JAMA Network Open最新文献

IF 10.5 1区医学

JAMA Network Open Pub Date : 2025-04-01 DOI: 10.1001/jamanetworkopen.2025.3466

Andre C Kalil, Anum Abbas, Sias J Scherger

引用次数: 0

Fine Particulate Matter From 2020 California Wildfires and Mental Health-Related Emergency Department Visits.

IF 10.5 1区医学

JAMA Network Open Pub Date : 2025-04-01 DOI: 10.1001/jamanetworkopen.2025.3326

Youn Soo Jung, Mary M Johnson, Marshall Burke, Sam Heft-Neal, Melissa L Bondy, R Sharon Chinthrajah, Mark R Cullen, Lorene Nelson, Caleb Dresser, Kari C Nadeau

{"title":"Fine Particulate Matter From 2020 California Wildfires and Mental Health-Related Emergency Department Visits.","authors":"Youn Soo Jung, Mary M Johnson, Marshall Burke, Sam Heft-Neal, Melissa L Bondy, R Sharon Chinthrajah, Mark R Cullen, Lorene Nelson, Caleb Dresser, Kari C Nadeau","doi":"10.1001/jamanetworkopen.2025.3326","DOIUrl":"10.1001/jamanetworkopen.2025.3326","url":null,"abstract":"Importance: A growing body of research suggests that exposure to fine particulate matter (PM2.5; particle size 2.5 microns or smaller) may be associated with mental health outcomes. However, the potential impact of wildfire-specific PM2.5 exposure on mental health remains underexplored.Objective: To investigate whether wildfire-specific PM2.5 exposure may be associated with emergency department (ED) visits for mental health conditions, including all-cause and for psychoactive substance use, nonmood psychotic disorders, anxiety, depression, and other mood-affective disorders during the extensive 2020 California wildfire season.Design, setting, and participants: This cross-sectional study used data on ED visits from July to December 2020 obtained from the California Department of Health Care Access and Information (HCAI). Eligible participants were California residents who presented to an ED in California for mental health conditions without COVID-19. The data were analyzed between July 2020 and December 2020.Exposure: Wildfire-specific PM2.5 exposure (with up to 7-day lags) based on participants' residential zip codes.Main outcomes and measures: Daily ED visit counts for all-cause and disease-specific mental health conditions (F00-F99) identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes at zip code tabulation areas.Results: Between July and December 2020, there were 86 609 ED visits for mental health conditions (median [IQR] patient age, 38 [27-54] years; 40 272 female [46.5%]; 10 657 Black [12.3%], 30 044 Hispanic [34.7%], 35 145 White [40.6%]). Visits included psychoactive substance use (23 966 [27.6%]), nonmood psychotic disorders (16 714 [19.3%]), anxiety (26 711 [30.8%]), depression (10 422 [12.0%]), and other mood-affective disorders (5338 [6.2%]). During peak wildfire months, the median (IQR) daily concentration of wildfire-specific PM2.5 increased to 11.9 (3.9-32.5) μg/m3. A 10-μg/m3 increase in wildfire-specific PM2.5 was associated with higher ED visits for all-cause mental conditions (cumulative relative risk [cRR] over lag 0-7 days, 1.08; 95% CI, 1.03-1.12), depression (cRR over lag 0-7 days, 1.15; 95% CI, 1.02-1.30), other mood-affective disorders (cRR over lag 0-7 days, 1.29; 95% CI, 1.09-1.54), and anxiety (cRR over lag 0-4 days, 1.06; 95% CI, 1.00-1.12). Subgroup analyses suggested that wildfire smoke was associated with disproportionately increased ED visits among female individuals (eg, depression: cRR over lag 0-4 days, 1.17; 95% CI, 1.03-1.32) and young people (other mood-affective disorders: cRR over lag 0-4 days, 1.46; 95% CI, 1.08-1.98). Effect modification by race was found, with non-Hispanic Black individuals having an increased risk of ED visits for other mood-affective disorders (cRR over lag 0-5 days, 2.35;","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e253326"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11971671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780096","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}

引用次数: 0

Therapeutic Benefit of Top-Selling Oncology Drugs in Medicare. 医疗保险中最畅销肿瘤药物的治疗效果。

IF 10.5 1区医学

JAMA Network Open Pub Date : 2025-04-01 DOI: 10.1001/jamanetworkopen.2025.3323

Stephanie Wang, Alexander C Egilman, Georg Hahn, Aaron S Kesselheim

引用次数: 0

Cytokine Storms in COVID-19, Hemophagocytic Lymphohistiocytosis, and CAR-T Therapy.

IF 10.5 1区医学

JAMA Network Open Pub Date : 2025-04-01 DOI: 10.1001/jamanetworkopen.2025.3455

James P Long, Rishab Prakash, Paul Edelkamp, Mark Knafl, Anath C Lionel, Ranjit Nair, Sairah Ahmed, Paolo Strati, Luis E Malpica Castillo, Ajlan Al-Zaki, Kelly Chien, Dai Chihara, Jason Westin, Fareed Khawaja, Loretta J Nastoupil, Victor Mulanovich, Andrew Futreal, Scott E Woodman, Naval G Daver, Christopher R Flowers, Sattva Neelapu, Joanna-Grace Manzano, Swaminathan P Iyer

{"title":"Cytokine Storms in COVID-19, Hemophagocytic Lymphohistiocytosis, and CAR-T Therapy.","authors":"James P Long, Rishab Prakash, Paul Edelkamp, Mark Knafl, Anath C Lionel, Ranjit Nair, Sairah Ahmed, Paolo Strati, Luis E Malpica Castillo, Ajlan Al-Zaki, Kelly Chien, Dai Chihara, Jason Westin, Fareed Khawaja, Loretta J Nastoupil, Victor Mulanovich, Andrew Futreal, Scott E Woodman, Naval G Daver, Christopher R Flowers, Sattva Neelapu, Joanna-Grace Manzano, Swaminathan P Iyer","doi":"10.1001/jamanetworkopen.2025.3455","DOIUrl":"10.1001/jamanetworkopen.2025.3455","url":null,"abstract":"Importance: Cytokine storm (CS) is a hyperinflammatory syndrome causing multiorgan dysfunction and high mortality, especially in patients with malignant hematologic neoplasms. Triggers include malignant neoplasm-associated hemophagocytic lymphohistiocytosis (MN-HLH), cytokine release syndrome from chimeric antigen receptor T-cell therapy (CAR-T CRS), and COVID-19, but the underlying mechanisms of inflammation and their impact on outcomes are poorly understood.Objective: To delineate the inflammatory patterns characterizing different CS etiologies and their association with clinical outcomes.Design, setting, and participants: This retrospective cohort study was conducted at the MD Anderson Cancer Center in Houston, Texas, between March 1, 2020, and November 20, 2022, using the software-as-a-service Syntropy Foundry Platform. Participants were patients with malignant hematologic neoplasms who developed CS from COVID-19 (COVID-CS), MN-HLH, or CAR-T CRS.Exposure: Diagnostic criteria for COVID-CS were developed based on surging inflammatory markers (interleukin-6, C-reactive protein, and ferritin), while diagnosis of MN-HLH and CAR-T CRS followed established guidelines.Main outcomes and measures: The study compared cytokine levels, clinical characteristics, and survival outcomes across the 3 cohorts and focused on inflammatory markers, survival times, and key factors associated with survival identified through univariate and multivariable analyses.Results: A total of 671 patients met the inclusion criteria. Of those, 220 (33%) had CAR-T CRS, 227 (34%) had COVID-CS, and 224 (33%) had MN-HLH. Patients were predominantly male (435 [65%]), and 461 (69%) were White, with significant differences in median age (CAR-T CRS, 63 [IQR, 54-71] years; COVID-CS, 63 [IQR, 52-72] years; MN-HLH, 55 [IQR, 41-65] years; P < .001) as well as number of admission days and underlying cancer type across cohorts. Marked variations in cytokine levels and survival outcomes were observed, with the MN-HLH cohort exhibiting the highest levels of inflammatory markers (eg, median TNF-α, 105 pg/mL [IQR, 38-201 pg/mL] for MN-HLH vs 23 pg/mL [IQR, 17-42 pg/mL] for COVID-CS) and lowest fibrinogen and albumin levels. The cohort with CAR-T CRS showed substantially longer survival times compared with the cohort with COVID-CS (hazard ratio [HR], 2.93; 95% CI, 1.95-4.41) and the cohort with MN-HLH (HR, 8.12; 95% CI, 5.51-12.00). Clustering analysis showed overlapping patterns between COVID-CS and CAR-T CRS, while MN-HLH formed a distinct cluster.Conclusions and relevance: This study of CS syndromes found distinct immune responses within each cohort. The distinct clinical patterns and outcomes associated with different CS etiologies emphasize the importance of early diagnosis and timely intervention.","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e253455"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795619","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}

引用次数: 0

Health Care Practitioner Bias and Access to Inpatient Rehabilitation Services Among Survivors of Violence.

IF 10.5 1区医学

JAMA Network Open Pub Date : 2025-04-01 DOI: 10.1001/jamanetworkopen.2025.4074

Megan R Georges, Alexa Courtepatte, Alice Hibara, Jennifer Harris, Tanesha Beckford, David Wiley, Emma Weinberger, Rebecca Rudel, Elizabeth Dugan, Jonathan Jay, Elizabeth C Pino

{"title":"Health Care Practitioner Bias and Access to Inpatient Rehabilitation Services Among Survivors of Violence.","authors":"Megan R Georges, Alexa Courtepatte, Alice Hibara, Jennifer Harris, Tanesha Beckford, David Wiley, Emma Weinberger, Rebecca Rudel, Elizabeth Dugan, Jonathan Jay, Elizabeth C Pino","doi":"10.1001/jamanetworkopen.2025.4074","DOIUrl":"10.1001/jamanetworkopen.2025.4074","url":null,"abstract":"Importance: Posthospital inpatient rehabilitation is essential for many patients with traumatic injuries. However, rehabilitation centers lack transparency and oversight in their admission practices and may be influenced by health care practitioner (HCP) use of stigmatizing language in patient medical records, leading to inequities in access to care.Objectives: To examine differences in admission to inpatient rehabilitation centers for patients hospitalized for violent penetrating (VP) injuries compared with motor vehicle crash (MVC) injuries.Design, setting, and participants: This mixed-methods retrospective qualitative study used data obtained from hospital records from 2015 to 2021. Data analysis occurred between July and December 2023. The study was performed at Boston Medical Center, an urban level I trauma center. The cohort included all patients hospitalized for VP or MVC injuries who were discharged to an inpatient rehabilitation center between 2015 and 2021.Exposures: Injury type, categorized as VP or MVC.Main outcomes and measures: The primary quantitative outcome was a denial for admission to an inpatient rehabilitation center. Qualitative content analysis identified similarities and differences across injury types in the manifestations of predetermined stigmatizing language categories in patients' medical records.Results: Of 323 patients discharged to an inpatient rehabilitation center (median [IQR] age, 38 [25-59] years; 208 men [64.4%]; 29 Hispanic patients [9.0%], 118 non-Hispanic Black patients [36.5%], and 152 non-Hispanic White patients [47.1%]), 107 patients (33.1%) experienced at least 1 denial by a center before being placed (32 of 55 patients with VP injuries [58.2%] vs 75 of 268 patients with MVC injuries [28.0%]). Compared with patients with MVC injuries, patients with VP injuries had greater than 3 times the odds of experiencing a denial (odds ratio, 3.51; 95% CI, 1.93-6.48; P < .001). Medical records of patients with VP injuries had increased use of stigmatizing language that indicated culturally based or injury-related stereotyping, skepticism toward patient-reported symptoms, and heightened HCP-power dynamics contributing to unilateral decision-making.Conclusions and relevance: In this mixed-methods qualitative study of hospital patients discharged to rehabilitation centers, significant disparities in denials for admission were observed among survivors of violence, who were disproportionally Black or Hispanic. Stigmatizing language found in medical records suggested that bias within the referral process may have contributed to these disparities. These findings underscore the need for reformed clinical documentation practices and enhanced oversight of rehabilitation referral processes to promote equitable access to care.","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e254074"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803189","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}

引用次数: 0

Winter Storm Uri, Mortality, and Health Care Use of Nursing Home Residents.

IF 10.5 1区医学

JAMA Network Open Pub Date : 2025-04-01 DOI: 10.1001/jamanetworkopen.2025.4111

Brian Downer, Alexandra Holland, Shuang Li, Huiwen Xu

{"title":"Winter Storm Uri, Mortality, and Health Care Use of Nursing Home Residents.","authors":"Brian Downer, Alexandra Holland, Shuang Li, Huiwen Xu","doi":"10.1001/jamanetworkopen.2025.4111","DOIUrl":"10.1001/jamanetworkopen.2025.4111","url":null,"abstract":"Importance: Extreme weather events disproportionately affect vulnerable populations, particularly nursing home residents. In February 2021, Winter Storm Uri caused unprecedented power outages and water shortages across Texas. However, its impact on nursing home residents remains poorly understood.Objective: To assess the association of power outages and water shortages during Winter Storm Uri with mortality and health care utilization among long-stay nursing home residents in Texas.Design, setting, and participants: A retrospective cohort study of long-stay nursing home residents before and after Winter Storm Uri (February 14 to February 17, 2021) in Texas. Data analysis was conducted from March 2024 to January 2025.Exposure: Residing in a nursing home that experienced a power outage or water shortage during Winter Storm Uri.Main outcomes and measures: The outcome measures were weekly rates of mortality, clinician visits to nursing homes, emergency department (ED) visits, and hospitalizations among long-stay nursing home residents. Medicare claims were used to determine weekly mortality, clinician visits, ED visits, and hospitalizations 6 weeks before and 6 weeks after the storm. Differences-in-differences (DiD) analysis using 2-level logistic regression models estimated changes in outcomes associated with nursing home power or water loss.Results: Of 1174 nursing homes, 231 (19.7%) reported power or water outages. The sample included 45 439 long-stay residents, with 8521 in facilities with outages (mean [SD] age, 80.07 [12.21] years; 5664 female [66.47%]) and 36 918 in facilities without outages (mean [SD] age, 80.42 [11.92] years; 12 705 female [65.59%]). DiD analysis found that residents of nursing homes with outages had a 0.13% (95% CI, 0.03% to 0.23%) higher mortality rate in the 3 to 5 weeks after the storm than those without outages. There were no significant differences in clinician visits (DiD, -0.31%; 95% CI, -1.08% to 0.47%), ED visits (DiD, 0.11%; 95% CI, -0.12% to 0.34%), or hospitalizations (DiD, 0.07%; 95% CI, -0.10% to 0.23%).Conclusions and relevance: In this cohort study of nursing home residents in Texas, power and water outages during Winter Storm Uri were associated with increased mortality but not ED visits or hospitalizations, highlighting the vulnerability of nursing home residents during extreme weather events.","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e254111"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803275","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}

引用次数: 0

JAMA Network Open.

IF 10.5 1区医学

JAMA Network Open Pub Date : 2025-04-01 DOI: 10.1001/jamanetworkopen.2025.8158

引用次数: 0

Psilocybin Dispensaries and Online Health Claims in Canada. 加拿大的迷幻剂药房和在线健康声明。

IF 10.5 1区医学

JAMA Network Open Pub Date : 2025-04-01 DOI: 10.1001/jamanetworkopen.2025.2853

Jenna Matsukubo, Sarah Dickson, Jennifer Xiao, Erik Loewen Friesen, Marco Solmi, Jess G Fiedorowicz, Benedikt Fischer, Daniel T Myran

{"title":"Psilocybin Dispensaries and Online Health Claims in Canada.","authors":"Jenna Matsukubo, Sarah Dickson, Jennifer Xiao, Erik Loewen Friesen, Marco Solmi, Jess G Fiedorowicz, Benedikt Fischer, Daniel T Myran","doi":"10.1001/jamanetworkopen.2025.2853","DOIUrl":"10.1001/jamanetworkopen.2025.2853","url":null,"abstract":"Importance: There is growing societal interest in and use of psilocybin. While psilocybin in Canada is illegal outside of clinical trials, there have been anecdotal reports of increasing access via unregulated online purchases and retail dispensaries.Objective: To describe access to and the characteristics of psilocybin dispensaries across Canada and the health claims and warnings made on dispensary websites.Design, setting, and participants: This cross-sectional study used systematic web searches and media reports to identify psilocybin dispensaries operating in Canada in May 2024. Data analysis was performed from June 17 to August 29, 2024.Main outcomes and measures: Descriptive and geospatial analyses were used to identify the psilocybin dispensary characteristics, product types, and store distribution. Content analysis assessed the nature and frequency of health claims and warnings on websites.Results: As of May 2024, 57 psilocybin dispensaries were identified in Canada (0.18 dispensaries per 100 000 individuals aged ≥15 years) in 15 of Canada's 42 major urban cities (35.7%). Approximately 815 628 (2.6%) of Canadians lived within 1 km of a dispensary. Only 4 of 13 provinces and territories had a dispensary, with most in Ontario and British Columbia. Of the 57 stores, 35 (61.4%) were part of a chain (≥2 stores owned by a single company) and 52 (91.2%) had an online presence. Stores sold a wide variety of products, including dried mushrooms (100.0%), microdosing capsules (97.8%), psilocybin-infused chocolate (91.3%) and gummies (93.4%), and most stores (65.2%) sold products mimicking popular food brands. Among stores with websites, 86.4% claimed mental health benefits of psilocybin (eg, alleviating anxiety). While 86.4% of websites provided health warnings, relevant warnings, such as those about use while driving (9.1%), during pregnancy (13.6%), or in individuals with a history of psychosis, schizophrenia, or bipolar disorder (31.8%) were rare.Conclusions and relevance: In this study, psilocybin retailers, who were present in over a third of major Canadian cities, made a variety of unverified health claims and lacked warnings of potential harms, suggesting the need for greater regulatory measures to protect the public.","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e252853"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752770","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}

引用次数: 0

Adolescent and Young Adult Cancer Representation in Claims Data.

IF 10.5 1区医学

JAMA Network Open Pub Date : 2025-04-01 DOI: 10.1001/jamanetworkopen.2025.3281

Jacob N Stein, Christopher Baggett, Jennifer L Lund, Hannah C Winslow, KyungSu Kim, Katherine E Reeder-Hayes

引用次数: 0

Moving Closer to Personalized Cancer Prevention Strategies by Assessing Comorbidity and Multimorbidity.

IF 10.5 1区医学

JAMA Network Open Pub Date : 2025-04-01 DOI: 10.1001/jamanetworkopen.2025.3476

Siran M Koroukian, Uriel Kim, Johnie Rose

引用次数: 0