JAMA Network Open最新文献

{"title":"Physician Perspectives on Ambient AI Scribes.","authors":"Shreya J Shah, Trevor Crowell, Yejin Jeong, Anna Devon-Sand, Margaret Smith, Betsy Yang, Stephen P Ma, April S Liang, Clarissa Delahaie, Caroline Hsia, Tait Shanafelt, Michael A Pfeffer, Christopher Sharp, Steven Lin, Patricia Garcia","doi":"10.1001/jamanetworkopen.2025.1904","DOIUrl":"10.1001/jamanetworkopen.2025.1904","url":null,"abstract":"<p><strong>Importance: </strong>Limited qualitative studies exist evaluating ambient artificial intelligence (AI) scribe tools. Such studies can provide deeper insights into ambient AI implementations by capturing lived experiences.</p><p><strong>Objective: </strong>To evaluate physician perspectives on ambient AI scribes.</p><p><strong>Design, setting, and participants: </strong>A qualitative study using semistructured interviews guided by the Reach, Efficacy, Adoption, Implementation, Maintenance/Practical, Robust Implementation, and Sustainability Model (RE-AIM/PRISM) framework, with thematic analysis using both inductive and deductive approaches. Physicians participating in an AI scribe pilot that included community and faculty practices, across primary care and ambulatory specialties, were invited to participate in interviews. This ambient AI scribe pilot at a health care organization in California was conducted from November 2023 to January 2024.</p><p><strong>Main outcome and measures: </strong>Facilitators and barriers to adoption, practical effectiveness, and suggestions for improvement to enhance sustainability.</p><p><strong>Results: </strong>Twenty-two semistructured interviews were conducted with AI pilot physicians from primary care (13 [59%]) and ambulatory specialties (9 [41%]), including physicians from community practices (12 [55%]) and faculty practices (10 [45%]). Facilitators to adoption included ease of use, ease of editing, and generally positive perspectives of tool quality. Physicians expressed positive sentiments about the impact of the ambient AI scribe tool on cognitive demand (16 of 16 comments [100%]), temporal demand (28 comments [62%]), work-life integration (10 of 11 comments [91%]), and overall workload (8 of 9 comments [89%]). Physician perspectives of the impact of the ambient AI scribe tool on their engagement with patients were mostly positive (38 of 56 comments [68%]). Barriers to adoption included limited functionality with non-English speaking patients and lack of access for physicians without a specific device. Physician perspectives on accuracy and style were largely negative, particularly regarding note length and editing requirements. Several specific suggestions for tool improvement were identified, and physicians were optimistic regarding the potential for long-term use of ambient AI scribes.</p><p><strong>Conclusion and relevance: </strong>In this qualitative study, ambient AI scribes were found to positively impact physician workload, work-life integration, and patient engagement. Key facilitators and barriers to adoption were identified, along with specific suggestions for tool improvement. These findings suggest the potential for ambient AI scribes to reduce clinician burden, with user-centered recommendations offering practical guidance on ways to improve future iterations and improve adoption.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e251904"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11933996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692193","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":"Alcohol Use Disorder Medication Coverage and Utilization Management in Medicaid Managed Care Plans.","authors":"Maureen T Stewart, Sage R Feltus, Christina M Andrews, Andrea Acevedo, Cindy Parks Thomas, Jeffrey Bratberg, Constance M Horgan, Dominic Hodgkin, Rachel Sayko Adams","doi":"10.1001/jamanetworkopen.2025.0695","DOIUrl":"10.1001/jamanetworkopen.2025.0695","url":null,"abstract":"<p><strong>Importance: </strong>Evidence-based, patient-centered treatment for alcohol use disorder (AUD) can include pharmacotherapy with naltrexone, acamprosate, or disulfiram; however, these medications are rarely used. Medicaid managed care plans (MCPs) manage health services for nearly 80% of Medicaid enrollees and are the largest payer for addiction treatment services. Little is known about Medicaid MCP policies for AUD medications.</p><p><strong>Objectives: </strong>To describe Medicaid MCPs' coverage and management of acamprosate, naltrexone, and disulfiram for AUD and examine associations of plan characteristics and state policies with medication coverage.</p><p><strong>Design, setting, and participants: </strong>In this cross-sectional study, a content analysis was performed of 2021 insurance benefit data for 241 comprehensive Medicaid MCPs in states using Medicaid managed care, as well as secondary sources. Data were analyzed from May to August 2024.</p><p><strong>Main outcomes and measures: </strong>Medicaid MCP-reported medication coverage and utilization management requirements (eg, prior authorization, quantity limit requirements) for acamprosate, disulfiram, and oral and injectable naltrexone together and for each medication separately. Independent variables included plan characteristics (profit status, market share) and the state policy environment in which plans are embedded (Section 1115 substance use disorder waiver, state-defined preferred drug list). Regressions examined associations of plan characteristics and state policies with medication coverage.</p><p><strong>Results: </strong>In this cross-sectional content analysis of 241 comprehensive Medicaid MCPs in 2021, 217 (90.0%) covered at least 1 medication for AUD: 132 (54.7%) covered acamprosate, 203 (84.2%) covered oral naltrexone, 175 (72.6%) covered injectable naltrexone, 152 (63.0%) covered disulfiram, and 103 (42.7%) covered all 4 medications. Prior authorization and quantity limits were rarely applied, except for injectable naltrexone, for which 75 plans (42.8%) imposed at least 1 of these utilization management requirements.</p><p><strong>Conclusions and relevance: </strong>This study suggests that efforts to expand AUD medication prescribing may be limited by gaps in health insurance coverage. Medicaid MCPs and states can support AUD medication utilization by covering these medications without applying utilization management strategies.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250695"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624639","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":"Probiotics and Fever Duration in Children With Upper Respiratory Tract Infections: A Randomized Clinical Trial.","authors":"Silvia Bettocchi, Anna Comotti, Marina Elli, Valentina De Cosmi, Cristiana Berti, Ilaria Alberti, Alessandra Mazzocchi, Chiara Rosazza, Carlo Agostoni, Gregorio Paolo Milani","doi":"10.1001/jamanetworkopen.2025.0669","DOIUrl":"10.1001/jamanetworkopen.2025.0669","url":null,"abstract":"<p><strong>Importance: </strong>Upper respiratory tract infections (URTIs) are prevalent in children, prompting frequent health care consultations, especially among those with fever. Probiotics show potential as an adjuvant treatment for URTIs, but evidence in children is limited.</p><p><strong>Objective: </strong>To evaluate the efficacy of a probiotic mixture containing Bifidobacterium breve M-16V, Bifidobacterium lactis HN019, and Lactobacillus rhamnosus HN001 in shortening fever duration among children with URTIs.</p><p><strong>Design, setting, and participants: </strong>This randomized clinical trial was conducted between November 19, 2021, and June 20, 2023, at the pediatric emergency department of the Ca' Granda Ospedale Maggiore Policlinico in Milan, Italy. Patients between 28 days and 4 years of age with a fever (≥38.5 °C) and URTI were eligible. Exclusion criteria included recent probiotic use, chronic autoimmune diseases, immunosuppressive treatment, and requirement for hospitalization. Randomization was computer generated and assigned participants to either the intervention (probiotics) or control (placebo) group. Participants, parents or caregivers, and investigators were masked to the group assignments. The primary analysis followed the intention-to-treat approach.</p><p><strong>Interventions: </strong>The probiotic group received daily single dose of 0.5 mL probiotic mixture containing Bifidobacterium breve M-16V, Bifidobacterium lactis HN019, and Lactobacillus rhamnosus HN001 for 14 days. The placebo group received daily single dose of 0.5 mL placebo for 14 days.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was fever duration, defined as the number of days between the first and the last days with fever.</p><p><strong>Results: </strong>Of the 128 patients enrolled (69 males [54%]; mean [SD] age 2.5 [1.3] years), 65 (51%) were randomly assigned to receive placebo and 63 (49%) to receive probiotics. The median (IQR) fever duration was shorter in the probiotic group than the placebo group (median [IQR], 3 [2-4] days vs 5 [4-6] days; adjusted risk ratio, 0.64; 95% CI, 0.51-0.80). Few mild adverse events were reported and did not significantly differ between the probiotic and placebo groups, including constipation (6 [16%] and 6 [12%]; P = .80) and abdominal pain (3 [8%] and 2 [4%]; P = .65).</p><p><strong>Conclusions and relevance: </strong>In this randomized clinical trial, administering a probiotic mixture reduced fever duration by 2 days compared with placebo, with no meaningful safety concerns. The probiotic mixture under investigation could be an effective adjuvant for shortening fever duration in children with URTIs.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT06052540.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250669"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624687","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":"Sexual Orientation- and Gender Identity-Affirming Activities Provided in Primary Care.","authors":"Ellesse-Roselee L Akre, Ching-Wen Wendy Yang, Greta R Bauer, Matthew Brian Mackwood, A James O'Malley, Elliott S Fisher, Karen E Schifferdecker","doi":"10.1001/jamanetworkopen.2025.0392","DOIUrl":"10.1001/jamanetworkopen.2025.0392","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Addressing health disparities in lesbian, gay, bisexual, transgender, and queer (LGBTQ+) communities has been a significant policy focus for more than a decade. Ensuring access to safe, respectful primary health care from knowledgeable clinicians is crucial for reducing health inequalities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess the engagement of primary care practices in LGBTQ+ affirming care activities and identify practice characteristics associated with increased engagement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cross-sectional study used data from the National Survey of Healthcare Organizations and Systems II, which focused on primary care practices in the US and was administered between June 2022 through February 2023. Participants were primary care physicians and practice managers. Percentages were weighted for national representation. Data were analyzed from November 2023 to December 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Practice characteristics including practice size, ownership, federally qualified health center (FQHC) designation; percentage of patients enrolled in Medicare; percentage of patients enrolled in Medicaid; having accountable care organization (ACO) contracts for Medicare, Medicaid, or commercial insurance; rurality; census region; and LGBTQ+ Equality Score by state policy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Sexual orientation- and gender identity- (SOGI) affirming activities, a composite variable reflecting activity specific to SOGI patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 1245 practices in the sample (38.4% response rate), 923 (77.40%) collected data on gender identity, 921 (75.62%) on sexual orientation, and 742 (65.83%) on patients' pronouns. Only 412 practices (34.42%) provided LGBTQ+ training for clinicians and 480 practices (39.20%) provided training for staff. Practices designated as FQHCs had 3.16 (95% CI, 4.60 to 19.73) percentage points higher probability of engaging in all SOGI-affirming activities) compared with non-FQHCs (P = .001). Practices with a Medicaid payer mix at least 50% had 3.28 (95% CI, 1.19 to 5.36) percentage points higher probability than practices with less than 50% Medicaid payer mix (P = .002), and participation in a Medicaid ACO was associated with 4.26 (95% CI, 0.78 to 7.73) percentage points increased probability compared with nonparticipants (P = .02). Each 1-unit increase in the state-level LGBTQ+ Equality Score was associated with 1.07 (95% CI, 0.28 to 1.85) percentage points higher probability of engaging in all SOGI-affirming activities (P = .02). High performance was negatively associated with practice rurality (average marginal effect, -16.00 [95% CI, -29.72 to -2.28]; P = .02), and rural practices were less likely to provide appropriate referrals (average marginal effect, -15.47 [95% CI, -29.22 to -1.72]; P = .03).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;These findings suggest there is a","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250392"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11894487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585625","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 Figure 3.","authors":"","doi":"10.1001/jamanetworkopen.2025.4939","DOIUrl":"10.1001/jamanetworkopen.2025.4939","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e254939"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11897830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605059","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":"Intentional Weight Loss, Waist Circumference Reduction, and Mortality Risk Among Postmenopausal Women.","authors":"Michael Hendryx, JoAnn E Manson, Robert J Ostfeld, Rowan T Chlebowski, Erin S LeBlanc, Molly E Waring, Wendy E Barrington, Marisa A Bittoni, Sylvia Wassertheil-Smoller, Jackie Gofshteyn Herold, Juhua Luo","doi":"10.1001/jamanetworkopen.2025.0609","DOIUrl":"10.1001/jamanetworkopen.2025.0609","url":null,"abstract":"<p><strong>Importance: </strong>Research investigating weight loss and mortality risk often fails to differentiate between intentional and unintentional weight loss and typically uses body mass index (BMI) as the measure of excess body weight.</p><p><strong>Objective: </strong>To evaluate associations between weight loss and waist circumference (WC) reduction and mortality, considering weight loss intentionality.</p><p><strong>Design, setting, and participants: </strong>This cohort study used data from the Women's Health Initiative Observational Study, which had a prospective cohort with mean follow-up of 18.6 years ending in February 2023. The study included women aged 50 to 79 years at 40 clinical centers in the US. Women with missing data, cancer at baseline, or considered underweight at baseline were excluded. Data were collected from September 1993 to February 2023 and were analyzed from June to December 2024.</p><p><strong>Exposures: </strong>Measured weight loss and WC reduction between baseline and year 3, stratified by women who reported intentional weight loss or not.</p><p><strong>Main outcomes and measures: </strong>Outcomes included adjudicated all-cause, cancer, cardiovascular, and other mortality through the end of follow-up. Cox proportional hazards regression models were used to evaluate the associations (hazard ratios [HRs] and 95% CIs) between weight loss, WC reduction, and mortality over 18.6 years of follow-up.</p><p><strong>Results: </strong>This study included 58 961 women at baseline (mean [SD] age, 63.3 [7.2] years; mean [SD] BMI, 27.0 [5.6]; mean [SD] WC, 84.1 [13.0] cm). As of February 28, 2023, 29 183 women (49.5%) died from all causes. Intentional weight loss measured by questionnaire was associated with lower subsequent mortality rates for all-cause mortality (HR, 0.88; 95% CI, 0.86-0.90), cancer mortality (HR, 0.87; 95% CI, 0.82-0.92), cardiovascular mortality (HR, 0.87; 95% CI, 0.83-0.91), and other mortality (HR, 0.89; 95% CI, 0.86-0.92), comparing loss of 5 pounds or more to stable weight. Reported intentional weight loss coupled with actual weight reduction of 5% or more was associated only with lower cardiovascular mortality (HR, 0.90; 95% CI, 0.81-0.99). Reported intentional weight loss coupled with measured WC loss was associated with lower rates of all-cause mortality (HR, 0.91; 95% CI, 0.86-0.95), cancer mortality (HR, 0.85; 95% CI, 0.76-0.95), and cardiovascular mortality (HR, 0.79; 95% CI, 0.72-0.87). Unintentional weight loss or unintentional WC loss were each associated with increased mortality risk for all groups, as were weight gain and WC gain.</p><p><strong>Conclusions and relevance: </strong>In this cohort study, reported intentional weight loss efforts that were coupled with measured WC reductions were associated with lower risk of all-cause, cancer, and cardiovascular mortality. Attention to diet and exercise that promote reductions in central adiposity should be encouraged.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250609"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567188","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":"From Gestational Diabetes to Type 2 Diabetes-Is Poor Sleep to Blame?","authors":"Christian Benedict, Marie-Pierre St-Onge","doi":"10.1001/jamanetworkopen.2025.0149","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.0149","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250149"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556973","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":"Cost-Effectiveness of Pembrolizumab With Chemoradiotherapy for Locally Advanced Cervical Cancer.","authors":"P Travis Courtney, Puja S Venkat, Ya-Chen Tina Shih, Albert J Chang, Alan Lee, Michael L Steinberg, Ann C Raldow","doi":"10.1001/jamanetworkopen.2025.0033","DOIUrl":"10.1001/jamanetworkopen.2025.0033","url":null,"abstract":"<p><strong>Importance: </strong>The KEYNOTE-A18 trial demonstrated that adding concurrent and adjuvant pembrolizumab to chemoradiotherapy and brachytherapy significantly improved survival in patients with newly diagnosed, locally advanced cervical cancer. However, considering the annual global incidence of 660 000 cases of cervical cancer, including 13 820 in the US in 2024, incorporating this regimen into the standard of care could have substantial health care economic implications for both patients and the health care system.</p><p><strong>Objective: </strong>To determine the cost-effectiveness of adding pembrolizumab to the first-line treatment of newly diagnosed, locally advanced cervical cancer.</p><p><strong>Design, setting, and participants: </strong>This economic evaluation created a Markov model simulating 50-year outcomes to evaluate cost-effectiveness from the payer perspective for patients receiving either pembrolizumab or placebo in addition to chemoradiotherapy plus brachytherapy. Probabilities, including disease progression, survival, and treatment-related toxic effects, were derived from KEYNOTE-A18 clinical trial data in patients with newly diagnosed, locally advanced cervical cancer. Costs and health utilities were obtained from published literature; 1-way, 3-way, and probabilistic sensitivity analyses were used to assess model uncertainty. Data analyses were conducted from April to November 2024.</p><p><strong>Exposure: </strong>Pembrolizumab.</p><p><strong>Main outcomes and measures: </strong>Costs, measured in 2024 US dollars, and effectiveness, measured in quality-adjusted life-years (QALYs) were used to calculate an incremental cost-effectiveness ratio (ICER). A willingness-to-pay threshold of $100 000 per QALY was chosen, below which pembrolizumab would be considered cost-effective.</p><p><strong>Results: </strong>KEYNOTE-A18 enrolled 1060 patients (529 in pembrolizumab group, 531 in placebo group). The median age was 50 years. Pembrolizumab increased costs by $257 000 and effectiveness by 1.40 QALYs, yielding an incremental cost-effectiveness ratio of $183 400 per QALY. The addition of pembrolizumab became cost-effective if its monthly cost was decreased from $16 990 to $9190 (a 45.6% reduction) or its maximum duration of 24 months was decreased to 10 months. The model was insensitive to assumptions about treatment-related toxic effects, progression-free survival, and overall survival. Probabilistic sensitivity analysis indicated that at a willingness-to-pay threshold of $100 000 per QALY, the addition of pembrolizumab was cost-effective 37.3% of the time.</p><p><strong>Conclusions and relevance: </strong>In this economic evaluation of adding concurrent and adjuvant pembrolizumab to first-line treatment of newly diagnosed, locally advanced cervical cancer, this regimen was not cost-effective at current prices despite data demonstrating improved survival with this regimen.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250033"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11880949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541967","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":"Veterans at High Risk for Post-COVID-19 Suicide Attempts or Other Self-Directed Violence.","authors":"David P Bui, Meike Niederhausen, Alex W Hickok, Diana J Govier, Mazhgan Rowneki, Jennifer C Naylor, Eric Hawkins, Edward J Boyko, Theodore J Iwashyna, Elizabeth M Viglianti, George N Ioannou, Jason I Chen, Denise M Hynes","doi":"10.1001/jamanetworkopen.2025.0061","DOIUrl":"10.1001/jamanetworkopen.2025.0061","url":null,"abstract":"<p><strong>Importance: </strong>US veterans have a higher risk of suicide than the general civilian population. Research suggests that COVID-19 infection is associated with increased risk of suicide attempts or other forms of self-directed violence (SDV) among veterans.</p><p><strong>Objective: </strong>To identify subgroups of veterans with high risk of post-COVID-19 suicide attempts or SDV.</p><p><strong>Design, setting, and participants: </strong>This is a retrospective cohort study conducted using data from the Veteran Health Administration (VHA). Participants included VHA enrollees with a first case of COVID-19 between May 1, 2021, and April 30, 2022, residing in the 50 states or Washington, DC.</p><p><strong>Exposure: </strong>COVID-19 infection.</p><p><strong>Main outcomes and measures: </strong>The main outcome was a suicide attempt or SDV 12 months after COVID-19 infection. Latent class analysis was used to identify subgroups. Outcome rates and 95% CIs per 10 000 veterans were calculated. Multinomial regressions were used to model outcome risk and marginal risk ratios with 99.5% CIs to compare outcome risk across latent classes.</p><p><strong>Results: </strong>The cohort included 285 235 veterans with COVID-19 and was predominantly male (248 118 veterans [87.0%]) and younger than 65 years (171 636 veterans [60.2%]). Chronic pain (152 788 veterans [53.6%]), depression (98 093 veterans [34.4%]), and posttraumatic stress disorder (79 462 veterans [27.9%]) diagnoses were common. The 12-month outcome rate was 73.8 events per 10 000 (95% CI, 70.7-77.0 events per 10 000). Two latent classes with high rates of suicide attempt or SDV were identified. The first high-risk subgroup (46 693 veterans [16.4%]) was older (34 472 veterans [73.8%] aged ≥65 years) and had a high prevalence of physical conditions (43 329 veterans [92.8%] had hypertension, and 36 824 veterans [78.9%] had chronic pain); the 12-month outcome rate was 103.7 events per 10 000 (95% CI, 94.7-113.3 events per 10 000). The second high-risk subgroup (82 309 veterans [28.9%]) was generally younger (68 822 veterans [83.6%] aged <65 years) with a lower prevalence of physical conditions but high prevalence of mental health conditions (61 367 veterans [74.6%] had depression, and 50 073 veterans [60.8%] had posttraumatic stress disorder); the 12-month outcome rate was 162.9 events per 10 000 (95% CI, 154.5-171.8 events per 10 000), and compared with the lowest risk subgroup, the 12-month risk of suicide attempts or SDV was 14 times higher in this subgroup (risk ratio, 14.23; 99.5% CI, 10.22-19.80).</p><p><strong>Conclusions and relevance: </strong>In this cohort study of veterans with COVID-19, 2 veteran subgroups with distinct health profiles had high rates of suicide attempts and SDV, suggesting that different groups may require different approaches to suicide prevention after COVID-19.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250061"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11880954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542176","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":"Demographic Differences in Mortality in the District of Columbia","authors":"Maryam Hashemian, Katherine M Conners, Jungnam Joo, Rebeka Rafi, Gretell Henriquez Santos, Joseph J Shearer, Marcus R Andrews, Tiffany M Powell-Wiley, Meredith S Shiels, Véronique L Roger","doi":"10.1001/jamanetworkopen.2025.2290","DOIUrl":"10.1001/jamanetworkopen.2025.2290","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Washington, District of Colombia (DC), has the largest gap in life expectancy between Black and White populations among major US cities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To investigate mortality, key modifiable cardiovascular disease (CVD) risk factors, and temporal trends for non-Hispanic Black and non-Hispanic White populations in Washington, DC, from 2000 to 2020.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cross-sectional study analyzed the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database for mortality and the Behavioral Risk Factor Surveillance System for the prevalence of risk factors (obesity, hypertension, diabetes, smoking, and hypercholesterolemia) among Black and White populations in Washington, DC, from 2000 to 2020. All analyses were conducted in January 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;All-cause and cause-specific, age-adjusted mortality rates per 100 000 person-years, prevalence of risk factors, and corresponding rate ratios (RRs) and 95% CIs comparing Black individuals to White individuals were assessed. Average annual percentage change (AAPC) was examined using joinpoint regression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 102 710 deaths in Washington, DC (51 712 among males [50.3%], 26 100 among individuals aged ≥85 years [25.4%]; 82 308 among Black [80.1%] and 20 402 among White [19.9%] individuals), CVD (33 254 deaths [32.4%]) and cancer (22 677 deaths [22.1%]) accounted for more than half of deaths. All-cause mortality declined between 2000 and 2012 (AAPC, -2.6%; 95% CI, -4.5% to -1.9%), stagnated between 2012 and 2018, and increased between 2018 and 2020 (AAPC, 10.9%; 95% CI. 3.8% to 15.1%). CVD mortality declined between 2000 and 2011 (AAPC, -3.1%; 95% CI, -4.3% to -2.4%) and plateaued thereafter in the Black population, contrasting with the monotonic decline in the White population from 2000 to 2020 (AAPC, -4.7%; 95% CI, -5.3% to -4.1%), for a magnification of disparities from 2000 (RR, 1.5; 95% CI, 1.4 to 1.7) to 2020 (RR, 2.9; 95% CI, 2.5 to 3.3). Cancer mortality decreased from 2000 to 2020 but with a greater magnitude in the White (AAPC, -3.4%; 95% CI, -3.9% to -2.9%) than Black (AAPC, -1.8%; 95% CI, -2.2% to -1.4%) population (RR for 2000, 1.6; 95% CI, 1.4 to 1.8 and RR for 2020, 2.1; 95% CI, 1.8 to 2.4). Risk factors were consistently more prevalent in the Black than White population (eg, hypertension: RR, 2.2; 95% CI, 1.8 to 2.7 in 2001 and 2.3; 95% CI, 1.9-2.6 in 2019). Disparities as assessed by RRs increased for smoking (AAPC, 4.3%; 95% CI, 3.8% to 5.6%), decreased for obesity (AAPC, -1.2%; 95% CI, -1.9% to -0.4%), and remained constant for diabetes, hypercholesterolemia, and hypertension.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this study, all-cause, age-adjusted mortality was higher in the Black than White population, racial disparities worsened for CVD and cancer, and CVD","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e252290"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11953761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729949","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}