JAMA Network Open最新文献

{"title":"Variability in Delirium After Noncardiac Surgery-Nature vs Nurture.","authors":"Jessica D Spence, Emilie Belley-Côté","doi":"10.1001/jamanetworkopen.2025.19476","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.19476","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 7","pages":"e2519476"},"PeriodicalIF":10.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583953","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":"Electronic Health Record Decision Aids for Prescribing-If You Build It, Will They Come?","authors":"Ashley Spann, Thomas Reese","doi":"10.1001/jamanetworkopen.2025.19044","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.19044","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 7","pages":"e2519044"},"PeriodicalIF":10.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553558","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":"Error in Author Affiliations.","authors":"","doi":"10.1001/jamanetworkopen.2025.25918","DOIUrl":"10.1001/jamanetworkopen.2025.25918","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 7","pages":"e2525918"},"PeriodicalIF":10.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12242676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591271","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":"Consumer Identification of Processed Foods and Their Health Effects.","authors":"Neal D Barnard, Anna Herby, Stephanie McBurnett, Hana Kahleova","doi":"10.1001/jamanetworkopen.2025.19518","DOIUrl":"10.1001/jamanetworkopen.2025.19518","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 7","pages":"e2519518"},"PeriodicalIF":10.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12238891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583890","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":"Structural Racism, Menthol Cigarettes, and Incident Lung Cancer Among Black Adults-Need to Revisit Evidence-Based Guidelines.","authors":"Jennifer A Campbell, Rebekah J Walker, Leonard E Egede","doi":"10.1001/jamanetworkopen.2025.18490","DOIUrl":"10.1001/jamanetworkopen.2025.18490","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 7","pages":"e2518490"},"PeriodicalIF":10.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540182","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":"Placenta Accreta Spectrum Disorder-Critical Time for a More Globally Used Management Guideline.","authors":"Babatunde Akinwunmi, Alexander Juusela","doi":"10.1001/jamanetworkopen.2025.21918","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.21918","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 7","pages":"e2521918"},"PeriodicalIF":10.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659262","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":"Residential Segregation and Lung Cancer Risk in African American Adults.","authors":"Yi Xiao, Xiaoke Zou, Calvin P Tribby, Peter Vien, Christina Chang, Richard J Curley, Olutola Akande, Melinda C Aldrich, Sophia Wang, Rick A Kittles, Kimlin Ashing, F Lennie Wong, Marta M Jankowska, Tarik Benmarhnia, Loretta Erhunmwunsee","doi":"10.1001/jamanetworkopen.2025.18481","DOIUrl":"10.1001/jamanetworkopen.2025.18481","url":null,"abstract":"<p><strong>Importance: </strong>Although structural racism as manifested by residential segregation is a documented root cause of race-based disparities in lung cancer survival and care, its impact on lung cancer development remains underexplored.</p><p><strong>Objective: </strong>To examine the association between residential segregation and lung cancer incidence and to identify modifiable factors mediating this association.</p><p><strong>Design, setting, and participants: </strong>This cohort study used data from the Southern Community Cohort Study (SCCS), which enrolled African American and non-Hispanic White participants who had no cancer at enrollment. The SCCS recruited participants from community health centers and random sampling from 12 southeastern states. Follow-up occurred between March 2002 to December 2019. Analysis was performed from April 2022 to March 2025.</p><p><strong>Exposures: </strong>Residential segregation, measured by the isolation index using 2010 census block group data, was linked to participants' baseline address.</p><p><strong>Main outcomes and measures: </strong>Incident lung cancer cases were identified via state cancer registries and the National Death Index (December 31, 2016, to December 31, 2019, depending on the state). Parametric g-computation estimated cumulative lung cancer risk under hypothetical interventions reducing residential segregation. Mediation analyses utilized inverse propensity weighting and marginal structural models to assess potential mediating pathways.</p><p><strong>Results: </strong>The cohort comprised 71 634 participants (median [IQR] age, 50 [45-57] years; 42 032 [58.7%] female; 50 898 [71.1%] African American and 20 736 [28.9%] non-Hispanic White) enrolled between 2002 and 2009. All hypothetical scenarios of lowering the isolation index were associated with lower 17-year culminative incidence of lung cancer among African American individuals but not among non-Hispanic White individuals. Approximately 24.7% (95% CI, 17.1%-36.6%) of the association between residential segregation and lung cancer risk in African American participants was mediated by menthol smoking, 13.1% (95% CI, 3.2%-25.4%) by exposure to particulate matter with a diameter of 2.5 μm or less, 4.7% (95% CI, 1.3%-9.6%) by secondhand smoke exposure at home, and 4.6% (95% CI, 2.1%-7.7%) by education.</p><p><strong>Conclusions and relevance: </strong>In this cohort study of non-Hispanic White and African American individuals, lower residential segregation was significantly associated with decreased lung cancer risk for African American individuals but not their non-Hispanic White counterparts. Mediation analysis identified mentholated smoking use and air pollution exposure as 2 major pathways between residential segregation and lung cancer incidence among African American adults. These findings suggest that lung cancer development reduction efforts should include policies with targetable segregation metrics and initiatives ","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 7","pages":"e2518481"},"PeriodicalIF":10.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12215573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540180","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":"Food and Housing Insecurity, Stress, and Health Care Use After Medicaid Expanded Services Program.","authors":"Anne N Thorndike, Jessica L McCurley, Yuchiao Chang, Jessica Cheng, Cheryl R Clark, Christine Vogeli, Sydney McGovern, Vicki Fung, Douglas E Levy","doi":"10.1001/jamanetworkopen.2025.19507","DOIUrl":"10.1001/jamanetworkopen.2025.19507","url":null,"abstract":"<p><strong>Importance: </strong>Massachusetts implemented a Flexible Services program (FSP) under a Medicaid Section 1115 waiver to address food and housing insecurity for accountable care organization (ACO) beneficiaries. Little is known about the social, behavioral, and clinical outcomes associated with Medicaid social needs interventions.</p><p><strong>Objective: </strong>To compare 1-year changes in food and housing insecurity, diet, stress, and acute health care use between individuals who participated in the Massachusetts FSP and those who did not.</p><p><strong>Design, setting, and participants: </strong>This prospective cohort study enrolled adult Medicaid beneficiaries from 5 community health centers in 1 eastern Massachusetts ACO from December 2019 through December 2020. Participants who were enrolled in FSP were compared with propensity score-weighted FSP-eligible study participants who were not enrolled in FSP (hereafter non-FSP participants). All FSP participants completed surveys and dietary recalls at enrollment and then annually for 3 years. In-depth interviews were conducted with 27 FSP participants. All data analyses were conducted from August 2024 to April 2025.</p><p><strong>Exposure: </strong>Enrollment in FSP.</p><p><strong>Main outcomes and measures: </strong>Primary outcomes were 1-year changes in food and housing insecurity, stress, dietary quality, and acute health care use. Secondary outcomes were changes in depression and anxiety symptoms. Annual surveys measured food insecurity (10-item US Department of Agriculture Food Security Scale Module; score range: 0-10, with ≥3 indicating food insecurity), housing insecurity (questions regarding current housing, moving ≥2 times in past year, and worrying about losing housing), and stress (the 10-item Perceived Stress Scale [PSS]; score range: 0-40, with ≥14 indicating moderate to severe stress). Diet quality was measured with the Healthy Eating Index-2020 (HEI-2020; score range: 0-100, with higher scores indicating healthier diet quality). Acute health care use included annual emergency department (ED) visits and acute hospitalizations.</p><p><strong>Results: </strong>There were 153 FSP participant episodes (representing 153 study participants; mean [SD] age, 43.6 [10.8] years; 129 females [84.3%]) and 1495 non-FSP participant episodes (representing 610 unique study participants; mean (SD) age 43.2 (11.2) years; 464 females [76.1%]) in the sample. Before FSP enrollment, 111 (72.5%) had food insecurity, 68 (44.4%) had housing insecurity, and 55 (35.9%) had both. There were no differences between the FSP and non-FSP groups in changes in proportion of individuals with food insecurity (difference in change, 4.96%; 95% CI, -3.13% to 13.05%) or housing insecurity (difference in change, 2.75%; 95% CI: -5.39% to 10.88%). There were no differences between groups in HEI-2020 scores, PSS scores, or acute health care use. Participant interviews reflected a range of experiences associated ","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 7","pages":"e2519507"},"PeriodicalIF":10.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12238900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583892","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":"Spillover of Azithromycin Mass Drug Administration and Child Survival: A Secondary Analysis of a Cluster-Randomized Clinical Trial.","authors":"Ahmed M Arzika, Abdou Amza, Ramatou Maliki, Bawa Aichatou, Ismael Mamane Bello, Diallo Beidi, Nasser Galo, Nasser Harouna, Alio M Karamba, Sani Mahamadou, Moustapha Abarchi, Almou Ibrahim, Carolyn Brandt, Elodie Lebas, Brittany Peterson, Zijun Liu, Catherine E Oldenburg, Thuy Doan, Travis C Porco, Benjamin F Arnold, Thomas M Lietman, Kieran S O'Brien","doi":"10.1001/jamanetworkopen.2025.19693","DOIUrl":"10.1001/jamanetworkopen.2025.19693","url":null,"abstract":"<p><strong>Importance: </strong>World Health Organization guidelines on azithromycin mass drug administration for child survival target infants aged 1 to 11 months, although prior studies included those aged 1 to 59 months. The AVENIR trial suggested that infants aged 1 to 11 months have lower mortality if children aged 12 to 59 months in the same household are also included.</p><p><strong>Objective: </strong>To assess the possibility of a spillover effect by examining the association of azithromycin and mortality among children aged 1 to 11 months in subgroups defined by the presence of a child aged 12 to 59 months in the same household.</p><p><strong>Design, setting, and participants: </strong>This exploratory secondary analysis of the AVENIR (Azithromycine Pour la Vie des Enfants au Niger: Implementation et Recherche) adaptive cluster-randomized clinical trial was performed in 3000 rural and periurban communities in Niger. AVENIR communities were randomized to 3 arms and followed up for 2 years (November 24, 2020, to July 31, 2023). Study arms consisted of children aged 1 to 59 months receiving azithromycin (child arm); infants aged 1 to 11 months receiving azithromycin with placebo to children aged 12 to 59 months (infant arm); and children aged 1 to 59 months receiving placebo (placebo arm). Participants, investigators, data collectors, and data analysts were masked to randomization.</p><p><strong>Intervention: </strong>A single 20-mg/kg dose of oral azithromycin or placebo administered by study staff biannually.</p><p><strong>Main outcomes and measures: </strong>All-cause mortality in infants aged 1 to 11 months (deaths per 1000 person-years) measured through biannual census. Subgroups were defined by the presence of a child aged 12 to 59 months in the household recorded during the census.</p><p><strong>Results: </strong>After exclusions, 2883 communities and 98 969 infants aged 1 to 11 months were included in the analysis. Among the 23 770 infants in allocation 1 at baseline, mean (SD) age was 6.2 (3.1) months and 11 974 (50.4%) were female. Mortality was 18.5 (95% CI, 16.7-20.4) deaths per 1000 person-years in the child arm, 22.3 (95% CI, 20.0-24.7) in the infant arm, and 23.9 (95% CI, 21.6-26.2) in the placebo arm. The incidence rate ratio comparing mortality in the child and infant arms among children with an older sibling was 0.78 (95% CI, 0.65-0.93) compared with 0.91 (95% CI, 0.73-1.15; P = .26 for interaction) among those without. Comparing the infant and placebo arms, the incidence rate ratio among children with an older sibling was 0.96 (95% CI, 0.81-1.14) compared with 0.90 (95% CI, 0.71-1.12; P = .61 for interaction) among those without.</p><p><strong>Conclusions and relevance: </strong>In this secondary analysis of a cluster-randomized clinical trial, interaction for the presence of a older sibling was not statistically significant, but results were consistent with lower mortality among infants aged 1 to 11 months living with o","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 7","pages":"e2519693"},"PeriodicalIF":10.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12246876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600412","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":"Electronic Health Record Interventions to Reduce Risk of Hospital Readmissions: A Systematic Review and Meta-Analysis.","authors":"Badal S B Pattar, Abigail Ackroyd, Emir Sevinc, Taylor Hecker, Keila Turino Miranda, Caitlin McClurg, Kyle Weekes, Matthew T James, Neesh Pannu, Pietro Ravani, Paul E Ronksley, Sofia B Ahmed, Tyrone G Harrison","doi":"10.1001/jamanetworkopen.2025.21785","DOIUrl":"10.1001/jamanetworkopen.2025.21785","url":null,"abstract":"<p><strong>Importance: </strong>Hospital readmissions are associated with significant health care costs and poor patient outcomes. Despite the rapid adoption of electronic health record (EHR) systems, the use of EHR-based interventions to reduce the risk of hospital readmissions is unknown.</p><p><strong>Objective: </strong>To systematically review and estimate the association of EHR-based interventions vs controls with preventing 30-day all-cause hospital readmissions as tested in randomized clinical trials (RCTs).</p><p><strong>Data sources: </strong>Ovid MEDLINE, Ovid Embase, CINAHL, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched from database inception to July 5, 2024, using text words with analogous terms within concept areas of \"randomized controlled trial,\" \"hospitalized adults,\" and \"readmissions.\"</p><p><strong>Study selection: </strong>RCTs were included if they evaluated the effect of EHR-based interventions on hospital readmissions compared with a control arm without an EHR-embedded component. Studies were excluded if they involved nonhospitalized, pediatric, obstetric, or psychiatric populations or did not report readmission outcomes. Results were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline.</p><p><strong>Data extraction and synthesis: </strong>Data were extracted independently by 3 reviewers in duplicate. A random-effects model was used to pool data, and the quality of studies was assessed using the Cochrane Risk of Bias tool. Heterogeneity was quantified using the I2 statistic and explored with prespecified subgroup analyses and univariable meta-regression by population demographics, intervention complexity, and publication year.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was 30-day all-cause hospital readmission, and other readmission outcomes (eg, unplanned readmissions and readmissions at 3, 6, 12, and 24 months) were examined as secondary outcomes.</p><p><strong>Results: </strong>A total of 116 RCTs involving 204 523 participants (weighted mean [SD] males, 56% [16%]; weighted mean [SD] age, 68 [9] years) were included, with telemonitoring (76 studies [66%]) being the most common EHR-based intervention component followed by case management (45 studies [39%]) and medication reconciliation (33 [28%]). EHR-based interventions were associated with a statistically significant reduction in 30-day all-cause readmissions (OR, 0.83 [95% CI, 0.70-0.99]; I2 = 82%; τ = 0.44 [95% CI, 0.30-0.62]; prediction interval [PI], 0.34-2.06) and 90-day all-cause readmissions (OR, 0.72 [95% CI, 0.54-0.96]; I2 = 78%; τ = 0.34 [95% CI, 0.19-1.00]; PI, 0.33-1.55) compared with control arms.</p><p><strong>Conclusions and relevance: </strong>In this systematic review and meta-analysis of RCTs, the use of EHR-based interventions was associated with a reduction in 30-day and 90-day hospital readmissions. Future resea","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 7","pages":"e2521785"},"PeriodicalIF":10.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12272288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649473","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}