JAMA Network Open最新文献

{"title":"Asymptomatic Hemorrhagic Events and Functional Outcomes in Acute Stroke: A Secondary Analysis of the DIRECT-MI Randomized Clinical Trial.","authors":"Rundong Chen, Weilong Hua, Yilei Zhang, Yongxin Zhang, Hongjian Zhang, Yongwei Zhang, Jianmin Liu, Pengfei Yang, Xiaoxi Zhang, Lei Zhang","doi":"10.1001/jamanetworkopen.2025.2411","DOIUrl":"10.1001/jamanetworkopen.2025.2411","url":null,"abstract":"<p><strong>Importance: </strong>Asymptomatic hemorrhagic infarction (HI) and subarachnoid hemorrhage (SAH) after endovascular treatment (EVT) for acute ischemic stroke are commonly considered low risk, but their long-term impact on functional outcomes is unclear.</p><p><strong>Objective: </strong>To determine whether asymptomatic HI and SAH are associated with worse 90-day functional recovery in patients with acute ischemic stroke treated with EVT.</p><p><strong>Design, setting, and participants: </strong>This is a secondary analysis of the DIRECT-MT randomized clinical trial, which compared intravenous thrombolysis prior to EVT with EVT alone. The multicenter study was conducted at tertiary hospitals in China between 2016 and 2019 with 90-day follow-up. Trial patients with asymptomatic HI, SAH, or no hemorrhage were included in the present analysis, which was performed in December 2024.</p><p><strong>Exposure: </strong>Asymptomatic HI and SAH detected on follow-up imaging.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the score on the modified Rankin scale (mRS) assessed at 90 days. Secondary analyses categorized mRS scores into thresholds of 0 to 1, 0 to 2, and 0 to 3, representing excellent, good, and favorable recovery, respectively.</p><p><strong>Results: </strong>A total of 490 patients were included (median [IQR] age, 70 [60-76] years; 210 [42.9%] female), with 133 (27.1%) in the asymptomatic HI and SAH group and 357 (72.9%) in the no hemorrhage group. After propensity score matching, the odds ratio of having a worse mRS scores at 90 days in the asymptomatic HI and SAH group compared with the no hemorrhage group was 2.59 (95% CI, 1.45-4.63; P = .001). For binary outcomes, asymptomatic HI and SAH were consistently associated with worse recovery across mRS score thresholds of 0 to 1 and 0 to 2 in all models.</p><p><strong>Conclusions and relevance: </strong>In this secondary analysis of a randomized clinical trial, asymptomatic HI and SAH were associated with worse 90-day functional outcomes in patients with acute ischemic stroke treated with EVT. These findings emphasize the need for close monitoring and tailored management strategies in patients with asymptomatic hemorrhagic events following thrombectomy.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT03469206.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e252411"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11953756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730153","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":"US Population Size and Outcomes of Adults on Liver Transplant Waiting Lists.","authors":"Tomohiro Tanaka, George Wehby, Mark Vander Weg, Keith Mueller, David Axelrod","doi":"10.1001/jamanetworkopen.2025.1759","DOIUrl":"10.1001/jamanetworkopen.2025.1759","url":null,"abstract":"<p><strong>Importance: </strong>Disparities in organ supply and demand led to geographic inequities in the score-based liver transplant (LT) allocation system, prompting a change to allocation based on acuity circles (AC) defined by fixed distances. However, fixed distances do not ensure equivalent population size, potentially creating new sources of disparity.</p><p><strong>Objective: </strong>To estimate the association between population size around LT centers and waiting list outcomes for critically ill patients with chronic end-stage liver disease and high Model for End-stage Liver Disease (MELD) scores or acute liver failure (ALF).</p><p><strong>Design, setting, and participants: </strong>This US nationwide retrospective cohort study included adult (aged ≥18 years) candidates for deceased donor LT wait-listed between June 18, 2013, and May 31, 2023. Follow-up was completed June 30, 2023. Participants were divided into pre-AC and post-AC groups.</p><p><strong>Exposure: </strong>Population size within defined radii around each LT center (150 nautical miles [nm] for participants with high MELD scores and 500 nm for those with ALF) based on AC allocation policy.</p><p><strong>Main outcomes and measures: </strong>LT candidate waiting list mortality and dropout rate were analyzed using generalized linear mixed-effect models with random intercepts for center and listing date before and after AC implementation. Fine-Gray competing risk regression, accounting for clustering, was used as a secondary model.</p><p><strong>Results: </strong>The study analyzed 6142 LT candidates (1581 with ALF and 4561 with high MELD scores) during the pre-AC era and 4344 candidates (749 with ALF and 3595 with high- MELD scores) in the post-AC era, for a total of 10 486 participants (6331 male [60.5%]; mean [SD] age, 48.5 [7.1] years). In the high-MELD cohort, being listed at a center in the lowest tertile of population size was associated with increased waiting list mortality in the AC era (adjusted odds ratio [AOR], 1.68; 95% CI, 1.14-2.46). Doubling of the population size was associated with a 34% reduction in the odds of mortality or dropout (AOR, 0.66; 95% CI, 0.49-0.90). These results were consistent with those of the extended Fine-Gray models and were also corroborated by multiple sensitivity analyses. However, there were no significant population density-associated disparities in the ALF cohort.</p><p><strong>Conclusions and relevance: </strong>In this retrospective nationwide cohort study, being wait-listed in less populated regions was associated with greater mortality among critically ill LT candidates with high MELD scores, underscoring the limitations of allocation systems based purely on fixed distances.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e251759"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11937946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700442","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":"Changes in Respiratory Viral Testing Before and After the COVID-19 Pandemic.","authors":"Todd W Lyons, Caroline G Kahane","doi":"10.1001/jamanetworkopen.2025.0168","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.0168","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250168"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567180","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":"Intentional Weight Loss, Waist Circumference Reduction, and Mortality Risk Among Postmenopausal Women.","authors":"Michael Hendryx, JoAnn E Manson, Robert J Ostfeld, Rowan T Chlebowski, Erin S LeBlanc, Molly E Waring, Wendy E Barrington, Marisa A Bittoni, Sylvia Wassertheil-Smoller, Jackie Gofshteyn Herold, Juhua Luo","doi":"10.1001/jamanetworkopen.2025.0609","DOIUrl":"10.1001/jamanetworkopen.2025.0609","url":null,"abstract":"<p><strong>Importance: </strong>Research investigating weight loss and mortality risk often fails to differentiate between intentional and unintentional weight loss and typically uses body mass index (BMI) as the measure of excess body weight.</p><p><strong>Objective: </strong>To evaluate associations between weight loss and waist circumference (WC) reduction and mortality, considering weight loss intentionality.</p><p><strong>Design, setting, and participants: </strong>This cohort study used data from the Women's Health Initiative Observational Study, which had a prospective cohort with mean follow-up of 18.6 years ending in February 2023. The study included women aged 50 to 79 years at 40 clinical centers in the US. Women with missing data, cancer at baseline, or considered underweight at baseline were excluded. Data were collected from September 1993 to February 2023 and were analyzed from June to December 2024.</p><p><strong>Exposures: </strong>Measured weight loss and WC reduction between baseline and year 3, stratified by women who reported intentional weight loss or not.</p><p><strong>Main outcomes and measures: </strong>Outcomes included adjudicated all-cause, cancer, cardiovascular, and other mortality through the end of follow-up. Cox proportional hazards regression models were used to evaluate the associations (hazard ratios [HRs] and 95% CIs) between weight loss, WC reduction, and mortality over 18.6 years of follow-up.</p><p><strong>Results: </strong>This study included 58 961 women at baseline (mean [SD] age, 63.3 [7.2] years; mean [SD] BMI, 27.0 [5.6]; mean [SD] WC, 84.1 [13.0] cm). As of February 28, 2023, 29 183 women (49.5%) died from all causes. Intentional weight loss measured by questionnaire was associated with lower subsequent mortality rates for all-cause mortality (HR, 0.88; 95% CI, 0.86-0.90), cancer mortality (HR, 0.87; 95% CI, 0.82-0.92), cardiovascular mortality (HR, 0.87; 95% CI, 0.83-0.91), and other mortality (HR, 0.89; 95% CI, 0.86-0.92), comparing loss of 5 pounds or more to stable weight. Reported intentional weight loss coupled with actual weight reduction of 5% or more was associated only with lower cardiovascular mortality (HR, 0.90; 95% CI, 0.81-0.99). Reported intentional weight loss coupled with measured WC loss was associated with lower rates of all-cause mortality (HR, 0.91; 95% CI, 0.86-0.95), cancer mortality (HR, 0.85; 95% CI, 0.76-0.95), and cardiovascular mortality (HR, 0.79; 95% CI, 0.72-0.87). Unintentional weight loss or unintentional WC loss were each associated with increased mortality risk for all groups, as were weight gain and WC gain.</p><p><strong>Conclusions and relevance: </strong>In this cohort study, reported intentional weight loss efforts that were coupled with measured WC reductions were associated with lower risk of all-cause, cancer, and cardiovascular mortality. Attention to diet and exercise that promote reductions in central adiposity should be encouraged.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250609"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567188","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":"Naloxone Knowledge, Carrying, Purchase, and Use.","authors":"Mireille Jacobson, David Powell","doi":"10.1001/jamanetworkopen.2024.62698","DOIUrl":"10.1001/jamanetworkopen.2024.62698","url":null,"abstract":"<p><strong>Importance: </strong>Widespread naloxone access is a key policy response to the opioid crisis. Naloxone availability is typically estimated from pharmacy sales, which exclude naloxone provided by community organizations, hospitals, and clinics, or sold over-the-counter.</p><p><strong>Objective: </strong>To estimate naloxone knowledge, carrying, purchase, and use among US adults.</p><p><strong>Design, setting, and participants: </strong>This survey study included noninstitutionalized adults aged 18 years and older from a national sample and a sample self-reporting opioid dependence. Respondents answered online questions between June 7 and June 29, 2024, about naloxone knowledge, carrying, purchase, and use.</p><p><strong>Exposures: </strong>Opioid misuse, risk of overdose, risk of overdose by person known to respondent.</p><p><strong>Main outcomes and measures: </strong>Naloxone knowledge, prevalence of naloxone carrying, purchase, and administration.</p><p><strong>Results: </strong>The survey included 1515 individuals from a national sample (median [IQR] age, 45 [33-58] years; 770 women [50.8%]; 215 Black [14.2%], 1087 White [71.8%]) and 512 who self-reported opioid dependence. In the national sample, 50 respondents (3.3%) reported opioid dependence, yielding 562 respondents reporting opioid dependence (median [IQR] age, 41 [35-48] years; 404 female [70.2%]; 17 Black [3.0%], 494 White [87.9%]). Overall, 1164 respondents-700 (46.2%) in the national sample and 500 (89.0%) reporting opioid dependence-had heard of naloxone and correctly identified its purpose. One hundred sixty participants (10.6%) in the national sample and 340 participants (60.5%) in the sample reporting opioid dependence reported carrying naloxone. Among those reporting they were \"very likely to overdose,\" 22 respondents (31.0%) in the national sample and 31 (73.8%) with opioid dependence reported carrying naloxone. Among those who know someone very likely to overdose, 43 participants (25.4%) in the national sample and 190 participants (70.1%) reporting opioid dependence reported carrying naloxone. Among those who ever carried naloxone, 108 (42.4%) in the national sample and 97 (22.6%) reporting opioid dependence had ever purchased naloxone. Overall, 128 respondents (8.4%) in the national sample and 267 respondents (47.5%) reporting opioid dependence reported administering naloxone to someone else while 93 (6.1%) in the national sample and 221 (39.3%) reporting opioid dependence reported being administered naloxone.</p><p><strong>Conclusions and relevance: </strong>In this survey study of naloxone, most respondents reporting opioid dependence correctly identified naloxone's purpose and carried it. Most naloxone carried was not purchased, suggesting a need for new ways, including rapid online surveys, to monitor naloxone possession.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e2462698"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542113","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":"Sexual Orientation- and Gender Identity-Affirming Activities Provided in Primary Care.","authors":"Ellesse-Roselee L Akre, Ching-Wen Wendy Yang, Greta R Bauer, Matthew Brian Mackwood, A James O'Malley, Elliott S Fisher, Karen E Schifferdecker","doi":"10.1001/jamanetworkopen.2025.0392","DOIUrl":"10.1001/jamanetworkopen.2025.0392","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Addressing health disparities in lesbian, gay, bisexual, transgender, and queer (LGBTQ+) communities has been a significant policy focus for more than a decade. Ensuring access to safe, respectful primary health care from knowledgeable clinicians is crucial for reducing health inequalities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess the engagement of primary care practices in LGBTQ+ affirming care activities and identify practice characteristics associated with increased engagement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cross-sectional study used data from the National Survey of Healthcare Organizations and Systems II, which focused on primary care practices in the US and was administered between June 2022 through February 2023. Participants were primary care physicians and practice managers. Percentages were weighted for national representation. Data were analyzed from November 2023 to December 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Practice characteristics including practice size, ownership, federally qualified health center (FQHC) designation; percentage of patients enrolled in Medicare; percentage of patients enrolled in Medicaid; having accountable care organization (ACO) contracts for Medicare, Medicaid, or commercial insurance; rurality; census region; and LGBTQ+ Equality Score by state policy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Sexual orientation- and gender identity- (SOGI) affirming activities, a composite variable reflecting activity specific to SOGI patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 1245 practices in the sample (38.4% response rate), 923 (77.40%) collected data on gender identity, 921 (75.62%) on sexual orientation, and 742 (65.83%) on patients' pronouns. Only 412 practices (34.42%) provided LGBTQ+ training for clinicians and 480 practices (39.20%) provided training for staff. Practices designated as FQHCs had 3.16 (95% CI, 4.60 to 19.73) percentage points higher probability of engaging in all SOGI-affirming activities) compared with non-FQHCs (P = .001). Practices with a Medicaid payer mix at least 50% had 3.28 (95% CI, 1.19 to 5.36) percentage points higher probability than practices with less than 50% Medicaid payer mix (P = .002), and participation in a Medicaid ACO was associated with 4.26 (95% CI, 0.78 to 7.73) percentage points increased probability compared with nonparticipants (P = .02). Each 1-unit increase in the state-level LGBTQ+ Equality Score was associated with 1.07 (95% CI, 0.28 to 1.85) percentage points higher probability of engaging in all SOGI-affirming activities (P = .02). High performance was negatively associated with practice rurality (average marginal effect, -16.00 [95% CI, -29.72 to -2.28]; P = .02), and rural practices were less likely to provide appropriate referrals (average marginal effect, -15.47 [95% CI, -29.22 to -1.72]; P = .03).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;These findings suggest there is a","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250392"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11894487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585625","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":"Time From Onset to Diagnosis of Alpha-Gal Syndrome.","authors":"Caroline K Maki, Eleanor F Saunders, Marissa L Taylor, Scott P Commins, Lance A Waller, Johanna S Salzer","doi":"10.1001/jamanetworkopen.2024.61729","DOIUrl":"10.1001/jamanetworkopen.2024.61729","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e2461729"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11894482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585628","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 3.","authors":"","doi":"10.1001/jamanetworkopen.2025.4939","DOIUrl":"10.1001/jamanetworkopen.2025.4939","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e254939"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11897830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605059","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":"Emergency Care, Hospitalization Rates, and Floods.","authors":"Zachary S Wettstein, Canada Parrish, Amber K Sabbatini, Matthew H Rogers, Edmund Seto, Jeremy J Hess","doi":"10.1001/jamanetworkopen.2025.0371","DOIUrl":"10.1001/jamanetworkopen.2025.0371","url":null,"abstract":"<p><strong>Importance: </strong>Flooding is a major environmental hazard, with events increasing in intensity and frequency in the context of climate change. Floods cause significant health and economic impacts, particularly among vulnerable populations, including older adults. However, comprehensive analyses of the health consequences of flooding remain limited.</p><p><strong>Objective: </strong>To evaluate the morbidity and health care costs among Medicare beneficiaries associated with flood exposure in the US.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study analyzed emergency department (ED) use and unplanned hospitalization among Medicare beneficiaries 65 years or older living in zip code tabulation areas (ZCTAs) that were exposed to large-scale flood events from January 1, 2008, to December 31, 2017. This analysis was conducted from April 3 to December 15, 2023.</p><p><strong>Exposure: </strong>The primary exposure was the presence of a flood as recorded in the Multisourced Flood Inventories, a spatially distributed flood database.</p><p><strong>Main outcomes and measures: </strong>A conditional fixed-effects regression approach was used to explore the incidence of all-case and cause-specific ED visits and hospitalizations before and after floods. The primary outcomes measured were the incident rate ratios (IRRs) and associated 95% CIs. Attributable risk percentages and estimated attributable excess visits were calculated. Stratified analyses were performed for evaluation of effect modification. Health care costs associated with these events were measured and standardized to 2017 US dollars.</p><p><strong>Results: </strong>Among 11 801 527 Medicare beneficiaries 65 years or older (mean [SD] age, 74.4 [7.6] years; 56.3% female), the rate of all-cause ED visits and hospital admissions increased by 4.8% (IRR, 1.05; 95% CI, 1.04-1.05) and 7.4% (IRR, 1.07; 95% CI, 1.07-1.08) after flood exposure, respectively. The mean ZCTA-level cost was $3230 (95% CI, $3198-$3261) per ED visit and $11 310 (95% CI, $11 252-$11 367) for hospitalizations. The national costs to the Medicare system were estimated to be $69 275 429 (95% CI, $63 010 840-$76 315 210) for ED visits and $191 409 579 (95% CI, $172 782 870-$206 181 300) for hospitalizations. Stratified analyses highlighted greater impacts for certain demographic groups, including adults older than 85 years, and specific seasonal patterns.</p><p><strong>Conclusions and relevance: </strong>In this cohort study of Medicare beneficiaries 65 years or older, flood exposure was associated with increased health care use and costs, underscoring the need for targeted public health strategies and improved disaster preparedness, especially for older adults. These findings contribute to a more comprehensive understanding of the health-related costs of flooding and can be used to inform future climate change resilience and health care planning.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250371"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11894485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584860","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":"From Gestational Diabetes to Type 2 Diabetes-Is Poor Sleep to Blame?","authors":"Christian Benedict, Marie-Pierre St-Onge","doi":"10.1001/jamanetworkopen.2025.0149","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.0149","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250149"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556973","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}