JAMA Network Open最新文献

{"title":"Altered Empathy Processing in Frontotemporal Dementia.","authors":"Olof Lindberg, Tie-Qiang Li, Cecilia Lind, Susanna Vestberg, Ove Almkvist, Mikael Stiernstedt, Anita Ericson, Nenad Bogdanovic, Oskar Hansson, Luke Harper, Eric Westman, Caroline Graff, Theofanis Tsevis, Peter Mannfolk, Håkan Fischer, Gustav Nilsonne, Predrag Petrovic, Lars Nyberg, Lars-Olof Wahlund, Alexander F Santillo","doi":"10.1001/jamanetworkopen.2024.48601","DOIUrl":"10.1001/jamanetworkopen.2024.48601","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2448601"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11615710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769095","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":"Cardiovascular Health Score and Atherosclerotic Cardiovascular Disease in the Million Veteran Program.","authors":"Xuan-Mai T Nguyen, Yanping Li, Yusi Gong, Serena Houghton, Yuk-Lam Ho, Mary Pyatt, Timothy Treu, Ruifeng Li, Kitan Akinosho, Sridharan Raghavan, David R Gagnon, John Michael Gaziano, Peter W F Wilson, Kelly Cho","doi":"10.1001/jamanetworkopen.2024.47902","DOIUrl":"10.1001/jamanetworkopen.2024.47902","url":null,"abstract":"<p><strong>Importance: </strong>The American Heart Association proposed Life's Essential 8 (LE8) as an enhanced measurement tool for cardiovascular health.</p><p><strong>Objective: </strong>To examine the association of LE8 with risk of atherosclerotic cardiovascular disease (ASCVD) incidence and prognosis in veterans.</p><p><strong>Design, setting, and participants: </strong>This was a prospective cohort study of US veterans enrolled in the Department of Veterans Affairs (VA) Million Veteran Program (MVP) between 2011 and 2022. Data were analyzed from 2023 to 2024.</p><p><strong>Exposure: </strong>LE8 score ranged from 0 to 100, with higher score indicating better cardiovascular health.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was total ASCVD incidence in veterans without baseline ASCVD, and the secondary outcome was incidence of a major adverse cardiovascular event (MACE) among veterans with and without ASCVD at baseline.</p><p><strong>Results: </strong>A total of 413 052 veterans (mean [SD] age, 65.8 [12.1] years; 378 162 [91.6%] male) were included. Based on 1.7 million person-years of follow-up of 279 868 veterans without any ASCVD at baseline, 45 067 veterans had an ASCVD event during follow-up. Total LE8 score and each component LE8 factor score was associated with incident ASCVD in an inverse, linear, dose-response manner. For veterans without prior ASCVD, those with an LE8 score between 80 and 100 had lower risk of ASCVD compared with those with an LE8 score of 0 to 49 (adjusted hazard ratio [aHR], 0.36 [95% CI, 0.35-0.38]). Similarly, risk of MACE was significantly lower among veterans with an LE8 score of 80 to 100 regardless of baseline ASCVD status (with ASCVD: aHR, 0.52 [95% CI, 0.48-0.56]; without ASCVD: aHR, 0.14 [95% CI, 0.13-0.15]) compared with those with ASCVD and an LE8 score of 0 to 49.</p><p><strong>Conclusions and relevance: </strong>In this cohort study of US veterans, higher LE8 scores were associated with significantly lower ASCVD incidence risk and lower likelihood of developing adverse cardiovascular events regardless of ASCVD status at baseline. These results support the utility of LE8 for health promotion and ASCVD prevention.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2447902"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11624584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785673","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":"Error in Byline and Results.","authors":"","doi":"10.1001/jamanetworkopen.2024.53497","DOIUrl":"10.1001/jamanetworkopen.2024.53497","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2453497"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11612905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769148","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":"Estimated Radon Exposure in Eastern Pennsylvania Schools.","authors":"Brian Yang, Chrysan Cronin, Beth A Tarini","doi":"10.1001/jamanetworkopen.2024.48676","DOIUrl":"10.1001/jamanetworkopen.2024.48676","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2448676"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11615708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769149","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":"Estimated Reduction in Health Care Spending Associated With Weight Loss in Adults.","authors":"Kenneth E Thorpe, Peter J Joski","doi":"10.1001/jamanetworkopen.2024.49200","DOIUrl":"10.1001/jamanetworkopen.2024.49200","url":null,"abstract":"<p><strong>Importance: </strong>Recent data from federal surveys show that more than 70% of adults have either overweight or obesity. Overweight and obesity are associated with several expensive chronic conditions, such as type 2 diabetes, heart disease, hypertension, and hyperlipidemia. The prevalence of chronic disease is a key driver of rising health care spending among employers and the Medicare program.</p><p><strong>Objective: </strong>To estimate health care spending among adults with overweight or obesity and have employer-sponsored insurance or Medicare and examine the association of higher and lower body mass index (BMI).</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study included privately insured adults and adult Medicare beneficiaries with a BMI of 25 and higher. Data from the Medical Expenditure Panel Survey-Household Component were used to tabulate total annual health care spending. Data were analyzed from April 1 to June 20, 2024.</p><p><strong>Main outcomes and measures: </strong>The primary intended measures were total annual health care spending, controlling for patient demographics, income, education, and BMI. The baseline health care spending as a percentage reduction in BMI. An instrumental variable regression model with estimated total spending at various levels of BMI was used.</p><p><strong>Results: </strong>This study included 3774 adults who were insured with Medicare (mean [SD] age, 63.1 [11.1] years; mean [SD] percentage female, 50.4% [49.7%]; mean [SD] percentage non-Hispanic Black adults, 17.4% [37.7%]; mean [SD] percentage non-Hispanic White adults, 61.3% [48.4%]). The study also included 13 435 adults who had employer-sponsored insurance (mean [SD] age, 46.3 [6.9] years; mean [SD] percentage female, 47.6% [48.9%]; mean [SD] percentage non-Hispanic Black adults, 11.1% [30.7%]; mean [SD] percentage non-Hispanic White adults, 73.1% [43.4%]). Overall, adults with employer-sponsored insurance with a weight loss of 5% were estimated to spend a mean of $670 (95% CI, $654-$686) less on health care (8% less), and those with a weight loss of 25% spent an estimated mean of $2849 (95% CI, $2783-$2916) less on health care (34% less). Among adults with Medicare who had 1 or more comorbid conditions, a 5% weight loss was estimated to reduce spending by $1262 (95% CI, $1217-$1306) (7% less) and a 25% weight loss was estimated to reduce health care spending by a mean of $5442 (95% CI, $5254-$5629) (31% less).</p><p><strong>Conclusions and relevance: </strong>In this cross-sectional study, projected annual savings from weight loss among US adults with obesity were substantial for both Medicare and employer-based insurance.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2449200"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11621981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785687","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":"Allostatic Load, Educational Attainment, and Risk of Cancer Mortality Among US Men.","authors":"Cynthia Li, Sydney P Howard, Charles R Rogers, Sydney Andrzejak, Keon L Gilbert, Keith J Watts, Malcolm S Bevel, Myles D Moody, Marvin E Langston, Judah V Doty, Adetunji T Toriola, Darwin Conwell, Justin X Moore","doi":"10.1001/jamanetworkopen.2024.49855","DOIUrl":"10.1001/jamanetworkopen.2024.49855","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Health disparities among racial and ethnic minoritized populations, particularly for cancer mortality rates, remain a major public health concern. Men from underrepresented backgrounds (Black and Hispanic men, specifically) face the pervasive effects of discrimination in their daily lives, which also contribute to the complex associations among allostatic load (a marker of chronic stress), educational opportunities, and elevated risks of cancer mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To elucidate the associations among educational attainment, allostatic load, and cancer mortality risk among men.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This is a retrospective cohort analysis of data from the National Health and Nutrition Examination Survey, a nationally representative sample of approximately 5000 people across the US, from 1988 to 2010 linked with data from the National Death Index, which served as follow-up data for the cohort and was available through December 31, 2019. Participants included men aged 18 years and older. Data were analyzed from June to October 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Allostatic load data were stratified by educational attainment levels, categorized as (1) less than high school education and (2) high school graduate and above. Allostatic load score was calculated as the sum of total abnormal biomarkers and health measures (9 total). Participants were considered to have high allostatic load if their score was 3 or more.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcome was cancer death. Weighted Cox proportional hazards models were fitted to estimate adjusted hazard ratios (HRs) of cancer death between educational attainment and allostatic load (adjusted for age, income, and smoking status).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among all 20 529 men (mean [SE] age, 41.00 [0.22] years), those with high AL and less than high school educational attainment had a greater than 4-fold increased risk of cancer mortality (unadjusted HR, 4.71; 95% CI, 3.36-6.60) compared with those with low allostatic load and a college degree or higher. Similarly, both Black men (HR, 4.19; 95% CI, 2.09-8.40) and White men (HR, 5.77; 95% CI, 4.06-8.20) with high allostatic load and less than high school educational attainment had higher risks for cancer death compared with race-specific counterparts with college education and low allostatic load. After adjustments for age, poverty-to-income ratio, smoking status, history of cancer, and ever congestive heart failure and heart attack, the associations were attenuated, but all men (HR, 1.69; 95% CI, 1.15-2.47) and White men (HR, 1.82; 95% CI, 1.16-2.85) still had greater than 50% increased risk of cancer death compared with men with college education and low allostatic load.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;This study highlights the detrimental association of not attaining a high school degree, combined with hi","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2449855"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142800769","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":"Addressing Unanswered Questions in Lung Cancer Survivorship Care-Home-Based Physical Activity After Surgery.","authors":"Brett C Bade, Catherine M Alfano","doi":"10.1001/jamanetworkopen.2024.47287","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2024.47287","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2447287"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769046","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":"Are Cardiovascular Complications the Achilles' Heel of Osimertinib?","authors":"Nicholas S Wilcox, Michael G Fradley","doi":"10.1001/jamanetworkopen.2024.48309","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2024.48309","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2448309"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785671","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":"Variation in Case Exposure During Internal Medicine Residency.","authors":"Andrew C L Lam, Brandon Tang, Chang Liu, Marwa F Ismail, Surain B Roberts, Matthew Wankiewicz, Anushka Lalwani, Daniel Schumacher, Benjamin Kinnear, Amol A Verma, Fahad Razak, Brian M Wong, Shiphra Ginsburg","doi":"10.1001/jamanetworkopen.2024.50768","DOIUrl":"10.1001/jamanetworkopen.2024.50768","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Variation in residency case exposure affects resident learning and readiness for future practice. Accurate reporting of case exposure for internal medicine (IM) residents is challenging because feasible and reliable methods for linking patient care to residents are lacking.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To develop an integrated education-clinical database to characterize and measure case exposure variability among IM residents.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;In this cohort study, an integrated educational-clinical database was developed by linking patients admitted during overnight IM in-hospital call shifts at 5 teaching hospitals to senior on-call residents. The senior resident, who directly cares for all overnight IM admissions, was linked to their patients by the admission date, time, and hospital. The database included IM residents enrolled between July 1, 2010, and December 31, 2019, in 1 Canadian IM residency. Analysis occurred between August 1, 2023, and June 30, 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Case exposure was defined by patient demographic characteristics, discharge diagnoses, volumes, acuity (eg, critical care transfer), medical complexity (eg, Charlson Comorbidity Index), and social determinants of health (eg, from long-term care). Residents were grouped into quartiles for each exposure measure, and the top and bottom quartiles were compared using standardized mean difference (SMD). Variation between hospitals was evaluated by calculating the SMD between the hospitals with the highest and lowest proportions for each measure. Variation over time was assessed using linear and logistic regression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The integrated educational-clinical database included 143 632 admissions (median [IQR] age, 71 [55-83] years; 71 340 [49.7%] female) linked to 793 residents (median [IQR] admissions per shift, 8 [6-12]). At the resident level, there was substantial variation in case exposure for demographic characteristics, diagnoses, volumes, acuity, complexity, and social determinants. For example, residents in the highest quartile had nearly 4 times more admissions requiring critical care transfer compared with the lowest quartile (3071 of 30 228 [10.2%] vs 684 of 25 578 [2.7%]; SMD, 0.31). Hospital-level variation was also significant, particularly in patient volumes (busier hospital vs less busy hospital: median [IQR] admissions per shift, 10 [8-12] vs 7 [5-9]; SMD, 0.96). Over time, residents saw more median (IQR) admissions per shift (2010 vs 2019: 7.6 [6.6-8.4] vs 9.0 [7.6-10.0]; P = .04) and more complex patients (2010 vs 2019: Charlson Comorbidity Index ≥2, 3851 of 13 762 [28.0%] vs 2862 of 8188 [35.0%]; P = .03), while working similar shifts per year (median [IQR], 11 [8-14]).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this cohort study of IM residents in a Canadian residency program, significant variation in case exposure was found be","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2450768"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846698","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":"Disparities and Gaps in Breast Cancer Screening for Women Aged 40 to 49 Years.","authors":"Tianshu Gu, Jing Yuan, Shelley White-Means, Minghui Li","doi":"10.1001/jamanetworkopen.2024.51827","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2024.51827","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2451827"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864131","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}