JAMA Network Open最新文献

{"title":"Extended Endocrine Therapy and Survival for Breast Cancer Subtypes in Premenopausal Patients.","authors":"Carmine Valenza, Yue Zheng, Monica Milano, Pier Paolo Maria Berton Giachetti, Dario Trapani, Elisa Giordano, Lorenzo Guidi, Laura Boldrini, Grazia Castellano, Jalissa Katrini, Bianca Malagutti, Gabriele Antonarelli, Julian D Etessami, Nadia Bianco, Fabio Conforti, Gregory J Kirkner, Claudia Sangalli, Kate E Dibble, Nicola Fusco, Marco Colleoni, Meredith M Regan, Elisabetta Munzone, Giuseppe Curigliano, Ann H Partridge","doi":"10.1001/jamanetworkopen.2026.10427","DOIUrl":"10.1001/jamanetworkopen.2026.10427","url":null,"abstract":"<p><strong>Importance: </strong>Premenopausal patients with node-positive, hormone receptor-positive, early breast cancer derive benefit from extended endocrine therapy (EET) following 5 years of luteinizing hormone-releasing hormone (LHRH) agonist-based treatment. The benefit of EET may differ according to surrogate breast cancer subtypes in postmenopausal patients.</p><p><strong>Objective: </strong>To evaluate the risk of invasive and distant recurrence across all surrogate breast cancer subtypes among patients with node-positive, hormone receptor-positive early breast cancer who remained premenopausal after completing 5 years of adjuvant therapy with an LHRH agonist who received and did not receive EET.</p><p><strong>Design, setting, and participants: </strong>This multicenter cohort study conducted in the United States and Italy used data from 2 prospectively maintained datasets: the Young Women's Breast Cancer Study and the European Institute of Oncology Breast Cancer cohort. Eligible patients were diagnosed with early breast cancer at 40 years of age or younger between January 2005 and December 2016, had node-positive hormone receptor-positive disease, and remained premenopausal after 5 years of adjuvant LHRH agonist therapy with no evidence of recurrence. Median (IQR) follow-up was 7.3 (4.9-10.3) years. Data were analyzed June 2025.</p><p><strong>Exposure: </strong>EET (with tamoxifen monotherapy, LHRH agonist plus tamoxifen, or LHRH agonist plus aromatase inhibitor), irrespective of the duration of EET, measured at study baseline (defined as the first day of the sixth year after the initiation of adjuvant ET).</p><p><strong>Main outcomes and measures: </strong>Invasive breast cancer-free survival and distant recurrence-free survival (DRFS) distributions were estimated using the adjusted Kaplan-Meier method among patients with or without the exposure, weighted through propensity score (PS) weighting analysis, with the scientific approach.</p><p><strong>Results: </strong>In total, 487 patients were included (median [IQR] age at diagnosis, 37 [35-39] years in the EET group and 37 [33-39] years in the no EET group), and 276 received EET for a median (IQR) duration of 3.7 (2.2-5.0) years. Overall, 89 patients (18%) had luminal A-like disease, 298 (61%) had luminal B-like disease, and 100 (21%) had ERBB2 (formerly HER2)-positive disease. The PS-weighted hazard ratio (HR) for invasive breast cancer-free survival comparing the EET with the no EET group was 0.68 (95% CI, 0.32-1.45) in luminal A-like, 0.63 (95% CI, 0.40-1.00) in luminal B-like/ERBB2-negative, and 0.62 (95% CI, 0.21-1.87) in ERBB2-positive subgroups. The cause-specific PS-weighted HR for DRFS was 0.25 (95% CI, 0.08-0.75) in luminal A-like, 0.54 (95% CI, 0.32-0.94) in luminal B-like/ERBB2-negative, and 0.54 (95% CI, 0.12-2.53) in ERBB2-positive subgroups.</p><p><strong>Conclusions and relevance: </strong>In this cohort study, a lower estimated risk with EET use was observed across al","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 5","pages":"e2610427"},"PeriodicalIF":9.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13139950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815411","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":"Outcomes Associated With Hospital at Home vs Traditional Inpatient Stay.","authors":"J Priyanka Vakkalanka, Tracy L Young, Gabriel Bianchi, Fred Ullrich, Knute D Carter, Nicholas M Mohr, Jeydith Gutierrez","doi":"10.1001/jamanetworkopen.2026.10810","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.10810","url":null,"abstract":"<p><strong>Importance: </strong>Inpatient care is costly, and an aging population, hospital bed shortages, and practitioner shortages stretch inpatient capacity. Alternative modalities of acute care delivery may support growing demands.</p><p><strong>Objective: </strong>To compare outcomes of hospital at home (HaH) vs traditional inpatient hospital admissions and to assess facility-level variability in HaH utilization.</p><p><strong>Design, setting, and participants: </strong>This propensity score-matched, retrospective, comparative effectiveness research study used data for age-qualifying (≥65 years) fee-for-service Medicare beneficiaries admitted from January 1, 2021, through December 1, 2022, within HaH-waivered US hospitals that had 12 or more HaH admissions. Analyses were completed from November 2024 to March 2026.</p><p><strong>Exposure: </strong>HaH vs traditional inpatient hospitalization.</p><p><strong>Main outcomes and measures: </strong>Primary clinical outcomes were in-hospital mortality and hospital readmissions and emergency department (ED) visits within 30 days of index admission discharge. Facility-level characteristics were assessed for facilities that had HaH admissions above and below the median (≥149 admissions). Conditional logistic regression was used for dichotomous outcomes, with adjusted odds ratios (aORs) and 95% CIs reported. Log-transformed linear regression was used for skewed continuous outcomes within matched pairs, with adjusted percentage changes and 95% CIs reported.</p><p><strong>Results: </strong>Among 15 871 Medicare beneficiaries (4174 HaH and 11 697 traditional inpatient admissions), the overall mean (SD) age was 77.4 (8.0) years, and 8396 beneficiaries (56.2%) were female. Of 313 HaH-waivered hospitals, 68 were eligible for inclusion, and 11 hospitals accounted for approximately 50% of all HaH admissions. Compared with traditional inpatient admissions, HaH admissions were associated with lower in-hospital mortality (16 of 4174 admissions [0.4%] vs 423 of 11 697 admissions [3.6%]; aOR, 0.09; 95% CI, 0.06-0.16) and lower ED use within 30 days of discharge (366 of 4174 admissions [8.8%] vs 1164 of 11 697 admissions [10.0%]; aOR, 0.86; 95% CI, 0.76-0.97), with no significant difference in readmissions within 30 days of discharge (490 of 4174 admissions [11.7%] vs 1282 of 11 697 admissions [11.0%]; aOR, 1.07; 95% CI, 0.96-1.20).</p><p><strong>Conclusions and relevance: </strong>In this retrospective comparative effectiveness research study of Medicare beneficiaries, HaH was associated with lower in-hospital mortality and ED use within 30 days of discharge, but not hospital readmissions within 30 days, compared with traditional inpatient care. These findings support HaH as an approach that may maintain similar or better short-term outcomes among appropriately selected patients; future studies should evaluate implementation and equity.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 5","pages":"e2610810"},"PeriodicalIF":9.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837861","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":"In Search of Lost Time-Finding 314 Million Missing Years.","authors":"David H Rehkopf","doi":"10.1001/jamanetworkopen.2026.6124","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.6124","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 5","pages":"e266124"},"PeriodicalIF":9.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837865","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":"Pilot Results for Psilocybin-Assisted Psychotherapy for Cocaine Use Disorder-A Critical Appraisal.","authors":"Erin E Bonar","doi":"10.1001/jamanetworkopen.2026.11042","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.11042","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 5","pages":"e2611042"},"PeriodicalIF":9.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837923","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":"Causes of Excess Deaths in the US Compared With Other High-Income Countries.","authors":"Jacob Bor, Rafeya V Raquib, David Himmelstein, Steffie Woolhandler, Andrew C Stokes","doi":"10.1001/jamanetworkopen.2026.6147","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.6147","url":null,"abstract":"<p><strong>Importance: </strong>The US has higher mortality rates than other high-income countries (HICs). However, a comprehensive analysis of excess US deaths encompassing all leading causes of death over the past 2 decades is currently lacking.</p><p><strong>Objective: </strong>To investigate causes of death responsible for excess US mortality compared with other HICs and how the causes of death involved in this US mortality disadvantage have changed over time.</p><p><strong>Design, setting, and participants: </strong>This repeated cross-sectional study included mortality data from the World Health Organization Mortality Database spanning 1999 to 2022 for the US and 17 other HICs. Data were analyzed from September 2023 to December 2025.</p><p><strong>Exposures: </strong>Residing in the US vs another of the included HICs.</p><p><strong>Main outcome and measures: </strong>The main outcome was excess US mortality in each year due to specific causes of death. Differences between the US and other HICs were quantified for each cause of death as (1) excess US deaths (ie, absolute difference between observed deaths and deaths expected if US death rates equaled the rates of other HICs); (2) years of life lost (YLL) resulting from excess US deaths; and (3) mortality rate ratios (ie, ratios of observed to expected age-standardized death rates).</p><p><strong>Results: </strong>A total of 63 547 318 deaths occurred in the US from 1999 to 2022 (50.4% among males; mean [SD] age at death, 73.2 [18.5] years). In this period, 12 675 646 excess US deaths occurred, increasing from 346 166 in 1999 to 905 159 in 2022. Circulatory diseases were the leading cause of excess US deaths every year except 2010, increasing after 2001 for ages 45 to 64 years and after 2009 for ages 65 years or older. Together, circulatory and metabolic diseases accounted for 52% of excess US deaths in 2022. Excess US deaths due to drug poisonings, alcohol, and suicide increased from -5762 in 1999 to 131 151 in 2022; together, these 3 causes accounted for 24% of the increase in excess US deaths overall and most of the increase in excess US deaths for individuals aged 0 to 44 years. In 2022, deaths from drug poisonings were 7.48 times higher in the US than in other HICs. In 2020 and 2021, 19% and 23% of excess US deaths, respectively, were attributed to COVID-19, but excess US deaths from other causes also increased.</p><p><strong>Conclusions and relevance: </strong>In this repeated cross-sectional study of cross-national mortality, the US had substantially higher death rates than other HICs between 1999 and 2022, despite having similar access to advanced medical technology. Many of these excess US deaths could likely be avoided by adopting health and social policies that have benefited other HICs. These descriptive findings should be interpreted in light of uncertainty arising from differences in death coding, data completeness, and other aspects of data comparability across countries.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 5","pages":"e266147"},"PeriodicalIF":9.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837950","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":"Strengthening the 988 Lifeline Workforce-Policy and Workforce Implications of a National Survey.","authors":"Danielle R Adams, Sasha Zabelski, Morgan Shields","doi":"10.1001/jamanetworkopen.2026.10795","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.10795","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 5","pages":"e2610795"},"PeriodicalIF":9.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837977","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":"Access to Medications for Opioid Use Disorder Among Veterans With Homeless Experience in Permanent Supportive Housing.","authors":"Michael Hsu, Talia Panadero, Larissa J Mooney, David Kim, David Lawrence, Anita Yuan, Prabha Siddarth, Sonya Gabrielian","doi":"10.1001/jamanetworkopen.2026.10831","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.10831","url":null,"abstract":"<p><strong>Importance: </strong>Drug overdose is a leading cause of death among US veterans with homeless experience. Medications for opioid use disorder (MOUD) reduce overdose and all-cause mortality, yet receipt remains low among veterans with homeless experience. Identifying factors associated with MOUD receipt in Department of Veterans Affairs (VA) permanent supportive housing (PSH) can inform strategies to support MOUD implementation and advance health equity.</p><p><strong>Objective: </strong>To identify demographic, clinical, and service-related factors associated with MOUD receipt among veterans with homeless experience with opioid use disorder (OUD) in the Housing and Urban Development-VA Supportive Housing (HUD-VASH) program.</p><p><strong>Design, setting, and participants: </strong>This cohort study used linked national VA administrative and electronic health record data. US veterans with OUD entering HUD-VASH between October 1, 2017, and September 30, 2021, were followed up for 12 months after move-in. Eligible participants were diagnosed with OUD as defined by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision criteria within 5 years before or 1 year after move-in. Sequential logistic regression models examined associations between demographic, clinical, and service utilization factors and MOUD receipt. Statistical analyses were conducted between May 2025 and February 2026.</p><p><strong>Exposure: </strong>Demographic, clinical, and service-related factors.</p><p><strong>Main outcomes and measures: </strong>Receipt of MOUD (buprenorphine, methadone, or extended-release naltrexone) within 12 months after HUD VASH move-in.</p><p><strong>Results: </strong>Among 10 110 veterans with OUD, the mean (SD) age was 53.2 (12.0) years (9297 male [92%]; 3211 Black [32%], 606 Hispanic [6%], 5537 White [55%]); 1685 veterans (17%) received MOUD. Older age (age 55 to 64 years: adjusted odds ratio [AOR], 0.52 [0.42-0.64]) and non-Hispanic Black race (AOR, 0.47 [95% CI, 0.40-0.55]) were associated with lower odds of MOUD receipt, while depression (AOR, 1.24 [95% CI, 1.05-1.46]) and greater behavioral health engagement was associated with higher odds of receipt. Having 1 or more instances of inpatient hospitalization was associated with lower odds of MOUD receipt (AOR, 0.74 [95% CI, 0.64-0.87]).</p><p><strong>Conclusions and relevance: </strong>In this cohort study of veterans with homeless experience with OUD, 1 in 6 veterans received MOUD within a year of entering PSH. Lower rates of MOUD receipt among older veterans and veterans from racial minority groups highlighted persistent inequities, regardless of housing status.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 5","pages":"e2610831"},"PeriodicalIF":9.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837992","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":"Factors Associated With Thromboembolism in Neonates: A Systematic Review and Meta-Analysis.","authors":"Marie-Claude Pelland-Marcotte, Norma Maria Pérez Herrera, Elisabeth Boileau, Heleen van Ommen, Rukhmi Bhat","doi":"10.1001/jamanetworkopen.2026.10908","DOIUrl":"10.1001/jamanetworkopen.2026.10908","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;While venous thromboembolism (VTE) is increasingly recognized in neonates and prothrombotic risk factors are being identified, no risk assessment model currently exists to enable early identification of neonates at high risk of VTE. A thorough understanding of existing evidence is necessary to inform the development of a risk-assessment model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To describe maternal, obstetrical, and neonatal risk factors associated with VTE in neonates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data sources: &lt;/strong&gt;A literature search of Medline, Embase, CINAHL, and clinicaltrials.gov databases was performed on March 16, 2025, for peer-reviewed publications (1990-2025). Reference lists of included articles were screened to identify other potentially relevant publications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study selection: &lt;/strong&gt;Peer-reviewed studies describing factors associated with venous thrombosis in neonates up to 44 weeks of corrected gestational age were included. A total of 282 reports were retrieved and assessed for eligibility.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data extraction and synthesis: &lt;/strong&gt;Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-Analysis of Observational Studies in Epidemiology reporting guidelines were used to guide data abstraction. Studies were screened independently by 4 trained investigators. Data were pooled using a random-effects model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcome was the factors associated with venous thrombosis. Maternal and obstetrical and patient-related risk factors were considered; catheter-related risk factors are reported separately. Results are expressed using mean differences (MDs) or odds ratio (ORs) with 95% CIs. The degree of heterogeneity (ie, τ2) was estimated using the restricted maximum-likelihood model estimator. Risk of bias in included studies was assessed using the Risk of Bias in Non-randomised Studies of Interventions tool.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 60 studies (3 366 507 neonates) were included; most were retrospective cohort studies (26 studies [43%]) or case-control studies (15 studies [25%]). The following risk factors were significantly associated with venous thrombosis: preeclampsia (OR, 2.66; 95% CI, 1.70-4.16; P &lt; .001; τ2 = 0.00), low birth weight (OR, 2.05; 95% CI, 1.41-3.00; P &lt; .001; τ2 = 0.00), cardiac disease (OR, 5.90; 95% CI, 1.16-30.05; P = .03; τ2 = 1.27), and infection (OR, 2.90; 95% CI, 1.88-4.48; P &lt; .001; τ2 = 0.33). Several other factors were identified in multiple studies, but with inconsistent results, including maternal diabetes, gestational age and prematurity, asphyxia, mechanical ventilation, surgery, and elevated hemoglobin or hematocrit levels.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this systematic review and meta-analysis, preeclampsia, low birth weight, cardiac disease, and infection were identified as risk factors of neonatal venous thrombosis. Heterogeneity between stu","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 5","pages":"e2610908"},"PeriodicalIF":9.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837976","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":"Cost-Effectiveness of the START Hospital Addiction Consultation Service for Opioid Use Disorder Treatment.","authors":"Adeyemi Okunogbe, Alexandra Peltz, Itai Danovitch, Allison J Ober, Teryl K Nuckols","doi":"10.1001/jamanetworkopen.2026.11324","DOIUrl":"10.1001/jamanetworkopen.2026.11324","url":null,"abstract":"<p><strong>Importance: </strong>People with opioid use disorder (OUD) are often hospitalized for emergent medical problems, but opioid use is seldom addressed during the inpatient stay. In a recent trial, patients randomized to Substance Use Treatment and Recovery Team (START), a hospital-based addiction consultation service, were more likely to initiate medication for opioid use disorder and be linked to OUD-focused follow-up care compared with patients receiving usual OUD care, which was at the discretion of the primary team.</p><p><strong>Objective: </strong>To evaluate the incremental cost-effectiveness of START from the health sector and limited societal perspectives relative to usual care.</p><p><strong>Design, setting, and participants: </strong>This economic evaluation was an incremental cost-effectiveness analysis based on the START trial, which was conducted at 3 major academic medical centers. START participants were adults with a probable OUD diagnosis documented during an inpatient hospitalization from November 2021 to September 2023. This economic evaluation used trial participant-level cost and health outcomes data, supplemented with published data.</p><p><strong>Exposures: </strong>Two strategies were compared: (1) START and (2) usual care.</p><p><strong>Main outcomes and measures: </strong>Costs, quality-adjusted life year (QALYs), and incremental cost-effectiveness ratios (ICERs). ICERs were estimated using a Markov model over a 12-month horizon, with deterministic and probabilistic sensitivity analyses. ICERs were expressed as cost per QALY gained, with a willingness-to-pay threshold of USD $150 000/QALY.</p><p><strong>Results: </strong>A total of 325 participants were randomized to the START (164 [50.5%]) or usual care (161 [49.5%]); 213 were male (66%) and the median (IQR) age was 41 (32-50) years. START implementation costs were $640 per patient (personnel, $602; training and onboarding, $38). Compared with usual care, START was associated with an incremental cost of $162 (95% UI, -$93 to $179) and a gain in QALYs of 0.0103 (95% UI, 0.0102 to 0.0106) per person from a health sector perspective, leading to an ICER of $15 750 (95% UI, $8742 to $17 034) per QALY gained. The ICER was $20 921 (95% UI, $13 747 to $22 190) per QALY gained from a limited societal perspective. Sensitivity analyses demonstrated that health care expenditures and intervention effectiveness were the strongest drivers of cost-effectiveness.</p><p><strong>Conclusions and relevance: </strong>In this trial-based economic evaluation, START was a cost-effective approach for addressing opioid use disorder in the inpatient setting by increasing the initiation of medication for OUD and linkage to OUD-focused care after discharge.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 5","pages":"e2611324"},"PeriodicalIF":9.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13153993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838006","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":"Biomarkers, Cognitive Function, and Mortality in Centenarians.","authors":"Ryo Shikimoto, Takashi Sasaki, Yukiko Abe, Kenji Tai, Nobuyoshi Hirose, Hideyuki Okano, Yasumichi Arai","doi":"10.1001/jamanetworkopen.2026.11335","DOIUrl":"10.1001/jamanetworkopen.2026.11335","url":null,"abstract":"<p><strong>Importance: </strong>Blood-based neural biomarkers linked to aging may provide insights into the biological end point of the human lifespan. However, the key biomarker associated with cognition and mortality in centenarians remains unclear.</p><p><strong>Objective: </strong>To investigate the associations between 3 neural biomarkers-amyloid-β42 and amyloid-β40 ratio (Aβ42/40), phosphorylated tau 181 (p-tau181), and neurofilament light chain (NfL)-and both cognitive function and all-cause mortality in centenarians.</p><p><strong>Design, setting, and participants: </strong>This population-based cohort study included Japanese centenarians aged 100 years or older who were enrolled between September 2000 and January 2021. Participants underwent baseline cognitive assessments and blood sampling and were followed up for 17 years for mortality. Data analysis was performed in February 2026.</p><p><strong>Exposures: </strong>Baseline plasma levels of Aβ42/40, p-tau181, and NfL measured using ultrasensitive immunoassays.</p><p><strong>Main outcomes and measures: </strong>Cognitive function at baseline, measured using the Mini-Mental State Examination (MMSE), and all-cause mortality.</p><p><strong>Results: </strong>Of 495 participants (398 [80.4%] women; mean [SD] age 104.1 [3.0] years), 419 completed a cognitive assessment (mean [SD] MMSE, 14.9 [6.9]). During 17 years of follow-up, 466 participants (95.5%) died. Lower Aβ42/40 (β = 0.99; 95% CI, 0.46 to 1.52) and higher NfL levels (β = -0.92; 95% CI, -1.62 to -0.23) were significantly associated with lower MMSE scores after adjusting for confounders. Higher NfL levels were also associated with increased mortality (hazard ratio, 1.36; 95% CI, 1.17 to 1.57), showing the greatest point estimate among the biomarkers, all of which were standardized and statistically significant (change in Akaike Information Criterion, likelihood ratio test, χ2 = 30.16; P < .001). Aβ42/40 and p-tau181 were not statistically significant after full adjustment.</p><p><strong>Conclusions and relevance: </strong>In this cohort study of centenarians, higher plasma NfL levels were associated with lower cognitive function and increased all-cause mortality, whereas Aβ42/40 and p-tau181 showed no associations. These findings suggest that plasma NfL was associated with neurodegeneration in extreme aging. Further studies are needed to confirm its clinical utility before routine implementation.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 5","pages":"e2611335"},"PeriodicalIF":9.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13153989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838026","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}