JAMA Network Open最新文献

{"title":"Mobile App-Based Intervention and Cardiovascular Risk Factors in Patients With Uncontrolled Type 2 Diabetes: A Randomized Clinical Trial.","authors":"Pei-Zhen Zhang, Dan Guo, Chang-Qin Liu, Ning Chen, Jian-Fang Liu, Xu-Zhen Lei, Lin-Jie Yang, Ya-Ting Liu, Xu Li, Jun-Feng Huang, Chun-Min Du, Kai Wang, Wei Mo, Jia-Yang Lin, Chen-Si-Han Huang, Bing-Yan Xu, Xue-Yun Wei, De-Ying Liu, Jun-Lin Huang, Yan Huang, Yao-Ming Xue, Yan-Mei Zeng, Shi-Qun Liu, Zhi-Min Ma, Hui-Jie Zhang","doi":"10.1001/jamanetworkopen.2025.29762","DOIUrl":"10.1001/jamanetworkopen.2025.29762","url":null,"abstract":"<p><strong>Importance: </strong>Controlling modifiable cardiovascular risk factors is important but underused for patients with type 2 diabetes (T2D). Mobile message-based intervention strategies could address this gap but lack evidence of benefit on multiple risk factors.</p><p><strong>Objective: </strong>To evaluate the effectiveness of a mobile message-based intervention in controlling cardiovascular risk factors in patients with T2D.</p><p><strong>Design, setting, and participants: </strong>In this randomized clinical trial, adults with uncontrolled T2D comorbid with cardiovascular disease (CVD) risk factors were recruited from 5 clinical centers in China. Data were collected from November 2018 to March 2022 and analyzed from January to June 2023.</p><p><strong>Intervention: </strong>Participants were randomized to receive either usual care or a mobile message-based intervention of 6 text messages per week from different modules designed to remind, encourage, and motivate them to participate in the behaviors needed for improving glycemic control and CVD risk factor management for 12 months.</p><p><strong>Main outcomes and measures: </strong>The primary outcome included mean changes in hemoglobin A1c (HbA1c), low-density lipoprotein cholesterol (LDL-C), and systolic blood pressure (SBP) levels across 12 months. The secondary outcomes included the percentage of participants with controlled HbA1c at 12 months. Data were analyzed using the intention-to-treat principle.</p><p><strong>Results: </strong>A total of 819 participants (552 men [67.4%]; mean [SD] age, 50.1 [11.9] years; mean [SD] HbA1c level, 10.2% [2.1%]) were enrolled, of whom 410 were randomized to the intervention group and 409 to the control group. During the 12-month intervention, significant reductions in the mobile message-based intervention group were observed for HbA1c levels by -2.8% (95% CI, -2.9% to -2.6%), LDL-C by -11.1 mg/dL (95% CI, -14.7 to -7.4 mg/dL), and SBP by -2.5 mm Hg (95% CI, -3.9 to -1.2 mm Hg), and in the usual care group, by -2.5% (95% CI, -2.7% to -2.3%) for HbA1c, -11.9 mg/dL (95% CI, -15.8 to -8.0 mg/dL) for LDL-C, and -0.1 mm Hg (95% CI, -1.6 to 1.3 mm Hg) for SBP. The net group differences were -0.3% (95% CI, -0.5% to -0.0%) for HbA1c, 0.9 mg/dL (95% CI, -4.5 to 6.2 mg/dL) for LDL-C, and -2.4 mm Hg (95% CI, -4.3 to -0.4 mm Hg) for SBP (P = .001 for the combined overall effect). The percentage of participants with controlled HbA1c among all participants was significantly higher in the intervention group than in the control group at 12 months (195 participants [54.0%] vs 146 participants [46.1%]; P = .04).</p><p><strong>Conclusions and relevance: </strong>In this randomized clinical trial of adults with uncontrolled T2D in China, a mobile message-based intervention resulted in a modest improvement in HbA1c and SBP in patients with diabetes compared with usual care. These results suggest that mobile message-based strategies for improving glycemic control an","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 9","pages":"e2529762"},"PeriodicalIF":9.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954772","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":"Disparities in Nephrology Care Among Hispanic Adults-A Barrier to Timely Dialysis Vascular Access.","authors":"Kana Amari, Ana C Ricardo, Milda R Saunders","doi":"10.1001/jamanetworkopen.2025.30977","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.30977","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 9","pages":"e2530977"},"PeriodicalIF":9.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000612","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":"Comparative Safety of JAK Inhibitors vs TNF Antagonists in Immune-Mediated Inflammatory Diseases: A Systematic Review and Meta-Analysis.","authors":"Virginia Solitano, Dhruv Ahuja, Han Hee Lee, Ritu Gaikwad, Kuan-Hung Yeh, Antonio Facciorusso, Abha G Singh, Christopher Ma, Ashwin N Ananthakrishnan, Yuhong Yuan, Namrata Singh, Vipul Jairath, Siddharth Singh","doi":"10.1001/jamanetworkopen.2025.31204","DOIUrl":"10.1001/jamanetworkopen.2025.31204","url":null,"abstract":"<p><strong>Importance: </strong>Janus kinase (JAK) inhibitors are highly effective medications for several immune-mediated inflammatory diseases (IMIDs). However, safety concerns have led to regulatory restrictions.</p><p><strong>Objective: </strong>To compare the risk of adverse events with JAK inhibitors vs tumor necrosis factor (TNF) antagonists in patients with IMIDs in head-to-head comparative effectiveness studies.</p><p><strong>Data sources: </strong>For this systematic review and meta-analysis, the Ovid Medline, Ovid EMBASE, and Web of Science databases were searched from inception to June 25, 2025.</p><p><strong>Study selection: </strong>Head-to-head comparative effectiveness studies of adults (aged ≥18 years) with IMIDs (including rheumatoid arthritis, inflammatory bowel disease, psoriasis or psoriatic arthritis, or spondyloarthropathy) treated with either JAK inhibitors or TNF antagonists were included. Randomized clinical trials, noncomparative observational studies, studies not reporting outcomes of interest or focused solely on specific safety events, and studies with a sample size of less than 500 were excluded. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline was followed.</p><p><strong>Data extraction and synthesis: </strong>Four investigators independently, and in pairs, abstracted data from included studies. A random-effects meta-analysis was conducted to obtain incidence rates (IRs) and hazard ratios (HRs) for JAK inhibitors vs TNF antagonists for each safety outcome (serious infections, malignant neoplasms, major cardiovascular events [MACEs], or venous thromboembolism [VTE]), adjusting for key confounding variables. Heterogeneity was quantified using the I2 statistic. Risk of bias was assessed by 2 investigators independently using the Newcastle-Ottawa Scale.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was risk of serious infections, malignant neoplasms, MACEs, or VTE.</p><p><strong>Results: </strong>This meta-analysis of 42 studies with low to moderate risk of bias included 813 881 patients (median age, 55.7 years [IQR, 53.0-59.0 years] for JAK inhibitor users and 51.5 years [IQR, 42.7-57.4 years] for TNF antagonist users; 76.5% female). For patients using JAK inhibitors vs TNF antagonists, there was no significant difference in risk of serious infections (IR, 3.79 [95% CI, 2.85-5.05] vs 3.03 [2.32-3.95] per 100 person-years; pooled HR, 1.05 [95% CI, 0.97-1.13]), malignant neoplasms (IR, 1.00 [0.77-1.31] vs 0.94 [0.72-1.22] per 100 person-years; pooled HR, 1.02 [0.90-1.16]), or MACEs (IR, 0.72 [0.56-0.92] vs 0.66 [0.49-0.89] per 100 person-years; pooled HR, 0.91 [0.80-1.04]), with minimal to moderate heterogeneity. There was a slightly higher risk of VTE with JAK inhibitors vs TNF antagonists (IR, 0.57 [95% CI, 0.40-0.82] vs 0.52 [0.37-0.73] per 100 person-years; pooled HR, 1.26 [95% CI, 1.03-1.54]). Effect estimates were largely stable across sub","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 9","pages":"e2531204"},"PeriodicalIF":9.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12423869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029960","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":"Important Elements of Quality Home End-of-Life Care in China.","authors":"Yinshi Kan, Yao Xiao, Zhaoyu Li, Shan Zhang, Xiaotian Zhang, Xiaodong Wang, Dandan Huang, Minghui Wang, Li Gao, Shuang Gao, Guijun Lu, Xinyan Zhang, Peng Yue","doi":"10.1001/jamanetworkopen.2025.31176","DOIUrl":"10.1001/jamanetworkopen.2025.31176","url":null,"abstract":"<p><strong>Importance: </strong>The efficacy of home end-of-life care in enhancing the quality of life for terminally ill patients and families has been well documented. While previous studies have explored perspectives on quality home palliative care and end-of-life care in several countries, limited knowledge exists regarding its specific components in the Chinese context.</p><p><strong>Objective: </strong>To explore the core elements that constitute quality home end-of-life care in China.</p><p><strong>Design, setting, and participants: </strong>This qualitative study integrated semistructured interviews, participant observation, and document and record collection. Data were collected from March to November 2024 in 4 health care organizations with hospice wards in Beijing. Purposive sampling was used to recruit terminally ill patients and families who had received home end-of-life care, as well as professionals who had provided care. All data were analyzed using thematic analysis.</p><p><strong>Main outcomes and measures: </strong>Core elements of quality home end-of-life care in China.</p><p><strong>Results: </strong>A total of 39 participants were included: 12 patients (5 [41.7%] female and 7 [58.3%] male), 4 of whom were interviewed (mean [SD] age, 74 [3.5] years); 13 family members (6 [46.2%] female and 7 [53.8%] male; 6 interviewed, primarily spouses [mean (SD) age, 69 (6) years] and adult children [mean (SD) age, 41 (5.3) years]); and 14 professionals (mean [SD] age, 42 [7.8] years; 11 [78.6%] female and 3 [21.4%] male). Observations and interviews were conducted mainly during 19 home visits. Four themes and 10 subthemes were identified: (1) preliminary basis for home-based services, (2) communication strategies and practical support, (3) long-term stable care relationships, and (4) fulfilling end-of-life preferences in practice. These elements reflected a dynamic progression of trust relationships between patients, families, and professionals. While some elements were represented in previous studies, we found some unique aspects related to mutual efforts on both sides of the service and professionals' approach to the inconsistent needs of patients and families.</p><p><strong>Conclusions and relevance: </strong>In this qualitative study, quality home end-of-life care in China can be described as a dynamic process of building and maintaining trust relationships between professionals, patients, and families. The findings provide a distinct understanding and may serve as a reference for developing a quality assessment framework for home end-of-life care. Future research should further develop this framework and evaluate effective strategies for delivering quality home end-of-life care within distinctive cultural and policy contexts.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 9","pages":"e2531176"},"PeriodicalIF":9.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12423856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029972","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":"Concomitant Comedications and Survival With First-Line Pembrolizumab in Advanced Non-Small-Cell Lung Cancer.","authors":"Adrien Rousseau, Noémie Simon-Tillaux, Stefan Michiels, Lisa Derosa, Ariane Laparra, David Planchard, Jordi Remon, Fabrice Barlesi, Pernelle Lavaud, Maxime Frelaut, Claudia Parisi, Anas Gazzah, Benjamin Besse, Stéphanie Foulon","doi":"10.1001/jamanetworkopen.2025.29225","DOIUrl":"10.1001/jamanetworkopen.2025.29225","url":null,"abstract":"<p><strong>Importance: </strong>Antibiotics, steroids, and proton pump inhibitors (PPIs) are suspected to decrease the efficacy of immunotherapy.</p><p><strong>Objective: </strong>To explore the association of comedications with overall survival (OS) in patients with advanced non-small-cell lung cancer (NSCLC).</p><p><strong>Design, setting, and participants: </strong>This nationwide retrospective cohort study used target trial emulations of patients newly diagnosed with NSCLC from January 2015 to December 2022, identified from the French national health care database. Eligible patients were treated with pembrolizumab in a first-line setting and alive 2 months after initiating pembrolizumab. Exclusion criteria included hospitalization for infectious disease, autoimmune disorders, or peptic ulcer disease.</p><p><strong>Exposures: </strong>Antibiotic and PPI exposures were defined as at least 2 prescriptions 60 days before to 42 days after pembrolizumab start. Steroid exposure was defined as at least 2 prescriptions 30 days before to 30 days after pembrolizumab start.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was OS. Patients exposed were compared with those without exposure, using inverse probability of treatment weighting (IPTW) to adjust for confounding.</p><p><strong>Results: </strong>Between January 2015, and December 2022, 41 529 patients were treated with first line pembrolizumab for advanced disease (27 826 male [67.0%]; median [range] age, 65 [19-97] years; 14 835 [35.7%] treated with pembrolizumab alone; 26 694 [64.3%] treated with pembrolizumab plus chemotherapy). At treatment initiation, 12 898 (41.9%) patients were exposed to antibiotics, 18 210 (59.1%) to steroids, and 16 783 (53.7%) to PPIs. After IPTW, antibiotics (except for macrolide and penicillin) were associated with shorter OS (hazard ratio [HR], 1.08; 95% CI, 1.05-1.12; P < .001), but it varied by antibiotic type. Steroids were not associated with OS (HR, 0.98; 95% CI, 0.95-1.02; P = .37); however, there was an interaction with pembrolizumab regimen (ie, pembrolizumab alone or with chemotherapy) (P for interaction < .001), and there was a dose-dependent association according to daily prednisone-equivalent dose (P for trend < .001). Steroids were associated with worse OS when prescribed at doses greater than 20 mg per day for pembrolizumab alone (P for trend = .005) and greater than 30 mg per day for pembrolizumab combined with chemotherapy (P for trend < .001). PPIs were associated with worse OS (HR, 1.13; 95% CI, 1.10-1.17; P < 001).</p><p><strong>Conclusions and relevance: </strong>In this cohort study of patients with advanced NSCLC treated with pembrolizumab, exposure to some classes of antibiotics, to steroids (>20 mg per day of prednisone equivalent), and to PPIs was associated with worse OS, indicating that comedications should be monitored carefully in patients with immunotherapy.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 9","pages":"e2529225"},"PeriodicalIF":9.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12423871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029989","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":"Speeding Up Response Time for Antidepressive Treatment.","authors":"Jeroen A van Waarde, Guido A van Wingen","doi":"10.1001/jamanetworkopen.2025.29440","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.29440","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 9","pages":"e2529440"},"PeriodicalIF":9.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954720","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":"Burden of Acute Care Surgery and Trauma-Related Mortality in the US State Prisons.","authors":"Totadri Dhimal, Paula Cupertino, Owen Tolbert, Yusheng Jia, Bailey Hilty Chu, Raquel Arias-Camison, Camila Lage, Daniela Matute, Yue Li, Fergal Fleming, Anthony Loria","doi":"10.1001/jamanetworkopen.2025.31785","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.31785","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 9","pages":"e2531785"},"PeriodicalIF":9.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040130","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":"Circulating Tumor DNA and Tissue Testing for Pancreatobiliary Tumors.","authors":"Himil Mahadevia, Umair Majeed, Jaydeepbhai Patel, Ahmed K Ahmed, Ahmed Elhariri, Douaa Albelal, Nakka Naga Malleswara Rao, Hari Krishnareddy Rachamala, Osama Mosalem, Debabrata Mukhopadhyay, Jeremy Jones, Daruka Mahadevan, Mitesh J Borad, Daniel Ahn, Mohamad Bassam Sonbol, Nguyen Tran, Amit Mahipal, Wen Wee Ma, Robert R McWilliams, Thor R Halfdanarson, Lionel A Kankeu Fonkoua, Tanios Bekaii-Saab, Kabir Mody, Hani Babiker","doi":"10.1001/jamanetworkopen.2025.31373","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.31373","url":null,"abstract":"<p><strong>Importance: </strong>The prognosis of advanced pancreaticobiliary tumors is poor. Next-generation sequencing (NGS) of tissue samples is utilized to identify actionable alterations, but there are occasional limitations due to inadequate tissue acquisition. Circulating tumor DNA (ctDNA) is an alternative method, but its correlation with tissue-based NGS remains unexplored.</p><p><strong>Objectives: </strong>To assess the mutation concordance (mCR) rates between ctDNA and tissue testing for patients with pancreatic ductal adenocarcinoma (PDAC) and cholangiocarcinoma (CC) and to evaluate how ctDNA performs as a treatment response biomarker.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study was conducted among patients with PDAC and CC treated at academic institutions from January 2014 to January 2025. Patients underwent ctDNA testing using 1 platform and tissue NGS testing using 2 platforms.</p><p><strong>Main outcomes and measures: </strong>mCR, which measures the shared gene alterations observed by both ctDNA and tissue-based NGS testing, was calculated using the Spearman correlation for PDAC and CC. The performance of ctDNA as a treatment response biomarker was assessed by comparing serial ctDNA data with restaging scans and cancer antigen 19-9 levels in patients with PDAC.</p><p><strong>Results: </strong>Our cohort included 790 patients: 570 with advanced PDAC (265 [46.5%] female; median [IQR] age, 64 [33-84] years) and 220 with advanced CC (95 [43.2%] female; median [IQR] age, 66 [42-88] years). Overall, 461 patients with PDAC (80.9%) and 192 patients with CC (87.2%) underwent ctDNA testing, while 239 patients with PDAC (41.9%) and 70 patients with CC (31.8%) had tissue NGS testing. Among patients with PDAC, 85 of 130 patients (65.4%) showed shared specific gene alterations between ctDNA and tissue testing; there was a significant mCR, with a Spearman correlation of 0.47 (95% CI, 0.28-0.62; P < .001). For patients with CC, 32 of 48 (66.7%) had shared alterations between ctDNA and tissue testing; there was a significant mCR, with a Spearman correlation of 0.56 (95% CI, 0.35-0.70; P < .001). A subgroup analysis of patients with PDAC who underwent serial ctDNA testing suggested that new TP53 subclones and increased ctDNA variant allele frequency levels of TP53 and KRAS were associated with higher odds of progressive disease (eg, increased TP53 frequency: odds ratio, 7.28; 95% CI, 2.15-24.66; P = .001).</p><p><strong>Conclusions and relevance: </strong>In this cohort study of patients with pancreaticobiliary tumors, there was a significant mCR between ctDNA and tissue NGS testing. Additionally, results suggest that ctDNA might detect resistant clones and enable assessment of treatment response.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 9","pages":"e2531373"},"PeriodicalIF":9.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040153","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":"Bariatric Surgery and Incident Development of Obesity-Related Comorbidities.","authors":"Amanda L Bader, Jesse Y Hsu, Maria S Altieri, Charles M Vollmer, James D Lewis, David E Kaplan, Nadim Mahmud","doi":"10.1001/jamanetworkopen.2025.30787","DOIUrl":"10.1001/jamanetworkopen.2025.30787","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;As obesity rates rise in the US, managing associated metabolic comorbidities presents a growing burden to the health care system. While bariatric surgery has shown promise in mitigating established metabolic conditions, no large studies have quantified the risk of developing major obesity-related comorbidities after bariatric surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To identify common metabolic phenotypes for patients eligible for bariatric surgery and to estimate crude and adjusted incidence rates of additional metabolic comorbidities associated with bariatric surgery compared with weight management program (WMP) alone.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This retrospective, multicenter cohort study used data from the Veterans Health Administration (VHA) Corporate Data Warehouse, which incorporates data from 128 VHA centers. Participants were adults 18 years or older with a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 30 or higher and at least 1 of 5 metabolic comorbidities or with a BMI of 35 or higher who underwent bariatric surgery (Roux-en-Y gastric bypass or sleeve gastrectomy) or enrolled in the WMP (called MOVE!) between January 1, 2008, and December 31, 2023. Patients with all 5 comorbidities at baseline or missing key data were excluded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Bariatric surgery vs WMP.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome and measures: &lt;/strong&gt;Incident diagnosis of any of 5 metabolic comorbidities: type 2 diabetes (T2D), hypertension, hyperlipidemia, obstructive sleep apnea (OSA), and metabolic dysfunction-associated steatotic liver disease (MASLD).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 269 470 veterans, 263 657 were enrolled in the WMP and 5813 underwent bariatric surgery. Patients included 232 196 males (87.1%) and had a median (IQR) age of 57 (47-64) years. Median (IQR) follow-up time was 112.9 (79.5-145.4) months. At 5 years, incidence rates per 1000 person-years were 8.89 for hypertension, 9.67 for hyperlipidemia, 4.29 for T2D, 3.99 for OSA, and 2.44 for MASLD in the WMP group. For the bariatric surgery group, incidence rates per 1000 person-years were 3.35 for hypertension, 4.85 for hyperlipidemia, 1.06 for T2D, 3.43 for OSA, and 2.01 for MASLD. Bariatric surgery was associated with a statistically significant lower risk of incident T2D (79.2% lower; hazard ratio [HR], 0.21 [95% CI, 0.18-0.26]), hypertension (58.8% lower; HR, 0.41 [95% CI, 0.33-0.51]), hyperlipidemia (50.5% lower; HR, 0.49 [95% CI, 0.42-0.58]), OSA (56.9% lower; HR, 0.43 [95% CI, 0.35-0.52]), and MASLD (40.4% lower; HR, 0.60 [95% CI, 0.49-0.73]) compared with the WMP. Results were consistent in a subgroup analysis of only female veterans.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this cohort study, bariatric surgery was associated with a significantly lower risk of developing major metabolic comorbidities compared with the medical WMP. This findin","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 9","pages":"e2530787"},"PeriodicalIF":9.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023360","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":"Adherence to Updated Race and Ethnicity Reporting Guidance in Ophthalmology Journals.","authors":"Vivian Rajeswaren, Bridget Croniger, Karim Dirani, M Roy Wilson","doi":"10.1001/jamanetworkopen.2025.29778","DOIUrl":"10.1001/jamanetworkopen.2025.29778","url":null,"abstract":"<p><strong>Importance: </strong>The updated race and ethnicity reporting guidelines published in the AMA Manual of Style: A Guide for Authors and Editors highlight the importance of using specific racial and ethnic categories rather than generalized terms, promoting inclusive language, supporting diversity and respect, and examining sociodemographic factors that shape the relationship between race and ethnicity and health outcomes.</p><p><strong>Objective: </strong>To evaluate adherence to the AMA Manual of Style's updated race and ethnicity reporting guidelines in the 3 highest-impact ophthalmology journals.</p><p><strong>Evidence review: </strong>A systematic review of articles published in American Journal of Ophthalmology, JAMA Ophthalmology, and Ophthalmology from August 1, 2023, through August 31, 2024. Articles with a study population were included. Articles were excluded if they lacked a study population, used artificial intelligence, determined race and ethnicity by facial features, or reported ancestry instead of race or ethnicity.</p><p><strong>Findings: </strong>This review yielded 931 research articles, with 525 meeting inclusion criteria. Of these, 491 articles (93.5%) reported age, 472 (89.9%) sex and/or gender, 285 (54.3%) race and/or ethnicity, and 96 (18.3%) socioeconomic measures. Of the 285 articles reporting race and/or ethnicity, 159 (55.8%) reported \"race,\" 155 (54.4%) \"ethnicity,\" and 106 (37.2%) \"race/ethnicity\" as 1 category. Race was misclassified as ethnicity or vice versa in 54 articles (19.0%); 3 (5.6%) used primary datasets, 13 (24.1%) used secondary, and 38 (70.4%) did not specify. A total of 276 articles (96.8%) reported specific race and/or ethnicity categories; 19 articles (6.9%) collected race and ethnicity data without reporting categories. Race and ethnicity categories were used as nouns in 44 articles (15.4%). \"Minority/minorities\" was used in 39 articles (13.7%), and the use of a modifier was mixed, with a modifier consistently used in 22 (56.4%), inconsistently in 4 (10.3%), and not at all in 13 (33.3%). Of the 26 articles (9.1%) using \"multiracial\" or \"multiethnic,\" 5 (19.2%) reported the included categories. \"African American\" and \"Black\" were used interchangeably in 23 articles (8.1%), and 36 (12.6%) used \"Caucasian\" for White race.</p><p><strong>Conclusions and relevance: </strong>In this systematic review of research articles in the 3 highest-impact ophthalmology journals from August 2023 through August 2024, race and ethnicity reporting was substantially nonadherent with updated JAMA recommendations. These findings suggest that improvements in demographic reporting are needed.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 9","pages":"e2529778"},"PeriodicalIF":9.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954762","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}