JAMA Network Open最新文献

{"title":"Neurodegenerative Disease Death Certification Among National Football League Players With Dementia.","authors":"Charlotte B Luster, Christopher J Nowinski, Bobak Abdolmohammadi, Evan D Feigel, Michael J Mastrodicasa, Brenna Finegan, Lee Goldstein, Douglas I Katz, Robert C Cantu, Brigid Dwyer, Yorghos Tripodis, Thor D Stein, Michael L Alosco, Ann C McKee, Jesse Mez, Daniel H Daneshvar","doi":"10.1001/jamanetworkopen.2026.31614","DOIUrl":"10.1001/jamanetworkopen.2026.31614","url":null,"abstract":"<p><strong>Importance: </strong>Researchers frequently use death certificate data to evaluate occupational risks among National Football League (NFL) players, demonstrating elevated neurodegenerative mortality risk. Robust epidemiologic data suggest deaths attributable to neurodegenerative disease (NDD) are frequently underreported on death certificates, leading to substantial underascertainment of neurodegenerative mortality. Better characterization of the factors underlying neurodegenerative death certification is critical to addressing underreporting of NDDs, informing disease surveillance and resource allocation.</p><p><strong>Objective: </strong>To elucidate clinical, exposure, and neuropathologic factors associated with neurodegenerative death certification.</p><p><strong>Design, setting, and participants: </strong>This cohort study included 202 brain donors with clinician-adjudicated dementia who underwent postmortem neuropathologic assessment and retrospective clinical assessment with informants from February 15, 2008, to December 30, 2021, to ascertain clinical and lifetime exposure history. Statistical analysis was performed from October 2025 to June 2026.</p><p><strong>Exposure: </strong>NFL career.</p><p><strong>Main outcomes and measures: </strong>Neuropathologic diagnosis based on established diagnostic criteria, as well as informant-reported clinical measures and exposure history. Multiple logistic regression analysis was conducted to examine the association between factors and NDD death certification, adjusted for age at death, race and ethnicity, and educational level.</p><p><strong>Results: </strong>Of 202 male brain donors (mean [SD] age at death, 73.1 [10.5] years) with clinician-adjudicated dementia, 62 (30.7%) had a neurodegenerative underlying cause of death listed on their death certificate. Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) Global Executive Composite T-score (odds ratio [OR], 1.04; 95% CI, 1.01-1.06), BRIEF-A Metacognition Index T-score (OR, 1.03; 95% CI, 1.01-1.06), Cognitive Difficulties Scale score (OR, 1.02; 95% CI, 1.01-1.03), and Functional Activities Questionnaire score (OR, 1.13; 95% CI, 1.06-1.21), as well as a history of emergency department treatment for head injury (OR, 4.11; 95% CI, 1.72-9.82), were associated with increased odds of neurodegenerative death certification. High Alzheimer disease neuropathology (OR, 5.27; 95% CI, 1.93-14.40), frontotemporal lobar degeneration (OR, 4.48; 95% CI, 1.61-12.50), Braak stage IV to VI (OR, 2.99; 95% CI, 1.54-5.79), frequent diffuse plaques (OR, 4.21; 95% CI, 1.56-11.38), moderate to severe neuritic plaques (OR, 3.42; 95% CI, 1.55-7.54), and Thal phase 4 (OR, 4.50; 95% CI, 1.39-14.60) were associated with increased odds of neurodegenerative death certification.</p><p><strong>Conclusions and relevance: </strong>This cohort study found that only 30.7% of brain donors with clinician-adjudicated dementia had neurodegenerative death cert","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 9","pages":"e2631614"},"PeriodicalIF":11.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13535785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuropsychological Profile of Autopsy-Confirmed Chronic Traumatic Encephalopathy.","authors":"Anna Aaronson, Sophia B Nosek, Bobak Abdolmohammadi, Jadeynne Hadley, Jacob Labonte, Madeline Uretsky, Sydney Mosaheb, Christopher J Nowinski, Caroline Altaras, Breton M Asken, Sarah J Banks, William B Barr, Kristen Dams-O'Connor, Gabrielle Hromas, Monica T Ly, Jennifer V Wethe, Brett M Martin, Joseph N Palmisano, Robert A Stern, Yorghos Tripodis, Thor D Stein, Ann C McKee, Jesse Mez, Michael L Alosco","doi":"10.1001/jamanetworkopen.2026.31754","DOIUrl":"10.1001/jamanetworkopen.2026.31754","url":null,"abstract":"<p><strong>Importance: </strong>Chronic traumatic encephalopathy (CTE) is a neurodegenerative tauopathy associated with repetitive head impact exposure. CTE can only be diagnosed post mortem, and the antemortem neuropsychological profile is poorly understood, hindering accurate diagnosis before death.</p><p><strong>Objective: </strong>To characterize antemortem neuropsychological test performance of former National Football League (NFL) players with autopsy-confirmed CTE.</p><p><strong>Design, setting, and participants: </strong>This retrospective case series included former NFL players who completed an antemortem neuropsychological evaluation and had autopsy-confirmed CTE. Data were collected between January 1, 2017, and April 30, 2025. Statistical analysis was performed from September 2025 to June 2026.</p><p><strong>Exposure: </strong>CTE neuropathology, defined by the National Institute of Neurological Disorders and Stroke/National Institute of Biomedical Imaging and Bioengineering consensus panel.</p><p><strong>Main outcomes and measures: </strong>Neuropsychological test performance, neuropathologic diagnoses, and semiquantitative phosphorylated tau (p-tau) pathology across 11 brain regions were examined. Raw scores were converted to z scores using age, sex, and/or education level-based normative data. Test results with z scores of -1.5 or less were categorized as impaired; domains with 2 or more impaired test results were considered impaired.</p><p><strong>Results: </strong>The primary analytic sample included 33 men (mean [SD] age at death, 65.4 [13.3] years; mean [SD] time between testing and death, 2.4 [1.6] years), 25 with high- and 8 with low-stage CTE. Learning and memory was most impaired (17 of 27 [63.0%]), followed by executive function (15 of 29 [51.7%]) and language (12 of 29 [41.4%]). High-stage CTE participants generally had worse scores than low-stage CTE participants. Greater global p-tau burden was associated with worse learning and memory performance (B = -0.40; 95% CI, -0.70 to -0.09; P = .01). Findings were similar after excluding 9 participants with co-occurring Alzheimer disease or frontotemporal lobar degeneration tau.</p><p><strong>Conclusions and relevance: </strong>In this retrospective case series of NFL players with autopsy-confirmed CTE, memory, executive function, and language impairments were common, and p-tau burden was associated with worse memory performance. Findings provide insight into the expected CTE neuropsychological profile and may help advance diagnosis before death.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 9","pages":"e2631754"},"PeriodicalIF":11.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13539398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Historical Redlining and Spatiotemporal Patterns in Breast Cancer Screening.","authors":"Md Atikur Rahman, Isuru Ratnayake, Sam Pepper, Derrick Asante, Brahian Cano Urrego, Susan Beckman, Leah Lambart, Dinesh Pal Mudaranthakam","doi":"10.1001/jamanetworkopen.2026.30685","DOIUrl":"10.1001/jamanetworkopen.2026.30685","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Geographic variation in breast cancer screening may reflect persistent structural inequities in access to preventive care. Understanding whether historical redlining remains associated with screening, independent of contemporary social vulnerability, neighborhood conditions, and geographic access, is critical for targeting interventions within cancer center catchment areas.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To examine the association between historical redlining and breast cancer screening prevalence, accounting for social vulnerability, neighborhood characteristics, and geographic access, and to characterize spatiotemporal screening patterns.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cohort study used Census tract-level data from 2016 to 2024 across the University of Kansas Cancer Center catchment area, including communities in Kansas and adjacent Missouri counties. The analytic sample included Census tracts with available Homeowners' Loan Corporation (HOLC) grades A (indicating the least redlining) to D (indicating the most redlining). Statistical analysis was performed from July to December 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;HOLC grades; Social Vulnerability Index quintiles (with the first quintile indicating the lowest vulnerability and the fifth quintile indicating the highest); Census tract-level socioeconomic, housing, and transportation indicators; and distance to the nearest mammography facility.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Census tract-level breast cancer screening prevalence from the Centers for Disease Control and Prevention's PLACES database, reported as odds ratios (ORs) with 95% credible intervals (CrIs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 1152 historically redlined Census tracts were analyzed. Tracts were categorized by HOLC grades A (n = 27), B (n = 99), C (n = 423), and D (n = 603). The median (IQR) screening prevalence was highest in grade A tracts (79.6% [79.0%-80.0%]) and lowest in grade D tracts (75.2% [71.7%-79.2%]). Models demonstrated substantial spatial and temporal dependence with geographic clustering and localized variability. Compared with grade A tracts, grade C (OR, 0.94; 95% CrI, 0.90-0.99) and grade D tracts (OR, 0.94; 95% CrI, 0.89-0.99) had lower screening prevalence after adjustment. The highest Social Vulnerability Index quintile was associated with increased screening odds (OR, 1.08; 95% CrI, 1.01-1.14). Lower educational attainment (OR, 0.94; 95% CrI, 0.92-0.96) and higher mobile home prevalence (OR, 0.98; 95% CrI, 0.97-1.00) were associated with lower screening odds. Residual spatial heterogeneity persisted (711 of 1152 tracts [61.7%] excluding the null). Screening peaked in 2018 to 2019, stabilized through 2023, and declined in 2024, with most areas remaining below the Healthy People 2030 target of 80.3%.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;This study found that historical redlining was associated with ","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 9","pages":"e2630685"},"PeriodicalIF":11.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13539404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opioid Dispensing Volume and Per-Patient Intensity in Sickle Cell Disease.","authors":"Kevin Y Xu, Brandon K Attell, Joanna L Buss, Tashalee R Brown, Charles R Jonassaint, Richard A Grucza, Allison A King, Max Jordan Nguemeni Tiako","doi":"10.1001/jamanetworkopen.2026.32141","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.32141","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Opioids remain central to management of acute and chronic pain in sickle cell disease (SCD). Opioid dispensing declined over the 2010s amid opioid stewardship efforts, but patterns since 2020 are less clear. Analyses aggregating opioids into morphine milligram equivalents (MME) may obscure agent-specific patterns.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To characterize opioid dispensing volume and per-recipient frequency, duration, and dose among individuals with SCD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;A retrospective cohort study of commercially insured and Medicaid-enrolled patients with SCD using the Merative MarketScan databases across 3 periods from January 2011 to February 2016, March 2016 to December 2020, and January 2021 to December 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Calendar time across 3 prespecified periods: January 2011 to February 2016, March 2016 to December 2020, and January 2021 to December 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Changes in opioid dispensing were examined across 3 periods (January 2011 to February 2016, March 2016 to December 2020, and January 2021 to December 2023). Segmented regression models estimated monthly percentage changes (MPCs) in 4 outcomes: (1) total dispensed prescriptions per 100 enrollees; and, among enrollees receiving opioids, (2) mean prescriptions per person, (3) mean days supplied, and (4) mean daily MMEs. Analyses included 6 opioids (hydromorphone, hydrocodone, morphine, tramadol, oxycodone, methadone) stratified by insurance type (commercial vs Medicaid).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Across 48 760 individuals with SCD contributing person-time, 24 692 (50.6%) were Medicaid beneficiaries, 20 969 (43.0%) were aged 19 to 40 years, and 29 380 (60.3%) were female. From January 2021 through December 2023, total dispensing increased for all 6 agents among Medicaid beneficiaries, with the largest monthly increases for methadone (MPC, 1.76%; 95% CI, 1.24% to 2.29%) and hydromorphone (MPC, 1.43%; 95% CI, 1.00% to 1.86%). Among commercial enrollees, total dispensing increased for oxycodone (MPC, 0.84%; 95% CI, 0.60% to 1.07%) and morphine (MPC, 0.87%; 95% CI, 0.42% to 1.33%), was stable for hydrocodone, hydromorphone, and methadone, and declined for tramadol (MPC, -0.79%; 95% CI, -1.16% to -0.42%). Dispensed prescriptions increased only for oxycodone among commercially insured individuals (MPC, 0.14%; 95% CI, 0.08% to 0.20%) and tramadol among those with Medicaid (MPC, 0.96%; 95% CI, 0.56% to 1.36%). Mean days supplied and mean daily MMEs did not significantly increase for any opioid-insurance combination.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;Among individuals with SCD, total opioid dispensing increased or stabilized during 2021 to 2023 after prior declines, most prominently among Medicaid beneficiaries, without broad increases in per-recipient frequency, duration, or dose. These patterns are consistent with broader di","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 9","pages":"e2632141"},"PeriodicalIF":11.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891628","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":"Artificial Intelligence-Generated Discharge Dates and Estimation Accuracy in Hospitalized Patients.","authors":"Havish S Kantheti, Connor Dolan, Jordan Dale","doi":"10.1001/jamanetworkopen.2026.32033","DOIUrl":"10.1001/jamanetworkopen.2026.32033","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 9","pages":"e2632033"},"PeriodicalIF":11.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Large Language Models and Adverse Event Detection Within Immunotherapy Clinical Trials.","authors":"Marianna V Elia, Isabel D Friesner, Daniel Kwon, Lisa Ni, Sumi Sinha, Yuta Ishiyama, Travis Zack, Mark Bridge, Lawrence Fong, Julian C Hong","doi":"10.1001/jamanetworkopen.2026.31840","DOIUrl":"10.1001/jamanetworkopen.2026.31840","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 9","pages":"e2631840"},"PeriodicalIF":11.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moving From Depression Screening Mandates to Systems of Care.","authors":"Diana Montoya-Williams, Leo Velosa, Erika G Cordova-Ramos","doi":"10.1001/jamanetworkopen.2026.31207","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.31207","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 9","pages":"e2631207"},"PeriodicalIF":11.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880491","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":"Regional Variation in Bladder Cancer Clinical Trial Availability in the US.","authors":"Koral U Shah, Salvador Jaime-Casas, Ruchi Agarwal, George Zhang, Xiaochen Li, Vitor Abreu de Goes, Daniela V Castro, Benjamin Mercier, Ruth Simon, Samuel Dickter, Lily M Lau, Jaya Goud, Akasha Dukkipati, Jadon Fann, Lauren Lau, Joshua Lee, Kyra Shah, Ethan Swarat, Miguel Zugman, Nazli Dizman, Ali Moradi, Regina Barragan-Carrillo, Abhishek Tripathi, Charles B Nguyen, Alex Chehrazi-Raffle, Sumanta K Pal","doi":"10.1001/jamanetworkopen.2026.32012","DOIUrl":"10.1001/jamanetworkopen.2026.32012","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Geographic disparities in cancer clinical trial access are well described in the US, but patterns in bladder cancer remain poorly defined.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate bladder cancer trial availability across US counties and its associations with epidemiologic and socioeconomic factors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cross-sectional study of completed, open, or active bladder cancer clinical trials from June 1, 2019, to June 1, 2025, on ClinicalTrials.gov used data on county-level incidence, mortality, and Social Vulnerability Index (SVI) obtained from the Centers for Disease Control and Prevention, the National Cancer Institute, and the Agency for Toxic Substances and Disease Registry and included interventional bladder cancer clinical trials of adults at 1 or more US sites. Data were analyzed from July 1, 2025, to October 20, 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Epidemiologic and socioeconomic characteristics of bladder cancer clinical trials.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome and measures: &lt;/strong&gt;Trial availability was defined as 1 or more bladder cancer trial sites per county. Trial volume (number of unique trials per county) was modeled using a multivariable zero-inflated negative binomial regression and reported as incidence rate ratios. Associations between trial characteristics and location in highest vs lowest bladder cancer mortality quintile counties were assessed using a generalized linear mixed-effects logistic regression model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study identified 436 bladder cancer trials across 713 US counties. Of 3145 counties, 713 (22.7%) had 1 or more trial sites, and 2432 (77.3%) had none. Most trials were sponsored by pharmaceutical companies (211 [48.4%]) or academic institutions (170 [39%]). Most trials were drug focused (350 [80.2%]) and early phase (phase 1 or phase 2; 314 [72%]). Higher bladder cancer incidence was associated with higher trial rates (incidence rate ratio [IRR], 1.03; 95% CI, 1.003-1.06). A higher bladder cancer mortality rate was associated with lower trial rates (IRR, 0.80; 95% CI, 0.73-0.88). Compared with counties with a high SVI, trial rates were higher in counties with a lower-middle (IRR, 1.57; 95% CI, 1.18-2.08), middle-high (IRR, 1.60; 95% CI, 1.22-2.11), and low SVI (IRR, 2.53; 95% CI, 1.89-3.38). Of 7091 trial sites, 225 (3.2%) were located in counties in the highest quintile for bladder cancer mortality. Pharmaceutical company-sponsored trials were less likely than academic trials to be in counties with the highest mortality rate (odds ratio, 0.11; 95% CI, 0.04-0.29; P &lt; .001), as were trials enrolling fewer than 100 participants compared with more than 100 participants (odds ratio, 0.20; 95% CI, 0.09-0.46; P &lt; .001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this cross-sectional study of 436 bladder cancer clinical trials across US counties, most counties lacked trials, with geographic av","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 9","pages":"e2632012"},"PeriodicalIF":11.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unhealthy Food Television Advertising and Body Weight in Mexican Children.","authors":"Alexis Alonso-Bastida, Ana Basto-Abreu, Francisco Reyes-Sánchez, Alan Reyes-García, Martha Carnalla, C Gabriela García, Lizbeth Tolentino-Mayo, Francesca R Dillman Carpentier, Juan A Rivera, Tonatiuh Barrientos-Gutiérrez","doi":"10.1001/jamanetworkopen.2026.31619","DOIUrl":"10.1001/jamanetworkopen.2026.31619","url":null,"abstract":"<p><strong>Importance: </strong>Exposure to television advertisements for unhealthy food and beverages has been associated with poor dietary habits and childhood obesity. In Mexico, most school-aged children are regularly exposed to advertisements.</p><p><strong>Objective: </strong>To examine the association of removing television advertisements of unhealthy food and beverages with body weight among school-aged youth.</p><p><strong>Design, setting, and participants: </strong>This decision analytical model used a simulation model based on nonlinear differential equations to estimate 1-year changes in energy intake and obesity by removing television advertisements for unhealthy foods among children and adolescents aged 10 to 17 years. The study used national, representative survey waves from 2022 and 2023 (data collected between September and December of each year) of nonpregnant, nonlactating youths aged 10 to 17 years in Mexico with a plausible body mass index. Data were analyzed from May to December 2025.</p><p><strong>Exposure: </strong>Complete removal of television advertisements for unhealthy foods and beverages was simulated. For the main scenario, we assumed the intervention would apply to all children and adolescents exposed to television advertising (79.2%) regardless of the time of exposure. Sensitivity analyses varied adherence (30%-100%) and assumed a dose response between exposure time to advertisements and energy intake.</p><p><strong>Main outcomes and measures: </strong>Primary outcomes were changes in daily energy intake, body weight, body mass index, obesity prevalence, and obesity cases.</p><p><strong>Results: </strong>The analytic sample included 2834 children and adolescents, representing 17 735 608 individuals, with mean television viewing time of 99.8 min/d (95% CI, 92.5-107.2 min/d) and mean daily exposure to unhealthy food advertising of 2.8 min/d (95% CI, 2.6-3.0) min/d. Removing advertisements resulted in a projected mean decrease of 47 kcal/d (95% uncertainty interval [UI], 3-92 kcal/d), leading to a mean weight reduction of 1.2 kg (95% UI, 0.1-2.2 kg) per child in 1 year. Obesity prevalence decreased by 8.3% (95% UI, 0.3%-18.1%), equivalent to 271 000 cases averted. Results assumed no increase in digital marketing.</p><p><strong>Conclusions and relevance: </strong>In this decision analytical model, removing unhealthy food and beverage advertisements from television was associated with a substantial reduction in body weight and obesity among children and adolescents in Mexico. These results suggest that strong legislation should be prioritized to protect child health.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 9","pages":"e2631619"},"PeriodicalIF":11.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13535789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal Body Mass Index, Gestational Weight Gain, and Cardiovascular Disease in Offspring.","authors":"Hui Wang, Jette Möller, Yajun Liang, Imre Janszky, Krisztina D László","doi":"10.1001/jamanetworkopen.2026.31324","DOIUrl":"10.1001/jamanetworkopen.2026.31324","url":null,"abstract":"<p><strong>Importance: </strong>The long-term association of maternal body mass index (BMI) in early pregnancy and gestational weight gain (GWG) with offspring cardiovascular disease (CVD) risk remains unclear.</p><p><strong>Objective: </strong>To analyze the associations of maternal BMI and GWG with offspring CVD risk.</p><p><strong>Design, setting, and participants: </strong>This cohort study used data from national registers in Sweden for individuals born from January 1, 1982, to December 31, 2014. Participants were followed up from birth until the first diagnosis of CVD, death, emigration from Sweden, or December 31, 2023, whichever came first. Data were analyzed from February 1, 2025, to June 16, 2026.</p><p><strong>Exposures: </strong>Data were obtained on maternal BMI in early pregnancy and GWG from the Swedish Medical Birth Register. BMI was categorized as underweight (<18.5), normal weight (18.5-24.9), overweight (25.0-29.9), and obesity classes 1 (30.0-34.9), 2 (35.0-39.9), and 3 (≥40.0). GWG was standardized for gestational age into z scores.</p><p><strong>Main outcome and measures: </strong>Data on offspring CVD were retrieved from the Patient Register and the Cause of Death Register. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs. Sibling analyses were conducted to assess the potential association of shared familial factors.</p><p><strong>Results: </strong>Among 2 496 335 offspring, 1 283 648 (51.4%) were male. At the end of follow-up, the mean (SD) age of the offspring was 23.3 (9.8) years. During a median (IQR) follow-up of 22.0 (14.7-30.4) years, 22 510 offpsring (0.9%) were diagnosed with CVD. Compared with offspring of mothers with normal BMI, the CVD HRs were 1.29 (95% CI, 1.24-1.33) for maternal overweight, 1.66 (95% CI, 1.57-1.75) for maternal obesity class 1, 2.16 (95% CI, 1.96-2.39) for maternal obesity class 2, and 2.74 (95% CI, 2.29-3.28) for maternal obesity class 3. Greater GWG was associated with higher CVD risk across BMI groups; among offspring of mothers with normal BMI, the HR for higher GWG (z score ≥1) was 1.16 (95% CI, 1.09-1.22). In the sibling analyses, higher maternal BMI and GWG were associated with attenuated risk of offspring CVD, but the associations remained generally evident.</p><p><strong>Conclusions and relevance: </strong>This Swedish national cohort study found that high maternal BMI and greater GWG were associated with increased risks of early-onset offspring CVD, highlighting the importance of managing maternal weight during pregnancy.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 9","pages":"e2631324"},"PeriodicalIF":11.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13535790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}