JAMA Network Open最新文献

{"title":"Preterm Birth, Social Disadvantage, and the Path to Academic Success-From Early Challenges to Enduring Gaps.","authors":"Samudragupta Bora","doi":"10.1001/jamanetworkopen.2025.34924","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.34924","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2534924"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199490","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":"Prior Authorization, Quantity Limits, and Step Therapy for Patient-Administered Antiemetics.","authors":"Kaitlyn Vu, Arjun Gupta, Fumiko Chino, Justin Barnes, Bridgette Thom, Michael Anne Kyle","doi":"10.1001/jamanetworkopen.2025.35707","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.35707","url":null,"abstract":"<p><strong>Importance: </strong>Antiemetics have level 1 evidence supporting their role in improving quality of life and treatment tolerability for patients with cancer; they are an essential part of quality care. Utilization management (prior authorization, step therapy, and quantity limits) is implemented by insurance companies to improve effectiveness and efficiency and to control costs.</p><p><strong>Objective: </strong>To characterize utilization management policies for antiemetics for Patient Protection and Affordable Care Act (ACA) Marketplace and Medicaid plans.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study used a national sample of all available Medicaid and ACA drug formularies in 2024 linked to the US Food and Drug Administration's National Drug Codes. Formulations of the 13 most common self-administered (oral, sublingual, transdermal) antiemetics were identified.</p><p><strong>Exposure: </strong>Plans' prior authorization, quantity limit, and step therapy policies.</p><p><strong>Main outcomes and measures: </strong>The share of antiemetics subject to utilization management by coverage type (ACA, Medicaid, Medicaid managed care, state Medicaid), generic vs brand, and geographically by state was calculated.</p><p><strong>Results: </strong>A total of 561 formularies (301 [53.7%] ACA; 260 [46.3%] Medicaid) were included, amounting to 348 215 unique drug-plan formulations (173 607 [49.9%] ACA; 174 608 [50.1%] Medicaid). Overall, utilization management affected 66 981 covered antiemetic medications in ACA plans (39.7%) and 75 727 in Medicaid plans (43.4%). In ACA plans, a greater proportion of generic formulations faced restrictions than brand-name drugs (40.5% of generic [67 931 of 167 587] vs 17.4% of brand [1050 of 6020]). In Medicaid, this was the opposite: 82.5% of brand drugs (4357 of 5280) vs 42.2% of generic drugs (71 370 of 169 328) faced restrictions. Utilization management policies varied greatly by plan and state; some plans imposed at least 1 coverage restriction on 100% of antiemetic formulations, and others none. Quantity limits were the most prevalent utilization management tool, applying to more than one-third of covered antiemetic formulations in ACA (64 198 [37.0%]) and Medicaid plans (55 585 [38.1%]).</p><p><strong>Conclusions and relevance: </strong>In this cross-sectional study of Medicaid and ACA formularies, there was substantial variation in utilization management requirements for antiemetics across insurance type and state as well as drug type, use, and class. Efforts to increase standardization of utilization management policies may alleviate administrative burden for patients.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2535707"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232668","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":"Sugammadex for Postoperative Urinary Retention in Minimally Invasive Inguinal Hernia Repair: A Nonrandomized Clinical Trial.","authors":"William R Lorenz, Alexis M Holland, Brittany S Mead, Gregory T Scarola, Kent W Kercher, Sullivan A Ayuso, B Todd Heniford","doi":"10.1001/jamanetworkopen.2025.36944","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.36944","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2536944"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238918","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":"Body Composition and Cardiometabolic Risk in Children.","authors":"Irene Sequí-Domínguez, Mairena Sánchez-López, Miriam Garrido-Miguel, Monserrat Solera-Martínez, Valentina Díaz-Goñi, Sergio Núñez de Arenas-Arroyo, Pontus Henriksson, Ángel Herraiz-Adillo, Vicente Martínez-Vizcaíno, Eva Rodríguez-Gutiérrez","doi":"10.1001/jamanetworkopen.2025.35004","DOIUrl":"10.1001/jamanetworkopen.2025.35004","url":null,"abstract":"<p><strong>Importance: </strong>Understanding secular patterns in body composition and cardiometabolic risk factors (CMRFs) is essential for identifying early-life determinants of cardiovascular health, guiding public health policies, and developing early prevention strategies.</p><p><strong>Objective: </strong>To examine secular patterns in the prevalence of underweight, overweight, obesity, and CMRFs among schoolchildren in Spain from 1992 to 2022.</p><p><strong>Design, setting, and participants: </strong>Repeated cross-sectional study analyzing data from 7 time points over a 30-year period in public primary schools from the Cuenca province in Spain. Participants were children aged 8 to 11 years (fourth to fifth grade) from 7 cohorts studied in 1992, 1996, 1998, 2004, 2010, 2018, and 2022. Data were analyzed from April 2024 to May 2025.</p><p><strong>Main outcomes and measures: </strong>Prevalence of weight status (underweight, normal weight, overweight, and obesity), lipid parameters, glycemic markers, and resting systolic blood pressure (SBP) and diastolic blood pressure (DBP).</p><p><strong>Results: </strong>In a total of 4280 participants (mean [SD] age, 9.6 [0.7] years; 2137 [50.0%] girls), patterns in the prevalence of weight status show that increases in obesity appear to have slowed down and plateaued since 2018 (13.4%; 95% CI, 11.5% to 15.5% in 2010; 8.1%; 95% CI, 6.0% to 10.5% in 2018; 10.4% 95% CI, 8.1% to 13.2% in 2022; P < .001). A statistically significant decrease in mean (SD) total cholesterol (184.6 [27.4] to 160.3 [27.4] mg/dL) and low-density lipoprotein cholesterol (113.6 [24.0] to 90.1 [24.0] mg/dL) was observed, which was reflected in a reduction in non-high-density lipoprotein cholesterol (HDL-C) (125.3 [26.2] to 99.8 [26.1] mg/dL) from 1992 to 2022. Mean (SD) serum HDL-C appear to have peaked from 1998 to 2004 (66.2 [13.3] vs 66.9 [13.3] mg/dL, respectively), and its levels have decreased since then (60.5 [13.4] mg/dL in 2022; P < .001). Mean (SD) resting blood pressure showed a substantial decrease over the study period (SBP: 113.5 [9.6] to 101.0 [9.7] mm Hg and DBP: 70.4 [7.2] to 60.7 [7.3] mm Hg; P < .001). However, mean (SD) insulin levels show a significant rise from 2004 to 2022 (6.3 [5.3] to 8.7 [5.2] μIU/mL; P < .001).</p><p><strong>Conclusions and relevance: </strong>This repeated cross-sectional study provides a picture of the evolution of CMRFs in children over the last 30 years, showing that, in Spain, despite the concerning prevalences of excess weight, lipid parameters and blood pressure have improved over the studied period.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2535004"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12492057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206343","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":"Contemporary Incidence and Survival of Lung Neuroendocrine Neoplasms.","authors":"Julie Hallet, Mathieu Rousseau, Elliot Wakeam, Sten Myrehaug, Léamarie Meloche-Dumas, Anna Gombay, Wing Chan, Simron Singh","doi":"10.1001/jamanetworkopen.2025.35125","DOIUrl":"10.1001/jamanetworkopen.2025.35125","url":null,"abstract":"<p><strong>Importance: </strong>While the epidemiology of overall and gastrointestinal neuroendocrine neoplasms (NENs) has been reported, data specific to lung NENs remain scarce.</p><p><strong>Objective: </strong>To examine the incidence, overall survival (OS), and lung cancer-specific death for lung NENs.</p><p><strong>Design, setting, and participants: </strong>Population-based retrospective cohort study in Ontario, Canada, of adult patients with incident lung NENs from 2000 to 2020. Data were analyzed from July to December 2024.</p><p><strong>Main outcomes and measures: </strong>Yearly incidence rates of lung NENs. OS examined with Kaplan-Meier curves and Cox regression models. Lung cancer-specific deaths using cumulative incidence function and Fine-Gray models accounting for the competing risk of death from other causes.</p><p><strong>Results: </strong>Among 4479 total patients, the median (IQR) age at diagnosis was 67 (57-74) years, and 2521 (56.3%) were female; 2056 (45.9%) had typical neuroendocrine tumors (NET), 370 (8.3%) atypical NET, 998 (22.3%) large cell neuroendocrine carcinoma (NEC, including small cell and mixed NEC), and 1055 (23.6%) other NEC, as well as 1103 (24.6%) who presented as stage IV. The incidence of lung NENs increased 2.87-fold from 0.87 to 2.50 per 100 000 from 2000 to 2020. This rise in incidence was observed mostly for typical NET (from 0.51 to 1.09) and for stage I (0.68 to 1.18). With a median (IQR) follow-up of 34 (9-87) months, 5- and 10-year OS were 50% (95% CI, 49%-51%) and 40% (95% CI, 39%-41%) overall. Advancing age, lower socioeconomic status, type of lung NEN, and advancing stage were independently associated with inferior OS. Cumulative incidence of lung cancer-specific deaths was 41% (95% CI, 40%-42%) at 5 years and 46% (95% CI, 45%-47%) at 10 years. Advancing age, type of lung NEN, and increasing stage were independently associated with higher hazards of lung cancer-specific deaths. Lung cancer-specific deaths were exceeded by deaths from other causes starting 2 year after diagnosis for typical NET and 3 years after diagnosis for stage I disease.</p><p><strong>Conclusions and relevance: </strong>The incidence of lung NENs has increased over 20 years, mostly associated with stage I disease. Prolonged OS was observed after lung NEN diagnosis. Patients with typical lung NET and stage I disease were more likely to die of causes other than lung cancer after 1 and 3 years, respectively. These data are important to direct efforts in care, research, and patient counseling.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2535125"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12492052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206427","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":"AI-Based System for Analysis of Electron Microscope Images in Glomerular Disease.","authors":"Pengcheng Ma, Jinbang Li, Zhengyu Zhang, Weihao Qiu, Danyi Li, Jing Wang, Bingbing Li, Shujing Guo, Jin Zhang, Zhijian Cen, Jian Geng, Xiangsheng Huang, Xiaolei Xue, Aihetaimu Aimaier, Huanjiao Liu, Minyi Liang, Hao Chen, Qifeng Jiang, Xiaoyan Su, Tianjun Guan, Yu Tong, Weiyuan Lin, Li Liu, Jun Xu, Jie Lin, Yaping Ye, Li Liang","doi":"10.1001/jamanetworkopen.2025.34985","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.34985","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Kidney biopsy pathology via transmission electron microscopy (TEM) is essential for diagnosing glomerular diseases, offering critical information on glomerular basement membrane (GBM) thickness, foot process (FP) number, and electron-dense deposits (EDDs). These tasks are laborious and time-consuming.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To develop and validate an artificial intelligence (AI) diagnostic system, TEM image-based AI-assisted device (TEM-AID), that accurately segments and measures glomerular ultrastructures (including the GBM, FPs, and EDDs) and determines glomerular disease subtypes using TEM images.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This diagnostic study used a large, multicenter cohort including 160 727 TEM images from 31 670 patients with chronic kidney disease across 6 medical centers from January 2021 to December 2023. TEM-AID was trained and validated on 26 650 patients from 1 center and tested externally on 5020 patients (5 test sets) plus a human-AI test set (454 patients representing 7 glomerular disease subtypes). Data were analyzed from January to December 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;TEM-AID integrates 4 modules. Segmentation combined YOLO-v8 detection, segment anything model, and human-in-the-loop refinement to segment GBMs, podocyte FPs, and EDDs. Measurement quantified GBM thickness, FP fusion degree, and EDD deposition sites. Classification used least absolute shrinkage and selection operator-selected deep learning and statistical features with a stacking classifier to diagnose 7 glomerular disease subtypes: immunoglobin A nephropathy, membranous nephropathy, lupus nephritis, diabetic nephropathy, minimal change disease, mesangial proliferative glomerulonephritis, and thin basement membrane nephropathy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Outcomes of interest were segmentation performance (mean intersection-over-union [IOU], Dice coefficient), subtype classification accuracy, area under the receiver operating characteristic curve (AUC), and human-AI diagnostic concordance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 31 670 patients (mean [SD] age, 43.2 [16.5] years; 17 372 [54.9%] male) contributed 160 727 TEM images for analysis. Segmentation achieved a mean (SD) IOU of 0.835 (0.062) and Dice of 0.874 (0.023). Subtype classification accuracy was 0.911 (95% CI, 0.904-0.918) in internal validation and 0.895 to 0.914 in external tests. Macro-AUC ranged from 0.972 to 0.989 across cohorts. In human-AI testing (454 patients), TEM-AID accuracy (0.886 (95% CI, 0.859-0.912]; AUC, 0.963 [95% CI, 0.937-0.989]) exceeded clinicians' unaided performance. Clinicians' accuracy improved by a mean (SD) of 11.7% (5.2%) when they used TEM-AID.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this multicenter diagnostic study, TEM-AID precisely quantified glomerular ultrastructures and determined glomerular disease subtypes from TEM images, significantly e","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2534985"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238674","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":"Patient-Physician Messaging by Race, Ethnicity, Insurance Type, and Preferred Language.","authors":"Lisa S Rotenstein, Brianna Hardy, Mitchell Tang, Bryan Steitz, Robert W Turer, Emily Alsentzer, Michael L Barnett","doi":"10.1001/jamanetworkopen.2025.34549","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.34549","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Asynchronous patient-portal messaging has emerged as a central component of patient-physician communication, yet disparities in response patterns remain underexplored.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To examine variations in asynchronous messaging responses in primary care by race and ethnicity, insurance type, and primary language.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cross-sectional study of messaging data included 795 170 adult patients receiving primary care at Mass General Brigham in 2021, 341 836 of whom sent an asynchronous patient portal message. Data were analyzed from April 17, 2023, to July 29, 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Race and ethnicity, insurance status, and preferred language.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Receipt of a response within 1 or 3 business days and time to first response from care team. Multivariable regression models adjusted for patient demographics, clinic, and time fixed effects.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The analytic sample consisted of 341 836 patients, who sent a total of 3 525 905 messages comprising 1 270 662 message threads to 1113 physicians. Among these patients (mean [SD] age, 52.2 [17.3] years), 18 442 were Asian (5.4%), 14 089 were Black or African American (4.1%), 9979 were Hispanic or Latino (2.9%), 285 919 were White (83.6%), 232 661 had commercial insurance (68.1%), and 332 004 primarily spoke English (97.1%). Characteristics of patient-threads that received a response from any care team member within 1 business day were as follows: 65.7% of threads from Black participants (32 165 of 48 983), 63.9% of threads from Hispanic or Latino (21 732 of 34 014), 68.5% of threads from White participants (743 161 of 1 085 517), 70.0% of threads from patients with commercial insurance (529 803 of 756 923), 60.9% of threads from patients with dual-eligibility (40 846 of 67 045), 68.4% of threads from patients preferring English (847 489 of 1 239 768), and 58.0% of threads from patients preferring Spanish (6898 of 11 903). Similar disparities were found in the response rate from primary care physicians. After adjustment, compared with White patients, the rate of response from any care team member within 1 day was lower for Black patients (1.1 [95% CI, 0.2-2.0] percentage points; P = .01) and Hispanic patients (1.1 [95% CI, 0.3-1.9] percentage points; P = .01). Compared with patients with commerical insurance, the response rate within 1 day was lower for dual-eligible patients (4.9 [95% CI, 4.2-5.5] percentage points; P &lt; .001), and compared with patients who preferred English, the response rate within 1 day was lower for patients who preferred Spanish (4.1 [95% CI, 2.5-5.7] percentage points; P &lt; .001). Adjustment for clinic and time fixed effects accounted for most of the observed disparities in response rates and timing.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this cross-sectional study of primary care ","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2534549"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238872","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":"Missing Sentence in Methods.","authors":"","doi":"10.1001/jamanetworkopen.2025.40435","DOIUrl":"10.1001/jamanetworkopen.2025.40435","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2540435"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212617","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":"Comparison of 2 Doses vs 1 Dose in the First Season Children Are Vaccinated Against Influenza: A Systematic Review and Meta-Analysis.","authors":"Jessie J Goldsmith, Sarah Tavlian, Christy Vu, Annette K Regan, Patricia Therese Campbell, Sheena G Sullivan","doi":"10.1001/jamanetworkopen.2025.35250","DOIUrl":"10.1001/jamanetworkopen.2025.35250","url":null,"abstract":"<p><strong>Importance: </strong>Based on the findings of immunogenicity studies, the World Health Organization has recommended influenza vaccine-naive children younger than 9 years receive 2 doses of influenza vaccine in the first year of vaccination.</p><p><strong>Objective: </strong>To estimate the increase in protection associated with the second dose of influenza vaccine for influenza vaccine-naive children younger than 9 years.</p><p><strong>Data sources: </strong>MEDLINE, EMBASE, and CINAHL were searched for articles published from inception to March 24, 2025.</p><p><strong>Study selection: </strong>Peer-reviewed studies that reported vaccine efficacy or vaccine effectiveness against influenza for influenza vaccine-naive children aged 6 months to younger than 9 years by dose number were included. Modeling and cost-effectiveness studies were excluded.</p><p><strong>Data extraction and synthesis: </strong>Two reviewers independently screened and extracted data and assessed studies' risk of bias. The study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline.</p><p><strong>Main outcomes and measures: </strong>For studies reporting both 1 and 2 dose estimates, the difference in vaccine efficacy or effectiveness was calculated in order to estimate the additional protection associated with the second dose. Pooled vaccine efficacy or effectiveness and difference were calculated separately for inactivated influenza and live attenuated influenza vaccines.</p><p><strong>Results: </strong>There were 51 studies with 415 050 participants included in this analysis. The pooled absolute increase in vaccine effectiveness of a second inactivated influenza vaccine dose in the first year of vaccination was 15 percentage points (pp) (95% CI, -2.8 pp to 33 pp) for those younger than 9 years and 28 pp (95% CI, 4.7 pp to 51 pp) for children younger than 3 years. Insufficient estimates were available to assess the incremental benefit associated with a second dose of live attenuated influenza vaccine.</p><p><strong>Conclusions and relevance: </strong>In this systematic review and meta-analysis of influenza vaccine efficacy and effectiveness in the first year of vaccination, receiving 2 doses of inactivated influenza vaccine was associated with improved protection for children younger than 3 years compared with those who receive one dose; however, when the age range was broadened to younger than 9 years, the second dose of inactivated influenza vaccine was not significantly associated with increased protection. Additional high-quality studies are needed to assess the impact of the 2-dose schedule for both vaccine types by age to determine the age range for which a 2-dose schedule is beneficial.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2535250"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212605","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":"Acute Surgery vs Conservative Treatment for Traumatic Acute Subdural Hematoma.","authors":"Thomas A Van Essen, John K Yue, Jason Barber, Hester F Lingsma, Dana Pisica, Hugo F den Boogert, Jeroen T van Dijck, Wouter A Moojen, Peter Hutchinson, Amy J Markowitz, Ewout W Steyerberg, David O Okonkwo, Yelena G Bodien, Alex B Valadka, Ramon Diaz-Arrastia, Claudia S Robertson, Brandon Foreman, Vincent Y Wang, Michael A McCrea, Joseph T Giacino, Esther L Yuh, Godard C W de Ruiter, Nancy R Temkin, Andrew I R Maas, Wilco C Peul, Geoffrey T Manley","doi":"10.1001/jamanetworkopen.2025.35200","DOIUrl":"10.1001/jamanetworkopen.2025.35200","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;It is unclear whether performing surgery for most patients with an acute subdural hematoma (ASDH) and traumatic brain injury (TBI) is superior to conservative treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To compare the effectiveness of a strategy preferring acute surgical ASDH evacuation with one preferring initial conservative treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This comparative effectiveness study used data from February 1, 2014, to July 31, 2018, from the prospective observational Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study, conducted at 18 Level 1 trauma centers in the US. The study included patients with nonpenetrating TBI presenting to the emergency department and admitted within 24 hours after injury with ASDH detected on acute head computed tomography scan. Statistical analysis was performed from December 1, 2022, to December 20, 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Acute surgical hematoma evacuation vs initial conservative treatment, comparing outcomes between centers according to treatment preferences, measured by the case mix-adjusted probability of undergoing acute surgery (vs conservative treatment) per center.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Functional disability at 6 months was assessed with the Glasgow Outcome Scale-Extended at 6 months, analyzed with ordinal logistic regression adjusted for prespecified confounders, quantified with a common odds ratio (OR). Variation in center preference was quantified with a median OR (MOR).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 2697 included patients, 711 (mean [SD] age, 46.5 [19.4] years; 539 men [76%]) had an ASDH, of whom 148 (21%) underwent acute cranial surgery and 563 (79%) underwent initial conservative treatment. The acute surgery cohort had lower mean (SD) Glasgow Coma Scale scores (6.8 [4.4] vs 11.4 [4.6]), more pupil abnormalities (both pupils unreacting: 43 of 133 [32%] vs 41 of 477 [9%]), and fewer isolated ASDHs (eg, more with concurrent intracranial lesions; 92 of 133 [69%] vs 297 of 563 [53%%]) compared with the conservative treatment cohort. In the surgical cohort, 129 of 148 patients (87%) underwent decompressive craniectomy (DC), and 17 of 148 (11%) underwent craniotomy. In the conservative treatment cohort, 67 of 563 patients (12%) underwent delayed cranial surgery (DC or craniotomy). The proportion of patients undergoing acute surgery ranged from 0% to 86% (median, 17% [IQR, 5%-27%]) between centers, with up to a 3-fold higher probability of prognostically similar patients receiving acute surgery in one center compared with another random center (MOR, 2.95 [95% CI, 1.79-7.47]; P = .06). Center preference for acute surgery over initial conservative treatment was not associated with a better outcome (OR, 1.05 [95% CI, 0.88-1.26] per 22% [IQR, 5%-27%] increase in acute surgery at a given trauma center).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this c","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2535200"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212608","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}