JAMA Network Open最新文献

{"title":"Variation in Case Exposure During Internal Medicine Residency.","authors":"Andrew C L Lam, Brandon Tang, Chang Liu, Marwa F Ismail, Surain B Roberts, Matthew Wankiewicz, Anushka Lalwani, Daniel Schumacher, Benjamin Kinnear, Amol A Verma, Fahad Razak, Brian M Wong, Shiphra Ginsburg","doi":"10.1001/jamanetworkopen.2024.50768","DOIUrl":"10.1001/jamanetworkopen.2024.50768","url":null,"abstract":"<p><strong>Importance: </strong>Variation in residency case exposure affects resident learning and readiness for future practice. Accurate reporting of case exposure for internal medicine (IM) residents is challenging because feasible and reliable methods for linking patient care to residents are lacking.</p><p><strong>Objective: </strong>To develop an integrated education-clinical database to characterize and measure case exposure variability among IM residents.</p><p><strong>Design, setting, and participants: </strong>In this cohort study, an integrated educational-clinical database was developed by linking patients admitted during overnight IM in-hospital call shifts at 5 teaching hospitals to senior on-call residents. The senior resident, who directly cares for all overnight IM admissions, was linked to their patients by the admission date, time, and hospital. The database included IM residents enrolled between July 1, 2010, and December 31, 2019, in 1 Canadian IM residency. Analysis occurred between August 1, 2023, and June 30, 2024.</p><p><strong>Main outcomes and measures: </strong>Case exposure was defined by patient demographic characteristics, discharge diagnoses, volumes, acuity (eg, critical care transfer), medical complexity (eg, Charlson Comorbidity Index), and social determinants of health (eg, from long-term care). Residents were grouped into quartiles for each exposure measure, and the top and bottom quartiles were compared using standardized mean difference (SMD). Variation between hospitals was evaluated by calculating the SMD between the hospitals with the highest and lowest proportions for each measure. Variation over time was assessed using linear and logistic regression.</p><p><strong>Results: </strong>The integrated educational-clinical database included 143 632 admissions (median [IQR] age, 71 [55-83] years; 71 340 [49.7%] female) linked to 793 residents (median [IQR] admissions per shift, 8 [6-12]). At the resident level, there was substantial variation in case exposure for demographic characteristics, diagnoses, volumes, acuity, complexity, and social determinants. For example, residents in the highest quartile had nearly 4 times more admissions requiring critical care transfer compared with the lowest quartile (3071 of 30 228 [10.2%] vs 684 of 25 578 [2.7%]; SMD, 0.31). Hospital-level variation was also significant, particularly in patient volumes (busier hospital vs less busy hospital: median [IQR] admissions per shift, 10 [8-12] vs 7 [5-9]; SMD, 0.96). Over time, residents saw more median (IQR) admissions per shift (2010 vs 2019: 7.6 [6.6-8.4] vs 9.0 [7.6-10.0]; P = .04) and more complex patients (2010 vs 2019: Charlson Comorbidity Index ≥2, 3851 of 13 762 [28.0%] vs 2862 of 8188 [35.0%]; P = .03), while working similar shifts per year (median [IQR], 11 [8-14]).</p><p><strong>Conclusions: </strong>In this cohort study of IM residents in a Canadian residency program, significant variation in case exposure was found be","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2450768"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11656263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846698","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":"Ticagrelor vs Prasugrel for Acute Coronary Syndrome in Routine Care.","authors":"Nils Krüger, Johannes Krefting, Thorsten Kessler, Raphael Schmieder, Fabian Starnecker, Alexander Dutsch, Christian Graesser, Ulrike Meyer-Lindemann, Theresa Storz, Irina Pugach, Christian Frieß, Zhifen Chen, Dario Bongiovanni, Iulian Manea, Tobias Dreischulte, Frank Offenborn, Peter Krase, Hendrik B Sager, Jens Wiebe, Sebastian Kufner, Erion Xhepa, Michael Joner, Teresa Trenkwalder, Ulrich Gueldener, Adnan Kastrati, Salvatore Cassese, Heribert Schunkert, Moritz von Scheidt","doi":"10.1001/jamanetworkopen.2024.48389","DOIUrl":"10.1001/jamanetworkopen.2024.48389","url":null,"abstract":"<p><strong>Importance: </strong>In patients with acute coronary syndrome (ACS) undergoing invasive treatment, ticagrelor and prasugrel are guideline-recommended P2Y12 receptor inhibitors. The ISAR-REACT5 randomized clinical trial demonstrated superiority for prasugrel, although concerns were raised about the generalizability of some underpowered subgroup analyses.</p><p><strong>Objectives: </strong>To emulate a randomized clinical trial evaluating the safety and effectiveness of ticagrelor vs prasugrel under the conditions of routine care in individuals with ACS planned to undergo an invasive treatment strategy.</p><p><strong>Design, setting, and participants: </strong>This new-user cohort study included secondary data from a German statutory health insurance claims database between January 2012 and December 2021, using 1:1 propensity score nearest-neighbor matching to emulate ISAR-REACT5. Individuals with ACS receiving either ticagrelor or prasugrel treatment after hospital discharge were followed up for 1 year. Eligibility criteria closely emulated those of ISAR-REACT5 and included age of 18 years or older and cardiovascular risk factors. Data were analyzed from May 2023 to May 2024.</p><p><strong>Exposure: </strong>Outpatient prescription of ticagrelor or prasugrel.</p><p><strong>Main outcomes and measures: </strong>The primary end point was the composite of all-cause mortality, myocardial infarction (MI), or stroke within 1 year of outpatient treatment initiation. Secondary end points included individual components of the primary end point and stent thrombosis. The safety end point was major bleeding. A Cox proportional hazards regression model was fitted to the overall cohort.</p><p><strong>Results: </strong>Of 17 642 propensity score-matched individuals (mean [SD] age, 63.1 [10.9] years; 73.9% male), 8821 received ticagrelor and 8821 received prasugrel. Agreement was met in 11 of 12 predefined agreement metrics when comparing the results with ISAR-REACT5. The primary composite end point of all-cause mortality, MI, or stroke occurred in 815 individuals (9.2%) receiving ticagrelor and 663 (7.5%) receiving prasugrel (hazard ratio [HR], 1.24; 95% CI, 1.12-1.37). Myocardial infarction (HR, 1.20; 95% CI, 1.06-1.36) and stroke (HR, 1.33; 95% CI, 1.02-1.74) each occurred significantly more often in the ticagrelor group. Analysis of all-cause mortality (HR, 1.27; 95% CI, 0.99-1.64), stent thrombosis (HR, 1.11; 95% CI, 0.89-1.30), and major bleeding (HR, 1.12; 95% CI, 0.96-1.32) revealed no significant differences between treatment groups. Subgroup analysis showed that prasugrel was associated with the primary composite end point in fewer individuals with ST-segment elevation MI (338 of 4941 [6.8%] vs 451 of 4852 [9.3%]).</p><p><strong>Conclusions and relevance: </strong>This cohort study found that prasugrel was associated with lower rates of all-cause mortality, MI, or stroke compared with ticagrelor in individuals with ACS undergoing an invasive t","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2448389"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11612834/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768940","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":"Challenges of Surveillance in Implementing Nonoperative Management for Rectal Cancer.","authors":"Bailey K Hilty Chu, Anthony Loria, Totadri Dhimal, Xueya Cai, Shan Gao, Yue Li, Larissa K Temple, Fernando Colugnati, Paula Cupertino, Erika E Ramsdale, Fergal J Fleming","doi":"10.1001/jamanetworkopen.2024.48682","DOIUrl":"10.1001/jamanetworkopen.2024.48682","url":null,"abstract":"<p><strong>Importance: </strong>Close surveillance for detection of local tumor regrowth is critical for patients opting for nonoperative management after neoadjuvant therapy for rectal cancer. However, there are minimal data regarding the feasibility and adherence to National Comprehensive Cancer Network (NCCN) surveillance guidelines for these patients.</p><p><strong>Objective: </strong>To determine adherence rates to NCCN-recommended surveillance in patients undergoing nonoperative management for rectal cancer.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study included patients treated at a single academic center (University of Rochester, Rochester, New York) from 2012 to 2023, with analysis completed from March through May 2024. Patients with clinical stage I to III rectal cancer who underwent treatment with neoadjuvant therapy, achieved a clinical complete response (or initially near complete clinical response), and elected for nonoperative management were enrolled.</p><p><strong>Exposure: </strong>Achievement of recommended surveillance.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was adherence to surveillance guidelines for patients undergoing nonoperative management for rectal cancer. Secondary outcomes included assessment of oncologic outcomes stratified by adherence to surveillance.</p><p><strong>Results: </strong>Eighty-five patients (54 male [63.5%]; median [IQR] age, 63.0 [54.0-73.0] years) were managed nonoperatively and followed for a median of 4.04 years (95% CI, 3.17-4.58 years). The 5-year overall survival was 82.3% (95% CI, 71.8%-94.5%), the 5-year disease-specific survival was 95.1% (95% CI, 89.6%-100.0%), the rate of local regrowth was 24.7% (21 patients), and the rate of distant metastases was 12.9% (11 patients). Among the 77 patients with more than 6 months of follow-up in their first year of surveillance, only 39.0% of patients (30 patients) achieved NCCN-recommended surveillance in the first year, and this decreased to 15.0% (3 patients) by year 5. However, the time to local regrowth and distant metastasis were similar regardless of the level of surveillance.</p><p><strong>Conclusions and relevance: </strong>In this cohort study of patients with rectal cancer undergoing surveillance after nonoperative management, most did not achieve NCCN-recommended guidelines, although outcomes were not associated with surveillance intensity. This highlights the need for prospective evaluation of a surveillance regimen that is both feasible for patients and health care systems increasingly using nonoperative management. In addition, studies are warranted to explore patient preferences in rectal cancer care and to identify barriers to optimal surveillance.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2448682"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11615709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769102","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":"Redesigning the Hospital Environment to Improve Restfulness.","authors":"Caellagh D Catley, Kayla Paynter, Kendall Jackson, Ashley Huggins, Jenny Ji, Sai Anusha Sanka, Michelle Simkins, Thomas M Maddox, Patrick G Lyons","doi":"10.1001/jamanetworkopen.2024.47790","DOIUrl":"10.1001/jamanetworkopen.2024.47790","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Hospital wards are often not conducive to patient sleep, negatively affecting patient health and experience.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess determinants of in-hospital restfulness and to design and test rest-promoting interventions on the wards in partnership with clinicians, staff, and patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This rapid-sequential mixed-methods quality improvement study was performed at a large urban academic hospital in St Louis, Missouri, from May 1, 2021, to December 31, 2022, with follow-up through hospitalization. Mixed-methods activities involved purposively selected hospitalized adults on the wards, nurses, hospitalists, and hospital staff. Interventions included all adult hospitalizations on the study wards.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;Sequential stacked bundles of multimodal rest-promoting interventions (general education, focused education on light or noise, safely reducing overnight monitoring or testing, and environmental personalization).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measurements: &lt;/strong&gt;Pre-post comparisons of perceived nighttime quietness (via surveys) and sleep opportunity (coprimary outcomes) as well as clinical interruptions overnight, environmental noise, and adoption and satisfaction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Nine patients (4 female) and 14 staff members (10 female; 3 nurse managers or administrators, 10 nurses, and 1 physician) were interviewed, 38 surveys were collected, and more than 100 hours of observation were performed. Interventions were evaluated for 671 patients (mean [SD] age, 60 [16] years; 336 [50%] female). Determinants of in-hospital rest included infrastructure, staff attitudes, priorities, culture, and patient experiences of anxiety, uncertainty, and loss of control. Informed by these determinants, codesign workshops yielded 39 potential interventions, from which 9 were selected for testing. Related interventions were organized into bundles, which were tested in sequential 2-week sprints. Perceived nighttime quietness improved nonsignificantly during the project (wards \"always\" quiet at night: 51% preintervention vs 86% postintervention; P = .09), with excessive noise events decreasing from 0.65 (95% CI, 0.53-0.77) to 0 per 100 patient-nights before the intervention (P = .02). Sleep opportunity improved significantly (mean, 4.94 [95% CI, 4.82-5.06] hours per patient-night before the intervention vs 5.10 [95% CI, 5.00-5.20] hours per patient-night after the intervention; P = .01).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this quality improvement study, a set of feasible, acceptable, and beneficial rest-promoting interventions were developed. After implementation of these interventions on the wards, a significant improvement in nighttime quietness and sleep opportunity was observed. These results demonstrate how human-centered design methods can generate practical and effective strategies ","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2447790"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11618460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769169","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":"Glycemic Control With Layperson-Delivered Telephone Calls vs Usual Care for Patients With Diabetes: A Randomized Clinical Trial.","authors":"Maninder K Kahlon, Nazan S Aksan, Rhonda Aubrey, Nicole Clark, Maria Cowley-Morillo, Carolina DuBois, Carlos Garcia, Julia Guerra, David Pereira, Mathew Sither, Steven Tomlinson, Sandy Valenzuela, M Renee Valdez","doi":"10.1001/jamanetworkopen.2024.48809","DOIUrl":"10.1001/jamanetworkopen.2024.48809","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Diabetes is associated with emotional distress and poor mental health, especially for individuals with low income, hindering patients' ability to manage their condition. The health care system's workforce constraints limit its capacity to holistically support patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess the effectiveness of layperson-delivered empathetic engagement over the telephone in helping improve glycemic management for patients with diabetes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This parallel-arm randomized clinical trial with blinded outcome assessment was conducted from February 12, 2022, to April 15, 2023, with final measurements on November 18, 2023, among 260 patients with uncontrolled diabetes from a federally qualified health center in Austin, Texas, engaging telephonically from home.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Intervention: &lt;/strong&gt;Patients assigned to the intervention group received empathy-oriented telephone calls by community-hired laypeople for 6 months, while those assigned to the control group received usual care. Patients were stratified by baseline score (≥5 vs &lt;5) on the depressive symptom scale of the 9-item Patient Health Questionnaire (PHQ-9).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcome was hemoglobin A1c level at baseline, 3 months, and 6 months, assessed for interaction between time and trial arm. Secondary outcomes were self-perceptions of managing diabetes, diabetes-related behaviors and distress, and mental health symptoms (measured via surveys). Analysis was performed on an intention-to-treat basis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 260 participants (mean [SD] age, 49.5 [10.1] years; 163 of 259 women [62.9%]; 176 of 203 [86.7%] with annual income &lt;$40 000) enrolled, 6 withdrew. At 6 months, 204 of 254 (80.3%; intervention, 109 of 127 [85.8%] and control, 95 of 127 [74.8%]) returned for measurements. Participants in the intervention group had statistically significant mean (SD) decreases in hemoglobin A1c level at 6 months (from 10.0% [1.9%] to 9.3% [2.0%]) compared with those in the control group (from 9.8% [1.6%] to 9.7% [2.3%]) (P = .004). The within-person change in hemoglobin A1c level was -0.7% (95% CI, -1.0% to -0.4%) for the intervention group and 0.02% (95% CI, -0.4% to 0.4%) for the control group. For the subgroup with a PHQ-9 score of 5 or more at baseline (38.1% [99 of 260]), the within-person change in hemoglobin A1c was -1.1% (95% CI, -1.8% to -0.5%) for the intervention group and 0.1% (95% CI, -0.7% to 0.8%; P = .004) for the control group. For the subgroup with a PHQ-9 score less than 5, the within-person change in hemoglobin A1c was -0.4% (95% CI, -0.8% to -0.1%) for the intervention group and -0.02% (95% CI, -0.5% to 0.5%; P = .21) for the control group. At 6 months, 91.7% of the participants (99 of 108) responded that the program was very or extremely beneficial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2448809"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142800790","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":"Comparative Analysis of Indices for Social Determinants of Health in Pediatric Surgical Populations.","authors":"Caroline Q Stephens, Ava Yap, Lan Vu, Jacqueline M Saito, Dwight Barry, Amy M Shui, Hannah Cockrell, Sarah Cairo, Derek Wakeman, Loren Berman, Sarah Greenberg, Allison F Linden, Jonathan Kohler, KuoJen Tsao, Nicole A Wilson","doi":"10.1001/jamanetworkopen.2024.49672","DOIUrl":"10.1001/jamanetworkopen.2024.49672","url":null,"abstract":"<p><strong>Importance: </strong>Conclusions vary substantially among studies examining associations between area-based social determinants of health (SDOH) and pediatric health disparities based on the selected patient population and SDOH index. Most national studies use zip codes, which encompass a wide distribution of communities, limiting the generalizability of findings.</p><p><strong>Objectives: </strong>To characterize the distributions of composite SDOH indices for pediatric surgical patients within a national sample of academic children's hospitals and to assess SDOH index precision in classifying patients at similar levels of disadvantage.</p><p><strong>Design, setting, and participants: </strong>This multicenter retrospective cohort study included patients younger than 18 years who underwent surgery from January 1, 2016, to December 31, 2021, at 8 American College of Surgeons National Surgical Quality Improvement Program Pediatric children's hospitals. Data were analyzed November 15, 2023, to September 25, 2024.</p><p><strong>Exposures: </strong>Exposures included the Social Vulnerability Index (SVI), Area Deprivation Index (ADI), and Child Opportunity Index (COI), which are composite scores of SDOH factors within a geographic area. A standardized, high-fidelity process was developed to link individual patients to SDOH indices at the US census tract and census block group level.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was composite SDOH index distribution, which was assessed using interrater reliability scores. Substantial agreement was defined as a Cohen κ statistic higher than 0.60.</p><p><strong>Results: </strong>Of 55 865 included patients, 54.6% were male; 34.8% were infants and toddlers (0-3 years of age), 39.0% were school age (4-12 years), and 26.2% were adolescents (13-17 years). A total of 3468 patients (6.2%) could not be matched to either an SVI, ADI, or COI. Patients with missing geocodes were more likely to be Hispanic (20.1% vs 17.1%; P < .001) and have Medicaid insurance (48.1% vs 44.6%; P < .001) compared with patients with addresses that could be geocoded. With all institutions grouped, SDOH indices showed only minor variations. However, within each institution and among institutions, indices varied considerably, especially the ADI. Indices had low-to-fair interrater reliability within institutions (κ range, 0.15-0.33), indicating that each index classified individual patients differently according to disadvantage.</p><p><strong>Conclusions and relevance: </strong>In this multicenter retrospective cohort study of 55 865 pediatric surgical patients, 3 different composite measures of SDOH classified disadvantage for individual patients differently. The SDOH index components should be understood and carefully considered prior to inclusion of a composite measure in the analysis of children's surgical outcomes.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2449672"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142800777","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":"Loneliness and Social and Emotional Support Among Sexual and Gender Minority Caregivers.","authors":"Zhigang Xie, Hanadi Hamadi, Kassie Terrell, Laggy George, Jennifer Wells, Jiaming Liang","doi":"10.1001/jamanetworkopen.2024.51931","DOIUrl":"10.1001/jamanetworkopen.2024.51931","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Sexual and gender minority (SGM) adults in the US are more likely than their non-SGM counterparts to provide informal care to their family members and/or friends. Caregiving can impose substantial physical, mental, and social connection issues on caregivers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To examine the associations among loneliness, lack of social and emotional support, sexual orientation, gender identity, and informal caregiving status.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This population-based, cross-sectional study used data from the 2022 Behavioral Risk Factor Surveillance System collected from noninstitutionalized US civilian residents aged 18 years or older. Data analysis was conducted from June to July 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary dependent variables included self-reported dichotomized (yes vs no) loneliness and lack of social and emotional support. The primary independent variables were sexual orientation (straight, gay or lesbian, bisexual, or something else), gender identity (cisgender and transgender), and informal caregiving status (yes vs no). A binomial distribution and log link function were used to derive adjusted prevalence ratios (APRs) and their respective 95% CIs for each outcome measure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The analytic sample included 43 693 US adults (23 223 [51.6%] female at birth). In multivariable regression analyses adjusting for sociodemographic and health factors, among caregivers only, and compared with straight individuals, loneliness was significantly more likely among lesbian or gay individuals (APR, 1.30; 95% CI, 1.11-1.51), bisexual individuals (APR, 1.26; 95% CI, 1.12-1.43), and those who identify as something else (APR, 1.26; 95% CI, 1.09-1.46). Similarly, for noncaregivers, lesbian or gay individuals (APR, 1.34; 95% CI, 1.15-1.57), bisexual individuals (APR, 1.47; 95% CI, 1.34-1.61), and individuals identifying as something else (APR, 1.41; 95% CI, 1.25-1.58) experienced significantly higher risk of loneliness than straight noncaregivers. Transgender caregivers were more likely than cisgender caregivers to report loneliness (APR, 1.34; 95% CI, 1.24-1.46). In terms of lack of social and emotional support, bisexual caregivers (APR, 1.21; 95% CI, 1.00-1.48) and caregivers identifying as something else (APR, 1.34; 95% CI, 1.09-1.66) were significantly more likely than straight caregivers to report a lack of social and emotional support. Similarly, both bisexual noncaregivers (APR, 1.44; 95% CI, 1.28-1.63) and noncaregivers identifying as something else (APR, 1.38; 95% CI, 1.18-1.61) experienced a significantly higher risk of lacking support compared with straight noncaregivers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this cross-sectional study of social connections, SGM adults experienced significantly higher levels of loneliness compared with straight adults, irrespective of caregiving status","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2451931"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11645647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818214","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":"New Studies of Juvenile Idiopathic Arthritis-Complex Genetics of Complex Diseases.","authors":"Robert D Blank","doi":"10.1001/jamanetworkopen.2024.51350","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2024.51350","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2451350"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Error in Abstract, Results, and Supplement 1.","authors":"","doi":"10.1001/jamanetworkopen.2024.56980","DOIUrl":"10.1001/jamanetworkopen.2024.56980","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2456980"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11659905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854249","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.","authors":"","doi":"10.1001/jamanetworkopen.2024.56651","DOIUrl":"10.1001/jamanetworkopen.2024.56651","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2456651"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11659915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854252","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}