JAMA Network Open最新文献

{"title":"Early-Life Ozone Exposure and Asthma and Wheeze in Children.","authors":"Logan C Dearborn, Marnie F Hazlehurst, Allison R Sherris, Adam A Szpiro, Drew B Day, Christine T Loftus, Magali N Blanco, Margaret A Adgent, Aileen R Andrade-Torres, Yu Ni, Mary E Crocker, Jianzhao Bi, Joel D Kaufman, Ruby H N Nguyen, Kaja Z LeWinn, Paul E Moore, Kecia N Carroll, Catherine J Karr","doi":"10.1001/jamanetworkopen.2025.4121","DOIUrl":"10.1001/jamanetworkopen.2025.4121","url":null,"abstract":"<p><strong>Importance: </strong>Ozone (O3) is the most frequently exceeded air pollutant standard in the US. While short-term exposure is associated with acute respiratory health, the epidemiologic evidence linking postnatal O3 exposure to childhood asthma and wheeze is inconsistent and rarely evaluated as a mixture with other air pollutants.</p><p><strong>Objectives: </strong>To determine associations between ambient O3 and subsequent asthma and wheeze outcomes both independently and in mixture with fine particulate matter and nitrogen dioxide in regions with low annual O3 concentrations.</p><p><strong>Design, setting, and participants: </strong>This cohort study consisted of a pooled, multisite analysis across 6 US cities using data from the prospective ECHO-PATHWAYS consortium (2007-2023). Included children had complete airway surveys, complete address histories from age 0 to 2 years, and a full term birth (≥37 weeks). Logistic regression and bayesian kernel machine regression (BKMR) mixture analyses were adjusted for child anthropomorphic, socioeconomic, and neighborhood factors.</p><p><strong>Exposures: </strong>Exposure to ambient O3 in the first 2 years of life derived from a validated point-based spatiotemporal model using residential address histories.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was asthma and wheeze at ages 4 to 6 years; the secondary outcome was asthma and wheeze at ages 8 to 9 years. Outcomes were based on caregiver reports derived from a validated survey.</p><p><strong>Results: </strong>The analytic sample of 1188 participants had a mean (SD) age of 4.5 (0.6) years at the age 4 to 6 years visit and consisted of 614 female participants (51.7%) and 663 mothers who had a bachelor's degree or higher (55.8%). The mean (SD) O3 concentration was 26.1 (2.9) parts per billion (ppb). At age 4 to 6 years, 148 children had current asthma (12.3%) and 190 had current wheeze (15.8%). The odds ratio per 2 ppb higher O3 concentration was 1.31 (95% CI, 1.02-1.68) for current asthma and 1.30 (95% CI, 1.05-1.64) for current wheeze at age 4 to 6 years; null associations were observed for outcomes at age 8 to 9 years, and for sensitivity covariate adjustment. BKMR suggested that higher exposure to O3 in mixture was associated with current asthma and wheeze in early childhood.</p><p><strong>Conclusions and relevance: </strong>In this cohort study with relatively low ambient O3 exposure, early-life O3 was associated with asthma and wheeze outcomes at age 4 to 6 years and in mixture with other air pollutants but not at age 8 to 9 years. Regulating and reducing exposure to ambient O3 may help reduce the significant public health burden of asthma among US children.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e254121"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763938","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":"Radiotherapy Utilization in Traditional Medicare and Medicare Advantage.","authors":"Jacob Hogan, E John Orav, Tianfeng Zhang, Alexander Spektor, Jie Zheng, Thomas C Tsai, Miranda B Lam","doi":"10.1001/jamanetworkopen.2025.3018","DOIUrl":"10.1001/jamanetworkopen.2025.3018","url":null,"abstract":"<p><strong>Importance: </strong>As more than 50% of Medicare beneficiaries are enrolled in Medicare Advantage (MA), understanding whether the treatment covered by MA vs traditional Medicare (TM) is comparable can aid in providing high-value care. As the majority of patients with cancer undergo radiotherapy, it is important to quantify TM and MA utilization in oncology.</p><p><strong>Objective: </strong>To analyze the primary type of radiotherapy technology used, treatment length, and estimated spending for MA patients with cancer undergoing radiotherapy compared with TM patients with cancer.</p><p><strong>Design, setting, and participants: </strong>This retrospective cross-sectional study used 2018 Medicare claims data for TM and MA patients aged 65 years or older who received radiotherapy for 1 of 15 cancer types. Analyses were performed between May 1 and December 28, 2024.</p><p><strong>Exposures: </strong>Insurance type (MA vs TM), cancer type, age, dual-eligibility status, medical comorbidities, county, and radiotherapy center type.</p><p><strong>Main outcomes and measures: </strong>Primary type of radiotherapy technology used, treatment length, and estimated spending for 90-day radiotherapy episodes. Adjusted rates and odds ratios (ORs) were calculated to compare technology types and rate ratios (RRs) to compare treatment length and estimated spending between TM and MA episodes.</p><p><strong>Results: </strong>Of 31 563 treatment episodes among 30 941 patients, 22 594 (71.58%) were covered by TM (mean [SD] age, 74.76 [6.57] years; 50.76% among males) and 8969 (28.42%) were covered by MA (mean [SD] age, 74.51 [6.24] years; 51.78% among males). For radiotherapy episodes in patients with MA, adjusted analyses revealed lower odds of proton therapy use (52 [0.58% (95% CI, 0.34%-0.82%)] vs 373 [1.65% (95% CI, 1.50%-1.80%)]; OR, 0.36 [95% CI, 0.27-0.48]) and stereotactic radiotherapy use (1235 [13.77% (95% CI, 13.13%-14.41%)] vs 3391 [15.01% (95% CI, 14.61%-15.41%)]; OR, 0.87 [95% CI, 0.81-0.95]), higher odds of 2- or 3-dimensional radiotherapy use (3962 [44.17% (95% CI, 43.39%-44.96%)] vs 9584 [42.43% (95% CI, 41.93%-42.92%)]; OR, 1.13 [95% CI, 1.06-1.21]), greater mean treatment length (21.38 [95% CI, 21.14-21.61] vs 19.48 [95% CI, 19.33-19.62] treatments; RR, 1.10 [95% CI, 1.08-1.11]), and higher estimated radiotherapy spending ($8677.56 [95% CI, $8566.58-$8788.54] vs $8393.20 [95% CI, $8323.34-$8463.05]; RR, 1.04 [95% CI, 1.02-1.06]) compared with episodes in patients with TM.</p><p><strong>Conclusions and relevance: </strong>In this cross-sectional study, MA patients with cancer undergoing radiotherapy had higher estimated spending and greater mean treatment length than those covered by TM. Despite lower utilization of more expensive advanced treatment modalities, MA was not associated with cost savings. Whether MA meets the value proposition for radiation oncology requires further investigation.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e253018"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763945","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":"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":"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":"Symptomatic Necrosis With Dual Immune-Checkpoint Inhibition and Radiosurgery for Brain Metastases.","authors":"Eugene J Vaios, Rachel F Shenker, Peter G Hendrickson, Zihan Wan, Donna Niedzwiecki, David Carpenter, Warren Floyd, Sebastian F Winter, Helen A Shih, Jorg Dietrich, Chunhao Wang, April K S Salama, Jeffrey M Clarke, Karen Allen, Paul Sperduto, Trey Mullikin, John P Kirkpatrick, Scott R Floyd, Zachary J Reitman","doi":"10.1001/jamanetworkopen.2025.4347","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.4347","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e254347"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811381","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":"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":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To determine how estimates of active and disabled life expectancy differ based on exposure to intervening illnesses and injuries (or events).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Exposure to intervening events, which included critical illness, major elective and nonelective surgical procedures, and hospitalization for other reasons, was assessed each month.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;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":"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}

{"title":"Risk Stratification and Treatment Selection in Patients With Asymptomatic Abdominal Aortic Aneurysms.","authors":"Lorenz Meuli, Alexander Zimmermann, Jeppe Kofoed Petersen, Emil Loldrup Fosbøl, Vaiva Dabravolskaité, Vladimir Makaloski, Jonas Peter Eiberg, Lars Valeur Køber, Timothy Andrew Resch","doi":"10.1001/jamanetworkopen.2025.3559","DOIUrl":"10.1001/jamanetworkopen.2025.3559","url":null,"abstract":"<p><strong>Importance: </strong>Open surgical repair (OSR) should be prioritized for patients with asymptomatic abdominal aortic aneurysm (AAA) and long life expectancy, whereas endovascular repair (EVAR) is preferred for patients with suitable anatomy and life expectancy less than 2 to 3 years. However, life expectancy estimation and risk stratification are not well established.</p><p><strong>Objective: </strong>To evaluate risk-stratified survival differences between OSR and EVAR following elective AAA treatment.</p><p><strong>Design, setting, and participants: </strong>This cohort study used data from Danish national health registries. Patients older than 60 years undergoing elective AAA repair between 2004 and 2023 were categorized into 4 risk groups according to age, estimated glomerular filtration rate, and chronic obstructive pulmonary disease. Follow-up was until March 31, 2024.</p><p><strong>Exposure: </strong>OSR or EVAR for AAA.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was overall survival. Secondary outcomes were incidence of AAA rupture and new cancer diagnosis. Comorbidities were balanced using inverse probability weighting. Kaplan-Meier estimators were generated for both treatments and the 4 risk score groups.</p><p><strong>Results: </strong>Of 6891 identified patients, 5757 (83.4%) were men. Women were older (median [IQR] age, 75.4 [70.9-79.3] vs 74.5 [70.5-78.5] years), more often had chronic obstructive pulmonary disease (156 women [13.6%] vs 512 men [8.9%]), and had lower estimated glomerular filtration rate (median [IQR], 68.4 [54.2-80.4] vs 70.4 [56.5-82.4] mL/min/1.73 m2) compared with men. The median follow-up was 8.28 years (95% CI, 8.10-8.50 years). OSR was associated with higher perioperative mortality in all risk groups. In low-risk patients, OSR was associated with a 10-month (95% CI, 2.2-18.3 months; P = .02) longer mean survival time restricted at 15 years compared with EVAR. In moderate-to-high-risk patients, OSR was associated with a 9-month (95% CI, 1.9-16.9 months; P = .008) shorter mean survival time restricted after 12.5 years compared with EVAR. No difference in mean survival time was seen in low-to-moderate-risk and high-risk patients at the study end. No differences in 10-year incidence of secondary AAA ruptures (OSR, 2.6% [95% CI, 1.9%-3.4%] vs EVAR, 2.2% [95% CI, 1.7%-2.7%]; P = .34) or solid malignant tumor (OSR, 18.6% [95% CI, 16.7%-20.5%] vs EVAR, 20.5% [95% CI, 18.9%-22.1%]; P = .35) were detected.</p><p><strong>Conclusions and relevance: </strong>In this cohort study of 6891 patients with AAA, OSR was associated with higher perioperative mortality in all risk groups, but with longer mean survival only in low-risk patients. Conversely, EVAR was associated with longer mean survival in moderate-to-high-risk patients. These findings highlight the potential benefits of risk stratification when planning AAA treatment.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e253559"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795321","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":"Post-Intensive Care Syndrome and Caregiver Burden: A Post Hoc Analysis of a Randomized Clinical Trial.","authors":"Soojung Ahn, Marianna LaNoue, Han Su, Amanda C Moale, Leslie P Scheunemann, Amy L Kiehl, Ivor S Douglas, Matthew C Exline, Michelle N Gong, Babar A Khan, Robert L Owens, Margaret A Pisani, Peter Rock, James C Jackson, E Wesley Ely, Timothy D Girard, Leanne M Boehm","doi":"10.1001/jamanetworkopen.2025.3443","DOIUrl":"10.1001/jamanetworkopen.2025.3443","url":null,"abstract":"<p><strong>Importance: </strong>Understanding the reciprocal association between post-intensive care syndrome (PICS) and caregiver burden is crucial for optimal care of patients and caregivers following critical illness.</p><p><strong>Objective: </strong>To evaluate the associations between patient post-intensive care impairments and caregiver burden.</p><p><strong>Design, setting, and participants: </strong>This secondary analysis of the MIND-USA study, a multicenter randomized clinical trial, which enrolled patients admitted to intensive care units (ICU) from 16 academic medical centers across the US (December 2011 to August 2017), included 148 patient-caregiver dyads. Patients were adults aged 18 years or older with ICU delirium randomized to receive haloperidol, ziprasidone, or placebo. A caregiver who provided unpaid assistance to the patient was identified at enrollment. PICS and caregiver burden were assessed at 3 months and 12 months after randomization. Statistical analysis was performed from March 2023 to April 2024.</p><p><strong>Main outcomes and measures: </strong>ICU survivors were assessed for PICS domains, including physical and cognitive function, and posttraumatic stress disorder using the Katz Activities of Daily Living, the Functional Activities Questionnaire, the Telephone Interview for Cognitive Status, and the Posttraumatic Stress Disorder Checklist-Civilian version, respectively. Caregiver burden was assessed using the Zarit Burden Interview. The associations between patient PICS and caregiver burden at 3 and 12 months were examined using structural equation modeling.</p><p><strong>Results: </strong>Of 148 patients included in this study with a median (IQR) age of 58 (48-65) years, the majority identified as male (79 patients [53.4%]), and there were 16 (10.8%) Black, 139 (93.9%) non-Hispanic, and 127 (85.8%) White patients. PICS and caregiver burden at 3-month follow-up was positively associated with these outcomes at 12-month follow-up (PICS: β = 0.69; 95% CI, 0.50 to 0.88; P < .001; caregiver burden: β = 0.68; 95% CI, 0.53 to 0.82; P < .001). However, contrary to the study hypotheses, significant associations between 3-month PICS and 12-month caregiver burden and between 3-month caregiver burden and 12-month PICS were not observed (PICS→caregiver burden: β = 0.82; 95% CI, -0.02 to 1.66; P = .09; caregiver burden→PICS: β = 0.00; 95% CI, -0.03 to 0.03; P = .95). There was significant covariance between PICS and caregiver burden at each time point.</p><p><strong>Conclusions and relevance: </strong>In this secondary analysis of a randomized clinical trial of ICU survivors and their caregivers, patient PICS and caregiver burden were associated at concurrent time points but were not associated with each other longitudinally.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT01211522.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e253443"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803226","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":"Opioid Cap Laws and Opioid Prescriptions After Total Joint Replacements in Older Adults.","authors":"Caroline P Thirukumaran, Derek T Schloemann, Jalpa A Doshi, Kevin A Fiscella, Benjamin F Ricciardi, Meredith B Rosenthal","doi":"10.1001/jamanetworkopen.2025.4448","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.4448","url":null,"abstract":"<p><strong>Importance: </strong>Despite the opioid crisis and a growing call for minimizing opioid use, opioids remain an important part of postoperative pain management, with more than 80% of patients filling at least 1 opioid prescription following total joint replacements (TJRs). Little is known as to whether state laws that restrict or cap opioids for acute pain reduce post-TJR opioid use.</p><p><strong>Objective: </strong>To evaluate the association of an opioid cap law in New York (Section 3331) with post-TJR opioid prescribing.</p><p><strong>Design, setting, and participants: </strong>This cohort study analyzed Medicare data from 2014 to 2019 for New York and California (control state). Participants were Medicare beneficiaries who underwent elective TJRs before (April 2014 to June 2016) or after (August 2016 to September 2019) Section 3331 implementation. Data were analyzed from June 2023 to August 2024.</p><p><strong>Exposure: </strong>Implementation of New York Section 3331 in July 2016.</p><p><strong>Main outcomes and measures: </strong>The primary end point was total morphine milligram equivalents (MMEs) filled from discharge to day 7, days 8 to 30, and days 31 to 90 after TJR. Key independent variables were legislation phase (before or after Section 3331 implementation), treatment or control state, and the interactions between these 2 variables. Difference-in-differences regression models were used to assess the association of interest.</p><p><strong>Results: </strong>The pre-Section 3331 cohort included 32 253 TJR encounters among 31 028 patients, of whom 9924 (31.98%) underwent TJRs in New York hospitals. The mean (SD) age of the cohort was 73.43 (5.49) years; 19 442 encounters (60.28%) were among females. The estimated change in total MMEs filled in the 7-day post-TJR period after vs before Section 3331 implementation was -135.08 (95% CI, -146.62 to -123.53; P < .001) in California and -178.00 (95% CI, -191.98 to -164.02; P < .001) in New York, resulting in a Section 3331-associated change of -42.92 MMEs (95% CI, -61.04 to -24.80 MMEs; P < .001) in New York compared with California. Section 3331 was not associated with statistically significant changes in total MMEs filled in the 8 to 30-day and 31 to 90-day post-TJR periods.</p><p><strong>Conclusions and relevance: </strong>The findings of this retrospective cohort study of TJRs among Medicare beneficiaries suggest that New York Section 3331 achieved its intended objective, as it was associated with reduced opioid fills in the immediate 7-day post-TJR period in New York compared with California. Additional refinements may further reduce opioid prescribing in New York, and these findings may serve as a foundation for refining laws in other states that may not achieve their intended targets or have not implemented similar laws.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e254448"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811378","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}