Pub Date : 2025-12-01Epub Date: 2025-11-27DOI: 10.1016/j.jnma.2025.11.015
Marie L. Borum MD, EdD, MPH, MACP, FACG, AGAF, FRCP (Editor-in-Chief)
{"title":"Advancing access, equity, and innovation in health care","authors":"Marie L. Borum MD, EdD, MPH, MACP, FACG, AGAF, FRCP (Editor-in-Chief)","doi":"10.1016/j.jnma.2025.11.015","DOIUrl":"10.1016/j.jnma.2025.11.015","url":null,"abstract":"","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 6","pages":"Page 359"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145600405","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 : 2025-12-01Epub Date: 2025-09-04DOI: 10.1016/j.jnma.2025.08.007
Synéja Richards , Rawan Elkomi , Sair Ahmad Tabraiz , Emmanuel Kerolle , Samrawit Zinabu , Ahmed Ali , Miriam Michael
Introduction
Sickle cell trait (SCT) is a hereditary condition that affects millions worldwide, predominantly in individuals of African, Mediterranean, and Middle Eastern descent. While traditionally considered a benign carrier state, emerging evidence suggests a potential association between SCT and malignancies. This study aims to evaluate the relationship between SCT and the risk of multiple myeloma, renal cancer, leukemia, hepatocellular carcinoma (HCC), and colorectal cancer.
Methods
This study utilized de-identified electronic health records from the TriNetX database, covering a 20-year period. A retrospective cohort analysis was conducted to assess cancer incidence and survival outcomes among SCT and sickle cell disease (SCD) patients. Statistical analyses included risk difference (RD), risk ratio (RR), odds ratio (OR), Kaplan-Meier survival curves, and hazard ratios (HR) to determine associations between SCT and cancer risk.
Results
SCT was not associated with an increased risk for most cancers. However, individuals with SCT had a significantly lower risk of leukemia compared to those with SCD (RR =0.464, OR = 0.463, p < 0.001), suggesting a potential protective effect. Conversely, a modest but statistically insignificant increase in renal cancer risk was observed in SCT individuals (RR = 1.201, OR = 1.202, p = 0.059). No significant associations were found between SCT and multiple myeloma, HCC, or colorectal cancer.
Discussion
These findings highlight a complex relationship between SCT and malignancy risk. The observed protective effect against leukemia suggests a potential hematopoietic or immune-mediated mechanism. Meanwhile, the slight increase in renal cancer risk may be linked to chronic kidney stress and hematuria. Further studies are needed to validate these associations and investigate underlying biological mechanisms.
Conclusion
SCT does not significantly increase cancer risk overall but may confer protection against leukemia while showing a potential, though inconclusive, link to renal cancer. These findings emphasize the need for continued surveillance and further epidemiological studies to refine cancer risk assessment in SCT populations.
镰状细胞特征（SCT）是一种影响全世界数百万人的遗传性疾病，主要发生在非洲、地中海和中东血统的个体中。虽然传统上认为SCT是良性的载体状态，但新出现的证据表明SCT与恶性肿瘤之间存在潜在的联系。本研究旨在评估SCT与多发性骨髓瘤、肾癌、白血病、肝细胞癌（HCC）和结直肠癌风险的关系。方法：本研究利用TriNetX数据库中20年的去识别电子健康记录。回顾性队列分析评估SCT和镰状细胞病（SCD）患者的癌症发病率和生存结果。统计分析包括风险差异（RD）、风险比（RR）、优势比（OR）、Kaplan-Meier生存曲线和风险比（HR），以确定SCT与癌症风险之间的关系。结果：SCT与大多数癌症的风险增加无关。然而，与SCD患者相比，SCT患者患白血病的风险显著降低（RR =0.464, OR = 0.463,p ）。讨论：这些发现强调了SCT与恶性肿瘤风险之间的复杂关系。观察到的对白血病的保护作用提示潜在的造血或免疫介导的机制。同时，肾癌风险的轻微增加可能与慢性肾压力和血尿有关。需要进一步的研究来验证这些关联并调查潜在的生物学机制。结论：SCT总体上不会显著增加癌症风险，但可能对白血病有保护作用，同时显示出与肾癌的潜在联系，尽管不确定。这些发现强调需要继续进行监测和进一步的流行病学研究，以完善SCT人群的癌症风险评估。
{"title":"“Sickle cell trait and the risk for malignancy”","authors":"Synéja Richards , Rawan Elkomi , Sair Ahmad Tabraiz , Emmanuel Kerolle , Samrawit Zinabu , Ahmed Ali , Miriam Michael","doi":"10.1016/j.jnma.2025.08.007","DOIUrl":"10.1016/j.jnma.2025.08.007","url":null,"abstract":"<div><h3>Introduction</h3><div>Sickle cell trait (SCT) is a hereditary condition that affects millions worldwide, predominantly in individuals of African, Mediterranean, and Middle Eastern descent. While traditionally considered a benign carrier state, emerging evidence suggests a potential association between SCT and malignancies. This study aims to evaluate the relationship between SCT and the risk of multiple myeloma, renal cancer, leukemia, hepatocellular carcinoma (HCC), and colorectal cancer.</div></div><div><h3>Methods</h3><div>This study utilized de-identified electronic health records from the TriNetX database, covering a 20-year period. A retrospective cohort analysis was conducted to assess cancer incidence and survival outcomes among SCT and sickle cell disease (SCD) patients. Statistical analyses included risk difference (RD), risk ratio (RR), odds ratio (OR), Kaplan-Meier survival curves, and hazard ratios (HR) to determine associations between SCT and cancer risk.</div></div><div><h3>Results</h3><div>SCT was not associated with an increased risk for most cancers. However, individuals with SCT had a significantly lower risk of leukemia compared to those with SCD (RR =0.464, OR = 0.463, <em>p</em> < 0.001), suggesting a potential protective effect. Conversely, a modest but statistically insignificant increase in renal cancer risk was observed in SCT individuals (RR = 1.201, OR = 1.202, <em>p</em> = 0.059). No significant associations were found between SCT and multiple myeloma, HCC, or colorectal cancer.</div></div><div><h3>Discussion</h3><div>These findings highlight a complex relationship between SCT and malignancy risk. The observed protective effect against leukemia suggests a potential hematopoietic or immune-mediated mechanism. Meanwhile, the slight increase in renal cancer risk may be linked to chronic kidney stress and hematuria. Further studies are needed to validate these associations and investigate underlying biological mechanisms.</div></div><div><h3>Conclusion</h3><div>SCT does not significantly increase cancer risk overall but may confer protection against leukemia while showing a potential, though inconclusive, link to renal cancer. These findings emphasize the need for continued surveillance and further epidemiological studies to refine cancer risk assessment in SCT populations.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 6","pages":"Pages 407-411"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145002451","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 : 2025-12-01Epub Date: 2025-08-27DOI: 10.1016/j.jnma.2025.08.101
Marcela Almeida
{"title":"The unenlightened despot","authors":"Marcela Almeida","doi":"10.1016/j.jnma.2025.08.101","DOIUrl":"10.1016/j.jnma.2025.08.101","url":null,"abstract":"","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 6","pages":"Pages 370-372"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145031592","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}
<div><h3>Importance</h3><div>Underrepresented in medicine (URiM) students face significant barriers in medical education, including limited access to mentorship and professional networks. Mentorship is a critical factor in improving academic outcomes, career satisfaction, and overall success, highlighting the need for targeted support programs that broaden access in medical training.</div></div><div><h3>Objective</h3><div>To develop and evaluate a longitudinal four-year faculty-student dyad mentorship program to provide mentorship for URiM students, focusing on enhancing academic integration, professional networking, and career development.</div></div><div><h3>Design</h3><div>The study used a cross-sectional survey design to evaluate the pilot year of a four-year dyad mentorship program. Participants completed pre- and post-surveys assessing outcomes such as student-faculty engagement, professional networking, and progress toward goals. The survey measured students' experiences, comfort with faculty, satisfaction, and perceived career impact.</div></div><div><h3>Setting</h3><div>Long School of Medicine Student National Medical Association</div></div><div><h3>Participants</h3><div>Fourteen medical students applied and enrolled in the program. Fourteen completed the pre-survey, and twelve completed the post-survey.</div></div><div><h3>Interventions</h3><div>The program required participants to commit to monthly 30-minute mentor meetings, monthly shadowing for 2–4 h, and attendance at three mandatory professional development lectures.</div></div><div><h3>Main Outcomes and Measures</h3><div>Program satisfaction, comfort interacting with faculty, establishment of long-term professional connections, progress toward professional goals, motivation to complete medical school, and self-confidence in the ability to complete medical school.</div></div><div><h3>Results</h3><div>Of 14 participants, 71 % identified as Black/African American, and 57 % were first-year medical students. 58 % formed lasting professional connections, with first-generation students twice as likely to do so. Upon program completion, comfort with faculty improved, and 75 % reported greater specialty-related confidence. Workshops were rated moderately to extremely helpful by 83 %, and 75 % would recommend the program. Students identified mentorship, shadowing, and professional development as the most valuable components, underscoring the program’s impact on early-stage URiM learners.</div></div><div><h3>Conclusions and Relevance</h3><div>The mentorship program successfully enhanced student-faculty engagement, professional networking, and career development for URiM students. Supporting URiM students through structured mentorship is crucial for addressing disparities in medical education and ensuring they have the resources and guidance needed to succeed in their careers. Future improvements will focus on expanding networking opportunities and addressing confidence gaps, with the goal of
{"title":"Bridging the gap: Analysis of the long school of medicine SNMA pilot mentorship program","authors":"Laureen Raelly-Muze, Ayomide Akinsooto, Angel Gonzalez","doi":"10.1016/j.jnma.2025.08.100","DOIUrl":"10.1016/j.jnma.2025.08.100","url":null,"abstract":"<div><h3>Importance</h3><div>Underrepresented in medicine (URiM) students face significant barriers in medical education, including limited access to mentorship and professional networks. Mentorship is a critical factor in improving academic outcomes, career satisfaction, and overall success, highlighting the need for targeted support programs that broaden access in medical training.</div></div><div><h3>Objective</h3><div>To develop and evaluate a longitudinal four-year faculty-student dyad mentorship program to provide mentorship for URiM students, focusing on enhancing academic integration, professional networking, and career development.</div></div><div><h3>Design</h3><div>The study used a cross-sectional survey design to evaluate the pilot year of a four-year dyad mentorship program. Participants completed pre- and post-surveys assessing outcomes such as student-faculty engagement, professional networking, and progress toward goals. The survey measured students' experiences, comfort with faculty, satisfaction, and perceived career impact.</div></div><div><h3>Setting</h3><div>Long School of Medicine Student National Medical Association</div></div><div><h3>Participants</h3><div>Fourteen medical students applied and enrolled in the program. Fourteen completed the pre-survey, and twelve completed the post-survey.</div></div><div><h3>Interventions</h3><div>The program required participants to commit to monthly 30-minute mentor meetings, monthly shadowing for 2–4 h, and attendance at three mandatory professional development lectures.</div></div><div><h3>Main Outcomes and Measures</h3><div>Program satisfaction, comfort interacting with faculty, establishment of long-term professional connections, progress toward professional goals, motivation to complete medical school, and self-confidence in the ability to complete medical school.</div></div><div><h3>Results</h3><div>Of 14 participants, 71 % identified as Black/African American, and 57 % were first-year medical students. 58 % formed lasting professional connections, with first-generation students twice as likely to do so. Upon program completion, comfort with faculty improved, and 75 % reported greater specialty-related confidence. Workshops were rated moderately to extremely helpful by 83 %, and 75 % would recommend the program. Students identified mentorship, shadowing, and professional development as the most valuable components, underscoring the program’s impact on early-stage URiM learners.</div></div><div><h3>Conclusions and Relevance</h3><div>The mentorship program successfully enhanced student-faculty engagement, professional networking, and career development for URiM students. Supporting URiM students through structured mentorship is crucial for addressing disparities in medical education and ensuring they have the resources and guidance needed to succeed in their careers. Future improvements will focus on expanding networking opportunities and addressing confidence gaps, with the goal of","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 6","pages":"Pages 424-428"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008632","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 : 2025-12-01Epub Date: 2025-09-16DOI: 10.1016/j.jnma.2025.08.110
Zhiyuan Dong , Wenqing Mo , Zhougui Ling , Luqi Hou , Tingting Deng
Objective
To evaluate the efficacy of sodium-glucose cotransporter-2 (SGLT2) inhibitors in reducing the risk of acute kidney injury (AKI) in patients with chronic kidney disease (CKD), cardiovascular disease (CVD), and type 2 diabetes mellitus (T2DM).
Methods
A meta-analysis were conducted on the randomized controlled trials (RCTs) comparing SGLT2 inhibitors with placebo in the incidence of AKI. Databases were searched for relevant studies up to September 23, 2024. The primary outcome was the occurrence of AKI.
Results
There are 8 studies ultimately met the inclusion criteria. These studies encompassed a total of 65,606 patients, with 1,853 cases of AKI reported. The analysis demonstrated that SGLT2 inhibitors significantly reduced the risk of AKI compared to placebo (HR 0.78, CI 0.71-0.85, P < 0.001). In addition, subgroup analysis revealed that SGLT2 inhibitors effectively lowered the risk of AKI in patients with initial eGFR ≥ 60 mL/min/1.73 m² (HR 0.61, CI 0.42-0.88, P < 0.01) and eGFR < 60 mL/min/1.73 m² (HR 0.74, CI 0.58-0.94, P < 0.05). However, in patients with eGFR < 45 mL/min/1.73 m², there was no significant difference in AKI incidence between the SGLT2 inhibitor group and the placebo group (HR 1.04, CI 0.50-2.17, P = 0.91). In white or Asian patients, there was no significant difference in AKI incidence between the SGLT2 inhibitor group and the placebo group (0.75, CI 0.48–1.17, P = 0.21) and (0.97, CI 0.26–3.70, P = 0.96).
Conclusion
SGLT2 inhibitors significantly reduce the risk of AKI in patients with CKD, CVD, and T2DM, with greater efficacy observed in those with higher initial eGFR. However, when eGFR falls below 45 mL/min/1.73 m², SGLT2 inhibitors do not reduce the occurrence of AKI.
目的：评价钠-葡萄糖共转运蛋白-2 （SGLT2）抑制剂降低慢性肾病（CKD）、心血管疾病（CVD）和2型糖尿病（T2DM）患者急性肾损伤（AKI）风险的疗效。方法：对比较SGLT2抑制剂与安慰剂在AKI发生率方面的随机对照试验（rct）进行荟萃分析。检索截止到2024年9月23日的相关研究。主要终点是AKI的发生。结果：最终有8项研究符合纳入标准。这些研究共纳入65,606例患者，报告了1,853例AKI病例。分析表明，与安慰剂相比，SGLT2抑制剂显著降低AKI的风险（HR 0.78, CI 0.71-0.85, P < 0.001）。此外，亚组分析显示，SGLT2抑制剂可有效降低初始eGFR≥60 mL/min/1.73 m²（HR 0.61, CI 0.42-0.88, P < 0.01）和eGFR < 60 mL/min/1.73 m²（HR 0.74, CI 0.58-0.94, P < 0.05）患者的AKI风险。然而，在eGFR < 45 mL/min/1.73 m²的患者中，SGLT2抑制剂组与安慰剂组AKI发生率无显著差异（HR 1.04, CI 0.50-2.17, P = 0.91）。在白人或亚洲患者中，SGLT2抑制剂组和安慰剂组的AKI发生率无显著差异（0.75,CI 0.48-1.17, P = 0.21）和（0.97,CI 0.26-3.70, P = 0.96）。结论：SGLT2抑制剂可显著降低CKD、CVD和T2DM患者AKI的风险，在初始eGFR较高的患者中疗效更显著。然而，当eGFR低于45 mL/min/1.73 m²时，SGLT2抑制剂不能减少AKI的发生。
{"title":"Efficacy of SGLT2 inhibitors on acute kidney injury in patients with chronic kidney disease, cardiovascular disease, and type 2 diabetes: A meta-analysis","authors":"Zhiyuan Dong , Wenqing Mo , Zhougui Ling , Luqi Hou , Tingting Deng","doi":"10.1016/j.jnma.2025.08.110","DOIUrl":"10.1016/j.jnma.2025.08.110","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the efficacy of sodium-glucose cotransporter-2 (SGLT2) inhibitors in reducing the risk of acute kidney injury (AKI) in patients with chronic kidney disease (CKD), cardiovascular disease (CVD), and type 2 diabetes mellitus (T2DM).</div></div><div><h3>Methods</h3><div>A meta-analysis were conducted on the randomized controlled trials (RCTs) comparing SGLT2 inhibitors with placebo in the incidence of AKI. Databases were searched for relevant studies up to September 23, 2024. The primary outcome was the occurrence of AKI.</div></div><div><h3>Results</h3><div>There are 8 studies ultimately met the inclusion criteria. These studies encompassed a total of 65,606 patients, with 1,853 cases of AKI reported. The analysis demonstrated that SGLT2 inhibitors significantly reduced the risk of AKI compared to placebo (HR 0.78, CI 0.71-0.85, P < 0.001). In addition, subgroup analysis revealed that SGLT2 inhibitors effectively lowered the risk of AKI in patients with initial eGFR ≥ 60 mL/min/1.73 m² (HR 0.61, CI 0.42-0.88, P < 0.01) and eGFR < 60 mL/min/1.73 m² (HR 0.74, CI 0.58-0.94, P < 0.05). However, in patients with eGFR < 45 mL/min/1.73 m², there was no significant difference in AKI incidence between the SGLT2 inhibitor group and the placebo group (HR 1.04, CI 0.50-2.17, P = 0.91). In white or Asian patients, there was no significant difference in AKI incidence between the SGLT2 inhibitor group and the placebo group (0.75, CI 0.48–1.17, P = 0.21) and (0.97, CI 0.26–3.70, P = 0.96).</div></div><div><h3>Conclusion</h3><div>SGLT2 inhibitors significantly reduce the risk of AKI in patients with CKD, CVD, and T2DM, with greater efficacy observed in those with higher initial eGFR. However, when eGFR falls below 45 mL/min/1.73 m², SGLT2 inhibitors do not reduce the occurrence of AKI.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 6","pages":"Pages 458-469"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145083024","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 : 2025-12-01Epub Date: 2025-09-20DOI: 10.1016/j.jnma.2025.09.002
Chanelle Simmons
Black doctors have long navigated a medical field marked by exclusion, resistance and resilience. From legalized hospital segregation in the 19th and early 20th centuries to enduring racial and gender biases in contemporary residency programs, systemic barriers continue to drive the underrepresentation of Black physicians across specialties. Situating personal testimony within this historical context, this narrative examines statistical patterns in Black physician representation and the present-day challenges faced by Black residents through the lens of the Black narrative tradition of bearing witness and asserting truth. It honors the legacies of pioneering physicians—Drs. Daniel Hale Williams, Thomas R. Peyton, and Isabella Vandervall—whose lives exemplify both the persistence of structural inequality and a blueprint for achieving justice in medicine. Their influence resonates in the work of Black doctors today, who develop programs and initiatives (e.g., pipeline programs, racial affinity groups, and global health exchanges) that expand access, foster inclusion, and promote cross-cultural collaboration in medical education and training. By highlighting historical and contemporary strategies for overcoming systemic barriers, this article emphasizes the critical role of justice-oriented initiatives in transforming medical institutions and advancing equity, representation, and belonging across the profession.
{"title":"Shadowed legacy: Black doctors confronting structural inequality and reimagining opportunity in postgraduate medical training","authors":"Chanelle Simmons","doi":"10.1016/j.jnma.2025.09.002","DOIUrl":"10.1016/j.jnma.2025.09.002","url":null,"abstract":"<div><div>Black doctors have long navigated a medical field marked by exclusion, resistance and resilience. From legalized hospital segregation in the 19th and early 20th centuries to enduring racial and gender biases in contemporary residency programs, systemic barriers continue to drive the underrepresentation of Black physicians across specialties. Situating personal testimony within this historical context, this narrative examines statistical patterns in Black physician representation and the present-day challenges faced by Black residents through the lens of the Black narrative tradition of bearing witness and asserting truth. It honors the legacies of pioneering physicians—Drs. Daniel Hale Williams, Thomas R. Peyton, and Isabella Vandervall—whose lives exemplify both the persistence of structural inequality and a blueprint for achieving justice in medicine. Their influence resonates in the work of Black doctors today, who develop programs and initiatives (e.g., pipeline programs, racial affinity groups, and global health exchanges) that expand access, foster inclusion, and promote cross-cultural collaboration in medical education and training. By highlighting historical and contemporary strategies for overcoming systemic barriers, this article emphasizes the critical role of justice-oriented initiatives in transforming medical institutions and advancing equity, representation, and belonging across the profession.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 6","pages":"Pages 511-518"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145115891","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 : 2025-12-01Epub Date: 2025-09-24DOI: 10.1016/j.jnma.2025.09.001
Alex Joseph , Dhasarathi Kumar , Margret Beaula Alocious Sukumar , Harpreet Kaur , Roshni Mary Peter
Background
Hepatitis B infection rates are higher among the Irula tribes compared to other tribal communities in Tamil Nadu, India. Cultural practices such as tattooing, traditional medicine (e.g., bloodletting), rituals (e.g., scarification), and body piercing serve as potential sources of infection transmission. Additionally, limited access to government development programs further exacerbates their vulnerability. Given these challenges, the present study aims to assess the Knowledge, Attitudes, and Practices (KAP) related to Hepatitis B Virus (HBV) infection among the Irula tribes of Tamil Nadu.
Methods
This cross-sectional study was conducted among the Irula tribal population residing in the districts of Kancheepuram, Dharmapuri, and Chengalpattu, Tamil Nadu, India. The study population was identified using the 2011 Census data. A semi-structured questionnaire was developed based on an extensive literature review and was pilot-tested before implementation. Data collection was carried out using Open Data Kit (ODK), and statistical analysis was performed using SPSS version 16.
Results
A total of 1172 Irula adults participated in the study, with a mean age of 37 years (SD: 13.8). The majority of the respondents were female (79.2 %), while 44.1 % had no formal education, and 83.8 % were married. More than half (62.7 %) of the participants had heard about Hepatitis, and 46.3 % demonstrated a moderate level of knowledge regarding HBV. Among the participants, 25.5 % showed a poor attitude toward HBV infection and its transmission. However, a considerable proportion (64.9 %) reported good preventive practices related to HBV.
Conclusions
The study results highlights the urgent need for targeted interventions to enhance awareness and improve preventive behaviours in this vulnerable community.
{"title":"Barriers to hepatitis b prevention and care among the Irula Tribes: Addressing health disparities in a particularly vulnerable tribal groups","authors":"Alex Joseph , Dhasarathi Kumar , Margret Beaula Alocious Sukumar , Harpreet Kaur , Roshni Mary Peter","doi":"10.1016/j.jnma.2025.09.001","DOIUrl":"10.1016/j.jnma.2025.09.001","url":null,"abstract":"<div><h3>Background</h3><div>Hepatitis B infection rates are higher among the Irula tribes compared to other tribal communities in Tamil Nadu, India. Cultural practices such as tattooing, traditional medicine (e.g., bloodletting), rituals (e.g., scarification), and body piercing serve as potential sources of infection transmission. Additionally, limited access to government development programs further exacerbates their vulnerability. Given these challenges, the present study aims to assess the Knowledge, Attitudes, and Practices (KAP) related to Hepatitis B Virus (HBV) infection among the Irula tribes of Tamil Nadu.</div></div><div><h3>Methods</h3><div>This cross-sectional study was conducted among the Irula tribal population residing in the districts of Kancheepuram, Dharmapuri, and Chengalpattu, Tamil Nadu, India. The study population was identified using the 2011 Census data. A semi-structured questionnaire was developed based on an extensive literature review and was pilot-tested before implementation. Data collection was carried out using Open Data Kit (ODK), and statistical analysis was performed using SPSS version 16.</div></div><div><h3>Results</h3><div>A total of 1172 Irula adults participated in the study, with a mean age of 37 years (SD: 13.8). The majority of the respondents were female (79.2 %), while 44.1 % had no formal education, and 83.8 % were married. More than half (62.7 %) of the participants had heard about Hepatitis, and 46.3 % demonstrated a moderate level of knowledge regarding HBV. Among the participants, 25.5 % showed a poor attitude toward HBV infection and its transmission. However, a considerable proportion (64.9 %) reported good preventive practices related to HBV.</div></div><div><h3>Conclusions</h3><div>The study results highlights the urgent need for targeted interventions to enhance awareness and improve preventive behaviours in this vulnerable community.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 6","pages":"Pages 519-529"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145152705","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 : 2025-12-01Epub Date: 2025-08-05DOI: 10.1016/j.jnma.2025.07.012
Leslie A. Deane
{"title":"On autonomy in urology","authors":"Leslie A. Deane","doi":"10.1016/j.jnma.2025.07.012","DOIUrl":"10.1016/j.jnma.2025.07.012","url":null,"abstract":"","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 6","pages":"Page 377"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777496","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 : 2025-12-01Epub Date: 2025-09-18DOI: 10.1016/j.jnma.2025.08.112
Oluwakemi Tomobi , John Sampson , Robert Johnstone , Heather K. Hayanga
Background
For the first century of its practice, patients viewed anesthesiology with suspicion. Practitioners debated its professionalization as a medical field and their role in the operating room with the patient. This study looks at the debates around the development and incorporation of a pre-anesthesia evaluation into the patient experience and how these debates shape perceptions about current pre-anesthesia evaluation practices.
Methods
We conducted a qualitative descriptive analysis and a narrative synthesis was carried out on archival records of personal papers and paper documents at the Wood Library-Museum of Anesthesiology along with a content review on the history of anesthesia practice and the pre-anesthesia evaluation.
Results
The search for pertinent documents yielded 259 records. Fifty-four additional records were identified manually at the Wood Library-Museum of Anesthesiology. After removing duplicates, excluding non-relevant records, and accessing articles for pertinence, 72 sources were included in the qualitative analysis. Three themes emerged from 72 sources as impacting the evolution of the pre-anesthesia evaluation: growth of the anesthesia workforce, changes in communication in the anesthesiologist-patient relationship, and the patient perspective.
Conclusions
This history is a small, focused look at a part of anesthesia practice today. It reviews some changes over time in the patient-anesthesiologist relationship and covers some of the debates and concerns that arose. Varying viewpoints regarding the practice of anesthesiology and the proper roles of anesthesiologists delayed the requirement for a pre-anesthetic evaluation until 1965, affected its perceived value, and slowed the development of the anesthesiologist-patient relationship. Lack of patient knowledge about the responsibilities of anesthesiologists and the processes for administering anesthesia limits patient understanding of the pre-anesthetic evaluation and the importance of the anesthesiologist-patient relationship. Patient education may improve patient and public understanding of the integral role of anesthesiologists in perioperative management to maintain patient safety.
{"title":"History of the preanesthesia evaluation: Appreciating the tensions in the anesthesiologist-patient relationship","authors":"Oluwakemi Tomobi , John Sampson , Robert Johnstone , Heather K. Hayanga","doi":"10.1016/j.jnma.2025.08.112","DOIUrl":"10.1016/j.jnma.2025.08.112","url":null,"abstract":"<div><h3>Background</h3><div>For the first century of its practice, patients viewed anesthesiology with suspicion. Practitioners debated its professionalization as a medical field and their role in the operating room with the patient. This study looks at the debates around the development and incorporation of a pre-anesthesia evaluation into the patient experience and how these debates shape perceptions about current pre-anesthesia evaluation practices.</div></div><div><h3>Methods</h3><div>We conducted a qualitative descriptive analysis and a narrative synthesis was carried out on archival records of personal papers and paper documents at the Wood Library-Museum of Anesthesiology along with a content review on the history of anesthesia practice and the pre-anesthesia evaluation.</div></div><div><h3>Results</h3><div>The search for pertinent documents yielded 259 records. Fifty-four additional records were identified manually at the Wood Library-Museum of Anesthesiology. After removing duplicates, excluding non-relevant records, and accessing articles for pertinence, 72 sources were included in the qualitative analysis. Three themes emerged from 72 sources as impacting the evolution of the pre-anesthesia evaluation: growth of the anesthesia workforce, changes in communication in the anesthesiologist-patient relationship, and the patient perspective.</div></div><div><h3>Conclusions</h3><div>This history is a small, focused look at a part of anesthesia practice today. It reviews some changes over time in the patient-anesthesiologist relationship and covers some of the debates and concerns that arose. Varying viewpoints regarding the practice of anesthesiology and the proper roles of anesthesiologists delayed the requirement for a pre-anesthetic evaluation until 1965, affected its perceived value, and slowed the development of the anesthesiologist-patient relationship. Lack of patient knowledge about the responsibilities of anesthesiologists and the processes for administering anesthesia limits patient understanding of the pre-anesthetic evaluation and the importance of the anesthesiologist-patient relationship. Patient education may improve patient and public understanding of the integral role of anesthesiologists in perioperative management to maintain patient safety.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 6","pages":"Pages 499-510"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093393","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 : 2025-12-01Epub Date: 2025-09-13DOI: 10.1016/j.jnma.2025.08.106
Kristen A. Berg , Marquisha Marbury , Morgan A. Whaley , Adam T. Perzynski , Sanjay R. Patel , Lucas M. Donovan , J. Daryl Thornton
Rationale
Continuous positive airway pressure (CPAP) improves excessive daytime sleepiness, but there is insufficient evidence that CPAP prevents long-term clinically important adverse outcomes such as cardiovascular events and cognitive functioning particularly among diverse populations. This lack of evidence is particularly concerning for African American patients who face disproportionate barriers to care.
Goals
To determine the perceptions of African American patients with OSA and their bed partners regarding participating in clinical trials evaluating the effects of CPAP on long-term outcomes.
Methods
We interviewed African American patients of an urban safety-net health care system with OSA who were prescribed CPAP and their bed partners. Recruitment continued until theoretical saturation was achieved. Transcripts were analyzed using the principles of thematic analysis.
Results
We interviewed 18 OSA patients and 18 bed partners. We identified six themes pertaining to patients’ and bed partners’ perspectives of the benefits and risks to participation in clinical trials about CPAP effectiveness, and characteristics of optimal trial design. Participants described learning the true efficacy of CPAP as essentially the only benefit of participation, while emphasizing the jeopardization of health and navigating mistrust and deception as costs of participation. Participants encouraged the integration of patient voices, the participation of diverse investigators, the involvement of bed partners, and the incorporation of patient education on CPAP adherence in designing optimal clinical trials.
Conclusions
African American patients with OSA and their bed partners expressed several concerns regarding participation in clinical trials and offered suggestions for improving the design of clinical trials in this population.
{"title":"Perspectives of African American couples regarding participation in trials of treatments for obstructive sleep apnea","authors":"Kristen A. Berg , Marquisha Marbury , Morgan A. Whaley , Adam T. Perzynski , Sanjay R. Patel , Lucas M. Donovan , J. Daryl Thornton","doi":"10.1016/j.jnma.2025.08.106","DOIUrl":"10.1016/j.jnma.2025.08.106","url":null,"abstract":"<div><h3>Rationale</h3><div>Continuous positive airway pressure (CPAP) improves excessive daytime sleepiness, but there is insufficient evidence that CPAP prevents long-term clinically important adverse outcomes such as cardiovascular events and cognitive functioning particularly among diverse populations. This lack of evidence is particularly concerning for African American patients who face disproportionate barriers to care.</div></div><div><h3>Goals</h3><div>To determine the perceptions of African American patients with OSA and their bed partners regarding participating in clinical trials evaluating the effects of CPAP on long-term outcomes.</div></div><div><h3>Methods</h3><div>We interviewed African American patients of an urban safety-net health care system with OSA who were prescribed CPAP and their bed partners. Recruitment continued until theoretical saturation was achieved. Transcripts were analyzed using the principles of thematic analysis.</div></div><div><h3>Results</h3><div>We interviewed 18 OSA patients and 18 bed partners. We identified six themes pertaining to patients’ and bed partners’ perspectives of the benefits and risks to participation in clinical trials about CPAP effectiveness, and characteristics of optimal trial design. Participants described learning the true efficacy of CPAP as essentially the only benefit of participation, while emphasizing the jeopardization of health and navigating mistrust and deception as costs of participation. Participants encouraged the integration of patient voices, the participation of diverse investigators, the involvement of bed partners, and the incorporation of patient education on CPAP adherence in designing optimal clinical trials.</div></div><div><h3>Conclusions</h3><div>African American patients with OSA and their bed partners expressed several concerns regarding participation in clinical trials and offered suggestions for improving the design of clinical trials in this population.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 6","pages":"Pages 449-457"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145067065","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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