Journal of the National Medical Association最新文献

Purpose

In 2021 the NIH acknowledged the role of structural racism in research, including the systematic exclusion of diseaseaffected individuals in favor of cohorts that resemble the “census” population. To address future racial exclusion, understanding the attitudes towards research among current Underrepresented in Medicine (URiM) trainees is essential.

Methods

An ad-hoc survey of trainees (pre-medical students, medical students, and residents) was conducted at the 2024 Student National Medical Association (SNMA) Annual Medical Education Conference (AMEC). Demographic data was collected, and participants were surveyed on their experiences as research subjects. The anonymous survey was conducted via Microsoft Forms; deidentified data was stored securely on SNMA servers.

Results

Out of approximately 3500 attendees, 158 (4.5%) completed surveys. Most were current medical students (76.6%), and identified as Black (93.7%), and as female/women (65.8%). Most respondents (71.5%) had never been a research subject and 64.6% had never been invited. Non-participation was mainly due to scheduling conflicts (35.4%), ineligibility (21.5%), and being unaware of opportunities (12%). Only 8% of respondents cited historical mistrust or friend/family concerns.

Conclusion

This pilot survey of AMEC attendees suggests URiM trainees have infrequently been asked to participate in research as subjects, despite possible interest. Contrary to popular narratives, most respondents indicated that logistical concerns, not concerns of historical mistrust, drive underrepresentation in research studies, even among medical trainees. Future directions include surveying trainees’ experiences joining research teams, and further analyses by geographics, age, and levels of training.

Purpose

Healthcare workforce diversity is linked to improvements in health outcomes and healthcare spending. Barriers to increasing diversity in the health professions exist across all stages of educational development, including the K-12 level. This study qualitatively explores educational stakeholders’ perspectives of barriers and opportunities in pursuing health careers among youth in an urban Midwest city.

Methods

Snowball methodology among known network contacts was used to recruit educational stakeholders within Greater Cleveland. Key healthcare stakeholders were also invited to participate. Semi-structured interviews were performed to explore key questions including perceived challenges and opportunities in students pursuit of health careers and perspectives of ways that schools and health systems could work together to increase interest in health careers.

Results

Fifteen stakeholders participated with roles including teacher, assistant principal, administrator, school social worker, and career tech coordinators. Key healthcare stakeholder roles included DEI and workforce development professionals. Thematic analysis identified enabling and disabling factors at the personal, household, school and community levels. Such themes included parental awareness, early adult stress, school support, and role modeling. Participants highlighted an interest in both hands on experiences for students and relationships with health professionals. A suggested model of increasing student interest included experiential learning after health professionals first cultivate relationships with students.

Conclusions

Educational stakeholders are an important voice in the conversation of increasing diversity in the health professions. Based on their perspectives, key priorities are multifaceted and should include role modeling and relationship building with students.

Purpose

Health-related quality of life (HRQoL) is a key outcome for patients with Cutaneous T-cell Lymphoma (CTCL). The incidence of CTCL is higher in Black/African-American (Black/AA) compared to white patients. This study aims to identify if racial disparity in HRQoL exists among CTCL patients.

Methods

Patients who self identified as Black/AA were purposefully enrolled and patients who self identified as white were used as controls. Participants were ask to complete the FACT-G, SkinDex-29, and Visual Analog Scale (VAS) Itch Scale. The primary outcome evaluated was differences in health-related quality of life as assessed by the FACT-G/SkinDex-29, and VAS itch scale by race (Black/AA versus white/other).

Results

Seventy-one participants were enrolled, the median age was 62y. The cohort was predominately male with 39% identifying as Black/AA. The majority (86%) had MF and early-stage disease (IA-IIA). FACT-G scores were lower for Black/AA participants compared to white participants, with median scores of 77 and 92 {P=0.007}, respectively. Skindex-29 scores for Black/AA participants were higher compared to white participants, with median scores of 31 and 20 {P=0.035}, respectively. Black/AA participants also reported higher degrees of itch (2.2/10) than white participants (1.0/10).

Conclusion

In our cohort, participants with MF/SS identifying as Black/AA experienced worse HRQoL. The racial disparity in HRQoL was consistent across instruments and study sites. The reasons for this racial disparity are likely complex. Future studies should attempt to further discern underlying determinants contributing to these disparities.

Introduction

African-Americans have an increased risk for diet-related diseases. Cooking is a dietary behavior that increases self-efficacy and social support, factors shown to be efficacious in optimizing diet. However, the overall inclusion of African-Americans within dietary interventions remains a key gap area for addressing diet-related disparities. The use of implementation frameworks, such as RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) for planning interventions may assist in improving inclusion of African-American predominate communities in dietary interventions.

Methods

DC COOKS is a community-engaged cooking behavior intervention in Washington, D.C. The study population (n=35) are AfricanAmerican adults living within a low food access area with at least one reported risk factor for cardiovascular disease (CVD). The study was developed with a community advisory board, formative research including focus groups (n=20) and community-wide recruitment strategies were conducted. A review of study planning, formative research and recruitment strategies were evaluated according to REAIM framework to inform potential implementation.

Results

Community Reach was demonstrated by representation of individuals from multiple segments of the neighborhood areas in the study. Effectiveness and adoption by measuring quality of life, economic costs, post-intervention acceptability, and organization interest in adopting the intervention. Implementation and Maintenance will be aided by the use of technology for intervention delivery, inclusion of community food organizations and nutrition education to participants.

Conclusion

Use of the RE-AIM framework for planning a dietary intervention may aid in the inclusion of African-Americans living within a low food access area in dietary interventions and community-level implementation of the intervention.

Purpose

Cerebellar and medullary strokes are relatively rare, comprising only 1-4% of all cerebral infarctions [1–3]. Common symptoms include dizziness or vertigo, nausea, vomiting, and gait disturbance, with nausea and vomiting occurring > 50% of the time [4]. Despite the frequency of these symptoms, there is scarce literature on successful treatment regimens.

Methods

We report the case of a 48 year old male with history of diabetes mellitus II who presented with 10-days of nausea, vomiting, and rightsided weakness / paresthesias. MRI brain revealed infarcts in the inferomedial right cerebellum and posterior right medulla brainstem. Initial management of nausea and vomiting with ondansetron 4mg q6h and metoclopramide 10mg q8h proved ineffective.

Metoclopramide was discontinued and ondansetron increased to 8mg q8h. However, symptoms persisted followed by the development of hiccups. A more aggressive treatment plan was opted for, including chlorpromazine 25mg q4h for hiccups and prochlorperazine 10mg q6h for nausea. The patient saw marked improvement and was discharged on ondansetron 8mg q8h, prochlorperazine 10mg q6h, amitriptyline 25mg nightly, and a scopolamine patch every 3 days.

Results

On the patient's one week follow up in the resident clinic, the patient reported almost full resolution of nausea and vomiting.

Conclusion

Cerebellar and medullary infarcts may frequently present with nonspecific symptoms including intractable nausea and vomiting. Management is complex and may be confounded by underlying conditions with similar presentations. Implementation of successful treatment regimens may greatly expedite recovery and mitigate extraneous workup and expenses. This report details a successful option for treatment.

Introduction

The financial cost of mental illness in low- and middle-income countries in 2010 was estimated to be $870 billion USD, with this number expected to double by 2030. There is mounting evidence supporting a link between malaria in pregnancy (MIP) and adverse birth outcomes. However, substantial evidence verifying the impact of MIP on neurocognitive function in offspring is lacking. This viewpoint will discuss the burden of MIP globally and explore current literature linking MIP and neurodevelopmental outcomes.

Methods

Through an extensive database search, this narrative review summarized 66 references from the existing literature, which demonstrates a significant association between intrauterine exposure to malaria and adverse childhood neurodevelopment.

Results

Malaria incidence is on the rise in many countries and preventative measures not only improve the health outcomes for mother and infant but also potentially reduce the long-term economic burden on countries globally. Much attention has been focused on the effects of malaria on maternal health and birth outcomes, but foetal neurodevelopment is now emerging as an important risk factor. This review highlights the potential risk for neurodevelopmental delay in those children exposed to malaria infection in utero and consequently millions of children may not be meeting their developmental potential.

Conclusion

Treating MIP as a preventable risk factor for childhood neurocognitive and adult neuropsychiatric disorders could have overwhelming health and financial implications. Ideally, a shift from global health priorities focused on lifelong treatment and rehabilitation to disease prevention is necessary to combat the adverse outcomes from malaria infection.

Introduction

Malaria and Typhoid fever are significant diseases in many parts of the world, especially in the tropics and fever is a common sign. Prominent markers for early diagnosis and better comprehension of this pathological association and immunity are vital to reduce mortality, drug resistance and for clinical purposes. We sought to explore the profile of severity, oxidative stress, and inflammatory markers during malaria and typhoid fever co-infection.

Methods

From a cross-sectional study, 81 malaria and/or typhoid fever-positive patients from 288 fever patients were selected. Malaria was diagnosed using a Rapid diagnostic test and microscopy while typhoid fever was diagnosed using a Rapid typhoid test and Widal. Severity, stress level and inflammatory responses were evaluated by hematological analysis using full blood count, erythropoietin, cortisol, IL-10, IL-4 and IFN-γ through ELISA, superoxide dismutase and Catalase activities by spectrophotometer. Data were analysed using SPPS 26 and PRISM 9 software.

Results

Co-infected patients present significant alterations of red blood cell lines such as thrombocytopenia and anaemia. We founded also a significant increase of stress marker cortisol, IFN-γ and IFN-γ/IL-10 ratio compared to other groups, a decrease in anti-oxidant activities and an alteration of erythropoietin production. The levels of IL-10 and IL-4 were higher during mono-infections.

Conclusion

Co-infected subjects show changes in hematological parameters. The presence of malaria and typhoid fever results in a significant increase in stress, alterations in erythropoietin production, anti-oxidants and TH1- cytokine dominance. These findings allow for better management by the clinicians of these infections in the tropics.

Introduction

Bechet's disease is a rare auto-inflammatory systemic vasculitis characterized by recurrent oral and genital ulcerations, chronic uveitis, and vasculitis affecting arteries and veins of all sizes. Left untreated, it can lead to more severe complications such as stroke and blindness. Behcet's disease primarily affects individuals who are in their 20s to 40s, however the cause of the condition is still unknown. Additionally, there is a higher prevalence in Middle Eastern, Asian, and Mediterranean patients, suggesting a possible association with genetic predisposition and environmental influences. Other studies have indicated viral infection may play a role in the pathogenesis of Behcet's disease.

Methods

Articles in English were identified from January 1960 through March 2024 using PubMed and SCOPUS, adhering to the updated 2020 standards of the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statement. Search terms were ‘Bechet's disease’ and ‘case report’. Relevant abstracts were retrieved and assessed for inclusion by three reviewers.

Results

Out of 1127 studies identified, 467 met inclusion criteria. 73% of the studies (343) did not report/assess the viral status of the patient. Of the 124 studies that did report viral status, 9.7 % of patients (12) were found to be positive for one or more viruses. The most common virus identified was cytomegalovirus (CMV), which was positive in 3 patients.

Conclusion

Behcet's disease, though rare, remains poorly understood. Advancements in understanding its etiology and risk factors could lead to improved treatments and patient oues.

Purpose

Adverse childhood experiences (ACE) drive a variety of poor health outcomes, including anxiety, depression, and cognitive impairment. Little is known about the impact of ACE in HIV-positive children in Sub-Saharan Africa. We sought to develop and validate a culturally-sensitive instrument to evaluate ACE in HIV-positive Zambian children.

Methods

This was a prospective mixed-methods study within HIV-Associated Neurocognitive Disorders in Zambia (HANDZ), a longitudinal cohort study of children with HIV in Zambia, Africa. Qualitative interviews with families and community experts were conducted to generate a battery of questions for Adverse Life Experiences in Zambia (ALEZ) in three domains: violence exposure, serious illness, and family stressors. Standardized NIH Toolbox neuropsychological batteries of sadness, fearfulness, depression and anxiety were administered annually. The World Health Organization Adverse Childhood Experiences International Questionnaire (ACEIQ) was administered for comparison. Face, convergent and content validity were assessed using multivariate linear regression analyses.

Results

The baseline sample consisted of 331 HIV-positive, 208 HIV-exposed uninfected (HEU) and 75 HIV-unexposed uninfected (HUU) children. Interviews and linear regression analyses between ALEZ and ACE-IQ established face, content, and criterion validity. HIV-positive children experienced increased average NIH-Toolbox sadness and fearful emotion, but there were no significant differences in prevalence of depression and anxiety among all groups. ALEZ z-scores were more positively-correlated to sadness and fearful emotion than ACE-IQ z-scores.

Conclusion

ALEZ was the first instrument designed to measure ACE in Sub-Saharan Africa with appropriate face, content, and construct validity. Further studies are needed to establish ALEZ reliability predictive validity.