universal “opt-out” human immunodeficiency virus (HIV) or hepatitis C virus (HCV) testing involves testing individuals for HIV or HCV regardless of symptoms, unless they decline. Little is known about the characteristics of individuals who decline.

Methods

We conducted a retrospective, medical record review of adults evaluated at an outpatient clinic in South Carolina. “Opt-out” HIV/HCV testing was implemented in Feb 2019; we reviewed medical records of individuals evaluated in May - July 2019. We excluded individuals who did not meet age-based screening criteria (HIV: 18–65 years; HCV: 18–74 years), had a prior HIV/HCV diagnosis, were tested for HIV/HCV within the preceding 12 months, and whose “opt-out” decision was not documented. We used multivariable logistic regression to estimate adjusted odds ratios (aOR) and 95 % confidence intervals (CI) for “opt-out” decision, with age, sex, race/ethnicity, insurance status, visit type, and genitourinary vs. non-genitourinary chief complaints as predictors.

Results

The final analyses included 706 individuals for HIV and 818 for HCV. Most individuals were non-Hispanic Black (77 % and 78 %) and female (66 % and 64 %). The mean ages were 49.1 (±11.9) and 51.9 (±13.2). Nearly one-third of individuals declined HIV and HCV testing (31 % and 30 %). Black males were more likely to decline HIV and HCV testing than Black females (aOR = 1.61 [95 % CI. 1.08 - 2.40] and aOR = 1.50 [95 %CI. 1.04 - 2.16]).

Conclusion

Despite HIV/HCV testing being the standard of care, approximately one-third of eligible individuals may decline testing, the demographic characteristics of whom may overlap with individuals who are traditionally unaware of their status.

Main Point

Despite HIV/HCV testing being the standard of care, approximately one-third of eligible individuals may decline testing, the demographic characteristics of whom may overlap with individuals who are traditionally unaware of their status.

Background

The San Joaquin Valley (SJV) comprises diverse populations that are medically underserved and experience significant air pollution.

Objective

Provide education to health careers pathway high school students on hazards of air pollution to respiratory health, steps they can take to protect their health, and how to access the National Library of Medicine resources for reliable health information.

Methods

Two-hour interactive outreach sessions were provided at three local high schools in Fresno and Madera to students in health careers pathways. Librarians and student doctors from a local osteopathic medical school guided high school students in health professions pathways through activities to understand the causes of poor air quality in the SJV, describe the different parts of the respiratory system and how air pollutants impact it, identify steps they can take to monitor the air quality and adjust their activities to protect their health, and how zip code is a fairly accurate predictor of health, and to access National Library of Medicine resources for reliable health information.

Results

A comparison of pre- and post-surveys showed a significant improvement in understanding the air quality index (AQI), how air pollutants impact different body systems, and lifestyle modifications to reduce the health impacts of air pollution. Outreach sessions to high school students can effectively increase knowledge of environmental health issues.

Conclusions

This sample population showed a positive result between pre- and post-surveys following education on a focused health topic.

Background

Hairstyles common in Black communities, braids, twists, locs present as artifacts, posing unique diagnostic challenges in interpreting radiological imaging, though limited research has been conducted on the current climate of their interpretation.

Purpose

Present a review of hairstyles as hair artifacts in literature and investigate the comfortability and familiarity of physicians and radiology technicians in assessing braids, twists, and locs as hair artifacts on radiological imaging.

Methods

Cross-sectional study was conducted in an academic hospital using an online platform to assess the experiences and awareness of hairstyles on imaging. Responses were collected between April 2023 through August 2023 and included demographic information, career length, how often they came across hair artifacts in imaging, comfort and familiarity with Black hairstyles as artifact, and a quiz to distinguish pathology from hair artifact on chest x-ray images.

Results

46 participants from Temple Radiology (41.3%), Temple Emergency Medicine (21.7%), Temple Jeanes Campus (26.1%), and St. Lukes Bethlehem Radiology Group (2.2%), with the Radiologist cohort of an average experience of 9.40 years (SD=12.41), Emergency Medicine cohort 7.11 years (SD=7.08), and the Intern cohort had 0.5 years (SD=0.71). Career length (Row Factor: [9.8]; p < 0.0001) and patient load (Row Factor: [3.1], p = 0.029; p < 0.05) significantly affected self-reported scores, with longer careers and larger loads associated with higher score of comfort and familiarity among study participants.

Conclusions

Longer career lengths and a higher number of patients per day improved awareness of how Black hairstyles presents in medical imaging. This study highlighted a radiological phenomenon lacking in medical literature and provided valuable insights into the impact of experience on physicians' ability to identify and interpret radiological images affected by styles that can mimic pathology. An emphasis is put on the need for education earlier in training.

Introduction

HIV diagnosis rates are not evenly distributed and significantly impact black men and women residing in Georgia and Louisiana. Additionally, reporting in these specific states demonstrate late HIV diagnosis and a failure to link patients to care.

Methods

In response to this alarming issue, the “End the Epidemic” initiative l addresses structural barriers in HIV care impacting Black communities in Georgia, Louisiana by implementing: 1) Conduct asset mapping to examine the health systems gaps that prevent healthcare utilization for PLWHA. Train diverse healthcare professionals, learners and leaders, on the social/political determinants of health to develop sustainable and solutions-driven policies towards the achievement of health equity for PLWHA. 2) Assess jurisdictional policies which exacerbate/alleviate gaps in the HIV care continuum impacting PLWHA. Convene an HIV Equity Task Force to develop health equity strategies for retaining PLWHA. 3) Increase HIV data availability on the Health Equity Tracker to improve access to data for individuals and organizations. Provide technical assistance and policy assessments to jurisdictions concerning data practices, including tracking and measuring health inequities for PLWHA. Develop high-quality communications resources for community members, leaders, and influencers on HIV inequities. This initiative will apply a mixed methods approach to the data collection and analysis component of the project, as well as a process evaluation.

Conclusion

This novel approach will 1) Increase access and utilization of culturally competent healthcare to Black people impacted by the HIV epidemic 2) Gain insight into the disruption of the healthcare delivery system due to COVID-19 in the Black community and realign HIV service for PLWHA 3) Influence clinical provider training in HIV and 4) Initiate early engagement with experienced clinicians practicing in Black communities in the aforementioned cities.

Purpose

Prostate cancer remains a leading cause of mortality among men, partly due to challenges in early detection. This study investigates Plasmacytoma Variant Translocation 1 (PVT1) intron 10, hypothesized to overexpress in prostate cancer tissues and exhibit structural homology with the DNA replication protein MCM3, potentially defying the notion of introns as mere non-coding sequences.

Methods

An analysis of 550 patient-derived prostate adenocarcinoma transcripts was conducted. Transcript overexpression was quantified using TSVdb, and genetic/structural homology was determined through BLAST against major databases. HotSpot Wizard assessed 3D structural homology, while SpliceRover detected splicing motifs. Clinical relevance was verified by comparing expression levels in the dbGaP database.

Results

Significant overexpression of PVT1 intron 10 was found, with a 4.3-fold increase noted in specific exons and introns. Proteomic homology analysis revealed an 85% similarity with essential proteins, including a 68.8% structural alignment with MCM3. The 3D structural comparisons supported these findings. Database validation confirmed a 5.3-fold overexpression of intron 10 in cancerous tissues.

Conclusion

PVT1 intron 10′s significant overexpression and structural similarity to MCM3 protein in prostate cancer tissue suggests a potential functional role, disrupting the conventional understanding of intronic regions. These insights position intron 10 as a promising biomarker and therapeutic target, offering new directions in prostate cancer diagnostics and treatment through a refined understanding of alternative splicing and protein homology.

Introduction

Despite recent advances in identifying clinical risk factors for follicular lymphoma (FL), there remains a need for prognostic and predictive biomarkers. In this study, our objective was to identify biomarkers that are reliable indicators of FL relapse and overall survival via high-throughput screening using tissue microarray (TMA).

Methods

Records of patients diagnosed with FL between 1982 and 2009 were examined, with results sorted based on survival post-diagnosis. Corresponding patient biopsies were collected to create TMAs for high-throughput immunohistochemistry (IHC) screening of putative FL cancer stem cell (F-SC) markers (ABCG2, Ki67, OCT3/4) and CD20. Positivity was analyzed via digital batch processing method using Image-Pro software and microscopy.

Results

Fifty-nine patients were partitioned into short -(<5 years, n=26) and long- (>15 years, n=33) survival groups. IHC results showed there was no statistically significant difference in CD20 expression (p=0.6378). The results showed an increased expression pattern with significance for all 3 FL-SC markers. Compared with the long-survival group, the short-survival group had significantly higher expression levels of Ki67 (p=0.0275), ABCG2 (p=0.0251) and OCT3/4 (p=0.0226), as well as the combination of all three biomarkers (p=0.0229).

Conclusion

The prognostic biomarkers for FL identified may be used to distinguish those patients who are at greatest risk of relapse and in need of the most aggressive and novel therapies. Qualified prognostic markers for FL may direct clinical decision paradigms on which patients are favorable candidates for early therapy, and will obtain additional insight in the development of targeted regiments and treatment protocols to ameliorate outcomes.

Purpose

Statins are widely recognized for their efficacy in reducing cardiovascular risk through cholesterol reduction. Their use, however, is occasionally associated with adverse muscular effects, ranging from mild myalgias to statin-induced necrotizing autoimmune myopathies (SINAM). SINAM presents a significant clinical challenge due to persistent muscle weakness and elevated creatine kinase (CK) levels, even after statin withdrawal.

Methods

We explored the diagnostic journey of a 69-year-old African-American male with a history of extensive statin use, who presented with progressive muscular weakness and exceptionally high CK levels. A multidisciplinary diagnostic approach was employed, involving comprehensive laboratory testing, electromyography, muscle biopsy, and advanced imaging techniques. The diagnosis of SINAM was confirmed by identifying anti-HMGCR antibodies.

Results

Despite cessation of statin therapy, the patient's muscular symptoms persisted, with laboratory tests revealing remarkably elevated CK levels. The initiation of immunosuppressive therapy, including corticosteroids and intravenous immunoglobulin, led to a gradual improvement in muscle strength and a decrease in CK levels. However, the recovery journey highlighted the chronic nature of SINAM, necessitating ongoing management and careful consideration of long-term immunosuppressive treatment strategies.

Conclusion

This case report emphasizes the critical need for heightened vigilance and a high index of suspicion among healthcare providers when patients present with unexplained muscle weakness and elevated CK levels following statin use. Early and accurate diagnosis of SINAM, followed by the prompt initiation of immunosuppressive therapy, is paramount in preventing irreversible muscle damage and optimizing patient outcomes. Future research should focus on elucidating the precise mechanisms underlying SINAM, identifying at-risk populations, and developing targeted treatment protocols.