JAMA Network OpenPub Date : 2025-10-01DOI: 10.1001/jamanetworkopen.2025.37378
Alexandra E Hernandez, Angela Mazul, Neha Goel
{"title":"Social Adversity and Triple-Negative Breast Cancer Incidence Among US Black Women.","authors":"Alexandra E Hernandez, Angela Mazul, Neha Goel","doi":"10.1001/jamanetworkopen.2025.37378","DOIUrl":"10.1001/jamanetworkopen.2025.37378","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2537378"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12522001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145286287","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}
JAMA Network OpenPub Date : 2025-10-01DOI: 10.1001/jamanetworkopen.2025.37355
Elizabeth Wrigley-Field
{"title":"Early Adult Mortality in a Cross-National Context-Reconsidering American Exceptionalism Before and After the COVID-19 Pandemic.","authors":"Elizabeth Wrigley-Field","doi":"10.1001/jamanetworkopen.2025.37355","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.37355","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2537355"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145286180","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}
JAMA Network OpenPub Date : 2025-10-01DOI: 10.1001/jamanetworkopen.2025.38039
Clément Bernard, Tom Duchemin, Lise Marty, Jérôme Drouin, Sara Miranda, Laura Semenzato, Jérémie Botton, Laurent Chouchana, Rosemary Dray-Spira, Alain Weill, Mahmoud Zureik
{"title":"First-Trimester mRNA COVID-19 Vaccination and Risk of Major Congenital Anomalies.","authors":"Clément Bernard, Tom Duchemin, Lise Marty, Jérôme Drouin, Sara Miranda, Laura Semenzato, Jérémie Botton, Laurent Chouchana, Rosemary Dray-Spira, Alain Weill, Mahmoud Zureik","doi":"10.1001/jamanetworkopen.2025.38039","DOIUrl":"10.1001/jamanetworkopen.2025.38039","url":null,"abstract":"<p><strong>Importance: </strong>Although messenger RNA (mRNA) COVID-19 vaccines are widely recommended during pregnancy, data on their fetal safety during the teratogenic window remain limited.</p><p><strong>Objective: </strong>To evaluate the association between first-trimester exposure to mRNA COVID-19 vaccines and the risk of major congenital malformations (MCMs), across 75 individual MCMs grouped by 13 organ systems.</p><p><strong>Design, setting, and participants: </strong>This nationwide, population-based cohort study was conducted using the comprehensive Mother-Child EPI-MERES Register, including all live-born infants in France from pregnancies starting April 1, 2021, to January 31, 2022. Follow-up data were available up to December 2024.</p><p><strong>Exposure: </strong>Exposure was defined as receiving at least 1 dose of mRNA-based COVID-19 vaccine during the first trimester of pregnancy.</p><p><strong>Main outcomes and measures: </strong>MCMs were identified following European Surveillance of Congenital Anomalies guidelines. The main analyses compared exposed and nonexposed infants, and sensitivity analyses used alternative comparison groups based on maternal vaccination status and timing. Confounders were adjusted for using a propensity score-based standardized mortality ratio weighting method. Weighted odds ratios (ORs) were estimated using logistic regression.</p><p><strong>Results: </strong>Among 527 564 eligible live-born infants, 130 338 (24.7%) were exposed to at least 1 vaccine dose during the first trimester. Mothers of exposed infants were slightly older than mothers of unexposed infants (mean [SD] age, 30.4 [5.3] years vs 30.1 [5.1] years), were less socially deprived, and presented slightly more often with a comorbidity. The prevalence of MCMs was 176.6 per 10 000 (2302 infants) among exposed infants and 179.4 per 10 000 (7128 infants) among nonexposed infants. No increased risk of MCMs was observed overall (weighted OR, 0.98 [95% CI, 0.93-1.04]), by organ system (weighted ORs ranging from 0.84 [95% CI, 0.68-1.04] for digestive system MCMs to 1.20 [95% CI, 0.75-1.91] for abdominal wall defects), or for any of the 75 individual MCMs. Sensitivity and stratified analyses confirmed these findings.</p><p><strong>Conclusions and relevance: </strong>In this cohort study of pregnancies exposed to mRNA COVID-19 vaccines in the first trimester, exposure was not associated with an increased risk of any MCMs, overall, by organ group, or by individual MCM, supporting the safety of mRNA COVID-19 vaccines in early pregnancy.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2538039"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12529215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292126","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}
JAMA Network OpenPub Date : 2025-10-01DOI: 10.1001/jamanetworkopen.2025.38191
Peter B Sporns, Kartik D Bhatia, Prakash Muthusami, Carmen Parra-Farinas, Christine K Fox, Adam A Dmytriw, Sarah Lee, Jens Fiehler, Todd Abruzzo, Lisa Pabst, Stuart Fraser, Lisa R Sun, Grégoire Boulouis, Tanja Burkard, Marios Psychogios, Thi Dan Linh Nguyen-Kim, Moritz Wildgruber
{"title":"Intravenous Thrombolysis for Pediatric Acute Ischemic Stroke.","authors":"Peter B Sporns, Kartik D Bhatia, Prakash Muthusami, Carmen Parra-Farinas, Christine K Fox, Adam A Dmytriw, Sarah Lee, Jens Fiehler, Todd Abruzzo, Lisa Pabst, Stuart Fraser, Lisa R Sun, Grégoire Boulouis, Tanja Burkard, Marios Psychogios, Thi Dan Linh Nguyen-Kim, Moritz Wildgruber","doi":"10.1001/jamanetworkopen.2025.38191","DOIUrl":"10.1001/jamanetworkopen.2025.38191","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2538191"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12529207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292151","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}
JAMA Network OpenPub Date : 2025-10-01DOI: 10.1001/jamanetworkopen.2025.36100
Romain Neugebauer, Jaejin An, Sarah Krahe Dombrowski, Caryn Oshiro, Andrea Cassidy-Bushrow, Lisa Gilliam, Gregg Simonson, Andrew J Karter, Richard Bergenstal, Holly Finertie, Maher M Yassin, Greg Knowlton, Sharon R Lin, Wendy Dyer, Noel Pimentel, Keanu Izadian, Julie Schmittdiel, Tainayah W Thomas, Stephanie A Hooker, Margaret B Nolan, Eric Wright, Lindsey Aurora, Luis A Rodriguez, Jasleen Kaur, Alyce S Adams, Mark J van der Laan, Patrick J O'Connor
{"title":"Glucose-Lowering Medication Classes and Cardiovascular Outcomes in Patients With Type 2 Diabetes.","authors":"Romain Neugebauer, Jaejin An, Sarah Krahe Dombrowski, Caryn Oshiro, Andrea Cassidy-Bushrow, Lisa Gilliam, Gregg Simonson, Andrew J Karter, Richard Bergenstal, Holly Finertie, Maher M Yassin, Greg Knowlton, Sharon R Lin, Wendy Dyer, Noel Pimentel, Keanu Izadian, Julie Schmittdiel, Tainayah W Thomas, Stephanie A Hooker, Margaret B Nolan, Eric Wright, Lindsey Aurora, Luis A Rodriguez, Jasleen Kaur, Alyce S Adams, Mark J van der Laan, Patrick J O'Connor","doi":"10.1001/jamanetworkopen.2025.36100","DOIUrl":"10.1001/jamanetworkopen.2025.36100","url":null,"abstract":"<p><strong>Importance: </strong>Major adverse cardiovascular events (MACEs) are primary causes of morbidity and mortality in adults with type 2 diabetes (T2D), yet few head-to-head randomized trials have compared the effects of glucose-lowering medications on MACEs, and most observational analyses are limited by inadequate bias adjustment methods.</p><p><strong>Objective: </strong>To compare the effectiveness of sustained exposure to 4 classes of glucose-lowering medications (sulfonylureas, dipeptidyl peptidase-4 inhibitors [DPP4is], sodium-glucose cotransporter-2 inhibitors [SGLT2is], and glucagon-like peptide-1 receptor agonists [GLP-1RAs]) on MACEs in US adults with T2D using modern causal methods combined with machine learning.</p><p><strong>Design, setting, and participants: </strong>This comparative effectiveness study included adults with T2D who were members of 6 large US health care delivery systems and initiated treatment with 1 of 4 medication classes (sulfonylureas, DPP4is, SGLT2is, and GLP-1RAs) between January 1, 2014, and December 31, 2021. Data analysis was conducted from May 1 to December 31, 2024.</p><p><strong>Exposure: </strong>New use of a sulfonylurea, DPP4i, SGLT2i, or GLP-1RA based on filled prescriptions.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was MACEs defined as nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. Analyses were conducted using targeted learning within a trial emulation framework. Heterogeneity of treatment effects was assessed for prespecified subgroups.</p><p><strong>Results: </strong>This study included 296 676 adults. The cohort for emulating a 4-arm trial included a subset of 241 981 adults (mean [SD] age, 57.2 [12.9] years; 54.3% male) with T2D. In adjusted analyses, 2.5-year MACE risk was lowest in patients with sustained exposure to GLP-1RAs, followed by SGLT2is , sulfonylureas, and DPP4is. Comparing DPP4is with sulfonylureas and SGLT2is with GLP-1RAs, the 2.5-year cumulative risk difference was 1.9% (95% CI, 1.1%-2.7%) and 1.5% (1.1%-1.9%), respectively. Risk differences in patients with vs without atherosclerotic cardiovascular disease (ASCVD) were similar in direction but typically much smaller for patients without ASCVD. Evidence of a benefit of GLP-1RAs over SGLT2is was most pronounced in patients with baseline ASCVD or heart failure (HF), age 65 years or older, or low to moderate kidney impairment but was not found in patients younger than 50 years.</p><p><strong>Conclusions and relevance: </strong>In this study, MACE risk varied significantly by medication class, with most protection achieved with sustained treatment with GLP-1RAs followed by SGLT2is, sulfonylureas, and DPP4is. The magnitude of benefit of GLP-1RAs over SGLT2is depended on baseline age, ASCVD, HF, and kidney impairment. These results, along with consideration of cost, availability, and collateral clinical benefits, may inform treatment decisions for adults with T2D.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2536100"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12529185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292167","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":"Body Composition and Cardiometabolic Risk in Children.","authors":"Irene Sequí-Domínguez, Mairena Sánchez-López, Miriam Garrido-Miguel, Monserrat Solera-Martínez, Valentina Díaz-Goñi, Sergio Núñez de Arenas-Arroyo, Pontus Henriksson, Ángel Herraiz-Adillo, Vicente Martínez-Vizcaíno, Eva Rodríguez-Gutiérrez","doi":"10.1001/jamanetworkopen.2025.35004","DOIUrl":"10.1001/jamanetworkopen.2025.35004","url":null,"abstract":"<p><strong>Importance: </strong>Understanding secular patterns in body composition and cardiometabolic risk factors (CMRFs) is essential for identifying early-life determinants of cardiovascular health, guiding public health policies, and developing early prevention strategies.</p><p><strong>Objective: </strong>To examine secular patterns in the prevalence of underweight, overweight, obesity, and CMRFs among schoolchildren in Spain from 1992 to 2022.</p><p><strong>Design, setting, and participants: </strong>Repeated cross-sectional study analyzing data from 7 time points over a 30-year period in public primary schools from the Cuenca province in Spain. Participants were children aged 8 to 11 years (fourth to fifth grade) from 7 cohorts studied in 1992, 1996, 1998, 2004, 2010, 2018, and 2022. Data were analyzed from April 2024 to May 2025.</p><p><strong>Main outcomes and measures: </strong>Prevalence of weight status (underweight, normal weight, overweight, and obesity), lipid parameters, glycemic markers, and resting systolic blood pressure (SBP) and diastolic blood pressure (DBP).</p><p><strong>Results: </strong>In a total of 4280 participants (mean [SD] age, 9.6 [0.7] years; 2137 [50.0%] girls), patterns in the prevalence of weight status show that increases in obesity appear to have slowed down and plateaued since 2018 (13.4%; 95% CI, 11.5% to 15.5% in 2010; 8.1%; 95% CI, 6.0% to 10.5% in 2018; 10.4% 95% CI, 8.1% to 13.2% in 2022; P < .001). A statistically significant decrease in mean (SD) total cholesterol (184.6 [27.4] to 160.3 [27.4] mg/dL) and low-density lipoprotein cholesterol (113.6 [24.0] to 90.1 [24.0] mg/dL) was observed, which was reflected in a reduction in non-high-density lipoprotein cholesterol (HDL-C) (125.3 [26.2] to 99.8 [26.1] mg/dL) from 1992 to 2022. Mean (SD) serum HDL-C appear to have peaked from 1998 to 2004 (66.2 [13.3] vs 66.9 [13.3] mg/dL, respectively), and its levels have decreased since then (60.5 [13.4] mg/dL in 2022; P < .001). Mean (SD) resting blood pressure showed a substantial decrease over the study period (SBP: 113.5 [9.6] to 101.0 [9.7] mm Hg and DBP: 70.4 [7.2] to 60.7 [7.3] mm Hg; P < .001). However, mean (SD) insulin levels show a significant rise from 2004 to 2022 (6.3 [5.3] to 8.7 [5.2] μIU/mL; P < .001).</p><p><strong>Conclusions and relevance: </strong>This repeated cross-sectional study provides a picture of the evolution of CMRFs in children over the last 30 years, showing that, in Spain, despite the concerning prevalences of excess weight, lipid parameters and blood pressure have improved over the studied period.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2535004"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12492057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206343","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":"Contemporary Incidence and Survival of Lung Neuroendocrine Neoplasms.","authors":"Julie Hallet, Mathieu Rousseau, Elliot Wakeam, Sten Myrehaug, Léamarie Meloche-Dumas, Anna Gombay, Wing Chan, Simron Singh","doi":"10.1001/jamanetworkopen.2025.35125","DOIUrl":"10.1001/jamanetworkopen.2025.35125","url":null,"abstract":"<p><strong>Importance: </strong>While the epidemiology of overall and gastrointestinal neuroendocrine neoplasms (NENs) has been reported, data specific to lung NENs remain scarce.</p><p><strong>Objective: </strong>To examine the incidence, overall survival (OS), and lung cancer-specific death for lung NENs.</p><p><strong>Design, setting, and participants: </strong>Population-based retrospective cohort study in Ontario, Canada, of adult patients with incident lung NENs from 2000 to 2020. Data were analyzed from July to December 2024.</p><p><strong>Main outcomes and measures: </strong>Yearly incidence rates of lung NENs. OS examined with Kaplan-Meier curves and Cox regression models. Lung cancer-specific deaths using cumulative incidence function and Fine-Gray models accounting for the competing risk of death from other causes.</p><p><strong>Results: </strong>Among 4479 total patients, the median (IQR) age at diagnosis was 67 (57-74) years, and 2521 (56.3%) were female; 2056 (45.9%) had typical neuroendocrine tumors (NET), 370 (8.3%) atypical NET, 998 (22.3%) large cell neuroendocrine carcinoma (NEC, including small cell and mixed NEC), and 1055 (23.6%) other NEC, as well as 1103 (24.6%) who presented as stage IV. The incidence of lung NENs increased 2.87-fold from 0.87 to 2.50 per 100 000 from 2000 to 2020. This rise in incidence was observed mostly for typical NET (from 0.51 to 1.09) and for stage I (0.68 to 1.18). With a median (IQR) follow-up of 34 (9-87) months, 5- and 10-year OS were 50% (95% CI, 49%-51%) and 40% (95% CI, 39%-41%) overall. Advancing age, lower socioeconomic status, type of lung NEN, and advancing stage were independently associated with inferior OS. Cumulative incidence of lung cancer-specific deaths was 41% (95% CI, 40%-42%) at 5 years and 46% (95% CI, 45%-47%) at 10 years. Advancing age, type of lung NEN, and increasing stage were independently associated with higher hazards of lung cancer-specific deaths. Lung cancer-specific deaths were exceeded by deaths from other causes starting 2 year after diagnosis for typical NET and 3 years after diagnosis for stage I disease.</p><p><strong>Conclusions and relevance: </strong>The incidence of lung NENs has increased over 20 years, mostly associated with stage I disease. Prolonged OS was observed after lung NEN diagnosis. Patients with typical lung NET and stage I disease were more likely to die of causes other than lung cancer after 1 and 3 years, respectively. These data are important to direct efforts in care, research, and patient counseling.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2535125"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12492052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206427","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}
JAMA Network OpenPub Date : 2025-10-01DOI: 10.1001/jamanetworkopen.2025.35813
Zixin Wang, Siyu Chen, Josiah Poon, Soyeon Caren Han, Danhua Ye, Fuk-Yuen Yu, Yuan Fang, Zhao Ni, Martin C S Wong, Phoenix K H Mo
{"title":"A Hybrid Chatbot to Promote Pneumococcal Vaccination Among Older Adults: A Randomized Clinical Trial.","authors":"Zixin Wang, Siyu Chen, Josiah Poon, Soyeon Caren Han, Danhua Ye, Fuk-Yuen Yu, Yuan Fang, Zhao Ni, Martin C S Wong, Phoenix K H Mo","doi":"10.1001/jamanetworkopen.2025.35813","DOIUrl":"10.1001/jamanetworkopen.2025.35813","url":null,"abstract":"<p><strong>Importance: </strong>There are few robust evaluations assessing the efficacy of chatbots to improve pneumococcal vaccination (PV) uptake among adults 65 years of age or older.</p><p><strong>Objective: </strong>To evaluate the relative efficacy of a hybrid chatbot in increasing PV uptake among Hong Kong residents aged 65 years or older.</p><p><strong>Design, setting, and participants: </strong>This partially masked, parallel-group randomized clinical trial was conducted between May 1, 2023, and November 30, 2024 in Hong Kong, China. Participants were aged 65 years or older, had a Hong Kong identity card, could speak and comprehend Cantonese, were smartphone and WhatsApp users, and had no prior PV uptake. Participants were recruited through random telephone calls and were randomized to either the stage of change group or the standard intervention group.</p><p><strong>Interventions: </strong>In the stage of change group, the rule-based component of the hybrid chatbot assessed participants' stage of change regarding PV uptake and then delivered stage of change-tailored interventions at months 0, 1, 2, and 3. The natural language processing component of the hybrid chatbot provided real-time answers to participants' PV-related questions. In the standard intervention group, the chatbot sent participants a link to access a standard online video covering PV information at months 0, 1, 2, and 3.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was self-reported PV uptake at month 12, which was validated by the research team. The secondary outcome was participants' stage of change measured at month 0 and month 12 by using validated questions, with a score of 1 = precontemplation, 2 = contemplation, 3 = preparation, and 4 = action.</p><p><strong>Results: </strong>A total of 374 participants (213 female [57.0%]; mean [SD] age, 69.6 [3.1] years) were randomized to either the stage of change group (n = 187) or the standard intervention group (n = 187). The intention-to-treat analysis showed that the validated PV uptake rate was higher in the stage of change group than in the standard intervention group (29.4% vs 18.7%; P = .01). The mean (SD) stage of change score was higher in the stage of change group than in the standard intervention group (2.2 [1.3] vs 1.9 [1.1]; P = .02). More participants in the stage of change group than in the standard intervention group completed at least 1 intervention session (79.7% vs 57.8%; P < .001).</p><p><strong>Conclusions and relevance: </strong>In this randomized clinical trial, the hybrid chatbot was more efficacious than the standard intervention in increasing PV uptake among older adults in Hong Kong. A hybrid chatbot may be a sustainable PV promotion for older adults.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT05772117.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2535813"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12509012/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251113","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}
JAMA Network OpenPub Date : 2025-10-01DOI: 10.1001/jamanetworkopen.2025.36635
Julia M Dennett, Evan J Soltas, Gopi Shah Goda, Thomas A Thornhill, Kevin Werner, Gregg S Gonsalves
{"title":"Enduring Outcomes of COVID-19 Work Absences on the US Labor Market.","authors":"Julia M Dennett, Evan J Soltas, Gopi Shah Goda, Thomas A Thornhill, Kevin Werner, Gregg S Gonsalves","doi":"10.1001/jamanetworkopen.2025.36635","DOIUrl":"10.1001/jamanetworkopen.2025.36635","url":null,"abstract":"<p><strong>Importance: </strong>Although the adverse outcomes of the COVID-19 pandemic on the US labor market have been well documented, the impacts of ongoing SARS-CoV-2 circulation are less clear.</p><p><strong>Objective: </strong>To determine the extent to which COVID-19 continues to generate work absences and decrease labor force participation beyond the pandemic period in the US.</p><p><strong>Design, setting, and participants: </strong>This cohort study used monthly data from employed survey respondents in the nationally representative Current Population Survey spanning January 2010 to December 2024 and linked to COVID-19 wastewater surveillance data from the Centers for Disease Control and Prevention. The setting was the US before the COVID-19 pandemic (before March 2020), during the pandemic (March 2020 to April 2023), and after the end of the public health emergency declaration (May 2023 to December 2024).</p><p><strong>Exposures: </strong>COVID-19 prevalence as measured by wastewater viral activity levels and comparisons across the periods before, during, and after the pandemic.</p><p><strong>Main outcomes and measures: </strong>The primary outcomes were health-related absences from work and subsequent labor force exits. The association between health-related absences and all measures of wastewater viral activity was analyzed using state-level data and linear regressions with state and month fixed effects.</p><p><strong>Results: </strong>The study cohort was the employed US population and represented approximately 158.4 million workers in February 2020. At this baseline, approximately 35% of workers (55.3 million workers) were aged 15 to 34 years, 41% (65.1 million workers) were aged 35 to 54 years, and 24% (38.0 million workers) were aged 55 years and older; 48% (75.2 million workers) were female; 1% (1.7 million workers) were American Indian, 7% (10.5 million workers) were Asian, 18% (27.7 million workers) were Hispanic, 11% (18.1 million workers) were non-Hispanic Black, and 62% (97.9 million workers) were non-Hispanic White; and 33% (52.5 million workers) had educational attainment of high school or less. Adverse outcomes from the COVID-19 pandemic persisted, although at attenuated levels compared with the acute pandemic period. Health-related absences from work continued to track COVID-19 circulation and were 12.9% higher in the postpandemic period compared with before the pandemic (140 000 monthly absences). Workers in occupations at greater risk of exposure and some demographic groups continued to experience elevated levels of absences in the postpandemic period. Specifically, absences were 8.1% higher for workers in low work-from-home occupations and 12.5% higher for workers in high physical proximity occupations compared with prepandemic values. Labor force exits after a health-related absence also continued to be elevated, with 13.1% more exits in the postpandemic period compared with before the pandemic (13 500 monthly exits)","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2536635"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12514624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274625","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}