JAMA Pediatrics最新文献

{"title":"Mobile Subthreshold Exercise Program (MSTEP) for Youth With Prolonged Concussion Recovery","authors":"Sara P. D. Chrisman, Beth J. Bollinger, Allina Flaat, Jordan Sahlberg, Chuan Zhou, Jason A. Mendoza, M. Alison Brooks, Tonya M. Palermo, Colby R. Hansen, Frederick P. Rivara","doi":"10.1001/jamapediatrics.2026.4927","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2026.4927","url":null,"abstract":"Importance Research suggests that aerobic exercise improves recovery for youth with concussion; however, prior studies primarily focused on acute concussion and required multiple in-person visits. Objective To determine whether a virtually delivered aerobic exercise program improves recovery following concussion compared to a stretching control and examine potential moderators. Design, Setting, and Participants A randomized clinical trial was conducted from 2021 to 2025 comparing the Mobile Subthreshold Exercise Program (MSTEP) to a stretching control for 11- to 18-year-olds with concussion up to 1 year from injury. Participants were recruited from a variety of outpatient locations in 4 US states (Washington, Utah, Wisconsin, and Oregon). Recruitment and data collection occurred from March 2021 until October 2025, and data analysis occurred from November 2025 to April 2026. Interventions Youth randomized to MSTEP were provided activity trackers and an aerobic exercise program initiated at 60% of heart rate maximum. Exercise was advanced in intensity and duration over 6 weeks through weekly videoconferencing calls. Youth in the control group were given stretching exercises and similar weekly calls. Main Outcomes and Measures Primary outcomes included (1) concussive symptoms and (2) health-related quality of life (HRQoL). Secondary outcomes included sleep, depression, and anxiety. Moderation by sex, age, and time since injury was examined. Patients were followed up for 6 months. Results The sample included 210 participants, among whom 122 (58.1%) were female, mean (SD) age was 15.1 (2.2) years, and mean (SD) time since injury was 73.3 (63.3) days. Covariate-adjusted regression analysis showed significant improvement in concussive symptoms and HRQoL at all time points, with greater improvement in MSTEP compared to control at the 3-month time point for both concussive symptoms (β, −3.15; 95% CI, −6.05 to −0.25; adjusted <jats:italic>P</jats:italic> = .04) and HRQoL (β, 4.15; 95% CI, 0.64-7.66; adjusted <jats:italic>P</jats:italic> = .04). No significant differences by group were seen at 6 months. Nonlinear mixed-effects modeling with exponential decay showed significantly faster symptom recovery in MSTEP compared to control (difference in rates, −0.68; 95% CI, −2.22 to −0.04; <jats:italic>P</jats:italic> = .002). Secondary outcomes (sleep, depression, and anxiety) improved in all participants but were not different by group. Benefit of the intervention was only significant for individuals less than 3 months from injury (concussive symptoms: β, −4.44; 95% CI, −7.99 to −0.90; unadjusted <jats:italic>P</jats:italic> = .01; HRQoL: β, 6.64; 95% CI, 2.55-10.72; unadjusted <jats:italic>P</jats:italic> = .002). No evidence was found for moderation by other factors. Conclusions and Relevance Per the results of this randomized clinical trial, an aerobic exercise program improves speed of recovery following concussion for youth compared to stretching and can be","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"25 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149218584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ambulatory Electrocardiography Modalities in Pediatric Arrhythmia Detection and Management","authors":"Yen Teng Hsu, Wei Chieh Tseng, Ying Lun Hsu, Mei Hwan Wu, Chun Wei Lu, Kun Lang Wu, Wei Feng Peng, Shuenn Nan Chiu","doi":"10.1001/jamapediatrics.2026.4910","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2026.4910","url":null,"abstract":"Importance The diagnostic efficacy of different ambulatory electrocardiographic monitoring modalities in this patient population remains unclear. Objective To compare the diagnostic yield and clinical utility of 3 ambulatory electrocardiographic modalities in pediatric patients. Design, Setting, and Participants This single-center study took place at an outpatient clinic and an inpatient ward of National Taiwan University Children’s Hospital. Patients younger than 18 years who underwent ambulatory electrocardiographic monitoring between December 2022 and January 2025 were included. These data were analyzed February 2025 to March 2026. Exposure A continuous 7-day Holter device that functioned as an event recorder was used. Recordings from the first 24 hours were defined as the 24-hour Holter results. Main Outcomes and Measures Arrhythmias were categorized as major (tachyarrhythmia or bradyarrhythmia) or minor (extrasystolic arrhythmia). All patients were followed up for 1 year; the final arrhythmia diagnosis was used as the reference standard. The primary and secondary outcomes were detection of arrhythmia and a change in clinical management attributable to monitoring findings, respectively. Results In total, 435 children (235 female [54%] and 200 male [46%]; mean [SD] age, 12.3 [3.9] years) were included. The mean (SD) duration of analyzable ambulatory electrocardiographic data was 4.9 (1.7) days. Of 411 children who activated the event recorder, 10.7% had symptom-correlated arrhythmias. The 7-day Holter monitoring demonstrated a significantly higher rate of major arrhythmias (6.2%) than the 24-hour Holter or 7-day event recordings (2.3%; rate difference 95% CI, 1.9%-6.0%; <jats:italic toggle=\"yes\">P</jats:italic> &amp;amp;lt; .001). Seven-day Holter monitoring showed superior sensitivity (7-day Holter monitoring: 73%; rate difference 95% CI, 54.1%-84.6%; 24-hour Holter monitoring: 27%; rate difference 95% CI, 13.4%-43.1%; and 7-day event recorder: 27%, rate difference 95% CI, 13.4%-43.1%; <jats:italic toggle=\"yes\">P</jats:italic> &amp;amp;lt; .001) and a high negative predictive value (97.5%, 95% CI, 95.2%-98.6%). Tachyarrhythmias were associated with higher rates of management changes; management changed in 7.1% of patients with 7-day Holter monitoring, 1.6% with 24-hour Holter (rate difference 95% CI, 3.0%-7.6%; <jats:italic toggle=\"yes\">P</jats:italic> &amp;amp;lt; .001) and 2.8% with a 7-day event recorder (rate difference 95% CI, 2.0%-6.2%; <jats:italic toggle=\"yes\">P</jats:italic> &amp;amp;lt; .001). Conclusions and Relevance In this study of pediatric patients without structural heart disease who underwent electrocardiographic monitoring, 7-day continuous ambulatory electrocardiographic monitoring was associated with a significantly higher diagnostic yield than 24-hour Holter and 7-day event recording. Continuous monitoring may be preferred to detect tachyarrhythmias likely to influence clinical management.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"34 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149218583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Medicaid Work Requirements Will Impact Emerging Adults.","authors":"Emma K Edmondson, Patricia Y Chu, Noyonikaa Gupta, Mary Ellen Vajravelu","doi":"10.1001/jamapediatrics.2026.4924","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2026.4924","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":""},"PeriodicalIF":17.1,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evening Phone Use and Sleep Outcomes Among Youth","authors":"Yihong Zhao, Lauren Hale, Dimitri A. Christakis","doi":"10.1001/jamapediatrics.2026.4902","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2026.4902","url":null,"abstract":"Importance Smartphone use has been associated with poor sleep, but existing evidence primarily relies on self-reported, cross-sectional data. Objective To examine within-person and between-person associations between passively sensed evening smartphone use and objectively measured sleep outcomes in adolescents. Design, Setting, and Participants This intensive longitudinal cohort study assessed passively sensed data from US youths in the Adolescent Brain Cognitive Development Study. Participants were Android users with at least 14 days of concurrent Effortless Assessment Research System application data and Fitbit-measured sleep. Data were collected between November 30, 2020, and February 5, 2024, and analyzed from February 2 to June 1, 2026. Analysis used within-between decomposition in multilevel models to separate within-person from between-person associations. Exposures Smartphone use after each hourly cutoff from 8 &lt;jats:sc&gt;pm&lt;/jats:sc&gt; to midnight (cumulative) and within 5 to 30 minutes before sleep onset (proximal) were quantified. Main Outcomes and Measures Fitbit-derived sleep measures were assessed, including total sleep time (TST), onset, offset, and sustained and total wake after sleep onset (WASO). Results A total of 425 participants (mean [SD] age, 14.8 [1.1] years; 216 [50.8%] female) contributed 7591 person-nights of data. On nights when adolescents used their phones more than their own evening average (after 10 &lt;jats:sc&gt;pm&lt;/jats:sc&gt; ), they slept a mean (SD) of 20.05 (49.42) minutes less and fell asleep a mean (SD) of approximately 64.73 (50.95) minutes later. Adjusting for covariates, within-person analyses revealed that each additional minute of smartphone use after 10 &lt;jats:sc&gt;pm&lt;/jats:sc&gt; above a participant’s own average was associated with sleep onset that was 0.87 (95% CI, 0.84 to 0.90) minutes later, sleep offset that was 0.37 (95% CI, 0.33 to 0.41) minutes later, and a TST change of −0.43 (95% CI, −0.47 to −0.39) minutes (all &lt;jats:italic toggle=\"yes\"&gt;P&lt;/jats:italic&gt; &amp;amp;lt; .001). Estimates increased monotonically across cutoffs from 8 &lt;jats:sc&gt;pm&lt;/jats:sc&gt; to midnight. Proximal use was associated with greater sustained WASO, largest in the final 5 minutes of use before sleep onset (0.74 [95% CI, 0.50 to 0.98] additional minutes of wakefulness; &lt;jats:italic toggle=\"yes\"&gt;P&lt;/jats:italic&gt; &amp;amp;lt; .001) and negligible when looking at the final 20 minutes of use before sleep onset. This association was concentrated in the first 30 minutes after sleep onset. Conclusions and Relevance This cohort study found that greater cumulative late-evening phone use was associated with later sleep onset, delayed sleep offset, and shorter TST. Smartphone use immediately before sleep onset was associated with greater WASO, primarily during the first 30 minutes after sleep onset. These findings suggest that reducing evening smartphone use, particularly after 10 &lt;jats:sc&gt;pm&lt;/jats:sc&gt; and immediately before bedtime, may help improve s","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"28 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149218628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No Caffeine for Hypoxic-Ischemic Encephalopathy.","authors":"Floris Groenendaal","doi":"10.1001/jamapediatrics.2026.4610","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2026.4610","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":""},"PeriodicalIF":17.1,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rates of Nicotine Use Among Children and Adolescents.","authors":"Brandon T Sanford, Naomi C Brownstein, Tracy T Smith, Benjamin A Toll","doi":"10.1001/jamapediatrics.2026.4918","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2026.4918","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":""},"PeriodicalIF":17.1,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Precision Management After Childhood Acute Kidney Injury-Reply.","authors":"Jitendra Meena, Cal Robinson, Rahul Chanchlani","doi":"10.1001/jamapediatrics.2026.3700","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2026.3700","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":""},"PeriodicalIF":17.1,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supporting LGBT Adolescents-A Global Need in Challenging Times.","authors":"Gina M Sequeira, Kacie M Kidd","doi":"10.1001/jamapediatrics.2026.4279","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2026.4279","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":""},"PeriodicalIF":17.1,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When Parents’ Rights Lead to Policy Wrongs","authors":"Denise F. Lillvis, Anna Kirkland","doi":"10.1001/jamapediatrics.2026.4712","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2026.4712","url":null,"abstract":"This Viewpoint discusses how the US parents’ rights movement is expanding its health policy advocacy in ways that threaten to sever adolescents’ access to care.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"8 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149151793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimates of Anxiety Symptoms Among US Adolescents","authors":"Tanner J. Bommersbach, Cynthia A. Fontanella, Mark Olfson, Taeho Greg Rhee","doi":"10.1001/jamapediatrics.2026.4702","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2026.4702","url":null,"abstract":"Importance Anxiety symptoms are common among US adolescents and associated with substantial psychiatric burden, yet contemporary nationally representative estimates of anxiety symptom severity, associated clinical conditions, and treatment utilization are lacking. Objectives To estimate the prevalence of anxiety symptoms and symptom severity among US adolescents and examine associated co-occurring psychiatric conditions and treatment utilization. Design, Setting, and Participants This cross-sectional study used data from the 2024 National Survey on Drug Use and Health, a nationally representative survey of the US civilian, noninstitutionalized population. Participants included adolescents aged 12 to 20 years. Data were analyzed in June 2026. Exposure(s) Anxiety symptoms were assessed using the 7-item Generalized Anxiety Disorder (GAD-7) questionnaire, a brief self-report screener designed to identify probable generalized anxiety disorder and measure symptom severity. Main Outcomes and Measures National estimates of anxiety symptom severity were generated overall and by sociodemographic characteristics. Co-occurring psychiatric and substance use conditions and past-year mental health treatment utilization were examined across anxiety symptom severity categories. Multivariable logistic regression was used to identify factors associated with severe anxiety and receipt of mental health treatment. Results Among 15 730 adolescents (7725 [48.9%] female), 3642 (23.7%) reported mild anxiety symptoms, 1599 (9.6%) reported moderate symptoms, and 1252 (7.2%) reported severe symptoms. Female adolescents had substantially higher rates of moderate (13.4% vs 6.0%) and severe (10.8% vs 3.7%) anxiety symptoms than males. Among adolescents with severe anxiety symptoms, 802 (65.8%) met criteria for a past-year major depressive episode, 536 (48.2%) reported past-year suicidal thoughts, and 392 (31.0%) reported past-month substance use. Despite this high burden of co-occurring mental health conditions, 512 adolescents (41.2%) with severe anxiety symptoms and 793 (48.3%) of those with moderate anxiety symptoms received no mental health treatment during the preceding year. In multivariable analyses, mental health treatment was less likely among male adolescents, racial and ethnic minoritized adolescents, and uninsured adolescents. Conclusions and Relevance Per the results of this cross-sectional study, approximately 1 in 6 US adolescents reported moderate or severe anxiety symptoms in 2024, yet a substantial proportion received no mental health treatment. The high prevalence of anxiety symptoms, frequent co-occurrence with depression and suicidal thoughts, and large unmet need underscore the importance of improving early identification and access to evidence-based treatment for adolescents with anxiety symptoms.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"29 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149151799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}