JAMA Network Open最新文献

{"title":"Nonsupine Sleep Position Among US Infants.","authors":"Guodong Ding, Anqi Peng, Yan Chen, Angela Vinturache, Yongjun Zhang","doi":"10.1001/jamanetworkopen.2024.50277","DOIUrl":"10.1001/jamanetworkopen.2024.50277","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2450277"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11638792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813266","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":"Primary Care-Based Digital Health-Enabled Stroke Management Intervention: Long-Term Follow-Up of a Cluster Randomized Clinical Trial.","authors":"Jie Tan, Enying Gong, John A Gallis, Shifeng Sun, Xingxing Chen, Elizabeth L Turner, Siran Luo, Jingying Duan, Zixiao Li, Yilong Wang, Bolu Yang, Shiyu Lu, Shenglan Tang, Janet P Bettger, Brian Oldenburg, J Jaime Miranda, Biraj Karmacharya, Sanjay Kinra, Ruitai Shao, Shah Ebrahim, Lijing L Yan","doi":"10.1001/jamanetworkopen.2024.49561","DOIUrl":"10.1001/jamanetworkopen.2024.49561","url":null,"abstract":"<p><strong>Importance: </strong>Despite evidence of the short-term benefits of multicomponent primary care-based interventions, their long-term effects are unproven.</p><p><strong>Objective: </strong>To evaluate the long-term outcomes of a system-integrated technology-enabled model of care (SINEMA intervention) for stroke management for systolic blood pressure (BP) and other outcomes among patients with stroke in China.</p><p><strong>Design, setting, and participants: </strong>This long-term follow-up included community-dwelling clinically stable surviving participants with stroke in an open-label cluster randomized clinical trial. Of 218 villages from Nanhe County in Hebei, China, an area with suboptimal health care resources and stroke prevalence doubling the national average, 50 villages (clusters) were recruited between June 23 and July 29, 2017, and randomized in a 1:1 ratio to an intervention or a control arm (usual care). The intervention lasted 1 year (to July 31, 2018), with a posttrial observational follow-up conducted from October 1, 2022, to August 27, 2023.</p><p><strong>Interventions: </strong>Village doctors were provided with training, performance-based incentives, technical support, and customized mobile health tools to deliver monthly follow-up to patients. Patients also received daily voice messages emphasizing medication adherence and physical activity. No intervention was requested or supported during the posttrial period.</p><p><strong>Main outcomes and measures: </strong>Between-arm differences in intention-to-treat analyses of individual-level changes from baseline to long-term posttrial in systolic BP (primary outcome) and stroke recurrence, diastolic BP, BP control, antihypertensive medication use and regimen adherence, and disability (secondary outcomes).</p><p><strong>Results: </strong>Among a total of 1042 stroke survivors, 44 (4.2%) were lost to follow-up and 998 (mean [SD] age at baseline: 65.0 [8.2] years; 544 [54.4%] men) completed posttrial assessment at a mean (SD) period of 66.6 (3.7) months (5.5 years) after baseline. The multicomponent intervention was associated with an estimated between-arm net reduction in systolic BP of -2.8 (95% CI, -5.3 to -0.3) mm Hg (P = .03). Most secondary outcomes showed a tendency toward lasting effects, with a notable absolute net reduction of 6.0 (95% CI, -11.3 to -0.7) percentage points and risk ratio of 0.77 (95% CI, 0.61-0.99) for stroke recurrence. In subgroup analyses, significant between-arm differences were observed among women and people with lower educational attainment, lower income, and higher use of and adherence to medications.</p><p><strong>Conclusions and relevance: </strong>In this long-term follow-up of a cluster randomized clinical trial, the 1-year intervention was associated with significantly reduced systolic BP and stroke recurrence at 5.5 years, providing evidence of long-term health and inequity-reducing benefits and holding promise for scaling up of the ","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2449561"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11645652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817881","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":"Racial and Ethnic Disparities in Child Abuse Identification and Inpatient Treatment.","authors":"Fereshteh Salimi-Jazi, Norah E Liang, Zhuoyi Huang, Lakshika Tennakoon, Talha Rafeeqi, Amber Trickey, Stephanie D Chao","doi":"10.1001/jamanetworkopen.2024.51588","DOIUrl":"10.1001/jamanetworkopen.2024.51588","url":null,"abstract":"<p><strong>Importance: </strong>Child abuse is a leading cause of morbidity in early childhood. Accurate detection remains challenging.</p><p><strong>Objective: </strong>To describe racial and ethnic disproportionalities in suspicion for child abuse (SCA) in pediatric patients admitted after traumatic injury.</p><p><strong>Design, setting, and participants: </strong>This retrospective, multicenter cross-sectional study performed between 2022 and 2024 examined a representative national sample of children and adolescents (aged <18 years) admitted for pediatric trauma indications from 2006 to 2019. Data were from the Kids' Inpatient Database (KID), the largest publicly available all-payer pediatric inpatient care database. Patient demographics, injury severity, and hospitalization characteristics were classified by race and ethnicity and compared using univariate and multivariate regression. Statistical analysis was performed between March 2022 and October 2024.</p><p><strong>Exposure: </strong>The SCA subgroup was identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes corresponding to child and adolescent maltreatment.</p><p><strong>Main outcome and measure: </strong>The primary outcome was the racial and ethnic composition of pediatric patients admitted after traumatic injury with SCA vs those without SCA.</p><p><strong>Results: </strong>Among the weighted total of 634 309 pediatric patients with complete data included in the study, 13 579 patients had injuries attributable to SCA (SCA subgroup; mean [SD] age, 1.70 [0.04] years; 7650 male [56.3%]; 2868 Black [21.1%], 2293, Hispanic [16.9%], and 5675 White [41.8%]) and 620 730 patients did not (non-SCA subgroup; mean [SD] age, 9.70 [0.01] years; 395 158 male [63.7%]; 86 376 Black [13.9%], 108 406 Hispanic [17.5%], and 298 748 White [48.1%]). The racial and ethnic distribution of the non-SCA subgroup was similar to that of the 2010 US Census. In the SCA subgroup, Black patients (odds ratio [OR], 1.75; 95% CI, 1.65-1.85; P < .001) and Hispanic patients were overrepresented (OR, 1.11; 95% CI, 1.05-1.18; P < .001) and White patients were underrepresented compared with the Census. After controlling for socioeconomic factors and hospital characteristics among 504 365 (weighted) observations in White, Black, and Hispanic patients (493 530 patients without and 10 835 patients with SCA), Black race remained an independent risk factor associated with SCA (OR, 1.10; 95% CI, 1.03-1.17; P = .004), whereas Hispanic race was found to be a protective factor associated with decreased odds of SCA (OR, 0.71; 95% CI, 0.67-0.76; P < .001). Compared with White patients in the SCA subgroup, Black patients had a 26.5% (95% CI, 11.0%-44.3%) longer length of stay (P < .001) for mild to moderate injuries and a 40.1% (95% CI, 16.4%-68.5%) longer length of stay (","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2451588"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846636","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":"Asthma Among Children With Primary Ciliary Dyskinesia.","authors":"Joe Zein, Arthur Owora, Hyun Jo Kim, Nadzeya Marozkina, Benjamin Gaston","doi":"10.1001/jamanetworkopen.2024.49795","DOIUrl":"10.1001/jamanetworkopen.2024.49795","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2449795"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11629127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142800772","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":"Physician Reasons for or Against Treatment Intensification in Patients With Metastatic Prostate Cancer.","authors":"Neeraj Agarwal, Daniel J George, Zachary Klaassen, Rickard Sandin, Jake Butcher, Amanda Ribbands, Liane Gillespie-Akar, Birol Emir, David Russell, Agnes Hong, Krishnan Ramaswamy, Stephen J Freedland","doi":"10.1001/jamanetworkopen.2024.48707","DOIUrl":"10.1001/jamanetworkopen.2024.48707","url":null,"abstract":"<p><strong>Importance: </strong>Clarifying the underutilization of treatment intensification (TI) for metastatic castration-sensitive prostate cancer (mCSPC) may improve implementation of evidence-based medicine and survival outcomes.</p><p><strong>Objective: </strong>To investigate physicians' beliefs about TI in mCSPC to understand the gap between evidence-based guidelines and clinical practice.</p><p><strong>Design, setting, and participants: </strong>This survey study analyzed data from the Adelphi Real World retrospective survey, which comprised physician surveys that were linked to medical record reviews of US adult patients treated for mCSPC between July 2018 and January 2022.</p><p><strong>Main outcomes and measures: </strong>The survey included questions on physician and practice demographics. Physicians completed patient record forms, based on patient medical records with information including patient demographics, clinical characteristics, and patient management. Physicians recalled reasons for prescribing decisions using 48 precoded and open-text responses. Bivariate and multivariable analyses assessed the likelihood of their patients receiving first-line TI; the main outcome was the likelihood of their patients receiving TI using odds ratios (ORs).</p><p><strong>Results: </strong>In total, 617 male patients met the analysis criteria (mean [SD] age, 68.6 [8.1] years). Among these patients, 349 (56.6%) were Medicare beneficiaries. Overall, 430 (69.7%) did not receive first-line TI with androgen receptor pathway inhibitors and/or chemotherapy. The 107 US-based physicians' top reasons for treatment choice for their patients were tolerability concerns (TI: 121 [64.7%]; no TI: 252 [58.6%]; P = .18) and following guideline recommendations (TI: 115 [61.5%]; no TI: 230 [53.5%]; P = .08). In the bivariate analysis, physicians seeking to reduce prostate-specific antigen (PSA) by 75% to 100% were more likely to provide first-line TI compared with physicians who aimed to lower PSA by 0% to 49% (OR, 1.63 [95% CI, 1.04-2.56]; P = .03). In the multivariable analysis, patients whose physicians based treatment choice on guidelines were more likely to receive TI than patients whose physicians did not report this reason (OR, 3.46 [95% CI, 1.32-9.08]; P = .01).</p><p><strong>Conclusions and relevance: </strong>The findings of this study, which analyzed data from a medical records-linked clinical practice survey, indicated low rates of first-line TI for mCSPC despite guideline recommendations. Barriers to TI included lack of knowledge about guidelines and published efficacy and safety data. Physicians with greater PSA reduction goals were more likely to use TI. Physician education on treatment guidelines and clinical trial data, while raising expectations for PSA response, may increase rates of first-line TI in mCSPC.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2448707"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11629128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142800801","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":"Urban Heat and Burden of Hyponatremia.","authors":"Monika Prpic, Christina Hoffmann, Wolfgang Bauer, Peter Hoffmann, Kai Kappert","doi":"10.1001/jamanetworkopen.2024.50280","DOIUrl":"10.1001/jamanetworkopen.2024.50280","url":null,"abstract":"<p><strong>Importance: </strong>Hyponatremia (sodium level <135 mEq/L), the most prevalent electrolyte disorder in clinical practice, is associated with considerable clinical and economic burdens. Despite its recognized effect and indication of seasonal patterns, there is a research gap regarding heat-related hyponatremia. Addressing this issue is crucial, especially regarding projected increases in environmental temperature, particularly in urban areas.</p><p><strong>Objective: </strong>To comprehensively analyze the association of heat in an urban setting with hyponatremia prevalence.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study using retrospective time series analysis was conducted among all adult patients (age ≥18 years) presenting to the Charité-Universitätsmedizin Berlin between March 1, 2000, and August 31, 2023, with a blood sodium measurement.</p><p><strong>Exposure: </strong>The daily heat index, which accounts for both outdoor air temperature and relative humidity.</p><p><strong>Main outcomes and measures: </strong>The primary outcome measure was the daily number of hyponatremia cases, further categorized by severity. Differences in prevalence across age groups (adult patients, aged 18-65 years; and older patients, aged >65 years) and sexes were also examined.</p><p><strong>Results: </strong>A total of 7 135 688 sodium measurements from 2 028 537 hospital visits were analyzed. The mean (SD) age at admission was 57.8 (17.8) years, and 51.7% of patients were male. A clear seasonal pattern of heat-related hyponatremia was evident among older patients, especially for moderate (sodium level, 125-129 mEq/L) and severe hyponatremia (sodium level, <125 mEq/L), where the cumulative risk over a lag period of 5 days reached a maximum relative risk (RR) of 1.26 (95% CI, 1.07-1.48) when the heat index reached 30 °C, compared with the temperature at which hyponatremia occurred least frequently. Older women were disproportionately more likely to experience hyponatremia compared with older men, with a cumulative RR of 1.10 (95% CI, 1.03-1.18) at a heat index of 26 °C. The highest RR was on lag day 0 for all subgroups (older patients: RR, 1.04 [95% CI, 1.00-1.08]; moderate and severe hyponatremia in older patients: RR, 1.05 [1.01-1.10]; and older women: RR, 1.07 [95% CI, 1.01-1.12]) and significantly increased when the heat index exceeded 15 °C (RR, 1.01 [95% CI, 1.00-1.02]).</p><p><strong>Conclusions and relevance: </strong>This cross-sectional study of patients with sodium measurements suggests that older people, especially women, were vulnerable to heat-related hyponatremia. Environmental heat was associated with an immediate exacerbation of hyponatremia. This finding highlights the importance of implementing prevention strategies to mitigate heat-related hyponatremia, as an increased burden in the future due to climate change is likely.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2450280"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828520","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":"Lithium Use During Pregnancy in 14 Countries.","authors":"Felix Wittström, Carolyn E Cesta, Brian T Bateman, Marie Bendix, Mette Bliddal, Adrienne Y L Chan, Yongtai Cho, Eun-Young Choi, Jacqueline M Cohen, Sarah Donald, Mika Gissler, Alys Havard, Sonia Hernandez-Diaz, Krista F Huybrechts, Bianca Kollhorst, Edward Chia-Cheng Lai, Maarit K Leinonen, Brian M H Li, Kenneth K C Man, Vanessa W S Ng, Lianne Parkin, Laura Pazzagli, Lotte Rasmussen, Ran S Rotem, Tania Schink, Ju-Young Shin, Duong T Tran, Ian C K Wong, Helga Zoega, Johan Reutfors","doi":"10.1001/jamanetworkopen.2024.51117","DOIUrl":"10.1001/jamanetworkopen.2024.51117","url":null,"abstract":"<p><strong>Importance: </strong>In pregnancy, the benefits of lithium treatment for relapse prevention in psychiatric conditions must be weighed against potential teratogenic effects. Currently, there is a paucity of information on how and when lithium is used by pregnant women.</p><p><strong>Objective: </strong>To examine lithium use in the perinatal period.</p><p><strong>Design, setting, and participants: </strong>This cohort study used individual-level data of pregnancies from January 1, 2000, to December 31, 2021, in Australia, Denmark, Finland, Germany, Hong Kong, Iceland, Israel, New Zealand, Norway, South Korea, Sweden, Taiwan, the UK, and 2 cohorts in the US. Analyses were performed from September 1 to November 30, 2023.</p><p><strong>Exposures: </strong>The prevalence of lithium use as the proportion of pregnancies with at least 1 prescription fill or prescription within 3 months before pregnancy until childbirth was estimated using a common protocol. Lithium use during pregnancy by trimester and in the 3 months before and after pregnancy was examined.</p><p><strong>Main outcomes and measures: </strong>Comparison of prevalence between the first and last 3-year periods of available data.</p><p><strong>Results: </strong>Among 21 659 454 pregnancies from all collaborating sites, the prevalence of lithium use ranged from 0.07 per 1000 pregnancies in Hong Kong to 1.56 per 1000 in the US publicly insured population. Lithium use increased per 1000 pregnancies in 10 populations (Australia [0.60 to 0.74], Denmark [0.09 to 0.51], Finland [0.10 to 0.29], Iceland [0.24 to 0.99], Israel [0.25 to 0.37], Norway [0.24 to 0.47], South Korea [0.30 to 0.44], Sweden [0.42 to 1.07], the UK [0.07 to 0.10], and Taiwan [0.15 to 0.19]), remained stable in 4 populations (Germany [0.17 to 0.16], Hong Kong [0.06 to 0.06], and the publicly [1.50 to 1.34] and commercially [0.38 to 0.36] insured US populations), and decreased in 1 population (New Zealand [0.54 to 0.39]). Use of lithium decreased with each trimester of pregnancy, while prevalence of postpartum use was similar to prepregnancy levels. The proportion of lithium use in the second trimester compared with the prepregnancy period ranged from 2% in South Korea to 80% in Denmark.</p><p><strong>Conclusions and relevance: </strong>Prevalence of lithium use in pregnant women over the past 2 decades varied markedly between populations. Patterns of use before, during, and after pregnancy suggest that many women discontinued lithium use during pregnancy and reinitiated treatment after childbirth, with large variations between countries. These findings underscore the need for internationally harmonized guidelines, specifically for psychiatric conditions among pregnant women that may benefit from lithium treatment.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2451117"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828581","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":"Quality of Hospices Used by Medicare Advantage and Traditional Fee-for-Service Beneficiaries.","authors":"Lindsay L Y White, Chuxuan Sun, Norma B Coe","doi":"10.1001/jamanetworkopen.2024.51227","DOIUrl":"10.1001/jamanetworkopen.2024.51227","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Although enrollment in both hospice care and Medicare Advantage (MA) have grown substantially, little is known about the quality of hospice care received by MA beneficiaries relative to traditional Medicare fee-for-service (FFS) beneficiaries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To compare hospice enrollment and the quality of hospices serving MA and FFS beneficiaries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This population-based cross-sectional study used Medicare enrollment and claims data from January 1, 2018, through December 31, 2019, and Hospice Quality Reporting Program (HQRP) data released between November 1, 2020, and August 30, 2022, to compare the probability of enrolling in hospice before death and the probability of using high- vs low-quality hospices between MA and FFS beneficiaries. Two sample populations were assessed: (1) all Medicare beneficiaries who died in 2018 or 2019, and (2) all Medicare hospice enrollees in 2018 and 2019, excluding beneficiaries with hospice use in 2017. Data were analyzed between April 1, 2023, and April 30, 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;MA enrollment was assessed 6 months prior to death for decedents and in the month of hospice admission for hospice enrollees. MA beneficiaries were further classified by plan type: regular MA, special needs plan (SNP), and Medicare-Medicaid plan (MMP).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;For decedents, the outcome of interest was the prevalence of any hospice use in the last 6 months of life. For hospice enrollees, the outcome of interest was 9 HQRP measures of hospice quality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Data from 4 215 648 decedents (51.6% female; mean [SD] age, 80.1 [11.6] years) and 2 211 826 hospice enrollees (56.6% female; mean [SD] age, 82.4 [10.5] years) were included. In the decedent sample, beneficiaries enrolled in every type of MA plan were significantly more likely than beneficiaries enrolled in FFS to use hospice care in the last 6 months of life (regular MA beneficiaries were 3.4 percentage points more likely to use hospice; MA SNP beneficiaries, 2.4 percentage points; and MA MMP beneficiaries, 3.6 percentage points). Regular MA and FFS beneficiaries enrolled in hospices of similar quality. However, beneficiaries in SNPs and MMPs were significantly more likely than FFS beneficiaries to use hospices with inferior quality (eg, MA SNP beneficiaries were 4.3 [95% CI, 3.9-4.7] percentage points more likely to use a hospice with a low Consumer Assessment of Healthcare Providers and Systems (CAHPS) global rating, and MA MMP beneficiaries were 6.8 [95% CI, 6.0-7.7] percentage points more likely). When beneficiaries entered hospice from the same hospital or nursing home the results were attenuated: the MA SNP beneficiaries entering from the same hospital were 0.9 (95% CI, 0.5-1.4) percentage points more likely to use a hospice with a low CAHPS global rating, and MA MMP beneficiaries were 3","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2451227"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828587","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 Drug Name.","authors":"","doi":"10.1001/jamanetworkopen.2024.56401","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2024.56401","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2456401"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864132","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":"Universal Health Checkups and Risk of Incident Diabetes and Hypertension.","authors":"Masato Takeuchi, Tomohiro Shinozaki, Koji Kawakami","doi":"10.1001/jamanetworkopen.2024.51813","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2024.51813","url":null,"abstract":"<p><strong>Importance: </strong>Type 2 diabetes and hypertension are obesity-related, noncommunicable diseases becoming increasingly common worldwide. In 2008, Japan launched a nationwide universal health checkup program, Specific Health Checkup (SHC), for the primary prevention of obesity-related diseases, but its effectiveness has been understudied.</p><p><strong>Objective: </strong>To investigate the association of the SHC program with incident diabetes and hypertension, using a target trial emulation framework.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study used data from a longitudinal health care database involving both checkup history and medical encounter records in Japan. Individuals aged 40 to 74 years, without diabetes or hypertension, and without a prior checkup history, were eligible. Individuals were repeatedly assessed for eligibility from April 1, 2008, to March 31, 2020, to assemble sequential cohorts of 78 620 SHC participants and 214 554 nonparticipants. Statistical analysis was conducted from June 8 to December 30, 2023.</p><p><strong>Main outcomes and measures: </strong>The composite risk of incident type 2 diabetes or hypertension over a period of up to 10 years, defined as the combination of a newly documented diagnosis and use of relevant medications. A propensity score-weighted survival analysis was conducted to adjust for baseline variables. A series of sensitivity analyses and a negative outcome control analysis were conducted using depression as a benchmark.</p><p><strong>Results: </strong>Sequential cohorts consisted of 78 620 SHC participants (median age, 46 years [IQR, 41-53 years]; 62.7% women) and 214 554 nonparticipants (median age, 49 years [IQR, 44-55 years]; 82.0% women) from 153 084 unique persons, each of whom entered the study cohort a mean (SD) of 1.9 (1.5) times. Within a median follow-up of 4.2 years (IQR, 2.7-6.3 years), the primary end point occurred among 11.2% of all individuals (10.6% of the SHC participants and 11.4% of the nonparticipants), with a lower hazard ratio (HR) among the SHC recipients (HR, 0.90; 95% CI, 0.89-0.92); the difference in cumulative incidence at 10 years was -1.6% (95% CI, -1.8% to -1.3%). The sensitivity analyses showed similar results. The negative control analysis suggested the potential for residual confounding (HR, 1.05; 95% CI, 1.02-1.07); the bias-calibrated HR was 0.86 (95% CI, 0.84-0.89) for the primary outcome.</p><p><strong>Conclusions and relevance: </strong>In this cohort study, within a median of 4.2 years of follow-up, SHC recipients had a 9.8% lower risk of incident diabetes and hypertension (13.8% in the bias-calibrated analysis). The cost-effectiveness of the SHC and its transportability to other regions are unclear, requiring future investigations.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2451813"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864137","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}