Tag: pubmed

JAMA Netw Open. 2024 Oct 1;7(10):e2439727. doi: 10.1001/jamanetworkopen.2024.39727.

ABSTRACT

IMPORTANCE: Investigating racial and ethnic discrimination in medical education is crucial for addressing disparities and fostering an inclusive environment.

OBJECTIVE: To assess how racial and ethnic discrimination in medical school is associated with personal and professional identity formation (PPIF) by race and ethnicity.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional study used deidentified data on 37 610 medical students who matriculated in 2014 or 2015 and took the Association of American Medical Colleges Graduation Questionnaire (GQ) between 2016 and 2020. Statistical analysis was performed from September 1 to November 20, 2023.

EXPOSURES: Experiences of racial and ethnic discrimination were assessed through responses to 3 GQ questions about denial of opportunities, offensive remarks or names, and lower evaluations or grades due to race or ethnicity.

MAIN OUTCOMES AND MEASURES: Personal and professional development were measured as 2 separate outcomes using 2 GQ statements rated on a 5-point Likert scale (where 1 indicated strongly disagree and 5 indicated strongly agree): “My medical school has done a good job fostering and nurturing my development as a person” and “My medical school has done a good job fostering and nurturing my development as a physician.” Variables of personal and professional development were both dichotomized.

RESULTS: Of 37 610 medical students, 18 200 (48.4%) were female, and 19 410 (51.6%) were male; 2458 (6.5%) were African American or Black, 7801 (20.7%) were Asian, 2430 (6.5%) were Hispanic, 21 380 (56.9%) were White, 2404 (6.4%) were multiracial, and 1137 (3%) were other race or ethnicity. Most respondents attested that their medical school fostered their personal (27 272 [72.5%]) and professional (34 560 [91.9%]) development. African American or Black students reported the lowest rates of personal (1603 of 2458 [65.2%]) and professional (2182 of 2458 [88.8%]) development, and experienced lower likelihoods of personal (adjusted risk ratio [ARR], 0.89 [95% CI, 0.86-0.93]) and professional (ARR, 0.95 [95% CI, 0.94-0.97]) development than White students. Racial discrimination was inversely associated with development, with the highest PPIF rates among those never experiencing discrimination (personal, 25 089 of 33 508 [74.9%]; and professional, 31 257 of 33 508 [93.3%]). Those experiencing isolated discrimination (personal: ARR, 0.83 [95% CI, 0.80-0.87]; professional: ARR, 0.92 [95% CI, 0.91-0.95]) and recurrent discrimination (personal: ARR, 0.63 [95% CI, 0.60-0.66]; professional: ARR, 0.82 [95% CI, 0.80-0.84]) had relatively lower likelihoods of PPIF. African American or Black students experienced the highest rate of recurrent discrimination (543 of 2458 [22.1%]). No significant PPIF risk differences were found for other racial and ethnic groups underrepresented in medicine without discrimination compared with White students without discrimination, but all groups with recurrent discrimination had relatively lower PPIF risk.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of US medical students, racial and ethnic discrimination was associated with lower PPIF across all racial and ethnic groups compared with White students without such experiences. African American or Black students disproportionately faced this discrimination. Systemic changes in medical education are needed to combat discrimination and ensure equity in holistic student development.

PMID:39412803 | DOI:10.1001/jamanetworkopen.2024.39727

JAMA Netw Open. 2024 Oct 1;7(10):e2439932. doi: 10.1001/jamanetworkopen.2024.39932.

ABSTRACT

IMPORTANCE: Publishing in health professions education (HPE) journals is an integral component of academic discourse and career progression. Research in this field is shifting to an open access (OA) publishing model.

OBJECTIVE: To identify the characteristics and publishing models of HPE journals and explore potential associations between publication costs and journal metrics.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was conducted between September 20, 2023, and February 14, 2024, using the World Bank purchasing power parity (PPP) index to analyze relative costs of article processing charges (APCs). Data on journal characteristics, impact metrics, APCs, and waiver or discount were extracted from the National Library of Medicine, Scimago, Scopus, journal websites, and email correspondence with editorial staff of journals. All HPE journals indexed in PubMed, written in or translated into English, and with HPE as a core component of their mission were included in the analysis.

MAIN OUTCOMES AND MEASURES: Two-year impact factor, H-index, cite score, Scientific Journal Ranking, and APC.

RESULTS: Among the 51 journals included, 27 (53%) adopted OA-only and 24 (47%) adopted hybrid publishing models. The median (IQR) APC for all journals was $2820.00 ($928.00-$3300.00). Associations were observed between impact factor and APC (β coefficient, $386.84; 95% CI, $226.84-$546.84; P < .001) and between cite score and APC (β coefficient, $282.40; 95% CI, $148.12-$416.61; P < .001). Of 20 journal websites with information regarding fee waivers or discounts, 7 journals (35%) confirmed fee waiver or discount. The PPP index analysis of the top 39 countries publishing HPE research showed that the financial burden of meeting the median APC for publication was 1.94 to 10.26 times higher for authors from lower-income countries than for authors from the US.

CONCLUSIONS AND RELEVANCE: Results of this cross-sectional study suggest that adoption by HPE journals of an OA publishing model was high but access to APC waivers or discounts was limited. These factors create barriers to equitable OA practices, necessitating concerted efforts, such as increasing transparency of publishing costs, implementing economic impact analysis, expanding waivers to eligible authors, and applying holistic impact factor scoring.

PMID:39412801 | DOI:10.1001/jamanetworkopen.2024.39932

JAMA Netw Open. 2024 Oct 1;7(10):e2439939. doi: 10.1001/jamanetworkopen.2024.39939.

ABSTRACT

IMPORTANCE: Pregnant individuals who repeatedly use emergency care during pregnancy represent a population who could be disproportionately vulnerable to harm, including severe maternal morbidity (SMM).

OBJECTIVE: To explore patterns of unscheduled care visits during pregnancy and ascertain its association with SMM at the time of birth.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from a statewide database that linked hospital records to births and fetal deaths occurring between October 1, 2002, and March 31, 2020, in Massachusetts. Pregnant individuals experiencing births or fetal deaths during the study period were included. Data analysis was conducted from June 2022 to September 2024.

EXPOSURE: The exposure was 4 or more cases of emergency use, defined as either an emergency department visit or observational stay during pregnancy not resulting in hospital admission. Pregnancy episode was ascertained by subtracting the gestational age at birth from the date of birth.

MAIN OUTCOMES AND MEASURES: The outcome of interest was the odds ratio (OR) for SMM at the time of birth. The algorithm includes 20 conditions or procedures (excluding transfusion) identified through International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes across the study period.

RESULTS: A total of 774 092 pregnant individuals (mean [SD] age, 31.2 [5.8] years; 16.8% Hispanic, 9.3% non-Hispanic Asian or Pacific Islander, 9.5% non-Hispanic Black, 63.1% non-Hispanic White) with emergency care visits during the pregnancy were included; 31.3% of these individuals had at least 1 visit. Overall, 18.1% had 1 visit and 3.3% had 4 or more visits. Four or more unscheduled visits were common among those younger than age 25 years (8.7%), with Hispanic (5.7%) or non-Hispanic Black (4.9%) race and ethnicity, with public insurance (6.5%), or with a comorbidity (19.0%) or an opioid use-related hospitalization (26.8%) in the year prior to pregnancy. Of those with 4 or more unscheduled visits, 43.8% visited more than 1 hospital during pregnancy. In a multivariable analysis of the likelihood of SMM, those with 4 or more unscheduled visits had an adjusted OR of 1.46 (95% CI, 1.29-1.66) compared with those with 0 visits.

CONCLUSIONS AND RELEVANCE: This cohort study found that high emergency care use during pregnancy was associated with an increased risk for SMM. With a significant proportion of those with frequent unscheduled visits also using multiple hospitals, solutions that are community-based and integrated across health systems may be most beneficial.

PMID:39412800 | DOI:10.1001/jamanetworkopen.2024.39939

JAMA Cardiol. 2024 Oct 16. doi: 10.1001/jamacardio.2024.3314. Online ahead of print.

ABSTRACT

IMPORTANCE: The differences between the use of fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR) in the long term are unknown.

OBJECTIVE: To compare long-term outcomes of iFR- and FFR-based strategies to guide revascularization.

DESIGN, SETTING, AND PARTICIPANTS: The DEFINE-FLAIR multicenter study randomized patients with coronary artery disease to use either iFR or FFR as a pressure index to guide revascularization. Patients from 5 continents with coronary artery disease and angiographically intermediate severity stenoses who underwent hemodynamic interrogation with pressure wires were included. These data were analyzed from March, 13, 2014, through April, 27, 2021.

MAIN OUTCOME MEASURES: Five-year major adverse cardiac events (MACE) (a composite of all-cause death, nonfatal myocardial infarction, and unplanned revascularization), as well as the individual components of the combined end point.

RESULTS: At 5 years of follow-up, no significant differences were found between the iFR (mean age [SD], 65.5 [10.8] years; 962 male [77.5%]) and FFR (mean age [SD], 65.2 [10.6] years; 929 male [74.3%]) groups in terms of MACE (21.1% vs 18.4%, respectively; hazard ratio [HR], 1.18; 95% CI, 0.99-1.42; P = .06). While all-cause death was higher among patients randomized to iFR, it was not driven by myocardial infarction (6.3% vs 6.2% in the FFR study arm; HR, 1.01; 95% CI, 0.74-1.38; P = .94) or unplanned revascularization (11.9% vs 12.2% in the FFR group; HR, 0.98; 95% CI, 0.78-1.23; P = .87). Furthermore, patients in whom revascularization was deferred on the basis of iFR or FFR had similar MACE in both study arms (17.9% in the iFR group vs 17.5% in the FFR group; HR, 1.03; 95% CI, 0.79-1.35; P = .80) with similar rates of the components of MACE, including all-cause death. On the contrary, in patients who underwent revascularization after physiologic interrogation, the incidence of MACE was higher in the iFR group (24.6%) compared with the FFR group (19.2%) (HR, 1.36; 95% CI, 1.07-1.72; P = .01).

CONCLUSIONS AND RELEVANCE: At 5-year follow up, an iFR based-strategy was not statistically different than an FFR strategy to guide revascularization in terms of MACE, nonfatal myocardial infarction, and unplanned revascularization.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02053038.

PMID:39412778 | DOI:10.1001/jamacardio.2024.3314

JAMA Psychiatry. 2024 Oct 16. doi: 10.1001/jamapsychiatry.2024.3194. Online ahead of print.

ABSTRACT

IMPORTANCE: In the neurotypical brain, regions develop in coordinated patterns, providing a fundamental scaffold for brain function and behavior. Whether altered patterns contribute to clinical profiles in neurodevelopmental conditions, including autism, remains unclear.

OBJECTIVES: To examine if, in autism, brain regions develop differently in relation to each other and how these differences are associated with molecular/genomic mechanisms and symptomatology.

DESIGN, SETTING, AND PARTICIPANTS: This study was an analysis of one the largest deep-phenotyped, case-control, longitudinal (2 assessments separated by approximately 12-24 months) structural magnetic resonance imaging and cognitive-behavioral autism datasets (EU-AIMS Longitudinal European Autism Project [LEAP]; study dates, February 2014-November 2017) and an out-of-sample validation in the Brain Development Imaging Study (BrainMapASD) independent cohort. Analyses were performed during the 2022 to 2023 period. This multicenter study included autistic and neurotypical children, adolescents, and adults. Autistic participants were included if they had an existing autism diagnosis (DSM-IV/International Statistical Classification of Diseases and Related Health Problems, Tenth Revision or DSM-5 criteria). Autistic participants with co-occurring psychiatric conditions (except psychosis/bipolar disorder) and those taking regular medications were included.

EXPOSURES: Neuroanatomy of neurotypical and autistic participants.

MAIN OUTCOMES AND MEASURES: Intraindividual changes in surface area and cortical thickness over time, analyzed via surface-based morphometrics.

RESULTS: A total of 386 individuals in the LEAP cohort (6-31 years at first visit; 214 autistic individuals, mean [SD] age, 17.3 [5.4] years; 154 male [72.0%] and 172 neurotypical individuals, mean [SD] age, 16.35 [5.7] years; 108 male [62.8%]) and 146 individuals in the BrainMapASD cohort (11-18 years at first visit; 49 autistic individuals, mean [SD] age, 14.31 [2.4] years; 42 male [85.7%] and 97 neurotypical individuals, mean [SD] age, 14.10 [2.5] years; 58 male [59.8%]). Maturational between-group differences in cortical thickness and surface area were established that were mostly driven by sensorimotor regions (eg, across features, absolute loadings for early visual cortex ranged from 0.07 to 0.11, whereas absolute loadings for dorsolateral prefrontal cortex ranged from 0.005 to 0.06). Neurodevelopmental differences were transcriptomically enriched for genes expressed in several cell types and during various neurodevelopmental stages, and autism candidate genes (eg, downregulated genes in autism, including those regulating synaptic transmission; enrichment odds ratio =3.7; P =2.6 × -10). A more neurotypical, less autismlike maturational profile was associated with fewer social difficulties and more typical sensory processing (false discovery rate P <.05; Pearson r ≥0.17). Results were replicated in the independently collected BrainMapASD cohort.

CONCLUSIONS AND RELEVANCE: Results of this case-control study suggest that the coordinated development of brain regions was altered in autism, involved a complex interplay of temporally sensitive molecular mechanisms, and may be associated with both lower-order (eg, sensory) and higher-order (eg, social) clinical features of autism. Thus, examining maturational patterns may provide an analytic framework to study the neurobiological origins of clinical profiles in neurodevelopmental/mental health conditions.

PMID:39412777 | DOI:10.1001/jamapsychiatry.2024.3194

JAMA. 2024 Oct 16. doi: 10.1001/jama.2024.18575. Online ahead of print.

NO ABSTRACT

PMID:39412770 | DOI:10.1001/jama.2024.18575

J Nephrol. 2024 Oct 16. doi: 10.1007/s40620-024-02099-z. Online ahead of print.

ABSTRACT

BACKGROUND: Hormone replacement therapy (HRT) is recommended for alleviating vasomotor symptoms or preventing bone loss in postmenopausal women. This study aimed to investigate the impact of hormone replacement therapy on major adverse cardiovascular events, kidney failure, and mortality in women with chronic kidney disease (CKD).

METHODS: This population-based cohort study analyzed data from the National Cancer Screening Program and the national health examination of South Korea. Data on postmenopausal women were extracted from the 2009 National Cancer Screening Program. Among these postmenopausal women, those with CKD without kidney replacement therapy were selected through a national health examination from 2009 to 2013. The study outcomes were the risks of major adverse cardiovascular events, kidney failure, and all-cause mortality according to hormone replacement therapy.

RESULTS: A total of 768,279 postmenopausal women with CKD were enrolled in this study; of these women, 13.8% (N = 106,052) had a history of hormone replacement therapy. The user and non-user groups differed with respect to baseline characteristics, with the latter being older and having risk factors for cardiovascular disease. After adjustment for confounding factors, the group exposed to hormone replacement therapy showed lower risks of major adverse cardiovascular events, kidney failure, and all-cause mortality.

CONCLUSIONS: This study suggests the potential benefits of hormone replacement therapy in postmenopausal women with CKD and highlighted its potential advantages for cardiovascular and kidney outcomes.

PMID:39412740 | DOI:10.1007/s40620-024-02099-z

J Robot Surg. 2024 Oct 16;18(1):372. doi: 10.1007/s11701-024-02104-4.

ABSTRACT

Total pancreatectomy is a complex procedure used in the management of pancreatic cancer. While minimally invasive techniques have been increasingly adopted, limited data exist comparing robotic total pancreatectomy (RTP) and laparoscopic total pancreatectomy (LTP). This study evaluates the utilization, short- and long-term outcomes of RTP and LTP using the National Cancer Database. Patients with stages I-III pancreatic adenocarcinoma who underwent RTP or LTP between 2010 and 2019 were identified. Patient demographics, treatment characteristics, pathologic outcomes, postoperative outcomes, and overall survival were compared. Multivariable logistic regression and Cox proportional-hazards models were used to assess the association of surgical approach with outcomes. Of the 995 patients included, 188 (19%) underwent RTP and 807 (81%) underwent LTP. The utilization of minimally invasive techniques increased over time, with RTP accounting for 24% of cases in 2019. RTP had lower conversion rates than LTP (16% vs. 24%, p = 0.031), but this difference was not significant after adjusting for confounders. Postoperative outcomes, including length of stay, 30-day readmission, and 30- and 90-day mortality, were similar between RTP and LTP. The median overall survival was 22.3 months for RTP and 23.6 months for LTP (p = 0.647). RTP and LTP demonstrate comparable perioperative, pathological, and oncological outcomes for the management of pancreatic adenocarcinoma. Despite the increasing adoption of minimally invasive total pancreatectomy, it remains a rare operation and should be performed in experienced centers to optimize outcomes.

PMID:39412737 | DOI:10.1007/s11701-024-02104-4

Mol Biol Rep. 2024 Oct 16;51(1):1055. doi: 10.1007/s11033-024-09999-0.

ABSTRACT

BACKGROUND: It is well known that telomerase activity is suppressed in normal human tissues and reactivated in tumors, suggesting that the human telomerase reverse transcriptase (hTERT, MIM: 187270) gene may be involved in carcinogenesis. A polymorphic tandem repeat minisatellite located downstream of exon 16 of hTERT and upstream in the putative promoter region of an antisense hTERT transcript, termed MNS16A, results in a functional polymorphism. Because the association between the MNS16A genetic polymorphism and breast cancer (BC) risk remains an open question, the present case-control study was conducted in Shiraz (Fars Province, Southern Iran).

METHODS: A total of 711 samples were collected, including 362 BC patients and 349 healthy individuals. Genotyping was performed by polymerase chain reaction method. Alleles were determined by classifying DNA amplicons of less than and greater than 300 bp as short (S) and long (L) alleles, respectively.

RESULTS: Different inheritance models (codominant, dominant, recessive, overdominant genotype models and the allele model) were used to evaluate the association between the MNS16A polymorphism and the risk of BC. No significant association was observed in any of the analyses. It should be noted that the statistical power of the comparisons was low.

CONCLUSION: The present study did not support the association between hTERT MNS16A polymorphism and breast cancer risk. Similar studies in other populations with larger sample sizes are needed to determine the association between the hTERT MNS16A polymorphism and susceptibility to breast cancer.

PMID:39412736 | DOI:10.1007/s11033-024-09999-0

Arch Dermatol Res. 2024 Oct 16;316(10):692. doi: 10.1007/s00403-024-03394-2.

NO ABSTRACT

PMID:39412704 | DOI:10.1007/s00403-024-03394-2