JAMA Network Open最新文献

{"title":"Continuous Glucose Monitoring and Long-Term Glycemic and Kidney Outcomes.","authors":"Andrew J Karter, Melissa M Parker, Holly Finertie, Joshua R Nugent, Lisa K Gilliam, Ajit Mahapatra","doi":"10.1001/jamanetworkopen.2026.37698","DOIUrl":"10.1001/jamanetworkopen.2026.37698","url":null,"abstract":"<p><strong>Importance: </strong>Real-time continuous glucose monitoring (rtCGM) improves short-term glycemic control in diabetes. However, scant evidence exists regarding rtCGM's longer-term benefits for glycemia or kidney health.</p><p><strong>Objective: </strong>To evaluate whether rtCGM initiation and sustained use is associated with improved glycemic control and kidney markers in high-risk adults with type 2 diabetes (T2D).</p><p><strong>Design, setting, and participants: </strong>This comparative effectiveness research study compared glycemic control and kidney markers among high-risk adults with T2D initiating and sustaining use of rtCGM (rtCGM arm) vs no initiation (controls) using inverse probability-weighted marginal structural models to estimate per-protocol outcomes of an emulated target trial. Target trial eligibility criteria were as follows: age of 19 years or older, T2D, no prior CGM use, and poor glycemic control (hemoglobin A1c [HbA1c] >8%) or emergency department or inpatient treatment for hypoglycemia. Baseline was defined by the rtCGM initiation date and applied to temporally matched CGM-naive controls who met the eligibility criteria, sampled monthly from risk sets from January 1, 2015, to June 30, 2023. Data were censored at nonadherence to the target trial protocol (eg, rtCGM arm discontinued use or controls initiated CGM), coverage gaps, death, or after 36 months of follow-up. Data analysis was performed July 2025 to March 2026.</p><p><strong>Exposure: </strong>rtCGM use.</p><p><strong>Main outcomes and measures: </strong>Cumulative differences for HbA1c, urinary albumin-creatinine ratio (UACR), and estimated glomerular filtration rate (eGFR).</p><p><strong>Results: </strong>The study included 25 648 individuals (2771 in the rtCGM arm and 22 877 in the control arm) who were target trial eligible (mean [SD] age, 61.5 [13.1] years; 13 885 [54.7%] male). The mean (SD) baseline HbA1c level was 9.5% (1.5%). After 36 months of follow-up, the rtCGM arm had an approximately 0.8-percentage point lower HbA1c level than controls (7.83% [95% CI, 7.55%-8.11%] vs 8.58% [95% CI, 8.49%-8.66%], P < .001). There was substantial attrition during follow-up; 1228 (44.3%) in the rtCGM arm were censored due to discontinuation and 4284 (18.7%) in the control group were censored due to CGM initiation. There were no significant differences in UACR between arms initially; however, by the end of 36 months, rtCGM initiators had a UACR of 125.3 mg/g (95% CI, -196.6 to -54.0 mg/g; P = .001) lower than that of controls. There were no differences in eGFR during follow-up.</p><p><strong>Conclusions and relevance: </strong>In this comparative effectiveness study using a target trial emulation, sustained, longer-term use of rtCGM was associated with durable improvements in glycemic control and later regression of UACR. By addressing glycemic deterioration, rtCGM may extend the time before pharmacologic escalation is required and potentially delay diabetic ki","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2637698"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127471","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":"Emergency Care Seeking and Utilization in a Changing Immigration Landscape-Balancing the Need for Evidence With Potential Risks.","authors":"Esmeralda Melgoza","doi":"10.1001/jamanetworkopen.2026.36700","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.36700","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2636700"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109764","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":"Identifying Differences in Autism Factors Using Maternal vs Child Race and Ethnicity.","authors":"Aisha S Dickerson","doi":"10.1001/jamanetworkopen.2026.37487","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.37487","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2637487"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109772","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":"Physician- and Practice-Level Variation in Clinical Trial Participation Among Patients With Advanced Cancer.","authors":"Changchuan Jiang, Chuan Angel Lu, Joshua M Liao, Ryan D Nipp, K Robin Yabroff, Helen H Moon, Song Zhang, Xin Hu, Tian Zhang","doi":"10.1001/jamanetworkopen.2026.33046","DOIUrl":"10.1001/jamanetworkopen.2026.33046","url":null,"abstract":"<p><strong>Importance: </strong>Clinical trial enrollment is essential to advancing cancer care, yet participation among patients with advanced cancer remains low. While patient-level barriers are frequently cited, the role of health care delivery factors-specifically physician- and practice-level variation-has been poorly quantified.</p><p><strong>Objective: </strong>To quantify variation in clinical trial participation and identify associated delivery system factors among patients with advanced cancer.</p><p><strong>Design, setting, and participants: </strong>This cohort study included adults with advanced or metastatic cancers diagnosed and treated between January 1, 2011, and December 31, 2024, by 1664 physicians across 107 trial-available oncology practices across the US. Data were obtained from the Flatiron Health Research Database. Analyses were conducted between January and April 2025.</p><p><strong>Exposures: </strong>Patient-level (eg, demographic characteristics, cancer type, and performance status), physician-level (eg, patient volume, subspecialization, and prior trial enrollment activity), and practice-level (eg, size, research engagement, and patient composition) factors.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was clinical trial participation, defined as receipt of a clinical study drug. Mixed-effects logistic regression models were used to decompose the proportion of variation attributable to patient-, physician-, and practice-level factors. Multivariable logistic regression was used to identify characteristics associated with trial participation.</p><p><strong>Results: </strong>Among the 205 743 patients with advanced or metastatic cancer (mean [SD] age at advanced cancer diagnosis, 67.5 [11.3]; 107 370 males [52.2%]), 10 785 (5.2%) participated in a clinical trial over the study period, increasing from 235 of 5964 (3.9%) in 2011 to 638 of 9336 (6.8%) in 2024. Participation remained highly concentrated: of 1664 physicians, 389 (23.4%) accounted for 9018 (83.6%) of all enrollments (10 785), while 21 of 107 practices (19.6%) accounted for 8686 (80.5%) of all enrolled patients. Additionally, 494 of 1664 physicians (29.7%) enrolled no patients. Physician-level (12.3%) and practice-level (15.1%) factors explained a greater share of variation in trial participation than observable patient-level characteristics (11.4%), with physician- and practice-level contributions increasing over time. Physician's subspecialization (treated 1-2 cancer groups: odds ratio [OR], 4.11 [95% CI, 2.53-6.68], P = .002; treated 3-4 cancer groups: OR, 2.38 [95% CI, 1.37-4.14], P < .001), physician's prior trial enrollment activity (enrolled patients in the 2 previous years: OR, 1.58; 95% CI, 1.43-1.76; P < .001), and practice's research engagement (OR, 2.68; 95% CI, 2.12-3.39; P < .001) were associated with higher odds of trial participation.</p><p><strong>Conclusions and relevance: </strong>In this cohort study of patients wit","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2633046"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13643575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109745","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":"Errors in Funding/Support Statement and Conflict of Interest Disclosures.","authors":"","doi":"10.1001/jamanetworkopen.2026.42535","DOIUrl":"10.1001/jamanetworkopen.2026.42535","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2642535"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13650657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136871","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":"Undeclared Pharmacologically Active Ingredients in Over-the-Counter Skin Products.","authors":"Zaur Abilov, Michael J James, Martina L Porter, Yury V Popov","doi":"10.1001/jamanetworkopen.2026.38654","DOIUrl":"10.1001/jamanetworkopen.2026.38654","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2638654"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13650659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136438","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.","authors":"","doi":"10.1001/jamanetworkopen.2026.42881","DOIUrl":"10.1001/jamanetworkopen.2026.42881","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2642881"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147586","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":"LGBTQ+ Disparities in Food Insecurity, Food Assistance Use, and Barriers to Food Assistance.","authors":"Austin R Waters, Lauren G Fiechtner, Meghan E Perkins, Man Luo, Michele F Schuckel, Catherine D'Amato, Brittany M Charlton","doi":"10.1001/jamanetworkopen.2026.38129","DOIUrl":"10.1001/jamanetworkopen.2026.38129","url":null,"abstract":"<p><strong>Importance: </strong>Food insecurity disproportionately affects lesbian, gay, bisexual, transgender, and queer (LGBTQ+) adults, yet population-based data on disparities in food assistance use and barriers to accessing services remain limited.</p><p><strong>Objectives: </strong>To estimate the prevalence of food insecurity and food assistance program use among LGBTQ+ adults in Massachusetts from 2022 to 2024 and identify LGBTQ+-specific barriers to assistance.</p><p><strong>Design, setting, and participants: </strong>This repeated cross-sectional analysis used 2022 to 2024 data from the Massachusetts Statewide Food Access Survey, an annual online survey conducted by the Greater Boston Food Bank and Mass General Brigham.</p><p><strong>Exposure: </strong>LGBTQ+ identity, defined using a 2-step measure of sexual orientation and gender.</p><p><strong>Main outcomes and measures: </strong>Food insecurity, measured using the 10-item US Department of Agriculture Food Security Survey Module; food pantry and Supplemental Nutrition Assistance Program (SNAP) use; and barriers to food assistance access. Weighted prevalence estimates and adjusted prevalence ratios with 95% CIs were calculated by LGBTQ+ status.</p><p><strong>Results: </strong>The sample included 9174 Massachusetts adults (10.4%-12.8% LGBTQ+ across survey years). The prevalence of food insecurity increased significantly from 2022 to 2024 among both non-LGBTQ+ adults (29.8% [95% CI, 27.7%-32.0%] to 33.3% [95% CI, 31.3%-35.3%]) and LGBTQ+ adults (43.7% [95% CI, 37.7%-49.9%] to 54.9% [95% CI, 48.5%-61.1%]). Food pantry and SNAP use among LGBTQ+ adults remained stable over time. Among LGBTQ+ nonusers of food pantries in 2024, the most common barriers to use were wanting to be self-reliant (49.4% [95% CI, 41.6%-57.4%]), embarrassment (37.4% [95% CI, 30.1%-45.2%]), and fear of being identified as a pantry user (35.6% [95% CI, 28.6%-43.3%]); all barriers increased over time and were more commonly reported than among non-LGBTQ+ adults. Common barriers to SNAP use among LGBTQ+ adults in 2024 included wanting to be self-reliant (52.7% [95% CI, 43.4%-61.8%]), concern about taking benefits from someone with more need (44.6% [95% CI, 35.8%-53.7%]), and not knowing how to apply (26.0% [95% CI, 18.5%-35.1%]). In 2024, LGBTQ+ adults frequently endorsed grocery gift cards (42.5% [95% CI, 36.6%-48.7%]), home delivery (42.4% [95% CI, 36.4%-48.6%]), and online ordering (34.0% [95% CI, 28.5%-39.9%]) as strategies to increase pantry use.</p><p><strong>Conclusions and relevance: </strong>In this cross-sectional study of food insecurity in Massachusetts, over half of LGBTQ+ adults experienced food insecurity in 2024, alongside barriers to food assistance use. Findings highlight the need for multilevel, community-co-created interventions to reduce disparities among LGBTQ+ individuals in food insecurity and improve equitable access to food assistance.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2638129"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13650663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136985","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":"Recent and Cumulative Cannabis Use and Sleep in Middle-Aged Adults.","authors":"Thanh-Huyen T Vu, Kristen L Knutson, Reto Auer, Julian Jakob, Donald M Lloyd-Jones, Mercedes R Carnethon","doi":"10.1001/jamanetworkopen.2026.38303","DOIUrl":"10.1001/jamanetworkopen.2026.38303","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Cannabis is widely used and often promoted as a sleep aid, but evidence of its long-term implications for sleep is limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To examine the associations of cumulative cannabis exposure from young adulthood to middle age and recent cannabis use with objective and subjective sleep outcomes in middle age.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cohort study analyzed data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, including 35 years of follow-up through the year-35 examination (conducted in 2020 to 2022), and the CARDIA Year-35 Sleep Ancillary Study. Analyses were conducted from January 15 to July 15, 2026.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Cumulative cannabis use (calculated in cannabis-years, with 1 cannabis-year equating to 365 days of use) and recent cannabis use (defined as past 30-day use vs former use and never use).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Objective sleep was assessed using data from 7-day wrist actigraphy, and subjective sleep was assessed with the Pittsburgh Sleep Quality Index (PSQI). Primary outcomes and measures were objective sleep duration (categorized as short [&lt;6 hours], optimal [6-8 hours], or long [&gt;8 hours]), sleep percentage (defined as percentage of time asleep; low percentage: &lt;85%), sleep fragmentation (defined as the index of restlessness during sleep; high fragmentation: highest quartile), and wakefulness after sleep onset (WASO; prolonged WASO: ≥30 minutes) and subjective sleep quality (PSQI score and poor sleep quality: PSQI &gt;5).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 1266 participants (891 with objective and 1128 with subjective sleep data) were analyzed. Among the 891 participants with objective sleep data, the mean (SD) age at the year-35 examination was 60.7 (3.6) years; the cohort included 564 females (63.3%) and 365 Black (41.0%) and 526 White (59.0%) participants. After multivariable adjustment, each additional cannabis-year was associated with higher odds of low sleep percentage (odds ratio [OR], 1.10; 95% CI, 1.06-1.14), high sleep fragmentation (OR, 1.04; 95% CI, 1.01-1.08), and prolonged WASO (OR, 1.21; 95% CI, 1.10-1.34). Compared with participants with former use and never use status, those with recent use had higher odds of low sleep percentage, high fragmentation, prolonged WASO, and long (vs optimal) sleep duration (eg, vs never use, prolonged WASO: OR, 3.23 [95% CI, 1.44-7.27]; long sleep duration: OR, 4.60 [95% CI, 1.81-11.70]). Cannabis use was not associated with subjective sleep quality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this cohort study, both cumulative use and recent cannabis use were associated with poorer objective sleep quality, although no association with self-reported sleep quality was found. These findings underscore the importance of assessing both subjective and objective sleep and suggest potential adverse association betwe","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2638303"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148964","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":"Self-Reported Adverse Effects Among Social Media Users Taking Nonapproved Retatrutide.","authors":"Neil K R Sehgal, Jena Shaw Tronieri, Benjamin Rader, Lyle Ungar, Sharath Chandra Guntuku","doi":"10.1001/jamanetworkopen.2026.38929","DOIUrl":"10.1001/jamanetworkopen.2026.38929","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2638929"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182004","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}