JAMA Pediatrics最新文献

{"title":"Reevaluating Nonoperative Management for Pediatric Uncomplicated Acute Appendicitis","authors":"Isabella Faria, Ana Carolina Godinho Cintra, Luiz Gustavo Albuquerque Mello de Oliveira, Frederico Squizzato, Alexandre Silva Maia, André Gusmão Cunha, Ravi S. Radhakrishnan","doi":"10.1001/jamapediatrics.2025.4091","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.4091","url":null,"abstract":"ImportanceNonoperative management (NOM) has emerged as a potential alternative to surgery for acute uncomplicated appendicitis in children; however, while short-term outcomes are often favorable, concerns remain about treatment durability, complication rates, and long-term failure. An updated meta-analysis of randomized clinical trials (RCTs) may help clarify the comparative safety and effectiveness of NOM vs appendectomy.ObjectiveTo evaluate the safety and effectiveness of NOM compared with appendectomy for uncomplicated appendicitis in children using the highest level of available evidence.Data SourcesA systematic review of PubMed, Embase, Scopus, Cochrane, and Web of Science was conducted from inception through March 2025 to identify randomized clinical trials comparing NOM with surgical management in pediatric patients.Study SelectionRCTs comparing NOM vs surgical management in pediatric patients younger than 18 years were included. Nonrandomized and quasi-randomized studies were excluded.Data Extraction and SynthesisData were extracted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Meta-analyses were conducted using random-effects models. Risk of bias was assessed independently by multiple reviewers. Trial sequential analysis was performed to determine whether the evidence was sufficiently robust and conclusive.Main Outcomes and MeasuresThe primary outcomes were treatment failure and treatment success in 1 year and major complications (Clavien-Dindo grade ≥IIIb). Secondary outcomes included time to return to school and time to return to normal activity.ResultsOf 1246 studies screened, 7 RCTs, including 1480 pediatric patients, met inclusion criteria. Treatment failure was significantly higher in the NOM group than in the appendectomy group at 1 year (risk ratio [RR], 4.97; 95% CI, 3.57-6.91; <jats:italic toggle=\"yes\">I</jats:italic><jats:sup>2</jats:sup> = 0.0%). Treatment success was significantly lower in the NOM group at 1 year (RR, 0.67; 95% CI, 0.60-0.75; <jats:italic toggle=\"yes\">I</jats:italic><jats:sup>2</jats:sup> = 31.1%). Major complications classified as Clavien-Dindo grade IIIb or worse were more frequent in the NOM group (RR, 33.37; 95% CI, 7.89-141.05; <jats:italic toggle=\"yes\">I</jats:italic><jats:sup>2</jats:sup> = 9.5%). Appendicitis recurred at a rate of 18.47 events/100 observations (95% CI, 12.62-25.07 events/100 observations; <jats:italic toggle=\"yes\">I</jats:italic><jats:sup>2</jats:sup> = 48.5%) among patients who received NOM. NOM, compared with appendectomy, was associated with a modestly faster return to school (mean difference, –1.36 days; 95% CI, −2.64 to −0.08 days; <jats:italic toggle=\"yes\">P</jats:italic> = .04; <jats:italic toggle=\"yes\">I</jats:italic><jats:sup>2</jats:sup> = 57.7%) and return to normal activities (–4.93 days; 95% CI, −8.68 to −1.19 days; <jats:italic toggle=\"yes\">P</jats:italic> = .01; <jats:italic toggle=\"yes\">I</jats:italic><jats:sup>2</jats:sup> =","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"46 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226703","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":"Errors in the Table.","authors":"","doi":"10.1001/jamapediatrics.2025.3606","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.3606","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"179 10","pages":"1135"},"PeriodicalIF":18.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232536","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":"Additional Studies on Abortion Restrictions and Adoption.","authors":"Roberta Siqueira Mocaiber Dieguez, Denise Clemente da Silva, Cristiane da Silva Cabral","doi":"10.1001/jamapediatrics.2025.2750","DOIUrl":"10.1001/jamapediatrics.2025.2750","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":"1134-1135"},"PeriodicalIF":18.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954634","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":"Additional Studies on Abortion Restrictions and Adoption-Reply.","authors":"Ashley L O'Donoghue, Savannah Adkins","doi":"10.1001/jamapediatrics.2025.2753","DOIUrl":"10.1001/jamapediatrics.2025.2753","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":"1135"},"PeriodicalIF":18.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954654","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":"Suicide Interventions for Youths: A Systematic Review.","authors":"Leslie Sim,M Hassan Murad,Paul E Croarkin,Alastair J McKean,Khaled S Mohammed,Tamim I Rajjo,Mohammed Firwana,Suvyaktha Simha,Farah Fleti,Mustafa Hegazi,Mohamed E Abusalih,Mohammad Al-Kordi,Rami Basmaci,Olena Chuzhyk,Samer Saadi,Bashar Hasan,Magdoleen H Farah,Larry J Prokop,Kelly E Viola,Zhen Wang","doi":"10.1001/jamapediatrics.2025.3485","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.3485","url":null,"abstract":"ImportanceSuicide is a leading cause of death among young people and an escalating public health crisis.ObjectiveTo assess the effectiveness and harms of available treatments for suicidal thoughts and behaviors among youths at heightened risk for suicide.Evidence ReviewA systematic review was conducted searching databases including MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus, and various gray literature sources from January 1, 2000, to September 26, 2024. We included randomized clinical trials, comparative observational studies, and before-after studies of psychosocial interventions, pharmacologic interventions, neurotherapeutics, emerging therapies, and combination therapies. Eligible patients were youths (aged 5-24 years) with heightened risk for suicide, adolescents from racial and ethnic minority groups known to be at increased risk of suicide, or those exposed to crime or violence. Pairs of independent reviewers selected and appraised studies.FindingsThis review included 65 studies (33 randomized clinical trials, 13 comparative observational studies, and 19 before-after studies) reporting on 14 534 patients (median age, 15.1 years; 75.1% female patients). Psychosocial interventions comprised psychotherapy interventions (33 studies; cognitive behavioral therapy, dialectical behavioral therapy, collaborative assessment and management of suicidality, dynamic deconstructive psychotherapy, attachment-based family therapy, and family-focused therapy), acute (ie, 1-4 sessions or contacts) psychosocial interventions (19 studies; safety planning, family-based crisis management, motivational interviewing crisis interventions, continuity of care after crisis, and brief adjunctive treatments), and school- or community-based psychosocial interventions (13 studies; social network interventions, school-based skills interventions, suicide awareness or gatekeeper programs, and community-based, culturally tailored adjunct programs). Dialectical behavior therapy showed moderate strength of evidence for reducing suicidal ideation. Other categories of psychosocial treatments showed insufficient to low strength of evidence for reducing suicidal outcomes. None of the studies evaluated adverse events. The evidence base on pharmacologic treatment for youths at risk of suicide was largely nonexistent.Conclusions and RelevanceThis systematic review found that the current evidence on available interventions targeting youths at heightened risk of suicide is uncertain. Medication, neurotherapeutics, and emerging therapies remain unstudied among this population. The limited evidence base calls for the development of novel, developmentally and trauma-informed treatments, as well as multilevel interventions to target the increasing suicide risk among youths.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"106 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182704","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":"Unexamined Effect Modification in the ACT-PAM Trial-Reply.","authors":"Yuen Yu Chong,Wai Tong Chien","doi":"10.1001/jamapediatrics.2025.3519","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.3519","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"27 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182687","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":"Modeling the Health Impact of Discontinuing COVID-19 Vaccination During Pregnancy in the US.","authors":"Nathan C Lo,Yvonne Maldonado,Helen Y Chu,Peter J Hotez,Mathew V Kiang","doi":"10.1001/jamapediatrics.2025.3561","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.3561","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"27 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182711","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":"Benefiting Us All-Population-Level Impact of the HPV Vaccine.","authors":"Teresa M Imburgia,Rachel A Katzenellenbogen","doi":"10.1001/jamapediatrics.2025.3575","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.3575","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"96 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182729","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":"Unexamined Effect Modification in the ACT-PAM Trial.","authors":"Habib Bhurawala","doi":"10.1001/jamapediatrics.2025.3516","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.3516","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"3 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182681","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":"Confronting Gaps in the Evidence for Youth Suicide Prevention-Why Inaction Is Not an Option.","authors":"Laura M Prichett,Emily E Haroz,Holly C Wilcox","doi":"10.1001/jamapediatrics.2025.3482","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.3482","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"326 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182691","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}