JAMA Network Open最新文献

{"title":"Error in Figure 1.","authors":"","doi":"10.1001/jamanetworkopen.2025.8665","DOIUrl":"10.1001/jamanetworkopen.2025.8665","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e258665"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752752","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":"Intersectional Racial and Sex Disparities in Unintentional Overdose Mortality.","authors":"Kechna Cadet, Bianca D Smith, Silvia S Martins","doi":"10.1001/jamanetworkopen.2025.2728","DOIUrl":"10.1001/jamanetworkopen.2025.2728","url":null,"abstract":"<p><strong>Importance: </strong>There are several apparent research gaps based on the intersectional sociodemographic dimensions of drug-related mortality disparities. Relatively marginal evidence exists on the potential roles of intersecting forms of race and sexual marginalization on the disparities across drug-related mortality.</p><p><strong>Objective: </strong>To examine intersectional sex-specific White and Black racial disparities in drug poisoning mortality across states from 2010 to 2020.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study used unintentional fatal drug poisoning mortality data from the Centers for Disease Control and Prevention's Web-Based Injury Statistics Query and Reporting System. Trends from 2010 through 2020 were analyzed by Black men, Black women, White men, and White women across states. One-sided Mann-Kendall trend analysis was used to examine statistically significant increasing or decreasing trends in age-adjusted mortality rates. Statistical analysis was performed from June to July 2024.</p><p><strong>Exposures: </strong>White and Black groups intersecting with male and female sex.</p><p><strong>Main outcomes and measures: </strong>Analysis of age-adjusted mortality rates, excess years of potential life lost (reference group: White men), years of potential life lost ratios (reference group: White men), and percentage change to highlight state differences.</p><p><strong>Results: </strong>From a total sample of 518 724 unintentional fatal drug poisoning deaths (9.0% in Black men, 3.9% in Black women, 29.0% in White women, and 58.1% in White men), 11 820 781 years of potential life lost were recorded. Black men had the highest mean (SD) age-adjusted mortality rate (23.25 [22.65]), followed by White men (22.49 [14.32]), with lower rates for White women (11.71 [5.96]) and Black women (9.01 [8.04]) (P < .001). Compared with White men, both Black men (τ = 0.298, slope = 0.002, intercept = 0.381, P < .001) and Black women (τ = 0.157, slope = 0.0004, intercept = 0.271, P < .001) had worsening YPLL over time, while White women (τ = -0.146, slope = -0.0003, intercept = 0.5252, P < .001) showed improvement in their YPLL over time compared with White men. At the state level, there was a disproportionate burden of deaths due to drug poisonings, with Maryland showing the highest increase in mortality rates among Black men (485.4%), while decreases were observed for White women in states such as Alaska (-23.0%).</p><p><strong>Conclusions and relevance: </strong>In this cross-sectional study of overdose deaths, disparities in overdose mortality were evident, with Black men and Black women experiencing a pronounced and increasing burden of mortality compared with their White counterparts. Addressing these disparities will require a multipronged approach targeting the social, physical, economic, and policy risk environments.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e252728"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752754","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":"Postpandemic Surges Proving the Mettle of Group A Streptococcus-Rising to the Occasion.","authors":"Anthony R Flores","doi":"10.1001/jamanetworkopen.2025.2872","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.2872","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e252872"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752738","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":"What's Missing From Value-Based Care-Accounting for the Costs and Benefits of Quality Improvement.","authors":"Donald E Casey","doi":"10.1001/jamanetworkopen.2025.2510","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.2510","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e252510"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763875","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":"Invasive Group A Streptococcal Infection in Children, 1992-2023.","authors":"Halima Dabaja-Younis, Christopher Kandel, Karen Green, Jennie Johnstone, Zoe Zhong, Caroline Kassee, Vanessa Allen, Irene Armstrong, Mahin Baqi, Kevin Barker, Ari Bitnun, Sergio Borgia, Aaron Campigotto, Sumon Chakrabarti, Wayne L Gold, Alyssa Golden, Ian Kitai, Julianne Kus, Liane Macdonald, Irene Martin, Matthew Muller, Jeya Nadarajah, Krystyna Ostrowska, Daniel Ricciuto, David Richardson, Medina Saffie, Manal Tadros, Gregory Tyrrell, Monali Varia, Huda Almohri, Shiva Barati, Gloria Crowl, Lubna Farooqi, Maxime Lefebvre, Angel Xinliu Li, Nadia Malik, Mare Pejkovska, Asfia Sultana, Tamara Vikulova, Kazi Hassan, Agron Plevneshi, Allison McGeer","doi":"10.1001/jamanetworkopen.2025.2861","DOIUrl":"10.1001/jamanetworkopen.2025.2861","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;The resurgence of invasive group A streptococcal (iGAS) infections and progress in GAS vaccine development emphasize the importance of understanding current trends in the epidemiology of iGAS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To describe the epidemiology of pediatric iGAS over a 32-year period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This case series uses population-based surveillance data for iGAS in Toronto and Peel Region, Canada, including emm typing from Canada's National Microbiology Laboratory and population data from Statistics Canada. All children (age &lt;18 years) with iGAS from January 1, 1992, to December 31, 2023, were included. Data were analyzed from July 15, 2023, to September 1, 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Outcomes of interest were disease incidence over time and by age; variation in clinical presentation, disease severity, outcomes and infecting emm types; and antimicrobial resistance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Overall, 498 iGAS cases (300 [60.2%] male; median [IQR] age, 5.1 [2.7-8.6] years) occurred, including 151 (30.7%) in children with comorbidities. The most common presentations were soft tissue infection (140 cases [28.1%]) and bacteremia without focus (131 cases [26.3%]). iGAS incidence increased from 1.8 events per 100 000 population per year in 1992 to 2011 to 2.4 events per 100 000 population per year in 2012 to 2019 (incidence rate ratio, 1.3 [95% CI, 1.1-1.6]), with the increase occurring in GAS infections of the respiratory tract. Incidence declined to 1.2 events per 100 000 population per year in 2020 and 0.5 events per 100 000 population per year in 2021 before increasing to 6.0 events per 100 000 population per year in 2023. In 2022 to 2023, 18 of 56 children with iGAS (32.0%) had a viral respiratory coinfection. Varicella-associated iGAS cases declined from 23 of 137 children (16.8%) in 1992 to 2001 to 2 of 223 children (0.9%) in 2012 to 2023 (P &lt; .001), after routine varicella vaccination implementation in 2004. Streptococcal toxic shock syndrome occurred in 29 children (5.8%), necrotizing fasciitis in 12 children (2.4%); 10 children (2.0%) died. The most common emm types were emm1 (182 of 471 isolates [38.6%]), emm12 (75 isolates [15.9%]), and emm4 (31 isolates [6.6%]). The M1UK subtype was first identified in 2019 and comprised 32 of 46 emm1 isolates (70.0%) from 2019 to 2023. Compared with other emm types, emm1 was more likely to be associated with pneumonia (odds ratio [OR], 1.99 [95% CI, 1.16-3.40]), bone and joint infections (OR, 1.70 [95% CI, 1.08-2.68]), and intensive care unit admission (OR, 1.67 [95% CI, 1.03-2.68]); emm4 was more likely to be associated with bacteremia without focus (OR, 6.10 [95% CI, 2.83-13.16]). Overall, 437 isolates (92.8%) were of emm types included in the 30-valent GAS vaccine.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;This case series found that pediatric iGAS incidence increased in sou","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e252861"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752757","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":"Social Risk and Acute Health Care Utilization Among Insured Adults.","authors":"Morgan Clennin, Mario Schootman, Emma L Tucher, Liza M Reifler, Suma Vupputuri, Meagan Brown, John Adams, Stacie L Daugherty","doi":"10.1001/jamanetworkopen.2025.4253","DOIUrl":"10.1001/jamanetworkopen.2025.4253","url":null,"abstract":"<p><strong>Importance: </strong>Millions of Americans are impacted by adverse social risk factors such as financial strain, housing instability, and food insecurity. A better understanding of if and how these factors are associated with acute care utilization is needed.</p><p><strong>Objective: </strong>To examine the association between exposure to social risk factors and emergency department (ED) visits and hospitalizations among a sample of insured adults.</p><p><strong>Design, setting, and participants: </strong>This cohort study used US health data from a national initiative that employed a multistage, stratified sampling framework across 8 regional markets of an integrated health care delivery system. Eligible participants were insured adults who responded to health surveys. Population-based samples were taken proportionate to the sex and age distribution of each market.</p><p><strong>Exposures: </strong>Validated survey questions captured social risk exposure (positive screening for financial strain, housing instability, and/or food insecurity) during the past year; across 2 survey waves (2020, 2022). Self-reported social risk was categorized into mutually exclusive risk levels, social risk vs no social risk.</p><p><strong>Main outcomes and measures: </strong>Primary outcome was acute health care utilization defined as time to the first event (ED visit, hospitalization) observed following the first survey completion (January 2020 to July 2023). Weighted Cox proportional hazards regression examined the association between social risk and subsequent care utilization, adjusting for demographic and clinical covariates.</p><p><strong>Results: </strong>The analytic cohort included 9785 survey respondents. The weighted cohort data (mean age, 48.4 years [95% CI, 47.9-48.9 years]) included 54.1% female respondents (95% CI, 52.3%-55.9%); 14.6% of the sample were Asian (95% CI, 13.3%-16.0%), 8.1% Black (95% CI, 7.3%-9.1%), 27.1% Hispanic (95% CI, 25.5%-28.8%), and 43.6% non-Hispanic White (95% CI, 41.2%-44.7%); and 50.3% reported exposure to 1 or more social risk factor. During the follow-up period (median [IQR], 3.48 [3.01-3.50] years), 25.4% (95% CI, 22.9%-28.1%) and 10.3% (95% CI, 8.9%-11.9%) of the cohort experienced an ED visit and hospitalization, respectively. Utilization rates varied by level of social risk exposure. Respondents who reported any social risk had a 21% higher risk of an ED visit compared with those with no social risk exposure (adjusted hazard ratio [HR], 1.21 [95% CI, 1.03-1.41]). Social risk was not associated with hospitalizations (adjusted HR, 1.05 [95% CI, 0.84-1.32]).</p><p><strong>Conclusions and relevance: </strong>In this cohort of 9785 adults, the significant association between social risk and time to first ED event warrants future study to determine if improved social risk are associated with lower ED utilization.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e254253"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752773","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":"Patient- and Community-Level Characteristics Associated With Respiratory Syncytial Virus Vaccination.","authors":"Diya Surie, Katharine A Yuengling, Basmah Safdar, Adit A Ginde, Ithan D Peltan, Samuel M Brown, Manjusha Gaglani, Shekhar Ghamande, Robert L Gottlieb, Cristie Columbus, Nicholas M Mohr, Kevin W Gibbs, David N Hager, Mary O'Rourke, Michelle N Gong, Amira Mohamed, Nicholas J Johnson, Jay S Steingrub, Akram Khan, Abhijit Duggal, Jennifer G Wilson, Nida Qadir, Steven Y Chang, Christopher Mallow, Laurence W Busse, Jamie Felzer, Jennie H Kwon, Matthew C Exline, Ivana A Vaughn, Mayur Ramesh, Adam S Lauring, Emily T Martin, Jarrod M Mosier, Estelle S Harris, Adrienne Baughman, Sydney A Swan, Cassandra A Johnson, Paul W Blair, Nathaniel M Lewis, Sascha Ellington, Rachel E Rutkowski, Yuwei Zhu, Wesley H Self, Fatimah S Dawood","doi":"10.1001/jamanetworkopen.2025.2841","DOIUrl":"10.1001/jamanetworkopen.2025.2841","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;In 2023, the first respiratory syncytial virus (RSV) vaccines were recommended for US adults 60 years or older, but few data are available about which patients were most likely to receive vaccine to inform future RSV vaccine outreach efforts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess patient- and community-level characteristics associated with RSV vaccine receipt and patient knowledge and attitudes related to RSV disease and RSV vaccines.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;During the first season of RSV vaccine use from October 1, 2023, to April 30, 2024, adults 60 years or older hospitalized with RSV-negative acute respiratory illness were enrolled in this cross-sectional study from 26 hospitals in 20 US states. Sociodemographic and clinical data were abstracted from health records, and structured interviews were conducted for knowledge and attitudes about RSV disease and RSV vaccines.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Age, sex, race and ethnicity, pulmonary disease, immunocompromised status, long-term care facility residence, medical insurance, social vulnerability index (SVI), and educational level.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The exposures were identified a priori as possible factors associated with RSV vaccine receipt and were entered into a modified Poisson regression model accounting for state clustering, to assess for association with RSV vaccine receipt. Knowledge and attitudes were summarized with frequencies and proportions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 6746 hospitalized adults 60 years or older, median age was 73 (IQR, 66-80) years and 3451 (51.2%) were female. Among the 6599 patients with self-reported race and ethnicity, 699 (10.6%) were Hispanic, 1288 (19.5%) were non-Hispanic Black, 4299 (65.1%) were non-Hispanic White, and 313 (4.7%) were other race or ethnicity. There were 700 RSV-vaccinated (10.4%) and 6046 unvaccinated (89.6%) adults. Among 3219 unvaccinated adults who responded to RSV knowledge questions, 1519 (47.2%) had not heard of RSV or were unsure; 2525 of 3218 (78.5%) were unsure if they were eligible for RSV vaccine or thought they were not. In adjusted analyses, characteristics associated with RSV vaccination were being 75 years or older (adjusted risk ratio [ARR], 1.23; 95% CI, 1.10-1.38, P &lt; .001), being male (ARR, 1.15; 95% CI, 1.01-1.30; P = .04), and having pulmonary disease (ARR, 1.39; 95% CI, 1.16-1.67; P &lt; .001), immunocompromised status (ARR, 1.30; 95% CI, 1.14-1.48; P &lt; .001), low (ARR, 1.47; 95% CI, 1.18-1.83, P &lt; .001) or moderate (ARR, 1.47; 95% CI, 1.21-1.79; P &lt; .001) SVI, and educational level consisting of 4 or more years of college (ARR, 2.91; 95% CI, 2.14-3.96; P &lt; .001), at least some college or technical training (ARR, 1.85; 95% CI, 1.35-2.53; P &lt; .001), or grade 12 education or General Educational Development (ARR, 1.44; 95% CI, 1.03-2.00; P = .03). RSV vaccination was less likely among residents of long-ter","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e252841"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752760","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":"Uterine Fibroid Diagnosis by Race and Ethnicity in an Integrated Health Care System.","authors":"Susanna D Mitro, Wendy Dyer, Catherine Lee, Ameek Bindra, Lana Wang, Miranda Ritterman Weintraub, Monique M Hedderson, Eve Zaritsky","doi":"10.1001/jamanetworkopen.2025.5235","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.5235","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Uterine fibroids are benign tumors that can cause severe symptoms. Fibroid burden among Asian or Pacific Islander individuals, particularly in specific subgroups, remains largely unexamined.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To describe fibroid diagnosis rates by race and ethnicity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This retrospective cohort study (January 2009 to December 2022) used data from electronic health records of the Kaiser Permanente Northern California (KPNC) integrated health care system. Eligible participants included female (sex assigned at birth) KPNC members aged 18 to 54 years with at least 12 months of continuous membership, no prior fibroid diagnosis, and no history of hysterectomy. Data were analyzed January to September 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Race and ethnicity was categorized into 9 groups: Black (African American, other Black [ie, any Black race or ethnicity not otherwise specified], and unknown Black race or ethnicity), East Asian (Chinese, Japanese, and Korean), Hispanic (Hispanic or Latino), South Asian (Asian Indian, Bangladeshi, East Indian, Nepali, Sri Lankan, and any South Asian ethnicity not otherwise specified), Southeast Asian (Filipino, Vietnamese, and other Southeast Asian [ie, any Southeast Asian ethnicity not otherwise specified]), White (White or White Middle Eastern), other Asian or Pacific Islander (Native Hawaiian or Pacific Islander, multiethnic Asian, and other or unspecified Asian ethnicity [ie, any Asian ethnicity not otherwise specified]), other races and ethnicities (American Indian or Alaska Native and multiracial), and unknown race or ethnicity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Incident fibroid diagnosis was identified using diagnostic codes. Poisson regression models were used to calculate incidence rates of fibroid diagnosis by racial and ethnic group, standardized to the 2022 US female population. Incidence rate ratios (IRRs) and 95% CIs compared incidence within each racial and ethnic group with White participants.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 1 917 794 patients were included (median [IQR] percentage, 7% [6%-7%] Black; 5% [5%-6%] East Asian; 22% [21%-23%] Hispanic; 3% [2%-3%] South Asian; 7% [7%-8%] Southeast Asian; 42% [39%-45%] White; 8% [6%-10%] other Asian or Pacific Islander; 2% [2%-2%] of other races and ethnicities; 4% [4%-5%] unknown or missing race and ethnicity), and 84 206 patients (4.4%) received a first fibroid diagnosis during the study period. Compared with White patients, there was a higher rate of fibroid diagnosis among Southeast Asian (IRR, 1.29; 95% CI, 1.26-1.33), East Asian (IRR, 1.47; 95% CI, 1.43-1.51), and South Asian patients (IRR, 1.71; 95% CI, 1.65-1.78). Black (IRR, 3.11; 95% CI, 3.05-3.17) and Hispanic patients (IRR, 1.37; 95% CI, 1.34-1.39) also had elevated rates of fibroid diagnosis. All Asian patients were less likely than other groups to have ICD-9 or ICD-10","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e255235"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763874","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":"App-Based Physical Activity Intervention Among Women With Prior Hypertensive Pregnancy Disorder: A Randomized Clinical Trial.","authors":"Lili L Kókai, Diarmaid Ó Ceallaigh, Anne I Wijtzes, Jeanine E Roeters van Lennep, Johannes J Duvekot, Martin S Hagger, John Cawley, Alex Burdorf, Kirsten I M Rohde, Hans van Kippersluis","doi":"10.1001/jamanetworkopen.2025.2656","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.2656","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Insufficient moderate to vigorous physical activity (MVPA) is a risk factor for cardiovascular disease (CVD). Effective interventions are needed to bridge the intention-behavior gap and increase MVPA, especially among women with prior hypertensive pregnancy disorder (HPD).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To test the effectiveness of two 8-week app-based MVPA interventions (motivation and action) that were based on the integrated behavior change (IBC) model and used evidence-based behavior change techniques from behavioral sciences.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This randomized clinical trial (RCT) included women with prior HPD. A purpose-built app was tested from October 2021 to March 2022, with follow-up immediately after the intervention (week 9), 3 months later (week 21), and 12 months later (week 61). The study ended in May 2023. Data were analyzed from March 31, 2022, to June 9, 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Intervention: &lt;/strong&gt;All participants received a wearable fitness tracker and a purpose-built physical activity intervention app and were randomized to 1 of 3 groups (control, motivation, or action): The control group received information on CVD, MVPA, and HPD; the motivation group received the same information as well as motivational interviewing-based counseling; and the action group received the same information as well as behavior change techniques that targeted all processes in the IBC model (motivational, volitional, automatic): motivational interviewing-based counseling, action and coping planning, commitment, positive psychology, and mindfulness-based stress reduction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcome was MVPA (in minutes per week). Treatment effects were estimated using available case ordinary least-squares regression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 619 women participated in this study: 205 in the control group, 209 in the motivation group, and 205 in the action group. Their mean (SD) age was 38.9 (7.3) years; 386 of 577 participants (67%) had a bachelor's degree or more and 550 of 577 (95%) were living with a child or children. The mean (SD) weekly MVPA for all 3 groups went from a high baseline of 242 (190) minutes to 197 (208) minutes immediately post intervention. No significant postintervention treatment effects on MVPA were observed for the action group (week 9 treatment effect, -17 [95% CI, -58 to 23] min/wk) or the motivation group (week 9 treatment effect, -3 [95% CI, -58 to 51] min/wk), despite the action intervention positively influencing motivational and volitional processes. The app and intervention components were all evaluated positively by participants.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this clinical trial of 2 app-based MVPA interventions among 619 women with prior HPD, no treatment effects on MVPA were observed. Possible explanations include (1) the importance of automatic processes in det","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e252656"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763935","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":"Increased Utilization of Overtime and Agency Nurses and Patient Safety.","authors":"Patricia Pittman, Hong-Lun Tiunn, Qian Luo, Michael Herron, Drew Tatum, John Martin","doi":"10.1001/jamanetworkopen.2025.2875","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.2875","url":null,"abstract":"<p><strong>Importance: </strong>The use of nurse overtime and agency nurses has increased in recent years, making it important to understand the opportunities and limits of these alternative staffing strategies on patient safety outcomes.</p><p><strong>Objective: </strong>To examine the association between overtime and agency nurse staffing hours and hospital patient safety.</p><p><strong>Design, setting, and participants: </strong>This quality improvement study used data from 70 US hospitals, from January 2019 through December 2022. Participants included patients and nurse staff across the 70 hospitals.</p><p><strong>Exposure: </strong>The use of overtime and agency nursing.</p><p><strong>Main outcomes and measures: </strong>The main outcomes were 10 of the US Agency for Healthcare Research and Quality's patient safety indicators and their associations with regular, overtime, and agency nursing hours per patient day: pressure ulcers, iatrogenic pneumothorax, in-hospital fall with hip fracture, perioperative hemorrhage or hematoma, postoperative acute kidney injury requiring dialysis, postoperative respiratory failure, perioperative thromboembolism, postoperative sepsis, postoperative wound dehiscence, and accidental puncture or laceration. A baseline Poisson regression model and a structural breakpoint analysis were used to identify safety thresholds. Pairwise interactions between staffing intensity variables and hospital bed size were also included. Adjustments were made for the COVID-19 hospital census, patient case mix, and hospital characteristics.</p><p><strong>Results: </strong>The sample included 46 hospitals in the South, 20 in the West, and 4 in the Northeast; 48 hospitals were urban, 32 hospitals had fewer than 200 beds, 26 had between 200 and 399 beds, and 12 had 400 or more beds. The average use of nurse overtime and agency nurse hours exceeded safe thresholds for pressure ulcers by 140.0% for agency staffing and by 63.6% for overtime, representing a 6.44% increase associated with excess agency nurse hours and a 2.09% increase for excess use of overtime. There also was a statistically significant association of agency hours with postsurgery hemorrhage or hematoma rates, but no breakpoint threshold. There were no significant associations with other outcomes.</p><p><strong>Conclusions and relevance: </strong>These findings suggest that both nurse overtime and nurse agency hours are associated with increased rates of pressure ulcers, a measure that is one of the most sensitive to nursing care. In future research, hospitals could use their own data to track safe thresholds.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e252875"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763940","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}