JAMA Network Open最新文献

{"title":"Development and Validation of a Tool to Measure Documented Health Care Encounter Time.","authors":"Ronald Chow, Sarah Bayrakdarian, Olivera Gojsevic, Emily MacMillan, Tracy Balboni, Joanne Bowen, Eduardo Bruera, Raymond J Chan, Arjun Gupta, Nicolas H Hart, Peter Hoskin, David Hui, Hirotoshi Iihara, Michael Jefford, Shing Fung Lee, Rachel Riechelmann, Hope S Rugo, Christina H Ruhlmann, Charles B Simone, Henry C Y Wong, Camilla Zimmermann, Hans Chung, Georgia C Richards, Carl Heneghan, Jennifer Leigh","doi":"10.1001/jamanetworkopen.2026.38034","DOIUrl":"10.1001/jamanetworkopen.2026.38034","url":null,"abstract":"<p><strong>Importance: </strong>Time toxicity, defined as the time patients spend receiving cancer treatment and interacting with health care systems, is an emerging treatment-related burden. Existing studies typically quantify time toxicity using health care contact days, which may inadequately capture patient burden because encounters of different durations are weighted equally.</p><p><strong>Objective: </strong>To develop and internally validate the Multinational Association of Supportive Care in Cancer (MASCC) Time Intensity and Measurement of Encounters (TIME) tool, a standardized medical record abstraction instrument for measuring documented health care encounter time.</p><p><strong>Design, setting, and participants: </strong>This multiphase mixed-methods prognostic study, including tool development, was conducted from March to May 2026, through a 3-round international consensus process involving 16 oncology trialists from 9 countries and internal validation using electronic medical records from a cohort of patients with prostate cancer treated at a tertiary cancer center in Toronto, Ontario, Canada. Validation compared standardized abstraction using the MASCC TIME tool with prior unstructured medical record abstraction across 367 health care encounters.</p><p><strong>Main outcomes and measures: </strong>Content validity, extraction accuracy compared with investigator consensus review, interrater reliability assessed using the Gwet agreement coefficient 1 (AC1) and percentage agreement, and abstraction feasibility.</p><p><strong>Results: </strong>Sixteen oncology trialists participated in tool development. The final tool included 8 variables: encounter start date, start time, end date, end time, purpose, planned or unplanned status, mode of contact, and primary clinician. All variables achieved a content validity ratio of 1.0. Accuracy of medical record extraction increased from 31% (95% CI, 28%-35%) to 90% (95% CI, 87%-93%) without the tool to 66% (95% CI, 62%-69%) to 99% (95% CI, 99%-100%) with the tool, with absolute differences of 2 percentage points (95% CI, -1 to 5 percentage points) to 35 percentage points (95% CI, 30 to 40 percentage points); 7 of 8 variables demonstrated statistically significant increases with the tool. Percentage agreement between abstractors increased from 31% to 82% without the tool to 42% to 99% with the tool, while the Gwet AC1 increased from -0.24 to 0.87 without the tool to 0.14 to 0.99 with the tool. Mean abstraction time decreased from 10 to 5 minutes per encounter.</p><p><strong>Conclusions and relevance: </strong>In this prognostic study of the MASCC TIME tool, it was found to be associated with excellent content validity, improved accuracy, high interrater reliability, and acceptable feasibility for standardized measurement of documented health care encounter time. Standardized assessment of time toxicity may improve comparability across oncology studies and support more rigorous evaluation of health c","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2638034"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13650670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136865","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":"Pubertal Testicular Function in Childhood Cancer Survivors and Future Fertility.","authors":"Mikael Koskela, Kathleen Duffin, Melanie Korhonen, Mikko Anttonen, Hanne Frederiksen, Anders Juul, Rod T Mitchell, Kirsi Jahnukainen","doi":"10.1001/jamanetworkopen.2026.38294","DOIUrl":"10.1001/jamanetworkopen.2026.38294","url":null,"abstract":"<p><strong>Importance: </strong>Childhood cancer treatment can result in male infertility. Understanding which patients are at risk of future infertility would facilitate early fertility counseling.</p><p><strong>Objectives: </strong>To investigate associations between pubertal reproductive hormone levels and adult gonadal outcomes and cancer treatment exposures.</p><p><strong>Design, setting, and participants: </strong>This cohort study was conducted at Helsinki Children's Hospital among male childhood cancer survivors who received a diagnosis under the age of 17 years between 1964 and 2000, for whom at least 1 reproductive hormone concentration (measured 1982-2017) was available. Data were analyzed from May to December 2025.</p><p><strong>Exposure: </strong>Alkylating chemotherapy, quantified using cyclophosphamide equivalent dose (CED), and testicular radiotherapy.</p><p><strong>Main outcomes and measures: </strong>Serum hormone levels (follicle-stimulating hormone [FSH], luteinizing hormone [LH], or testosterone) were collected at 2-year intervals between ages 12 and 18 years and at age 20 or older; hormone concentrations were converted to age-specific z scores. Data on gonadal outcomes were obtained in adulthood.</p><p><strong>Results: </strong>The study included 221 childhood cancer survivors (median age at diagnosis, 6.0 years [IQR, 3.2-11.7 years]). FSH showed a dose-dependent pattern with testicular radiotherapy, with elevated FSH z scores seen from age 12 years among patients who received more than 1 Gy of testicular radiotherapy. Compared with the group that received less than 4 g/m2 CED (median FSH z score, 0.1; IQR, -1.2 to 1.2) at age 18 years, higher FSH z scores occurred among patients who received 4 to less than 12 g/m2 CED (median FSH z score, 1.4; IQR, 0.5-2.6; P = .04) or received 12 g/m2 or more CED (median FSH z score, 1.6; IQR, 0.7-2.5; P = .007). There was evidence of normalization at age 20 years or older for patients who received 4 to less than 12 g/m2 CED (median FSH z score, 0.7; IQR, -0.6 to 1.7) but not those who received 12 g/m2 or more CED (median FSH z score, 1.7; IQR, 0.9-2.5). The highest FSH z score at age 14 to 16 years was associated with azoospermia in adulthood, with an optimal cutoff corresponding to 11.2 IU/L at age 14 years and 12.5 IU/L at age 16 years (area under the curve, 0.87). Elevated LH z scores occurred from age 12 years onward among patients receiving more than 14 Gy of radiotherapy, but exposure to high CED was not associated with impaired Leydig cell function.</p><p><strong>Conclusions and relevance: </strong>In this cohort study of male patients treated for childhood cancer, gonadotrophin levels during puberty were associated with future testicular function. Impairment of testicular function after radiotherapy persisted into adulthood, while there was evidence of recovery after alkylating chemotherapy. The results suggest increased sensitivity of the Sertoli cell-germ cell compartment compar","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2638294"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148291","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":"Exclusive Breastfeeding Among Infants Younger Than 6 Months in Zambia.","authors":"David Owiredu, Penias Tembo, Monique J Brown, James R Hébert","doi":"10.1001/jamanetworkopen.2026.38310","DOIUrl":"10.1001/jamanetworkopen.2026.38310","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2638310"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147093","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":"Postoperative Opioid Use Prediction Calculator Performance in Patients Undergoing Gynecologic Surgery.","authors":"Stephanie L Lim, Mary Katherine Anastasio, Melissa Greene, Joyce Liu, Joseph Lafferty, Laura J Havrilesky, J Eric Jelovsek, Brittany A Davidson","doi":"10.1001/jamanetworkopen.2026.37664","DOIUrl":"10.1001/jamanetworkopen.2026.37664","url":null,"abstract":"<p><strong>Importance: </strong>Postoperative opioid overprescription contributes to the opioid epidemic.</p><p><strong>Objective: </strong>To expand and validate a gynecologic oncology-developed postoperative opioid use prediction calculator in a diverse surgical population and evaluate whether it could be modified for preoperative prescribing.</p><p><strong>Design, setting, and participants: </strong>This prognostic study in a quaternary health system used patient preoperative surveys and postoperative assessments to measure opioid use and pain scores from November 1, 2023, to November 1, 2024, with follow-up up to 6 weeks. Patients aged 18 years or older who underwent gynecologic surgery were eligible; those undergoing only minor procedures were excluded. Data were analyzed from January 15, 2025, through July 27, 2026.</p><p><strong>Main outcomes and measures: </strong>The original 7-predictor model was externally validated. The prespecified updated proportional odds model included anticipated pain medication use, restricted cubic splines for age (3 knots) and anticipated operating time (5 knots), education, smoking, and anxiety. A total of 71 imputation-specific models were fitted. The outcome variable was the number of pills used. Validation methods included model discrimination and calibration.</p><p><strong>Results: </strong>Of 884 identified patients, 870 were eligible, 835 underwent surgery, and 616 had complete opioid use outcome data (median [IQR] age, 48 [39-65] years). The median number of pills used was 2 (IQR, 0-7 pills), and 226 patients (36.7%) used no pills. For the original model, threshold-specific C statistics were 0.70 (95% CI, 0.66-0.74), 0.72 (95% CI, 0.68-0.76), and 0.74 (95% CI, 0.70-0.78) for use of at least 2, 5, and 10 pills, respectively. Calibration intercepts were -0.11 (95% CI, -0.30 to 0.08), -0.35 (95% CI, -0.54 to -0.17), and -0.51 (95% CI, -0.71 to -0.31), respectively, indicating overpredicted use at the higher thresholds of pill use. For the updated model, optimism-corrected C statistics were 0.71 (95% CI, 0.66-0.74), 0.73 (95% CI, 0.68-0.76), and 0.73 (95% CI, 0.67-0.77); calibration intercepts were -0.05 (95% CI, -0.09 to -0.01), -0.04 (95% CI, -0.08 to 0.002), and -0.03 (95% CI, -0.07 to 0.01); and calibration slopes were 0.93 (95% CI, 0.80-1.02), 1.06 (95% CI, 0.89-1.19), and 1.15 (95% CI, 0.85-1.37) for at least 2, 5, and 10 pills, respectively.</p><p><strong>Conclusions and relevance: </strong>This prognostic study of patients who underwent major gynecologic surgery found that the original calculator showed moderate threshold-specific discrimination but overpredicted opioid use at the higher thresholds of pill use. The updated model showed moderate discrimination after internal validation, with calibration intercepts near 0 and slopes ranging from 0.93 to 1.15. External institutional validation is needed. Individualized estimates may support opioid stewardship.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2637664"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13643585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109725","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":"Patient Perspectives on Offers of Buprenorphine in the Emergency Department.","authors":"Lindsey K Jennings, Kelly Barth, Suzanne Lane, Alyssa Rafferty, Carrie Papa, Louise Haynes, Susan Sonne, Heather McCowin, Phillip Moschella, Alain H Litwin, Jacob J Manteuffel, Kathleen Brady, Angela Moreland","doi":"10.1001/jamanetworkopen.2026.37671","DOIUrl":"10.1001/jamanetworkopen.2026.37671","url":null,"abstract":"<p><strong>Importance: </strong>Buprenorphine reduces mortality in opioid use disorder (OUD), and emergency department-initiated buprenorphine (EDIB) doubles 30-day treatment retention, yet many patients decline EDIB when offered. Patient-driven factors limiting uptake are not well characterized.</p><p><strong>Objective: </strong>To identify factors associated with patients accepting or declining EDIB.</p><p><strong>Design, setting, and participants: </strong>Convergent parallel mixed-methods qualitative study conducted from May 1 to December 31, 2023, with data analyses performed from March 2025 to April 2026, at 4 emergency departments within the National Drug Abuse Treatment Clinical Trials Network (CTN) in South Carolina, Michigan, and Ohio. Adult patients (aged ≥18 years) with OUD who were offered buprenorphine by clinical staff were eligible; prisoners and patients concurrently enrolled in other CTN trials of OUD treatment or overdose prevention were excluded.</p><p><strong>Main outcomes and measures: </strong>The main outcomes were acceptance or declination of EDIB; validated measures of treatment readiness (Stages of Change Readiness and Treatment Engagement Scale [SOCRATES]), cultural mistrust, perceived discrimination, and social needs; and qualitative interview themes regarding reasons for accepting or declining buprenorphine.</p><p><strong>Results: </strong>Eighty-two participants completed the study (median [IQR] age, 38 [31-53.5] years; 52 male [64%]). Overall, 19 participants (23%) declined buprenorphine. Among 54 participants who described reasons for accepting EDIB, motivators for accepting EDIB included assistance with opioid withdrawal (37 [69%]), desire to be substance free (21 [39%]), wanting to return to a \"normal life\" (15 [28%]), fear of overdose or death (13 [24%]), and caring for children (7 [13%]). Among 22 participants who described reasons for declining EDIB, barriers included concern about precipitated withdrawal or adverse effects (11 [50%]), not wanting to be physically dependent on buprenorphine (7 [32%]), and housing and logistical barriers (5 [23%]). SOCRATES treatment readiness (1-5 scale) was similar in patients who accepted (mean [SD] score, 4.11 [0.55]) and declined (mean [SD] score, 4.05 [0.50]) EDIB.</p><p><strong>Conclusions and relevance: </strong>In this mixed-methods qualitative study of adult ED patients with OUD who were offered buprenorphine, declination was driven less by low treatment readiness than by specific, addressable concerns: precipitated withdrawal, physical dependence, and housing and logistical barriers. Targeted interventions addressing these concerns may increase uptake of this life-saving treatment.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2637671"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13643581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109803","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":"Reproductive Privacy Risk Disclosure in US Clinical Trial Informed Consent Forms After the Dobbs Decision.","authors":"Ava Glazier, Willyanne DeCormier Plosky, Barbara E Bierer","doi":"10.1001/jamanetworkopen.2026.37862","DOIUrl":"10.1001/jamanetworkopen.2026.37862","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2637862"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated With Postpandemic Decline in US Motor Vehicle Mortality.","authors":"Mathew V Kiang, Monica J Alexander","doi":"10.1001/jamanetworkopen.2026.38041","DOIUrl":"10.1001/jamanetworkopen.2026.38041","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2638041"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13650661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136996","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":"Organ Preservation and Quality of Life After Total Neoadjuvant Treatment in Rectal Cancer.","authors":"Markus Diefenhardt, Emmanouil Fokas, Rebekka Kosmala, Bülent Polat, Christoph Thomas Germer, Anke Schlenska-Lange, Thomas Kuhnt, Michael Ghadimi, Stefan Rieken, Armin Wiegering, Matthias Schwarzbach, Maximilian Fleischmann, Robert Grützmann, Oliver J Ott, Peter Martus, Alfred Königsrainer, Daniel Zips, Ralf-Dieter Hofheinz, Cihan Gani, Claus Rödel","doi":"10.1001/jamanetworkopen.2026.39063","DOIUrl":"10.1001/jamanetworkopen.2026.39063","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Data on quality of life (QOL) after total neoadjuvant therapy (TNT) are important for counseling patients on the benefits of watch-and-wait (WW) vs total mesorectal excision (TME) for rectal cancer. A thorough understanding of both options and their long-term impact on bowel, urinary, sexual function, and other QOL domains remains limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To examine the association of organ preservation with QOL and functional outcomes among patients with rectal cancer treated in 2 phase 2 clinical trials.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This unplanned, post hoc, cohort study used data from the CAO/ARO/AIO-12 and CAO/ARO/AIO-16 trials, recruiting participants from June 15, 2015, through October 7, 2020, from 19 centers in Germany. Included patients had cT3 to cT4 or node-positive rectal adenocarcinoma. Total neoadjuvant treatment included chemoradiation therapy combined with induction or consolidation chemotherapy. The statistical analysis was performed from March 6 to December 23, 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The association of WW with functional outcomes and QOL was assessed using prospectively recorded EORTC QLQ-C30, EORTC QLQ-CR29, and Wexner score questionnaires. Differences in QOL scores were estimated using adjusted longitudinal and cross-sectional analyses with a predefined clinically meaningful difference of at least 5 points.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Baseline questionnaires were available from 346 of 385 eligible patients (89.9%; median [range] age, 60 [19-80] years; 257 male [67%]), while available QOL questionnaires decreased over time to 185 (48.1%) at 5 years. Using the longitudinal analytic approach, statistically significant and clinically meaningful differences in favor of WW were noted for fecal incontinence (-21.2 [95% CI, -30.0 to -12.3]; P &lt; .001); stool frequency (-19.8 [95% CI, -27.6 to -11.9]; P &lt; .001); embarrassment (-17.0 [95% CI, -27.4 to -6.6]; P = .002); flatulence (-15.2 [95% CI, -24.4 to -6.0]; P &lt; .001), buttock pain (-11.9 [95% CI, -20.8 to -3.0]; P = .01); social (9.7 [95% CI, 1.1-18.3]; P = .03), physical (10.2 [95% CI, 4.1-16.3]; P = .002), and role (13.9 [95% CI, 4.9-22.9]; P = .003) functioning; and global health status (9.2 [95% CI, 3.2-15.2]; P = .004). These clinically meaningful differences were detectable in both the intended organ preservation and disease-free groups. Patients with sustained clinical complete response at 3 years (n = 29) vs those with pathologic complete response or matched baseline characteristics favored WW for fecal incontinence (-24.0 and -11.6, respectively), stool frequency (-34.6 and -19.1), sore skin (-18.0 and -18.1), buttock pain (-14.7 and -17.6), embarrassment (-41.1 and -20.5), role functioning (19.1 and 10.9), and social functioning (20.0 and 8.4).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In the absence of prospective randomized trials, this study provid","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2639063"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193939","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":"Homicide Mortality Among Female Adolescents and Women Aged 15 to 44 Years and US State Abortion Policies.","authors":"Liana R Woskie, Maeve E Wallace","doi":"10.1001/jamanetworkopen.2026.38986","DOIUrl":"10.1001/jamanetworkopen.2026.38986","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Homicide is a leading cause of death among female adolescents and women aged 15 to 44 years (hereinafter, women of reproductive age) in the US. Whether homicide trajectories differed across state abortion policy environments after the COVID-19 surge and the Dobbs v Jackson Women's Health Organization (hereinafter, Dobbs) decision is unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To characterize national homicide trends among women of reproductive age and assess whether post-2022 trajectories in homicide mortality among women of reproductive age diverged between states with and without sustained abortion bans.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This quasi-experimental study used national interrupted time series and comparative interrupted time series analyses of homicide mortality from January 1, 2016, through December 31, 2024, among women of reproductive age.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;The COVID-19 pandemic and sustained state abortion bans after Dobbs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The main outcome was monthly homicide deaths. The population-offset Poisson model estimated differential post-Dobbs changes in homicide rates. Absolute rate differences, excess deaths, and years of life lost were estimated from fitted and counterfactual Poisson models. States with sustained total or near-total abortion bans after Dobbs were compared with states without such bans; states with partial or legally fluid restrictions were excluded. A triple-difference analysis comparing those aged 15 to 29 years with those aged 45 to 59 years served as a negative-control analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The analysis included 19 118 homicide deaths among women of reproductive age. Nationally, homicide increased sharply during the COVID-19 surge and subsequently decreased, with no clear national level or slope change beginning in July 2022. In policy-stratified analyses, however, homicide trajectories diverged. After July 2022, the exposed states (those with total or near-total abortion bans) vs unexposed states homicide monthly rate ratio (RR) was 1.006 (95% CI, 1.000-1.011; P = .03). Across calendar years 2023 and 2024, the fitted homicide rate in exposed states was higher than the modeled counterfactual (2023: RR, 1.07; 95% bootstrap interval, 1.01-1.13; and 2024: RR, 1.15; 95% bootstrap interval, 1.03-1.29). This corresponded to an estimated 48 excess deaths (95% bootstrap interval, 11-81) in 2023 and 87 excess deaths (95% bootstrap interval, 20-149) in 2024. A triple-difference model indicated greater post-Dobbs divergence among those aged 15 to 29 years than those aged 45 to 59 years (monthly ratio of RRs, 1.017; 95% CI, 1.000-1.034; P = .046); placebo Dobbs dates yielded nonsignificant results.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this study, national homicide mortality rates among women of reproductive age returned toward prepandemic levels after COVID-19, but pos","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2638986"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206954","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":"Disparities in Autism Spectrum Disorder and Perinatal Risk Factors.","authors":"Francesca Del Giorgio, Bénédicte Driollet, Emmalin Buajitti, Asma Ahmed, Jennifer A Hutcheon, Laura Rosella, Seungmi Yang","doi":"10.1001/jamanetworkopen.2026.37174","DOIUrl":"10.1001/jamanetworkopen.2026.37174","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;In universal health care settings, trends in autism spectrum disorder (ASD) diagnosis remain poorly characterized, yet are critical for identifying inequities that persist despite more equitable health care access.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To describe temporal trends in ASD diagnosis and in perinatal risk factors for ASD across maternal socioeconomic and immigration factors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This is a population-based retrospective cohort study of children born in Ontario, Canada (2002-2020), linked to maternal health, immigration, and census data. Children were followed up from age 1 year until ASD diagnosis, death, out-migration, or April 2020. Data analysis was performed between August 2024 and March 2026.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Maternal socioeconomic indicators (area-level deprivation, ethnic diversity, income, Ontario Drug Benefit enrollment, and rural vs urban residence) and immigration characteristics (immigration status, category, time since immigration, region of origin, and country income level). Perinatal risk factors included maternal diabetes, maternal age 35 years or older, severe maternal morbidity, and prematurity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;ASD was identified using a validated administrative algorithm. Incidence rates were calculated per 10 000 person-years and cumulative incidence per 1000 live births at 8 years. Temporal trends were estimated using negative binomial regression with interaction terms between birth year and covariates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 2 319 302 children (1 188 270 male [51.2%]), 29 374 (1.3%) met ASD criteria, with 80.0% (23 068 children) receiving a diagnosis by age 8 years and 78.5% of cases (23 071 cases) occurring in male children. Diagnosis increased by 10% per birth cohort (95% CI, 10%-11%). Disparities in ASD diagnosis by socioeconomic and immigration characteristics widened across birth cohorts: by the 2012 birth cohort, diagnosis was 2.2-fold (95% CI, 2.0-2.4-fold) higher in the most vs least deprived neighborhoods, 2.0-fold (95% CI, 1.8-2.2-fold) higher in the most vs least ethnically diverse areas, and lower in rural vs urban regions. Diagnosis was 1.4-fold (95% CI, 1.3-1.5-fold) higher among children of immigrant mothers, with the highest rates among mothers from low- and middle-income regions. Diabetes during pregnancy, severe maternal morbidity, and prematurity were more common in marginalized populations, with disparities in maternal diabetes widening over time.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this cohort study of more than 2.3 million mother-child pairs, ASD diagnoses occurred disproportionately among children from socioeconomically disadvantaged and immigrant families, with disparities widening over time. The higher prevalence of maternal diabetes, obstetric complications, and prematurity in these populations may have contributed to these dif","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2637174"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13650662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136861","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}