Faculty Bibliography

[This corrects the article DOI: 10.7759/cureus.113024.].

Background A landmark study of 1,600 Italian-Americans in Roseto, PA, challenged the prevailing view that high saturated fat intake was a major cause of myocardial infarction (MI). Despite similar rates of cigarette smoking and obesity, and even higher levels of saturated fat consumption compared to neighboring towns, Rosetans experienced far lower MI death rates. More than 50 years later, it remains uncertain whether Roseto's residents had better heart health than the average American and, if so, what protective factors may have been responsible. Methodology We compared MI deaths in Roseto and neighboring towns to the contemporaneous Framingham Heart Study cohort matched for age and sex. Results We found no evidence that MI deaths were lower in Roseto, PA, than in Framingham, MA when controlling for age and sex. While the role of social support in health has been established in subsequent studies, methodological issues, confounding factors, and biases challenge the validity of the Roseto study. Conclusions The dramatically lower MI and MI mortality rates among males in Roseto reflect biases in sampling and comparison populations, which also impacted the contrasting Diet-Heart Hypothesis that saturated fats cause heart disease. Although social support enhances health outcomes, the Roseto study neither supported nor refuted this connection.

BACKGROUND:Artificial intelligence (AI) is increasingly embedded in health systems globally and has the potential to improve efficiency, diagnostic accuracy, and decision support. However, its benefits remain unevenly distributed, particularly in low- and middle-income countries (LMICs). Models developed using datasets from specific populations may perform poorly in other settings, reinforcing structural inequities rather than correcting them. OBJECTIVE:This viewpoint proposes a composite framework, the AI in Healthcare Equity Index (AIHEI), to support measurable assessment of equity in health AI systems. FRAMEWORK/METHODS:The AIHEI is designed to assess equity across five domains: data representation, algorithmic fairness, transparency and explainability, governance and oversight, and community impact and benefit sharing. By generating a standardised score, the index could enable comparisons across technologies, incentivise improvement, and support regulation, procurement, publication, and funding decisions. IMPLICATIONS/CONCLUSIONS:Pilots across diverse health domains and geographic settings are needed to assess feasibility, refine domain weighting, and evaluate reliability, reproducibility, and validity. Important challenges include contextual definitions of fairness, data sovereignty, post-deployment monitoring, and the risk of metric gaming. CONCLUSIONS:Quantifying equity in health AI is essential to ensure that AI does not create, widen, or exacerbate existing disparities by neglecting underserved populations. A common, objective measure of AI-related health equity can help move the field from ethical aspiration toward measurable accountability, monitoring, and enforcement.

Sickle cell disease (SCD) has been documented for more than 115 years, yet its scientific and clinical history extends far deeper, beginning with African physicians such as Dr. James Africanus Horton, who described symptoms consistent with SCD decades before its formal recognition in Western medicine. The first modern clinical report, published by Dr. James B. Herrick in 1910, initiated a century of discovery that transformed SCD into the first fully elucidated "molecular disease." Advances in diagnostics, especially newborn screening, comprehensive care, and treatments, including penicillin, prophylaxis hydroxyurea, stem cell transplant and gene therapies, have transformed hematology and improved survival and quality of life. However, access to these advances remains uneven, reflecting persistent inequities that disproportionately impact SCD communities domestically and globally. Against this backdrop, the SCD 115 Years Later Symposium, held November 12, 2025, explored three interconnected pillars shaping the future of SCD care: research, collaboration, and policy. Four sessions illuminated structural and clinical challenges across the lifespan, emphasizing poor access to care, the need for more holistic care models, the importance of engaging community-based organizations, optimizing and expanding SCD surveillance systems, and stronger policy alignment at state and federal levels. Central themes included unified advocacy, improved care transitions, expansion of multidisciplinary care models, improved access to emerging therapies, and the integration of mental health and psychosocial support into clinical practice. Collectively, the symposium-derived priorities connected scientific progress, policy innovation, and community leadership to improve outcomes for all individuals living with SCD and their families.

OBJECTIVE:To examine the early experiences influencing research career intentions (RCI) among MD students from racial and ethnic backgrounds underrepresented in medicine (URiM). METHODS:We conducted semi-structured, in-depth interviews with 31 first-year URiM medical students from MD-granting programs across the US to examine student-reported experiences influencing RCI. RESULTS:Participants were first-year medical students (N = 31; mean age 24.8 ± 2.6 years; 64.5% female) identifying as Black (38.7%), Hispanic (32.3%), or Multiracial (29%). Four themes were identified: (1) structured premedical research exposure was described as pivotal to developing early research engagement and interest in research careers; (2) research orientations reflected a commitment to using research as a vehicle for social justice and community impact; (3) high-quality research mentorship was characterized by authentic relational investment, skill development, and the distinct value of racial and ethnic identity-concordant role models; and (4) the research arms race for residency placement was described as amplifying systemic inequities that constrained students' research engagement. Across themes, students described tensions between academic research culture and their personal values, including a desire to advance equity and contribute meaningfully to science. For some, this misalignment made research feel less purposeful or personally aligned. CONCLUSIONS:Medical training programs seeking to support URiM students' RCI should invest in structured premedical research programs and expand access to research mentorship that is both relationally invested and identity concordant. Efforts to cultivate sustained engagement should address publication pressures tied to residency competitiveness, which amplify structural barriers and misalign with students' motivations for pursuing research. Broadening definitions of scholarly contribution and fostering research environments that affirm students' values may be critical to building a robust physician-scientist workforce.

BACKGROUND:Timely transport of critically injured patients by Emergency Medical Services to verified trauma centers significantly reduces morbidity and mortality. Prior studies demonstrate that undertriage in the prehospital setting impacts outcomes, with rural communities facing additional geographic and systemic barriers to timely trauma care. The area deprivation index, a validated measure of neighborhood-level socioeconomic disadvantage, is associated with poorer health outcomes and may further influence access to trauma centers. Yet, the association between socioeconomic deprivation, rurality, and trauma center transport remains poorly defined. This study aimed to evaluate the extent of urban-rural inequities in Emergency Medical Services transport of critically injured patients to verified trauma centers across all regions of the United States and to assess the association between area deprivation index and likelihood of transport to a trauma center. METHODS:We identified all Emergency Medical Services transported critically injured patients meeting Centers for Disease Control and Prevention field triage criteria for trauma center transport in the National Emergency Medical Services Information System from 2018 to 2022 and mapped Zone Improvement Plan (ZIP) Codes containing verified trauma centers (Levels I-V) using data from the American College of Surgeons, the Trauma Center Association of America, and the American Trauma Society. The cohort was stratified by regions in the United States: Northeast, Midwest, South, and West. The incident scene area deprivation index was obtained from the Neighborhood Atlas at the census block group level. The total number and percentage of patients located in urban and rural Zone Improvement Plan (ZIP) codes transported either to a confirmed trauma center (via the National Emergency Medical Services Information System data) or to a Zone Improvement Plan (ZIP) code that contains a trauma center and the area deprivation index distribution in tertiles (low area deprivation index, moderate area deprivation index, and high area deprivation index) within regions in the United States were calculated with their statistical significance derived from t tests and analyses of variance with post hoc Tukey tests. RESULTS:A total of 36,897,269 critically injured patients met the inclusion criteria, of which 19,874,008 (53.86%) were brought to a trauma center. When stratified by rurality, 7,608,704 (54.01%) and 12,265,304 (53.77%) of critically injured patients within rural and urban areas, respectively, were transported to a trauma center. When comparing across regions, the Northeast region of the United States had the lowest percentage of critically injured patients being transported to a trauma center, whereas the Midwest region had the highest percentage (44.04% vs 67.40%; P < .001). When stratified by rurality, 35.33% vs 46.92% of critically injured patients within rural versus urban areas of the Northeast were transported to a trauma center, whereas 65.47% vs 68.57% of critically injured patients within rural versus urban areas of the Midwest were transported to a trauma center (P < .001). When evaluating area deprivation index, critically injured patients who were injured in more disadvantaged versus advantaged Zone Improvement Plan (ZIP) codes had a higher percentage of patients being transported to a trauma center even when controlling for rurality (56% vs 47%; P < .001). CONCLUSION/CONCLUSIONS:Substantial geographic inequities in the Emergency Medical Services transport of critically injured adult patients to verified trauma centers, varied by geographic region, rurality, and neighborhood-level socioeconomic disadvantage that exist. These findings highlight the complex and regionally variable landscape of trauma access in the United States and underscore the need for targeted, equity-focused strategies to optimize prehospital triage and ensure timely, trauma-informed care across diverse communities.

Adolescents and young adults (AYA) in Nigeria with increased HIV risk, such as those who engage in multiple sexual partnerships (i.e., more than one sexual partner within a specified period), transactional sex (i.e., exchange of money or gifts for sex), or needle-sharing (i.e., needles or other injection equipment are shared by multiple people), are eligible for pre-exposure prophylaxis (PrEP). One strategy that has the potential to reach PrEP-eligible AYA is HIV self-testing, which can expand existing HIV testing services and support differentiated PrEP programs. However, little is known about HIV self-testing in these AYA populations. We examined associations between these three high-risk behaviors and HIV self-testing. We analyzed data from Innovative Tools to Expand Youth-friendly HIV Self-Testing (I-TEST), a stepped-wedge trial examining the impact of a combination intervention package on HIV self-testing among AYA aged 14-24 years in Nigeria. We fit generalized linear models, with an identity link and a binomial error distribution, using generalized estimating equations. We generalized trial estimates to all AYA in Nigeria using a two-stage weighted approach. Of 1,429 participants, the median age was 20 years (IQR: 18-22), 50.3% were female, and 69.4% reported secondary school as their highest education level completed. AYA who engaged in transactional sex had higher HIV self-testing uptake (8.1% [4.8, 11.5]) than AYA with no history of transactional sex. There were no statistically significant differences in recent HIV self-testing uptake among AYA by sexual partnerships or needle-sharing history. The trial estimates were similar in the adjusted models. The estimates for the trial and generalized samples were in the same direction, except for AYA with two recent sexual partners. There was a high level of HIV self-testing uptake across all categories of sexual partnerships, transactional sex, and needle-sharing, with significantly higher uptake among those who engaged in transactional sex, indicating that HIV self-testing strategies are reaching these various AYA populations and the need to sustain access for these groups.

OBJECTIVE:Masked hypertension [nonhigh office blood pressure (BP) and high out-of-office BP] is associated with cardiovascular risk. Obstructive sleep apnea (OSA) is associated with high office BP, but few data exist on its association with masked hypertension, especially in Black adults who have a high prevalence of both conditions. METHODS:We analyzed pooled data from 1078 Black adults, 713 in the Jackson Heart Study and 365 in the Coronary Artery Risk Development in Young Adults study, with office BP less than 140/90 mmHg, who completed 24-h ambulatory BP monitoring. Masked hypertension was defined as mean awake BP at least 135/85 mmHg, asleep BP at least 120/70 mmHg, or 24-h BP at least 130/80 mmHg. A high likelihood of OSA was defined using sleep questionnaires and physical measurements. Poisson regression was used to estimate prevalence ratios, adjusting for demographics, lifestyle behaviors, and comorbidities. Analyses were stratified by antihypertensive medication use. RESULTS:Overall, 34% of participants had a high likelihood of OSA; 53.3% had masked hypertension. Among participants not taking antihypertensive medication (n = 505), adjusted prevalence ratios comparing those with versus without a high likelihood of OSA were 1.31 [95% confidence interval (CI) 1.06-1.61], 0.88 (95% CI 0.59-1.29), 1.37 (95% CI 1.09-1.73), and 1.35 (95% CI 1.00-1.83) for any, awake, asleep, and 24-h masked hypertension. Among those taking antihypertensive medication (n = 573), the adjusted prevalence ratios were 1.15 (95% CI 0.99-1.32), 1.04 (95% CI 0.83-1.31), 1.14 (95% CI 0.97-1.33), and 1.19 (95% CI 0.96-1.47), respectively. CONCLUSION/CONCLUSIONS:A high likelihood of OSA was associated with a higher prevalence of masked hypertension among participants not taking antihypertensive medication.