JAMA Network Open最新文献

{"title":"Changes in Point-of-Sale Drug Prices After Medicare Eliminated Retroactive Pharmacy Fees.","authors":"Benjamin N Rome, Christopher L Cai, Jason B Gibbons, Aaron S Kesselheim, Kelly E Anderson","doi":"10.1001/jamanetworkopen.2026.38776","DOIUrl":"10.1001/jamanetworkopen.2026.38776","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2638776"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181932","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":"Immunohistochemistry vs Molecular Breast Cancer Subtyping Among African Populations.","authors":"Shahin Sayed, Li Feng, Hela Koka, Manel Haj Mansour, Difei Wang, Maria Brown, Kristine Jones, Margaret Maina, Veronica Ngundo, Alfred Mburu Githuka, Zaitun Ajuoga, Shaoqi Fan, Amber N Hurson, Xing Hua, Petra Lenz, Rosemary Wangari Kamau, Beryl Akinyi Ooro, Francis Makokha, Stefan Ambs, Aaron M Rozeboom, Amy Hutchinson, Belynda Hicks, Mustapha Abubakar, Xiaohong R Yang","doi":"10.1001/jamanetworkopen.2026.38664","DOIUrl":"10.1001/jamanetworkopen.2026.38664","url":null,"abstract":"<p><strong>Importance: </strong>Breast cancer subtyping based on immunohistochemistry (IHC) guides systemic therapy where gene expression profiling assays are unavailable, yet its validity against molecular reference standards remains poorly characterized in African populations, where laboratory infrastructure and access to pathology services are limited.</p><p><strong>Objective: </strong>To evaluate concordance between IHC-based breast cancer subtyping and PAM50 intrinsic subtypes in East and West African populations and identify resource-appropriate strategies to improve classification.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study included Kenyan (diagnosed 2012-2022) and Ghanaian women (diagnosed 2013-2015) with invasive breast cancer, from whom formalin-fixed, paraffin-embedded tumor specimens were collected during the same periods. Gene expression profiling and data analyses were performed between April 2020 and August 2026 for both cohorts.</p><p><strong>Exposures: </strong>Tumor subtyping using standard IHC markers (estrogen receptor [ER], progesterone receptor [PR], and ERBB2 status and Ki-67) and histologic grade vs PAM50 intrinsic subtyping derived from a gene expression panel.</p><p><strong>Main outcomes and measures: </strong>Concordance between IHC-based and PAM50 intrinsic subtypes was assessed using Cohen κ statistics, with sensitivity and specificity calculated against PAM50.</p><p><strong>Results: </strong>Among 460 women in Kenya with breast cancer (mean [SD] age at diagnosis, 50.3 [12.5] years), 224 (49.4%) had grade 3 disease and 148 (42.3%) had stage III or IV tumors. A total of 451 women in Ghana with breast cancer (mean [SD] age, 49.9 [12.0] years; 317 [75.1%] with grade 3 disease) were enrolled as a validation cohort. PAM50 classified patients' tumors as luminal A (201 tumors [43.7%]), luminal B (82 tumors [17.8%]), ERBB2-enriched (50 tumors [10.9%]), basal-like (99 tumors [21.5%]), and normal-like (28 tumors [6.1%]). Concordance between IHC and PAM50 was highest for basal-like tumors (sensitivity ranging from 73.3% [95% CI, 61.9%-82.9%] to 79.6% [95% CI, 70.3%-87.1%]; specificity ranging from 96.9% [95% CI, 93.9%-98.6%] to 97.3% [95% CI, 94.9%-98.7%]) and moderate for ERBB2-enriched tumors (sensitivity was 50.0% across all schemes, with 95% CIs ranging from 33.8%-66.2% to 35.5%-64.5%; specificity ranging from 97.6% [95% CI, 95.6%-98.9%] to 97.9% [95% CI, 95.6%-99.2%]). Luminal subtypes showed substantial misclassification using ER, PR, and ERBB2 status alone. Incorporation of Ki-67 (≥20%) or histologic grade improved discrimination between luminal A and luminal B tumors, increasing luminal B classification from 12.2% (95% CI, 8.5%-16.7%) to 41.2% (95% CI, 35.2%-47.4%), even when PR status was excluded from the panel. Findings were independently validated in women with breast cancer from Ghana.</p><p><strong>Conclusions and relevance: </strong>In this cross-sectional study of African","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2638664"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169696","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":"Ultraprocessed Food Intake and Adiposity, Vascular Brain Injury, and Cognition in Middle-Aged Adults.","authors":"Russell J de Souza, Karleen M Schulze, Dipika Desai, Jean-Pierre Després, Trevor J B Dummer, Matthias G Friedrich, Jason Hicks, Vikki Ho, Scott A Lear, Douglas S Lee, Andrew Mente, Victoria Miller, Paul Poirier, Eric E Smith, Jean-Claude Tardif, Koon K Teo, Jennifer E Vena, Salim Yusuf, Sonia S Anand","doi":"10.1001/jamanetworkopen.2026.39118","DOIUrl":"10.1001/jamanetworkopen.2026.39118","url":null,"abstract":"<p><strong>Importance: </strong>Ultraprocessed foods (UPFs) account for a substantial and increasing proportion of dietary intake in Canada. Although UPFs are consistently associated with adiposity and cardiometabolic disease, their associations with subclinical vascular brain injury (VBI) and cognitive performance in midlife are unclear.</p><p><strong>Objective: </strong>To evaluate associations of UPF consumption with adiposity, magnetic resonance imaging (MRI)-defined VBI, and cognitive performance in middle-aged adults in Canada.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study included 8783 adults aged 35 to 69 years without cardiovascular disease who were enrolled in the Canadian Alliance for Healthy Hearts and Healthy Minds (CAHHM) and Prospective Urban and Rural Epidemiology-MIND (PURE-MIND) studies. Participants from CAHHM were recruited from January 1, 2014, to December 31, 2018, and participants from PURE-MIND were recruited from January 1, 2010, to December 31, 2018. Data analyses were conducted between July 16, 2024, and August 16, 2026.</p><p><strong>Exposures: </strong>UPF consumption assessed using previously validated semiquantitative food frequency questionnaires and expressed as servings per 2000 kcal/d.</p><p><strong>Main outcomes and measures: </strong>The main outcomes were body fat (BF) percentage (bioelectrical impedance), visceral adipose tissue (VAT) volume, hepatic fat fraction (HFF), VBI defined as covert brain infarcts or high white matter hyperintensities (HWMHs) (measured by MRI), and cognitive performance measured by the Montreal Cognitive Assessment (MOCA) and the Digital Symbol Substitution Test (DSST).</p><p><strong>Results: </strong>In this cross-sectional study of 8783 participants (mean [SD] age, 57.7 [8.7] years; 4917 females [56.6%]), those in the highest quartile of UPF intake had a BF percentage that was 1.7 (95% CI, 1.2-2.2) percentage points higher and a 5.7 (95% CI, 3.2-8.3) mL greater VAT volume compared with those in the lowest quartile, but no significant difference in HFF. Compared with the lowest quartile, the highest UPF quartile had higher odds of VBI (adjusted OR, 1.40; 95% CI, 1.10-1.77; P for trend = .009). No significant associations were observed between UPF intake and MOCA or DSST performance.</p><p><strong>Conclusions and relevance: </strong>In this cross-sectional study of middle-aged adults in Canada, higher UPF intake was associated with greater adiposity and higher odds of MRI-defined VBI but not cognitive performance. Associations with VBI were sensitive to UPF exposure definition. Longitudinal studies are needed to establish temporality.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2639118"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194050","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":"Dual Health and Economic Burden of Multimorbidity in Aging Populations.","authors":"Wenjing Ji, Jiacheng Zheng, Suzhen Guan, Yang Liu, Xi Chen, Zhuoer Lin, Joan Costa-Font, Reshma Aziz Merchant, Alessandra Guariglia, Chenyan Wang, Sen Xu, Caijun Yang, Mingwang Shen, Minghuan Jiang, Duolao Wang, Yu Fang","doi":"10.1001/jamanetworkopen.2026.33002","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.33002","url":null,"abstract":"<p><strong>Importance: </strong>Population aging is contributing to rising multimorbidity across physical, psychological, and cognitive domains, yet global evidence integrating health and economic burdens in older adults remains limited.</p><p><strong>Objectives: </strong>To quantify the global health and economic burden of multimorbidity among adults aged 60 years or older and to assess trends from 2000 to 2023.</p><p><strong>Design, setting, and participants: </strong>This economic evaluation used observational modeling of Global Burden of Disease study 2023 estimates as health inputs and integrated them with macroeconomic, health expenditure, and population data from World Bank Open Data, the World Health Organization Global Health Expenditure Database, and United Nations population data. Health burden analyses covered adults aged 60 years or older in 204 countries and territories from 2000 to 2023, and economic burden analyses covered 180 countries and territories. Data analyses were performed from January 27 to July 22, 2026.</p><p><strong>Exposures: </strong>Cross-domain multimorbidity spanning physical conditions, psychological disorders, and cognitive disorders, operationalized as 78 multimorbidity combinations.</p><p><strong>Main outcomes and measures: </strong>The main outcomes were years lived with disability (YLDs) per 100 000 population and economic losses. All economic indicators are reported in 2021 international dollars (USD) adjusted for purchasing power parity. Joinpoint regression characterized 2000 to 2023 trends.</p><p><strong>Results: </strong>From 2000 to 2023, total YLDs increased from 2367.81 (95% uncertainty interval [UI], 1067.67-4969.59) to 2941.68 (95% UI, 1252.99-6816.95) per 100 000 population, while economic losses increased from $80.10 billion (95% UI, $59.60-$104.69 billion) to $363.25 billion (95% UI, $264.04-$502.74 billion). The highest 2023 YLD rate was observed for osteoarthritis and Alzheimer disease and other dementias (369.87 [95% UI, 163.86-752.23] per 100 000 population), whereas the largest 2023 economic loss was observed for osteoarthritis and anxiety disorders ($48.51 billion [95% UI, $31.68-$76.57 billion]). The fastest-growing combination was diabetes, anxiety disorders, and Parkinson disease, with a YLD average annual percentage change (AAPC) of 3.94% (95% CI, 3.79%-4.08%) and an economic loss AAPC of 9.92% (95% CI, 9.69%-10.13%).</p><p><strong>Conclusions and relevance: </strong>In this economic evaluation of the global health and economic burden of multimorbidity among adults aged 60 years or older, multimorbidity burden increased worldwide, with economic losses growing faster than YLDs. Heterogeneity across sex, country income groups, and disease combinations, together with divergence between disability and economic burden, suggest that policy priorities for aging populations should consider both health burden and economic vulnerability.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2633002"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149238447","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":"Neurology Wait Times in the Cognitive Care Journey.","authors":"Tabasa Ozawa, Soeren Mattke","doi":"10.1001/jamanetworkopen.2026.39843","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.39843","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2639843"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149238569","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":"Skin Toxic Effects and Survival With Enfortumab Vedotin-Pembrolizumab in Advanced Urothelial Carcinoma.","authors":"Zachariah Thomas, Cindy Y Jiang, Patrick J Speck, Emanuele Crupi, Mohammad Jad Moussa, Adrienne Joseph, Carly Stender, Michael Glover, Andrew C Johns, Jianjun Gao, Monica Desai, Amishi Y Shah, Sangeeta Goswami, Arlene Siefker-Radtke, Anishia-Rawther Karedath, Sheeba P Varughese, Wenhong Ren, Comron Hassanzadeh, Kelly K Bree, Ashish M Kamat, Charles C Guo, Omar Pacha, Anisha Patel, Jonathan Curry, Alex D Sherry, Pavlos Msaouel, Matthew T Campbell, Omar Alhalabi","doi":"10.1001/jamanetworkopen.2026.39517","DOIUrl":"10.1001/jamanetworkopen.2026.39517","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Skin toxic effects are a common early adverse event of enfortumab vedotin plus pembrolizumab (EVP) therapy, but its association with clinical outcomes in patients receiving first-line therapy remains uncertain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the association between treatment-emergent skin toxic effects and clinical outcomes among patients receiving first-line EVP.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This retrospective cohort study was performed at the University of Texas MD Anderson Cancer Center among adults with locally advanced or metastatic urothelial carcinoma receiving first-line EVP therapy between March 3, 2022, and July 31, 2025. Skin toxic effects were used as a time-dependent exposure in Cox proportional hazards regression to account for immortal-time bias. Prespecified sequential adjustment models and 30-day landmark analyses were performed to assess the robustness of the findings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Treatment-emergent skin toxic effects (rash or pruritus) were identified from medical records.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Primary outcome was overall survival (OS). Secondary outcomes included progression-free survival and objective response rate (ORR). OS and PFS were measured from EVP therapy initiation to the respective event or last follow-up. ORR was evaluated among patients with a response assessment after the 30-day landmark, according to skin toxic effects status within the first 30 days.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 185 patients (median age, 73 [IQR, 67-79] years; 140 [75.7%] male), skin toxic effects occurred in 98 (53.0%) at a median of 14 (IQR, 7-28) days after EVP therapy initiation. Skin toxic effects of grade 3 or higher occurred in 10 patients (5.4%). Skin toxic effects resulted in EV dose reduction in 31 patients (16.8%), treatment interruption in 20 (10.8%), and treatment discontinuation in 9 (4.9%). At a median follow-up of 17.7 (IQR, 11.3-24.2) months, Simon-Makuch curves demonstrated longer OS and PFS among all patients and longer OS among patients with visceral metastases in the skin toxic effects stratum than in the no toxicity stratum. In adjusted time-dependent Cox proportional hazards regression, skin toxic effects were associated with longer OS (hazard ratio, 0.34 [95% CI, 0.20-0.57]). The association remained consistent across sequential adjustment models and prespecified 30-day landmark analyses. In the 30-day landmark analyses, associations with PFS and ORR remained directionally favorable but were attenuated after multivariable adjustment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this cohort study of 185 patients with locally advanced or metastatic urothelial carcinoma receiving first-line EVP therapy, treatment-emergent skin toxic effects were associated with longer OS. These findings support further prospective validation of skin toxic effects as an early clinical marker of treatm","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2639517"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13684480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227883","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":"Clinical Evidence on Psilocybin and Its Representation in Media Reporting: A Systematic Review.","authors":"Kim Madden, Breanne Flood, Imad Kashir, Rayan Ahmad, Hiba Ali, Rotem Petranker, James MacKillop, Anthony Adili","doi":"10.1001/jamanetworkopen.2026.38843","DOIUrl":"10.1001/jamanetworkopen.2026.38843","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Psilocybin has received increased attention as a potential therapeutic intervention, but it is unclear whether news media reporting reflects the strengths and limitations of the clinical trial evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To describe the annual counts of published clinical trials of therapeutic psilocybin and contemporaneous media articles and compare tone, efficacy, and safety messaging.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Evidence review: &lt;/strong&gt;This systematic review included English-language randomized and nonrandomized trials of psilocybin for clinical indications published from January 1, 2014, to October 10, 2024, and media articles describing its clinical use published from January 1, 2014, to April 22, 2025. Trials were found by searching Medline, Embase, PsycInfo, and the Cochrane Central Register of Controlled Trials (CENTRAL) and were characterized by design, indication, use of psychotherapy, and reporting of efficacy and safety. Media articles were found through the Factiva database and were characterized by audience, tone, indication, efficacy claim, and safety content. Data were extracted by 2 reviewers. Risk of bias for randomized clinical trials was assessed descriptively using the Cochrane Risk of Bias tool.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Annual counts of both published clinical trials (n = 70) and media reports (n = 172) increased from 2018 onward. Depression was the most common clinical indication in trials (47 [67%]) and media articles (138 [80%]), while media articles frequently referenced posttraumatic stress disorder (PTSD) (74 [43%]) and anxiety (72 [42%]) as clinical indications despite absent and limited trial evidence, respectively, for these conditions. Overall, 49 trials (70%) reported benefit for the primary indication; 125 media articles (73%) made at least 1 positive efficacy claim, and 122 (71%) adopted a favorable tone. Trials typically described small sample sizes of less than 100 participants (65 trials [93%]) and methodologic limitations. Overall, 31 trials (44%) reported safety outcomes, with some (24 [34%]) documenting short-term adverse events, such as transient anxiety, nausea, or headache; long-term safety was rarely assessed (4 trials [6%]). Only 51 media articles (30%) mentioned safety; when harms were discussed, potential long-term psychological risks were sometimes noted (12 articles [7%]).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this systematic review of clinical trials and media articles, both reported positive effects of therapeutic psilocybin with similar frequency. Academic publications were more cautious and explicit about methodologic limitations, whereas media reports often presented benefits as established, extrapolated them to indications with little or no trial evidence, and provided less safety information. Clarifying these differences in emphasis may support more transparent public communication of indication-specific evidence and uncertainty as ","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2638843"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13684485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227824","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":"Cervical Cancer Screening Rates by Race and Ethnicity, Age, Language, and Census Region.","authors":"Yunbo Xie, Linh Nguyen, Yen-Chi Le, Abigail Zamorano","doi":"10.1001/jamanetworkopen.2026.39938","DOIUrl":"10.1001/jamanetworkopen.2026.39938","url":null,"abstract":"<p><strong>Importance: </strong>Longitudinal evidence of cervical cancer screening (CCS) trends before and after COVID-19 across demographic cohorts remains limited.</p><p><strong>Objective: </strong>To examine CCS rates by race and ethnicity, age, language, and census region among patients with at least 1 health care encounter in an electronic medical record (EMR) system from 2019 through 2024, and to evaluate longitudinal trends across these groups.</p><p><strong>Design, setting, and participants: </strong>Using an EMR database, this cross-sectional study evaluated CCS rates among female patients aged 21 to 64 years between 2019 and 2024, stratified by race and ethnicity, age, language, and census region.</p><p><strong>Exposures: </strong>Race and ethnicity, age, language, and census region.</p><p><strong>Main outcomes and measures: </strong>Descriptive statistics were used to summarize annual CCS rates across demographic groups. The Cochran-Armitage test assessed linear trends over time.</p><p><strong>Results: </strong>Annual sample sizes ranged from approximately 9 to 16 million patients and increased steadily over time; analytic population sizes varied across subgroups. Most patients were non-Hispanic White, aged 30 to 49 years, English-speaking, and resided in either the South or Northeast. Non-Hispanic White patients had the highest annual CCS rates from 2019 to 2021 but experienced the smallest percentage increase, from 10.98% (95% CI, 10.96%-11.01%) to 13.85% (95% CI, 13.82%-13.87%), over the study period. Hispanic patients experienced the largest percentage increase in CCS rates, from 9.85% (95% CI, 9.80%-9.90%) to 15.51% (95% CI, 15.47%-15.55%). American Indian, Alaska Native, Native Hawaiian, and Pacific Islander patients had the lowest screening rates throughout the study period. Patients aged 30 to 49 years and non-English-speaking patients consistently had the highest CCS rates across all years. Patients in the Western and Southern census regions had lower CCS rates than those in other regions.</p><p><strong>Conclusions and relevance: </strong>In this cross-sectional study of patients with at least 1 health care encounter in an EMR system, all CCS rates increased across all racial and ethnic groups from 2019 to 2024, with the greatest gains observed among Hispanic patients. However, persistent disparities remained, particularly among American Indian, Alaska Native, Native Hawaiian, and Pacific Islander patients and those in the Western and Southern regions. These findings suggest that although screening uptake has improved over time, substantial geographic and racial and ethnic disparities in CCS persist, highlighting important areas for future research and intervention efforts.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2639938"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206932","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":"Balancing Timely Access and Human Oversight in Patient-Facing Artificial Intelligence-Waiting for the Human in the Loop.","authors":"Felix Busch, Dennis M Hedderich","doi":"10.1001/jamanetworkopen.2026.39080","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.39080","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2639080"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181971","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":"Clinical Walking Speed, Free-Living Walking Cadence, and All-Cause Mortality.","authors":"Rayane Haddadj, Ian Meneghel Danilevicz, Alex V Rowlands, Vincent T van Hees, Benjamin Landré, Alexis Le Faucheur, Archana Singh-Manoux, Paul Jarle Mork, Séverine Sabia","doi":"10.1001/jamanetworkopen.2026.40122","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.40122","url":null,"abstract":"<p><strong>Importance: </strong>Walking speed has been shown to be associated with mortality and is conventionally obtained from short walking tests in clinical settings. Free-living walking parameters such as walking cadence can be derived from accelerometers.</p><p><strong>Objective: </strong>To examine whether walking parameters measured in clinical and free-living settings are associated with comparable discriminative ability for all-cause mortality risk.</p><p><strong>Design, setting, and participants: </strong>This population-based cohort study, the Whitehall II accelerometer substudy in the UK, included a baseline from January 2012 to December 2013 and follow-up through August 19, 2024. The study included participants with valid accelerometer data, clinical walking speed, covariates, and electronic health records information. Analyses were performed between September 2025 and February 2026.</p><p><strong>Exposures: </strong>Clinical walking speed in meters per second was obtained from a 2.44-m walking test, and 2 free-living metrics of walking cadence in steps per minute (the median walking cadence and the 95th percentile walking cadence) were derived from 9 days of wrist-worn accelerometer data.</p><p><strong>Main outcomes and measures: </strong>All-cause mortality was ascertained from a British national mortality register. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) for all-cause mortality. Discriminative ability was assessed using the Harrel concordance index (C index).</p><p><strong>Results: </strong>A total of 4067 participants (mean [SD] age, 69.3 [5.7] years; 3024 males [74.4%]) were included in the analysis. The median (IQR) follow-up was 11.8 (11.5-12.1) years. In models containing mortality risk factors (sociodemographic, behavioral, and health-related factors), higher clinical walking speed (HR, 0.77 [95% CI, 0.71-0.84]), median walking cadence (HR, 0.83 [95% CI, 0.77-0.90]), and 95th percentile walking cadence (HR, 0.82 [95% CI, 0.75-0.89]) were associated with lower all-cause mortality risk (per 1 higher SD) and with a similar discriminative ability (clinical walking speed: C index, 0.747 [95% CI, 0.730-0.764]; median walking cadence: C index, 0.744 [95% CI, 0.726-0.761]; and 95th percentile walking cadence: C index, 0.745 [95% CI, 0.727-0.762]). Only clinical walking speed was associated with an improved discriminative ability of a model including mortality risk factors.</p><p><strong>Conclusions and relevance: </strong>In this cohort study, clinical walking speed and free-living walking cadence were both associated with all-cause mortality risk and had a similar discriminative ability for all-cause mortality. These results suggest that both measures can be used in population-based studies, and the choice between the 2 methods may depend on research objectives, implementation constraints, and the strengths of each method.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2640122"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244487","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}