JAMA Network Open最新文献

{"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}

{"title":"Trends in Extended-Release and Non-Extended-Release Buprenorphine Dispensing.","authors":"Thomas J Stopka, Netrali Dalvi, Leonard D Young, Shikhar Shrestha, Danielle DeNufrio Valerio, Alexander Y Walley","doi":"10.1001/jamanetworkopen.2025.3158","DOIUrl":"10.1001/jamanetworkopen.2025.3158","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e253158"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11971669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780164","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":"Intravenous Immunoglobulin Alone for Coronary Artery Lesion Treatment of Kawasaki Disease: A Randomized Clinical Trial.","authors":"Ho-Chang Kuo, Ming-Chih Lin, Chung-Chih Kao, Ken-Pen Weng, Yun Ding, Zhi Han, Chih-Jung Chen, Sheng-Ling Jan, Kuang-Jen Chien, Chun-Hsiang Ko, Chien-Yu Lin, Wei-Te Lei, Mindy Ming-Huey Guo, Kuender D Yang, Karl G Sylvester, John C Whitin, Lu Tian, Henry Chubb, Scott R Ceresnak, Doff McElhinney, Harvey J Cohen, Xuefeng B Ling","doi":"10.1001/jamanetworkopen.2025.3063","DOIUrl":"10.1001/jamanetworkopen.2025.3063","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Aspirin (acetylsalicylic acid) and intravenous immunoglobulin (IVIG) are standard treatments for Kawasaki disease (KD) to reduce coronary artery lesions (CALs). However, the optimal duration and dosage of aspirin remain inconsistent across hospitals. The absence of large-scale, multicenter randomized clinical trials hinders a clear understanding of the effectiveness of high-dose aspirin.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the effectiveness of IVIG alone compared with IVIG combined with high-dose aspirin as the active interventional therapy for KD and to compare treatment effectiveness across various KD subgroups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;In this prospective, evaluator-blinded, multicenter noninferiority randomized clinical trial, children (aged &lt;6 years) who had been diagnosed with KD according to American Heart Association criteria were recruited from 5 medical centers in Taiwan and were enrolled between September 1, 2016, and August 31, 2018, with follow-up assessments at 6 weeks and 6 months after treatment. Data were analyzed between January 23, 2023, and January 29, 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Intervention: &lt;/strong&gt;The standard group received IVIG (2 g/kg) plus high-dose aspirin (80-100 mg/kg per day) until fever subsided for 48 hours. The intervention group received IVIG (2 g/kg) alone.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcome was the occurrence of CALs at 6 weeks. The noninferiority margin was set at 10%. Data analysis was performed using χ2 tests for categorical variables; independent t tests for continuous, normally distributed variables; generalized estimating equations for variables without specific distributions at multiple time points; and repeated-measures analysis of variance for continuous variables at multiple time points.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The final cohort consisted of 134 patients with KD (mean [SD] age, 1.8 [1.3] years; 82 males [61.2%]), with matched age, weight, height, and sex distributions in 2 groups. Overall, in the IVIG plus aspirin group, among 69 patients, CAL occurrence decreased from 9 (13.0%) at baseline to 2 (2.9%) at 6 weeks and to 1 (1.4%) at 6 months. In the IVIG-only group, among 65 patients, CAL occurrence decreased from 7 (10.8%) at diagnosis to 1 (1.5%) at 6 weeks and to 2 (3.1%) at 6 months. No statistically significant differences in CAL frequency were observed between the 2 groups (0.7 percentage points [95% CI, -4.5 to 5.8 percentage points]; P = .65). There were also no significant differences in the treatment or prophylactic effect.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;This randomized clinical trial demonstrated the noninferiority of IVIG alone compared with IVIG plus aspirin, with a noninferiority margin set at 10%. The findings suggest that addition of high-dose aspirin during initial IVIG treatment is not clinically meaningful for CAL reduction in children with KD. Future st","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e253063"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772308","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":"Medicare Beneficiary Receipt of Methadone by Drive Time to Opioid Treatment Programs.","authors":"Jonathan Cantor, Helin G Hernandez, Aaron Kofner, Julie Lai, Denis Agniel, Kosali I Simon, Bradley D Stein, Erin A Taylor","doi":"10.1001/jamanetworkopen.2025.3099","DOIUrl":"10.1001/jamanetworkopen.2025.3099","url":null,"abstract":"<p><strong>Importance: </strong>To combat the ongoing opioid crisis, policy makers and public health officials are developing novel policies to increase the availability of medications for opioid use disorder (OUD). An important question is to what extent geographic availability of opioid treatment programs (OTPs) is associated with treatment receipt. Understanding this association may help with developing additional policies to increase medication for OUD dispensing and improve population health outcomes.</p><p><strong>Objective: </strong>To quantify trends in dispensing methadone to Medicare beneficiaries based on proximity to an OTP.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study analyzed 2020 Medicare fee-for-service claims for methadone for beneficiaries with a recent diagnosis of OUD merged with drive times to OTP locations. Medicare beneficiaries enrolled in a Part D prescription plan and diagnosed with OUD in any of the 3 quarters before and during the 2020 quarter of interest were examined.</p><p><strong>Exposure: </strong>Drive time between the centroid of a beneficiary's zip code and the closest OTP.</p><p><strong>Main outcomes and measures: </strong>Quarterly methadone receipt among Medicare beneficiaries with a recent OUD diagnosis was assessed using logistic regression models.</p><p><strong>Results: </strong>In 2020, there were 640 706 Medicare beneficiaries with a recent OUD diagnosis (mean [SD] age, 62.5 [13.5] years; 55.6% female; 65.5% residing in an urban locality at the time of diagnosis). Of these beneficiaries, 9.6% lacked an OTP within a 60-minute drive time. The probability of a beneficiary receiving methadone decreased as the drive time from an OTP increased. Specifically, in urban areas, the likelihood of methadone receipt decreased by a relative 54% from a mean of 5.29% (national interval, 4.27%-6.52%) for beneficiaries who lived within a 5-minute drive of an OTP to 2.39% (national interval, 1.92%-2.98%) for those who lived within a 15-minute drive from an OTP. For rural beneficiaries, the likelihood of methadone receipt decreased by a relative 27% from a mean of 3.42% (national interval, 2.73%-4.28%) for a 5-minute drive time to 2.39% (national interval, 1.92%-2.98%) for a 15-minute drive time. Evidence of a threshold effect at a drive time of 20 minutes was observed for methadone receipt, after which the rate slowed and was similar between urban and rural beneficiaries.</p><p><strong>Conclusions and relevance: </strong>These findings suggest that the likelihood of methadone receipt may vary based on proximity to OTP facilities. Where OTPs are located may be a contributor to whether an individual receives methadone treatment.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e253099"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772479","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":"Yoga or Strengthening Exercise for Knee Osteoarthritis: A Randomized Clinical Trial.","authors":"Bedru J Abafita, Ambrish Singh, Dawn Aitken, Changhai Ding, Steffany Moonaz, Andrew J Palmer, Leigh Blizzard, Andrew Inglis, Stan J J Drummen, Graeme Jones, Kim L Bennell, Benny Antony","doi":"10.1001/jamanetworkopen.2025.3698","DOIUrl":"10.1001/jamanetworkopen.2025.3698","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;There is limited evidence on the comparative effectiveness of different exercise modalities, such as yoga and strengthening exercises, for managing knee osteoarthritis (OA).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To compare the effectiveness of yoga vs strengthening exercise for reducing knee pain over 12 weeks in patients with knee OA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This single-center, assessor-blinded (for nonpatient-reported outcomes), parallel-arm, active-controlled, superiority randomized clinical trial included adults aged 40 years or older with knee OA and knee pain levels of 40 or higher on a 100-mm visual analog scale (VAS) in Southern Tasmania, Australia. Participants were recruited from April 2021 to June 2022, and follow-up was completed in December 2022. Data were analyzed from May 2023 to July 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;Participants were randomized 1:1 to the yoga and strengthening exercise groups. Both groups attended 2 supervised and 1 home-based session per week for 12 weeks followed by 3 unsupervised home-based sessions per week for weeks 13 to 24.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcome was the between-group difference in VAS score over 12 weeks assessed using a range of 0 (no pain) to 100 (worst possible pain) with a prespecified noninferiority margin of 10 mm. Secondary outcomes included knee pain over 24 weeks; Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) knee pain, function, and stiffness; patient global assessment; Osteoarthritis Research Society International-Outcome Measures in Rheumatology Clinical Trials response; physical performance measures; leg muscle strength; health-related quality of life assessed via the Assessment of Quality of Life-8 Dimensions (AQol-8D) utility score; depression assessed with the Patient Health Questionnaire-9; and neuropathic pain assessment over 12 and 24 weeks. Analyses were based on the intention-to-treat principle.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In total, 117 participants were randomized to the yoga (n = 58) or strengthening exercise (n = 59) program. Baseline characteristics of the participants were similar, with a mean (SD) age of 62.5 (8.3) years, and 85 participants (72.6%) were female. The mean (SD) baseline VAS knee pain score of 53.8 (16.0) indicated moderate knee pain. Over 12 weeks, the between-group mean difference in VAS knee pain change was -1.1 mm (95% CI, -7.8 to 5.7 mm), which was not statistically significant but remained within the prespecified noninferiority margin. Of 27 secondary outcomes assessed over 12 and 24 weeks, 7 were statistically significant in favor of yoga. The yoga group showed modestly greater improvements than the strengthening exercise group (between-group differences) over 24 weeks for WOMAC pain (-44.5 mm [95% CI, -70.7 to -18.3 mm]), WOMAC function (-139 mm [95% CI, -228.3 to -49.7 mm]), WOMAC stiffness (-17.6 mm [95% CI,","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e253698"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803277","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":"Pregnancy-Related Deaths in the US, 2018-2022.","authors":"Yingxi Chen, Meredith S Shiels, Tarsicio Uribe-Leitz, Rose L Molina, Wayne R Lawrence, Neal D Freedman, Christian C Abnet","doi":"10.1001/jamanetworkopen.2025.4325","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.4325","url":null,"abstract":"<p><strong>Importance: </strong>The US has the highest rate of preganncy-related death among high-income countries, and disparities continue to widen despite many of these deaths being largely preventable.</p><p><strong>Objective: </strong>To examine the age-standardized national rates of pregnancy-related death from 2018 to 2022 in the US, stratified by cause, and to compare the rates across state and race and ethnicity.</p><p><strong>Design, setting, and participants: </strong>This serial cross-sectional study used nationwide data on births and pregnancy-related deaths from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research. All pregnancy-related deaths among women aged 15 to 54 years from 2018 to 2022 were included.</p><p><strong>Exposure: </strong>State, race and ethnicity, and age.</p><p><strong>Main outcomes and measures: </strong>The primary outcomes were all-cause and cause-specific maternal death and late maternal death (ie, deaths occurring >42 days and up to 1 year after pregnancy). The age-standardized annual and aggregated rate of pregnancy-related mortality (ASR) was estimated by age group and race and ethnicity, and state-specific crude pregnancy-related mortality rates per 100 000 live births and 95% CIs were calculated.</p><p><strong>Results: </strong>During 2018 to 2022, there were 6283 pregnancy-related deaths, including 1891 late maternal deaths. The ASR increased by 27.7% from 25.3 deaths per 100 000 live births (95% CI, 23.7-26.9) in 2018 to 32.6 deaths per 100 000 live births (95% CI, 31.2-34.8) in 2022. The increase was observed across age group and was disproportionately driven by deaths that occurred among women aged 25 to 39 years (by 36.8%, 2018 vs 2022). There was a considerable variation in rates by state, ranging from 18.5 to 59.7 deaths per 100 000 live births. If the national rate was reduced to the lowest state rate, 2679 pregnancy-related deaths could have been prevented in 2018 to 2022. American Indian and Alaska Native women had the highest ASR (106.3 deaths per 100 000 live births), followed by non-Hispanic Black women (76.9 deaths per 100 000 live births). Although cardiovascular disease was the leading cause of the overall pregnancy-related deaths, cancer, mental and behavior disorders, and drug-induced and alcohol-induced death were important contributing causes of late maternal death.</p><p><strong>Conclusions and relevance: </strong>In this cross-sectional analysis of pregnancy-related deaths in the US, rates increased during 2018 to 2022, with large variations by state and race and ethnicity. The concerning rates in the US should be an urgent public health priority.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e254325"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811379","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":"Intersectional Racial and Sex Disparities in Unintentional Overdose Mortality.","authors":"Kechna Cadet, Bianca D Smith, Silvia S Martins","doi":"10.1001/jamanetworkopen.2025.2728","DOIUrl":"10.1001/jamanetworkopen.2025.2728","url":null,"abstract":"<p><strong>Importance: </strong>There are several apparent research gaps based on the intersectional sociodemographic dimensions of drug-related mortality disparities. Relatively marginal evidence exists on the potential roles of intersecting forms of race and sexual marginalization on the disparities across drug-related mortality.</p><p><strong>Objective: </strong>To examine intersectional sex-specific White and Black racial disparities in drug poisoning mortality across states from 2010 to 2020.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study used unintentional fatal drug poisoning mortality data from the Centers for Disease Control and Prevention's Web-Based Injury Statistics Query and Reporting System. Trends from 2010 through 2020 were analyzed by Black men, Black women, White men, and White women across states. One-sided Mann-Kendall trend analysis was used to examine statistically significant increasing or decreasing trends in age-adjusted mortality rates. Statistical analysis was performed from June to July 2024.</p><p><strong>Exposures: </strong>White and Black groups intersecting with male and female sex.</p><p><strong>Main outcomes and measures: </strong>Analysis of age-adjusted mortality rates, excess years of potential life lost (reference group: White men), years of potential life lost ratios (reference group: White men), and percentage change to highlight state differences.</p><p><strong>Results: </strong>From a total sample of 518 724 unintentional fatal drug poisoning deaths (9.0% in Black men, 3.9% in Black women, 29.0% in White women, and 58.1% in White men), 11 820 781 years of potential life lost were recorded. Black men had the highest mean (SD) age-adjusted mortality rate (23.25 [22.65]), followed by White men (22.49 [14.32]), with lower rates for White women (11.71 [5.96]) and Black women (9.01 [8.04]) (P < .001). Compared with White men, both Black men (τ = 0.298, slope = 0.002, intercept = 0.381, P < .001) and Black women (τ = 0.157, slope = 0.0004, intercept = 0.271, P < .001) had worsening YPLL over time, while White women (τ = -0.146, slope = -0.0003, intercept = 0.5252, P < .001) showed improvement in their YPLL over time compared with White men. At the state level, there was a disproportionate burden of deaths due to drug poisonings, with Maryland showing the highest increase in mortality rates among Black men (485.4%), while decreases were observed for White women in states such as Alaska (-23.0%).</p><p><strong>Conclusions and relevance: </strong>In this cross-sectional study of overdose deaths, disparities in overdose mortality were evident, with Black men and Black women experiencing a pronounced and increasing burden of mortality compared with their White counterparts. Addressing these disparities will require a multipronged approach targeting the social, physical, economic, and policy risk environments.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e252728"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752754","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}