JAMA Network Open最新文献

{"title":"Critical Illness, Major Surgery, and Other Hospitalizations and Active and Disabled Life Expectancy.","authors":"Thomas M Gill, Emma X Zang, Linda Leo-Summers, Evelyne A Gahbauer, Robert D Becher, Lauren E Ferrante, Ling Han","doi":"10.1001/jamanetworkopen.2025.4208","DOIUrl":"10.1001/jamanetworkopen.2025.4208","url":null,"abstract":"<p><strong>Importance: </strong>Estimates of active and disabled life expectancy, defined as the projected number of remaining years without and with disability in essential activities of daily living, are commonly used by policymakers to forecast the functional well-being of older persons.</p><p><strong>Objective: </strong>To determine how estimates of active and disabled life expectancy differ based on exposure to intervening illnesses and injuries (or events).</p><p><strong>Design, setting, and participants: </strong>This prospective cohort study was conducted in south-central Connecticut from March 1998 to December 2021 among 754 community-living persons aged 70 years or older who were not disabled. Data were analyzed from January 25 to September 18, 2024.</p><p><strong>Exposures: </strong>Exposure to intervening events, which included critical illness, major elective and nonelective surgical procedures, and hospitalization for other reasons, was assessed each month.</p><p><strong>Main outcomes and measures: </strong>Disability in 4 essential activities of daily living (bathing, dressing, walking, and transferring) was ascertained each month. Active and disabled life expectancy were estimated using multistate life tables under a discrete-time Markov process assumption.</p><p><strong>Results: </strong>The study included 754 community-living older persons who were not disabled (mean [SD] age, 78.4 [5.3] years; 487 female [64.6%]; 67 Black [8.9%], 4 Hispanic [0.5%], 682 non-Hispanic White [90.5%], and 1 other race [0.1%]). Within 5-year age increments from 70 to 90 years, active life expectancy decreased monotonically as the number of admissions for critical illness and other hospitalization increased. For example, at age 70 years, sex-adjusted active life expectancy decreased from 14.6 years (95% CI, 13.9-15.2 years) in the absence of a critical illness admission to 11.3 years (95% CI, 10.3-12.2 years), 8.1 years (95% CI, 6.3-9.9 years), and 4.0 years (95% CI, 2.6-5.7 years) in the setting of 1, 2, or 3 or more critical illness admissions, respectively. Corresponding values for other hospitalization were 19.4 years (95% CI, 18.0-20.8 years), 13.5 years (95% CI, 12.2-14.7 years), 10.0 years (95% CI, 8.9-11.2 years), and 7.0 years (95% CI, 6.1-7.9 years), respectively. Consistent monotonic reductions were observed for sex-adjusted estimates in active life expectancy for nonelective but not elective surgical procedures as the number of admissions increased; for example, at age 70 years, estimates of active life expectancy were 13.9 years (95% CI, 13.3-14.5 years), 11.7 years (95% CI, 10.5-12.8 years), and 9.2 years (95% CI, 7.4-11.0 years) for 0, 1, and 2 or more nonelective surgical admissions, respectively; corresponding values were 13.4 years (95% CI, 12.8-3-14.1 years), 14.6 years (95% CI, 13.5-15.5 years), and 12.6 years (95% CI, 11.5-13.8 years) for elective surgical admissions. Sex-adjusted disabled life expectancy decreased as the number o","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e254208"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772345","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":"Error in Figure 1.","authors":"","doi":"10.1001/jamanetworkopen.2025.8167","DOIUrl":"10.1001/jamanetworkopen.2025.8167","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e258167"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752750","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":"Error in Abstract, Results, and Figure.","authors":"","doi":"10.1001/jamanetworkopen.2025.10141","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.10141","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e2510141"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803175","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":"Geographic Disparities in Oral Cancer Survival From 10 Population-Based Cancer Registries in India.","authors":"Krishnan Sathishkumar, Jayasankar Sankarapillai, Stephen Santhappan, Aleyamma Mathew, Rekha A Nair, Nitin Gangane, Sushma Khuraijam, Debanjana Barman, Shashank Pandya, Gautam Majumdar, Vinay Deshmane, Eric Zomawia, Ashok T Sherpa, Preethi George, Swapna Maliye, Tashnin Rahman, Anand Shah, Shravani Koyande, Lalawmpuii Pachuau, Priya D Pradhan, Shalin Lily Giboy, Prashant Mathur","doi":"10.1001/jamanetworkopen.2025.3910","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.3910","url":null,"abstract":"<p><strong>Importance: </strong>India accounts for more than one-third of oral cancer (OC) cases globally. Cancer survival measures the effectiveness of the health care system's cancer control efforts and the proportion of people who survive during a specified time.</p><p><strong>Objective: </strong>To estimate the 5-year survival rates among patients with OC diagnosed in India and assess the association of survival with age, place of residence, histologic type, and clinical extent of OC.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study evaluated survival of patients diagnosed with primary OC (International Classification of Diseases for Oncology, Third Revision, codes C01-C06) between January 1, 2012, and December 31, 2015, and followed up until June 30, 2021. Patients were included from 10 population-based cancer registries (PBCRs). Data were analyzed between March 15 and August 20, 2024.</p><p><strong>Exposures: </strong>Demographic factors (patient age, sex, and place of residence) and disease factors (clinical extent of disease and histologic type).</p><p><strong>Main outcomes and measures: </strong>The main outcome was 5-year age-standardized relative survival (ASRS) for OC among male and female patients. A multivariable Cox proportional hazards model estimated hazard ratio (HR) and 95% CI, adjusting for covariates.</p><p><strong>Results: </strong>Data from the 10 PBCRs encompassed 14 059 patients of all ages (median age, 55 [IQR, 45-65] years; 10 380 male [73.8%]) diagnosed with OC. The overall 5-year ASRS rate for OC was 37.2% (range, 20.9%-58.4%). The estimated ASRS rates at 5 years were 36.0% (range, 20.7%-59.3%) for male and 39.6% (range, 21.4%-54.8%) for female patients. Ahmedabad urban had the highest 5-year ASRS at 58.4% (95% CI, 56.3%-60.4%) for both sexes, while Manipur had the lowest rates at 20.9% (95% CI, 14.9%-27.6%). Survival rates differed significantly between rural areas (34.1%; 95% CI, 31.4%-36.9%) and urban areas (48.5%; 95% CI, 47.4%-49.7%). Pooled data from Kollam and Thiruvananthapuram revealed that individuals 65 years or older (HR, 1.76; 95% CI, 1.44-2.14) and those with distant metastasis (HR, 3.95; 95% CI, 2.78-5.60) had a significantly higher risk of death.</p><p><strong>Conclusions and relevance: </strong>In this cohort study from India, significant survival disparities were observed among patients with OC based on demographic factors and clinical characteristics. Survival rates were lower in rural areas compared with urban regions, underscoring the inequalities in quality of care and services and emphasizing the need to improve OC survival rates in India.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e253910"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803186","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":"Psychological Therapy Outcomes and Engagement in People of Different Religions.","authors":"Zainab Shafan-Azhar, Jae Won Suh, Henry Delamain, Laura-Louise Arundell, Syed Ali Naqvi, Tania Knight, Sarah Ellard, Stephen Pilling, Rob Saunders, Joshua E J Buckman","doi":"10.1001/jamanetworkopen.2025.4026","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.4026","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Identifying whether people of minoritized religious identities are less likely to benefit from psychological therapy is key to tackling inequalities in mental health treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess inequalities in the effectiveness of routinely delivered psychological therapy across religious groups and by the intersections with ethnicity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;Retrospective cohort study including all patients who completed a course of treatment at 5 London-based National Health Service Talking Therapies for anxiety and depression (NHS TTad) services between 2011 and 2020. Individuals reported their religion using routine patient records collected by the services. Data were analyzed from September 2023 to October 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Self-identified religion was categorized into (1) no religion, (2) Christian, (3) Muslim, and (4) other (which was further categorized into Buddhist, Hindu, Jewish, Sikh, and any other in a sensitivity analysis). Ethnicity was conceptualized as a potential confounder and separately as an effect modifier. Self-reported ethnicity was categorized based on UK Census codes into Asian, Black, mixed race, White, and other ethnic groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Psychological treatment outcomes used to assess NHS TTad services nationally, including reliable recovery, recovery, and reliable deterioration. Dropout from treatment was also examined. These outcomes were defined based on pre-post treatment changes in depression and anxiety symptom measures according to national guidelines.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 70 098 patients with data on self-reported religion were included in the study (mean [SD] age at referral, 39.2 [14.1] years; 47 797 [68.2%] female). After adjusting for sociodemographic, treatment-related, and clinical characteristics, the odds of reliable recovery were higher in patients who did not have any religious belief (odds ratio [OR], 1.34; 95% CI, 1.26-1.42) or self-reported Christian (OR, 1.39; 95% CI, 1.31-1.48) and other religion (OR, 1.25; 95% CI, 1.17-1.34) compared with Muslim patients. While treatment outcomes improved each year in all groups, Muslim patients remained least likely to improve and more likely to deteriorate. There were interactions between religion and ethnicity; in particular, Muslim patients of White or other ethnic backgrounds had worse outcomes than Muslim patients of Asian, Black, or mixed race ethnic backgrounds and compared with non-Muslim patients of those ethnicities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In England, patients who identified as Muslim, and particularly those of White or other ethnicities, had poorer outcomes from psychological therapies for depression and anxiety disorders than patients who reported no religion or any other religion. This may be partly due to unmeasured characteristics that warrant fu","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e254026"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803194","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":"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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962662/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cultivate Connection at Home, Reduce Burnout.","authors":"Kristine Olson","doi":"10.1001/jamanetworkopen.2025.3225","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.3225","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e253225"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780083","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":"Preferred Advanced Airway Device Use Among Adults With Out-of-Hospital Cardiac Arrest.","authors":"Christopher B Gage, Henry E Wang, Jacob C Kamholz, Jonathan R Powell, Ashish R Panchal","doi":"10.1001/jamanetworkopen.2025.2913","DOIUrl":"10.1001/jamanetworkopen.2025.2913","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e252913"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763944","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":"Risk of New-Onset Type 2 Diabetes Among Vaccinated Adults After Omicron or Delta Variant SARS-CoV-2 Infection.","authors":"Liang En Wee, Jue Tao Lim, Enoch Xueheng Loy, Calvin J Chiew, E Shyong Tai, Su Chi Lim, Yong Mong Bee, Sock Hwee Tan, Charmaine Qing Fei Chan, Wai Leng Chow, James Wei Luen Yip, Khung Keong Yeo, Benjamin Ong, David Chien Boon Lye, Mark Yan Yee Chan, Derek J Hausenloy, Kelvin Bryan Tan","doi":"10.1001/jamanetworkopen.2025.2959","DOIUrl":"10.1001/jamanetworkopen.2025.2959","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e252959"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763946","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":"Border Region Emergency Medical Services in Migrant Emergency Care.","authors":"Christine Crudo Blackburn, Mayra Rico, Lauren Knight, Brandy Sebesta, Kirk Niekamp","doi":"10.1001/jamanetworkopen.2025.3111","DOIUrl":"10.1001/jamanetworkopen.2025.3111","url":null,"abstract":"<p><strong>Importance: </strong>Focusing on the US southern land border only through a security lens minimizes the impact of security infrastructure and migrant health needs on local emergency medical services (EMS) clinicians.</p><p><strong>Objective: </strong>To explore the perceptions and experiences regarding the impact of migration on EMS clinicians in the communities of study.</p><p><strong>Design, setting, and participants: </strong>This qualitative study included in-depth interviews with fire department-based EMS clinicians in 3 Arizona communities on the Mexico border from June 23 to 27, 2024. Interviews were conducted 1-on-1 while clinicians were on shift. Participants were recruited with the help of fire department leadership in each fire department.</p><p><strong>Main outcomes and measures: </strong>This was an exploratory study designed to identify how EMS clinicians perceive the influence of migration in the study communities. Thematic analysis was conducted using inductive, latent coding.</p><p><strong>Results: </strong>The 67 participants were predominately male (62 [93%]), which is reflective of the EMS profession in the border region. Years of experience as EMS clinicians were fairly evenly distributed: 5 years or less (14 [21%]), 6 to 10 years (18 [27%]), 11 to 20 years (18 [27%]), and 21 or more years (17 [25%]). EMS clinicians in these communities reported serving multiple populations, often responding to complex calls, and experiencing limited downtime and mass casualty-like scenarios when there are high numbers of border crossings. Participants perceived that the local EMS system was strained, and occasionally overwhelmed, and that greater financial support from the federal government was necessary.</p><p><strong>Conclusions and relevance: </strong>The findings of this qualitative study of EMS clinicians suggest that migration has a complex, multidimensional influence on EMS clinicians in the border region. Deterrence-focused actions have not decreased the number of crossings but rather pushed migrants to cross in more dangerous ways, leading to more injuries and deaths. Our findings suggest that the strain placed on local EMS clinicians is unsustainable and may be exacerbated by increased deterrence-based policies. Instead, border-region EMS clinicians need increased federal funding to support their work.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e253111"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772338","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}