JAMA Network Open最新文献

{"title":"Geographic and Temporal Differences in Sickle Cell Disease Hospitalizations in New York State.","authors":"Chukwuemeka Iloegbu, Jonathan Odumegwu, Joyce Gyamfi, John Patena, Dorice Vieira, Xinyu Wang, Etornam Amesimeku, Prince Amegbor, Andrew Campbell, Folasade Ogunlesi, Uju Ozoh, Emmanuel Peprah","doi":"10.1001/jamanetworkopen.2026.10045","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.10045","url":null,"abstract":"<p><strong>Importance: </strong>Sickle cell disease (SCD) disproportionately affects racial and ethnic minority groups in the US and is associated with high levels of morbidity and health care utilization. However, population-level geographic differences and temporal variation in SCD hospitalization outcomes remain incompletely characterized.</p><p><strong>Objective: </strong>To assess temporal and regional patterns of SCD hospitalizations in New York State from 2009 through 2022.</p><p><strong>Design, setting, and participants: </strong>This retrospective cross-sectional study analyzed inpatient SCD hospitalizations recorded in the New York State Statewide Planning and Research Cooperative System deidentified database between January 1, 2009, and December 31, 2022. The analytic sample included 42 271 hospitalizations after exclusion of records with missing demographic, cost, or facility information. Data analysis was conducted from July 17, 2024, to February 14, 2025.</p><p><strong>Exposures: </strong>Hospitalization with SCD across 8 state-defined health service areas.</p><p><strong>Main outcomes and measures: </strong>Outcomes included regional distribution of hospitalizations, mean length of stay, mean total charges, and trends in severity of illness and risk of mortality as defined by the All Patient Refined Diagnosis Related Groups classification system. Demographic and regional distributions were compared across years and regions.</p><p><strong>Results: </strong>Among 42 271 SCD hospitalizations (21 777 female [51.5%]), most occurred among individuals identified as Black (35 318 [83.6%) compared with White (750 [1.8%]), multiracial (242 [0.6%]), and other race or ethnicity 5956 (14.1%) and were aged 18 to 29 (16 794 [39.7%]) or 30 to 49 years (13 480 [31.8%]). New York City accounted for the largest proportion of hospitalizations statewide. There were significant differences in the length of stay and total charges across service areas; Central New York had the longest mean (SD) length of stay of 6.3 (7.3) days, followed by the Hudson Valley (6.2 [7.2]) days, while Long Island had the highest mean (SD) total charges at $59 476.3 ($63 823.5). The proportion of hospitalizations classified as major severity increased from 751 of 5897 (12.7%) in 2009 to 1011 of 3709 (27.3%) in 2022, and the proportion classified as major risk of mortality increased from 170 of 5897 (2.9%) to 469 of 3709 (12.6%) during the same period. Long Island had the highest proportion of hospitalizations with major risk of mortality (93 of 970 [9.6%]), whereas New York City exhibited one of the lower proportions of major risk of mortality (1531 of 27 923 [5.5%]) despite high hospitalization volume.</p><p><strong>Conclusions and relevance: </strong>In this cross-sectional study, geographic and temporal differences in SCD hospitalization outcomes were observed across New York State during a 14-year period. These findings suggest the need for region-specific strategies to imp","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 5","pages":"e2610045"},"PeriodicalIF":9.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13135208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815378","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":"Housing Insecurity, Incident Geriatric Conditions, and Mortality in Community-Living Older Persons.","authors":"Yi Wang, Kendra Davis-Plourde, Brent Vander Wyk, Lucero G Paredes, Thomas M Gill, Robert D Becher","doi":"10.1001/jamanetworkopen.2026.9335","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.9335","url":null,"abstract":"<p><strong>Importance: </strong>Housing insecurity is a key social determinant of health, yet its association with health outcomes among older persons has been understudied.</p><p><strong>Objective: </strong>To examine the associations between housing insecurity and the development of frailty, disability, and dementia, as well as mortality.</p><p><strong>Design, setting, and participants: </strong>This prospective cohort study was based on data from the National Health and Aging Trends Study (NHATS) from 2015 to 2020. Data analysis was conducted from August 2024 to February 2026. Participants were community-living persons aged 65 years or older in the contiguous US.</p><p><strong>Exposures: </strong>Three forms of housing insecurity derived from the NHATS annual survey: poor housing affordability, poor housing quality, and poor neighborhood quality.</p><p><strong>Main outcomes and measures: </strong>The primary outcomes were time to onset of frailty, disability, and dementia, and time to death over 5 years. Geriatric conditions were obtained from the NHATS annual survey, and all-cause mortality from linked Medicare records. Discrete cause-specific hazards models accounting for the competing risk of death (equivalent to multinomial logistic regression) were used to estimate relative risk ratios (RRRs) for geriatric conditions, and time-varying Cox regression models were used to estimate hazard ratios (HRs) for mortality.</p><p><strong>Results: </strong>Among the 7499 participants (mean [SD] age, 78.2 [7.8] years; 4335 [55.3%] female), after adjustment for age, sex, race and ethnicity, education, Medicaid eligibility, household income, smoking status, and comorbidity, poor housing affordability was significantly associated with higher risks of frailty (RRR, 1.23; 95% CI, 1.01-1.49), disability (RRR, 1.24; 95% CI, 1.01-1.54), dementia (RRR, 1.37; 95% CI, 1.11-1.69), and mortality (HR, 1.51; 95% CI, 1.34-1.70). Similarly, poor housing quality was significantly associated with higher risks of frailty (RRR, 1.30; 95% CI, 1.04-1.62), disability (RRR, 1.33; 95% CI, 1.13-1.57), and mortality (HR, 1.15; 95% CI, 1.01-1.32), but not dementia (RRR, 1.16; 95% CI, 0.90-1.49). Poor neighborhood quality was not associated with any outcome in the adjusted analyses. The adjusted risk differences ranged from 1.9 percentage points (95% CI, 0.2-3.1 percentage points) for housing quality with mortality to 11.1 percentage points (95% CI, 7.9-14.3 percentage points) for housing affordability with disability.</p><p><strong>Conclusions and relevance: </strong>In this cohort study of community-living older US persons, poor housing affordability was associated with higher risks of frailty, disability, dementia, and mortality, and poor housing quality was associated with higher risks of frailty, disability, and mortality. These findings highlight housing insecurity as a clinically relevant social determinant of health among older persons.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 5","pages":"e269335"},"PeriodicalIF":9.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13135211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815398","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":"Hematopoietic Cell Transplant Access and Patient Diversity.","authors":"Rachel Cusatis, Jianqun Kou, Caitrin Bupp, Deborah Mattila, Ramzi Abboud, Sally Arai, Javier Bolaños Meade, George Carrum, Bhagirathbhai Dholaria, Fatema Fareh, Mehdi Hamadani, William J Hogan, Katarzyna Jamieson, Antonio M Jimenez Jimenez, Farhad Khimani, Amar H Kelkar, Satyajit Kosuri, Karilyn T Larkin, Monzr M Al Malki, Shannon R McCurdy, Jordan Milner, Dipenkumar Modi, Ran Reshef, Brian C Shaffer, Krithika Shanmugasundaram, Uttam Rao, Jeffrey J Auletta, Steven M Devine, Brent R Logan, Bronwen E Shaw","doi":"10.1001/jamanetworkopen.2026.10839","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.10839","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Allogeneic hematopoietic cell transplant (HCT) is curative for hematologic cancers, yet access remains inequitable for racially and ethnically underrepresented and socioeconomically disadvantaged populations, making the goal of having a suitable donor for every patient who needs a transplant challenging. The ACCESS trial broadened access by enrolling patients without matched donors, who instead received an HCT from a mismatched unrelated donor.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To compare baseline characteristics of ACCESS trial participants with participants enrolled in a similar clinical trial and a patient-reported outcome (PRO) protocol cohort.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cross-sectional study included adult participants (aged ≥18 years) from 3 cohorts-the ACCESS trial (2021-2024), BMT CTN 1703 trial (2019-2021), and Center for International Blood and Marrow Transplant Research (CIBMTR) PRO Protocol observational study (2020-2025)-who completed a baseline PRO survey. The ACCESS and PRO Protocol cohorts were stratified by conditioning intensity (myeloablative [MAC] vs reduced-intensity and nonmyeloablative [RIC/NMA]); all BMT CTN 1703 participants received RIC/NMA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Hematopoietic cell transplant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Racial and ethnic diversity, insurance type, education, and income were compared among cohorts using counts and percentages, and socioeconomic and structural disadvantage were measured using the Social Vulnerability Index and Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Baseline surveys were completed by 208 participants in the ACCESS trial (median [range] age at transplant, 62.3 [20.4-78.9] years; 108 male [51.9%]), 122 participants in the PRO Protocol study (median [range] age at transplant, 63.9 [21.1-78.0] years; 67 male [54.9%]), and 342 participants in the BMT CTN 1703 trial (median [range] age at transplant, 66.9 [20.7-78.6] years; 218 male [63.7%]). Participants in ACCESS were more racially and ethnically diverse, with 15 (7.2%), 25 (12.1%), 46 (22.2%), 110 (53.1%), and 11 (5.3%) of Asian, Black or African American, Hispanic or Latino, White, and other race and ethnicity, respectively, compared with 4 (3.3%), 2 (1.6%), 8 (6.6%) 104 (85.2%), and 4 (3.3%), respectively, in the PRO Protocol and 10 (3.0%), 0, 16 (4.8%), 302 (91.0%), and 4 (1.2%), respectively, in the BMT CTN 1703 trial. Participants in ACCESS were more likely to have Medicaid (36 [18.1%]) vs PRO Protocol (8 [6.7%]) and BMT CTN 1703 (16 [5.1%]) participants and reported lower education (some college or an associate's degree: 103 [49.5%] vs 73 [59.8%] in the PRO Protocol; postcollege education: 34 [17.3%] vs 35 [29.2%] in the PRO Protocol) and household income (&lt;$40 000 annually: 25 [24.0%] vs 8 [11.6%] in the PRO Protocol and 7 [38.9%] in the BMT CTN 1703 ","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 5","pages":"e2610839"},"PeriodicalIF":9.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837779","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":"Newborn Screening and Early Cord Blood Transplant for Mucopolysaccharidosis.","authors":"Hirotoshi Sakaguchi, Motomichi Kosuga, Tetsumin So, Yoshihiro Gocho, Sayaka Ono, Shiho Yasue, Shoji Mizuno, Sonoko Minato, Toru Higuchi, Yuka Kim, Masahiro Sekiguchi, Masaki Yamada, Takao Deguchi, Hideki Ogiwara, Kenji Kurosawa, Torayuki Okuyama, Akihiro Iguchi, Daisuke Tomizawa, Kimikazu Matsumoto","doi":"10.1001/jamanetworkopen.2026.10243","DOIUrl":"10.1001/jamanetworkopen.2026.10243","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 5","pages":"e2610243"},"PeriodicalIF":9.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13139958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815370","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":"Patient Safety Events Among Children Receiving Home Health Care.","authors":"Carolyn C Foster, Peter Walsh, Michelle High, Leo Barrera, Cara L Coleman, Margaret M Storey, Nikki Montgomery, Debbi Simmons Harris, Danny Valdez, Carol Haywood, Tara Lagu, Kathleen E Walsh, Alisa Khan, Nicole E Werner","doi":"10.1001/jamanetworkopen.2026.10321","DOIUrl":"10.1001/jamanetworkopen.2026.10321","url":null,"abstract":"<p><strong>Importance: </strong>Children with medical complexity often require complicated home care regimens, yet health care safety issues in community settings have been rarely described. Systems-level approaches to addressing patient safety in pediatric home health care (HHC) also remain nascent. Quantifying and categorizing HHC staff incidents is a first step toward preventing the occurrence of safety events in this population.</p><p><strong>Objective: </strong>To identify the rates and types of patient safety events within a US national pediatric population receiving HHC.</p><p><strong>Design, setting, and participants: </strong>This was a retrospective cohort study (September 1, 2022, to August 31, 2023) that used staff incident reports from a pediatric HHC agency with sites in 11 US states. Participants were patients aged younger than 21 years receiving HHC within the study year, excluding psychiatric HHC.</p><p><strong>Exposure: </strong>Days of HHC receipt.</p><p><strong>Main outcomes and measures: </strong>Rate and type of staff-reported patient safety events per 1000 HHC-days, reviewed by 3 trained clinician reviewers, and classified using the National Coordinating Council for Medication Error Reporting and Prevention Index.</p><p><strong>Results: </strong>This study identified 2901 children (males, 1710 [59.0%]) who received a median of 98.0 (IQR, 14.0-312.0) days of HHC. The mean (SD) age was 8.7 (5.3) years. A total of 678 incident reports were filed for 348 children (11.9%). Of these, 307 (45.3%) were patient safety events, including 168 harmful errors (54.7%), 110 nonharmful errors (35.8%), and 22 hazards (7.2%). This equated to a mean (SD) of 0.68 (4.40) patient safety events per 1000 HHC-days. Errors most frequently involved medications (108 [38.8%]) and implanted devices (91 [32.7%]). Harmful errors were most frequently related to non-pressure-related skin injuries (45 [26.8%]) and falls (30 [17.9%]). Approximately half of all errors required additional monitoring (133 [47.8%]) and 45 (16.2%) required emergency care. Patient safety events were more likely in children with invasive home ventilation compared with other types of implanted medical technology.</p><p><strong>Conclusions and relevance: </strong>In this cohort study of children receiving HHC, more than 1 in 10 had a reported incident, of which approximately half were patient safety related. This work provides new data about pediatric HHC safety. Further work should explore factors contributing to and preventing health care-related harms to children at home and include parent perspectives.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 5","pages":"e2610321"},"PeriodicalIF":9.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13139962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815408","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":"Clinical Decision Support for Chronic Kidney Disease in Primary Care: A Cluster Randomized Clinical Trial.","authors":"Xizi Zheng, Miao Hui, Hongyu Yang, Zhao Yang, Linger Tang, Youlu Zhao, Lingyi Xu, Qingqing Zhou, Jingwei Wang, Mengrui Li, Shuhong Zhu, Fengjuan Gao, Jing Li, Jicheng Lv, Li Yang","doi":"10.1001/jamanetworkopen.2026.11112","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.11112","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Optimal clinical decision support system (CDSS) implementation for chronic kidney disease (CKD) management in Chinese primary care remains undefined despite the high disease burden.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To examine whether a CDSS for CKD could improve physician behavior and patient outcomes in primary care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cluster randomized clinical trial is being conducted in Chinese primary care centers. The trial spans a 3-year period (January 1, 2023, to December 31, 2026) and is divided into 2 phases; this phase 1 analysis includes data from the initial 6-month follow-up (June 10 to December 10, 2023). Centers were stratified by size and randomized 1:1 to intervention or control. Participants are adults (aged ≥18 years) with CKD who had 2 visits or more during the 1-year screening period, all enrolled before randomization.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;Both groups received government-supported, nephrologist-delivered training on CKD management. The intervention group was additionally equipped with a CDSS embedded into the electronic health record.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcome was a 36-month composite of kidney-related and cardiovascular hospitalizations (phase 2). This phase 1 analysis evaluated 6-month process measures (ie, CKD diagnosis and renin-angiotensin-aldosterone system inhibitor or sodium-dependent glucose transporter 2 inhibitor use) and clinical outcomes (ie, blood pressure, glycated hemoglobin, and low-density lipoprotein cholesterol control).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 3390 patients (mean [SD] age, 72.0 [10.2] years; 1881 [55.5%] female) from 30 primary care centers were included (1912 in the intervention group and 1478 in the control group). Follow-up at 6 months was completed by 3055 patients (90.1%; 1743 [91.2%] in the intervention group and 1312 [88.8%] in the control group). CKD diagnosis rates increased by 21.4 (95% CI, 18.6-24.3) percentage points in the intervention group and by 27.9 (95% CI, 24.4-31.3) percentage points in the control group, with a nonsignificant between-group difference (adjusted odds ratio [AOR], 0.91; 95% CI, 0.72-1.14). Renin-angiotensin-aldosterone system inhibitor use (AOR, 0.96; 95% CI, 0.78-1.19), sodium-dependent glucose transporter 2 inhibitor use (AOR, 1.02; 95% CI, 0.78-1.32), and low-density lipoprotein cholesterol control (AOR, 1.10; 95% CI, 0.83-1.46) showed parallel improvements with no between-group differences. Blood pressure (AOR, 0.88; 95% CI, 0.71-1.09) and glycated hemoglobin (AOR, 1.22; 95% CI, 0.74-2.01) control showed no improvement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this cluster randomized trial of a CDSS for CKD in primary care, both the intervention and control groups demonstrated comparable improvements in 6-month outcomes, with no independent effect of the CDSS detected.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Trial registra","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 5","pages":"e2611112"},"PeriodicalIF":9.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838043","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":"Sustainment of Hydroxyurea Adherence in Patients With Sickle Cell Disease.","authors":"Andrew M Heitzer, Zachary Wooten, Guangjin Luo, Marsha Treadwell, Allison A King, Victor R Gordeuk, Nirmish Shah, Christina M Abrams, Sarah McCuskee, Siera Gollan, Jennifer Longoria, Jane S Hankins","doi":"10.1001/jamanetworkopen.2026.11257","DOIUrl":"10.1001/jamanetworkopen.2026.11257","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Despite established treatment guidelines and strong therapeutic benefit, hydroxyurea remains underused among patients with sickle cell disease.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess the change in self-reported hydroxyurea use (ie, taking the medication at all) and adherence (ie, the number of days taken per week) over time and to examine factors associated with the trajectory of hydroxyurea use and adherence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;Data were collected through the Sickle Cell Disease Implementation Consortium, a longitudinal, multicenter, observational cohort study that recruited patients from 8 centers across the US. Data collection occurred from 2017 to 2022, and analyses were performed from January to October 2025. Data were collected via self-report survey at baseline and 3 follow-up surveys distributed yearly. Patients with sickle cell disease of all genotypes between the ages of 15 and 45 years were included.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Sickle cell disease.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Hydroxyurea use was analyzed as a binary variable according to whether the participant was currently taking hydroxyurea. Among those taking hydroxyurea, adherence was analyzed as a continuous variable according to the number of days hydroxyurea was taken within the past week. Continuous variables were z scored to ensure model convergence, and odds ratios (ORs) are reported.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 2514 eligible participants, surveys were completed by 2207 participants at baseline, 1802 at follow-up 1, 1281 at follow-up 2, and 783 at follow-up 3. Of 2207 participants at baseline, 1265 (57.3%) were female, with a mean (SD) age of 28.06 (7.86) years. Overall rates of hydroxyurea use remained stable throughout the study (1089 of 2207 patients [49.3%] at baseline, 887 of 1802 patients [48.7%] at first follow-up, 609 of 1281 patients [47.5%] at second follow-up, and 378 of 783 patients [48.3%] at third follow-up). However, patients with HbSS/SB0-thalassemia showed declining use (790 of 1550 patients [50.9%] at baseline, 627 of 1276 patients [49.1%] at first follow-up, 429 of 905 patients [47.4%] at second follow-up, and 282 of 586 patients [48.1%] at third follow-up), whereas patients with other genotypes showed increasing use (299 of 657 patients [45.5%] at baseline, 250 of 526 patients [47.5%] at first follow-up, 168 of 352 patients [47.7%] at second follow-up, and 90 of 186 patients [48.4%] at third follow-up) across time points (OR, 0.76; 95% CI, 0.63 to 0.91; P = .004). Hydroxyurea adherence declined over time (-0.19 days/week/year; 95% CI, -0.24 to -0.14 days/week/year; P &lt; .001). Executive difficulties were associated with worse adherence across time points (-0.17 days/week/year; 95% CI, -0.26 to -0.08 days/week/year; P &lt; .001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this cohort study of patients with sickle cell disease, declining use ","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 5","pages":"e2611257"},"PeriodicalIF":9.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837986","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":"Impact of Cannabis Edibles Combined With Alcohol on Driving, Field Sobriety Performance, and Subjective Effects: A Within-Participant Crossover Trial.","authors":"C Austin Zamarripa, Spencer Lin, McKenna Klausner, Kriti Rastogi, Daniel J O Roche, Matthew Novak, Denis Antoine, David Wolinsky, Thomas D Marcotte, Elise M Weerts, Ryan Vandrey, Tory R Spindle","doi":"10.1001/jamanetworkopen.2026.9842","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.9842","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Simultaneous cannabis and alcohol use (co-use) is a public safety concern. Controlled data on the effects of co-ingestion of oral cannabis products (edibles) with alcohol are lacking, despite an increased prevalence of this behavior.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the individual and interactive effects of cannabis edibles and alcohol on simulated driving and subjective and objective impairment measures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This within-participant, double-blind, double-dummy crossover study of healthy adults included 7 outpatient sessions, separated by 1 week, at Johns Hopkins University School of Medicine from February 2022 to August 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Intervention: &lt;/strong&gt;Brownies containing 0 mg, 10 mg, or 25 mg Δ9-tetrahydrocannabinol (THC) combined with placebo drinks or alcohol-containing drinks, calculated to achieve breath alcohol concentrations (BrACs) of 0%, 0.05%, or 0.08%.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Driving outcomes included the global drive score (GDS), a composite index of multiple driving measures, and the standard deviation of lateral position as the main outcomes. Other outcomes included cumulative impairment clues on standardized field sobriety tests (SFSTs), subjective drug effects, cognitive and psychomotor performance (using the DRUID [Driving Under the Influence of Drugs] application), and blood cannabinoid concentrations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Participants included 25 healthy adults (15 males [60%]; mean [SD] age, 25.6 [4.9] years) who reported recent binge drinking, prior cannabis and alcohol co-use, and fewer than 3 cannabis uses per week. Compared with placebo, all active drug conditions except 10 mg THC negatively impacted driving performance (ie, GDS). Driving impairment from alcohol alone at 0.08% BrAC was comparable with that of 0.05% BrAC and 10 mg THC (mean [SD] GDS, 1.6 [1.6] vs 1.6 [1.4]) and significantly lower than 0.05% BrAC and 25 mg THC (mean [SD] GDS, 2.5 [1.7]; P = .02). Driving impairment and subjective intoxication (eg, confidence to drive) were often greater under co-use conditions compared with cannabis or alcohol alone. Relative to placebo, SFST performance worsened at 0.08% BrAC (mean [SD] score, 2.2 [2.2] vs 0.2 [1.3]; P = .008) but not in several other conditions in which marked driving decrements were observed. THC and metabolite pharmacokinetics were not influenced by alcohol.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this crossover trial of healthy adults who co-used cannabis and alcohol, cannabis edibles combined with alcohol augmented driving impairment. The legal alcohol intoxication limit in most of the US (0.08% BrAC) may be too liberal if a driver has co-used cannabis and alcohol. In this era of expanding cannabis legalization, there is a pressing public health need for improved impairment detection strategies and consideration of cannabis and alcohol co-use i","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 5","pages":"e269842"},"PeriodicalIF":9.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13135220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815329","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":"Adjuvanted vs High-Dose Influenza Vaccines in Older US Adults: A Cluster Randomized Crossover Study.","authors":"Amber Hsiao, Thomas Leong, Bruce Fireman, John Hansen, Ousseny Zerbo, Karen B Jacobson, Lauren D Liao, Mendel D M Haag, Ian McGovern, Bin Zhang, Juliet Dang, Nicola P Klein","doi":"10.1001/jamanetworkopen.2026.10120","DOIUrl":"10.1001/jamanetworkopen.2026.10120","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;In the US, adjuvanted or higher-dose influenza vaccines are preferentially recommended for annual use among adults aged 65 years or older. Adjuvanted and high-dose influenza vaccines have not been compared in a pragmatic randomized study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess the relative vaccine effectiveness (rVE) of adjuvanted vs high-dose inactivated influenza vaccine against polymerase chain reaction (PCR)-confirmed influenza in older adults at Kaiser Permanente Northern California (KPNC).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;In this cluster randomized crossover study, during the 2023 to 2024 influenza season, 65 KPNC facilities were cluster randomized such that approximately half of facilities administered adjuvanted and half high-dose influenza vaccine on the first week of the vaccination season (and thereafter every facility crossed over and alternated formulations weekly). Using Cox proportional hazards regression on a calendar time scale, the rVE of adjuvanted vs high-dose vaccine was estimated for each outcome as 1 minus the hazard ratio, adjusted for age, sex, race and ethnicity, comorbidities, and health care utilization. Study participants included all adults 65 years or older who were vaccinated with adjuvanted or high-dose inactivated influenza vaccine during routine care at a KPNC facility between August 17, 2023, and April 16, 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Adjuvanted or high-dose inactivated influenza vaccine receipt during the 2023 to 2024 influenza season. Individuals were considered vaccinated 14 days after immunization.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcome was PCR-confirmed influenza in any clinical setting. Secondary outcomes were PCR-confirmed influenza with hospitalization or emergency department visits and hospitalization for community-acquired pneumonia. Outcomes were assessed starting October 1, 2023, or 14 days after vaccination, whichever came later.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;This study included 429 595 individuals from the 2023 to 2024 influenza season (mean [SD] age, 75 [7] years; 236 857 [55.1%] female; 86 287 [20.1%] Asian, 22 910 [5.3%] Black, 53 820 [12.5%] Hispanic, 1123 [0.3%] American Indian or Alaska Native, 2562 [0.6%] Pacific Islander, 252 709 [58.8%] White, 1638 [0.4%] multiracial, and 8546 [2.0%] unknown race), of whom 212 875 (49.6%) received adjuvanted and 216 720 (50.4%) received high-dose influenza vaccine. There were 836 cases of PCR-confirmed influenza (3.9 per 1000 persons) identified after adjuvanted and 867 cases (4.0 per 1000 persons) after high-dose vaccine. The rVE of adjuvanted compared with high-dose influenza vaccine was 1.5% (95% CI, -8.4% to 10.5%) against influenza, 9.1% (95% CI, -4.0% to 20.4%) against influenza with hospitalization or emergency department visits, and 1.0% (95% CI, -11.4% to 12.0%) against hospitalizations for community-acquired pneumonia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclus","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 5","pages":"e2610120"},"PeriodicalIF":9.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13139963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815372","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":"Extended Endocrine Therapy and Survival for Breast Cancer Subtypes in Premenopausal Patients.","authors":"Carmine Valenza, Yue Zheng, Monica Milano, Pier Paolo Maria Berton Giachetti, Dario Trapani, Elisa Giordano, Lorenzo Guidi, Laura Boldrini, Grazia Castellano, Jalissa Katrini, Bianca Malagutti, Gabriele Antonarelli, Julian D Etessami, Nadia Bianco, Fabio Conforti, Gregory J Kirkner, Claudia Sangalli, Kate E Dibble, Nicola Fusco, Marco Colleoni, Meredith M Regan, Elisabetta Munzone, Giuseppe Curigliano, Ann H Partridge","doi":"10.1001/jamanetworkopen.2026.10427","DOIUrl":"10.1001/jamanetworkopen.2026.10427","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Premenopausal patients with node-positive, hormone receptor-positive, early breast cancer derive benefit from extended endocrine therapy (EET) following 5 years of luteinizing hormone-releasing hormone (LHRH) agonist-based treatment. The benefit of EET may differ according to surrogate breast cancer subtypes in postmenopausal patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the risk of invasive and distant recurrence across all surrogate breast cancer subtypes among patients with node-positive, hormone receptor-positive early breast cancer who remained premenopausal after completing 5 years of adjuvant therapy with an LHRH agonist who received and did not receive EET.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This multicenter cohort study conducted in the United States and Italy used data from 2 prospectively maintained datasets: the Young Women's Breast Cancer Study and the European Institute of Oncology Breast Cancer cohort. Eligible patients were diagnosed with early breast cancer at 40 years of age or younger between January 2005 and December 2016, had node-positive hormone receptor-positive disease, and remained premenopausal after 5 years of adjuvant LHRH agonist therapy with no evidence of recurrence. Median (IQR) follow-up was 7.3 (4.9-10.3) years. Data were analyzed June 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;EET (with tamoxifen monotherapy, LHRH agonist plus tamoxifen, or LHRH agonist plus aromatase inhibitor), irrespective of the duration of EET, measured at study baseline (defined as the first day of the sixth year after the initiation of adjuvant ET).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Invasive breast cancer-free survival and distant recurrence-free survival (DRFS) distributions were estimated using the adjusted Kaplan-Meier method among patients with or without the exposure, weighted through propensity score (PS) weighting analysis, with the scientific approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In total, 487 patients were included (median [IQR] age at diagnosis, 37 [35-39] years in the EET group and 37 [33-39] years in the no EET group), and 276 received EET for a median (IQR) duration of 3.7 (2.2-5.0) years. Overall, 89 patients (18%) had luminal A-like disease, 298 (61%) had luminal B-like disease, and 100 (21%) had ERBB2 (formerly HER2)-positive disease. The PS-weighted hazard ratio (HR) for invasive breast cancer-free survival comparing the EET with the no EET group was 0.68 (95% CI, 0.32-1.45) in luminal A-like, 0.63 (95% CI, 0.40-1.00) in luminal B-like/ERBB2-negative, and 0.62 (95% CI, 0.21-1.87) in ERBB2-positive subgroups. The cause-specific PS-weighted HR for DRFS was 0.25 (95% CI, 0.08-0.75) in luminal A-like, 0.54 (95% CI, 0.32-0.94) in luminal B-like/ERBB2-negative, and 0.54 (95% CI, 0.12-2.53) in ERBB2-positive subgroups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this cohort study, a lower estimated risk with EET use was observed across al","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 5","pages":"e2610427"},"PeriodicalIF":9.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13139950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815411","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}