JAMA Network Open最新文献

{"title":"Comorbidity in Midlife and Cancer Outcomes.","authors":"Jessica A Lavery, Paul C Boutros, Chaya S Moskowitz, Lee W Jones","doi":"10.1001/jamanetworkopen.2025.3469","DOIUrl":"10.1001/jamanetworkopen.2025.3469","url":null,"abstract":"<p><strong>Importance: </strong>Comorbidities in midlife are common but how these conditions are associated with cancer outcomes is poorly understood.</p><p><strong>Objective: </strong>To investigate the association between different comorbidities and risk of incident cancer and cancer mortality.</p><p><strong>Design, setting, and participants: </strong>This cohort study is a secondary analysis of the prospective Prostate, Lung, Colorectal, and Ovarian (PLCO) screening trial conducted at 10 PLCO screening centers across the US. Participants included adults aged 55 to 74 years without a history of cancer enrolled between 1993 and 2001. Statistical analysis was performed from June 2023 to December 2024.</p><p><strong>Exposures: </strong>Self-reported history of 12 comorbid conditions classified into 5 distinct classifications guided by World Health Organization categorization.</p><p><strong>Main outcome and measures: </strong>Outcomes included risk of all cancers combined, risk of 19 individual cancer types, and cancer mortality. Multivariable Cox proportional hazards models were used to estimate the association between comorbidity classifications and cancer outcomes.</p><p><strong>Results: </strong>Among 128 999 participants included in the analysis, 330 (0.3%) were American Indian, 5414 (4.2%) were Asian or Pacific Islander, 6704 (5.2%) were non-Hispanic Black, and 114 073 (88.4%) were non-Hispanic White; 64 171 (49.7%) were male; and the median (IQR) age was 62 (58-66) years. After a median (IQR) follow-up of 20 (19-22) years, the risk of any incident cancer was significantly higher for individuals with a history of respiratory (hazard ratio [HR], 1.07 [95% CI, 1.02-1.12]) and cardiovascular conditions (HR, 1.02 [95% CI, 1.00-1.05]). History of each comorbid condition evaluated was significantly associated with incidence of at least 1 cancer type. The strongest association was between history of liver conditions and risk of liver cancer (HR, 5.57 [95% CI, 4.03-7.71]), whereas metabolic conditions (obesity or type 2 diabetes) were significantly associated with higher risk of 9 cancer types and lower risk of 4 cancer types. Respiratory (HR, 1.19 [95% CI, 1.11-1.28]), cardiovascular (HR, 1.08 [95% CI, 1.04-1.13]), and metabolic (HR, 1.09 [95% CI, 1.05-1.14]) conditions were positively associated with a higher hazard of cancer death.</p><p><strong>Conclusions and relevance: </strong>In this cohort study of 128 999 adults without a history of cancer, comorbidities in midlife were associated with the overall risk of cancer and more strongly associated with risk of multiple individual cancer types, with the direction of association differing across cancer types. These results may inform clinical management of patients at risk for cancer.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e253469"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795618","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":"Multimodal Monitoring of Hemodynamics in Neonates With Extremely Low Gestational Age: A Randomized Clinical Trial.","authors":"Renjini Lalitha, Eyad Bitar, Matthew Hicks, Aimann Surak, Abbas Hyderi, Dawn Pepper, Po Yin Cheung, Kumar Kumaran","doi":"10.1001/jamanetworkopen.2025.4101","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.4101","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Evaluation and treatment of transitional circulation in neonates with extremely low gestational age (ELGA) varies greatly across centers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To determine whether multimodal hemodynamic monitoring in neonates with ELGA during the transitional period (first 72 hours of life) will improve cardiorespiratory-kidney health by decreasing vasoactive-ventilation-renal (VVR) score at 7 days.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This unmasked, 2-arm randomized clinical trial included neonates born at a gestational age of 230 to 286 weeks and admitted to a neonatal unit in Canada. Patients were enrolled from February 15, 2019, to December 31, 2021, with follow-up completed in April 2022.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;Neonates in the multimodal arm received early targeted neonatal echocardiography at 18 to 24 and 66 to 72 hours of life and cerebral near-infrared spectroscopy (NIRS) for the first 72 hours. A study guideline incorporating clinical-biochemical and cerebral near-infrared spectroscopy data was used for hemodynamic consultation in the multimodal arm. Neonates in the standard arm received hemodynamic assessment using clinical-biochemical data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome and measures: &lt;/strong&gt;The primary outcome was VVR score at 7 days. The VVR score incorporates measures of inotrope use, ventilation support, and kidney function to reflect cardiorespiratory-kidney health, with possible scores ranging from 0 to 69.62 at 7 days; higher scores indicate worse cardiorespiratory-kidney health.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Primary analysis included 132 neonates with ELGA (68 in the multimodal arm and 64 in the standard arm) with mean (SD) gestational age of 26.4 (1.5) weeks (75 [56.8%] male). The mean (SD) VVR score at 7 days was 16.5 (15.4) in the multimodal arm and 18.9 (20.2) in the standard arm (P = .45). A day 7 peak VVR score greater than 53 (&gt;95th percentile for VVR in the entire cohort) was seen only in the standard arm (7 of 63 [11.1%] vs 0 in the multimodal arm; P = .005) and was associated with a composite outcome of death or severe intraventricular hemorrhage (odds ratio [OR], 12.37; 95% CI, 1.92-79.63; P = .001) and bronchopulmonary dysplasia (BPD) (6 of 6 [100%] vs 55 of 116 [47.4%]; P = .01). Incidence of BPD was lower in the multimodal arm (26 of 63 [41.3%] vs 36 of 61 [59.0%]; P = .04). Logistic regression showed that VVR score at 7 days in the top quartile (adjusted OR [AOR], 11.40; 95% CI, 2.04-63.67), late sepsis (AOR, 65.24; 95% CI, 5.70-748.18), and patent ductus arteriosus treatment after 72 hours of life vs early or no treatment needed (AOR, 7.20; 95% CI, 1.60-32.41) were associated with BPD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this study of neonates with ELGA, multimodal hemodynamic assessment was not associated with decreased VVR scores at 7 days. However, this approach led to lower incidence of VVR associated with sever","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e254101"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811477","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":"Cytochrome P450 2C19 Genotypes and Clopidogrel in Patients With Ischemic Stroke: A Nonrandomized Clinical Trial.","authors":"Yo Han Jung, Tae-Jin Song, Jinkwon Kim, Hee-Kwon Park, Sang Won Han, Young Dae Kim, Jong-Ho Park, Jae-Kwan Cha, Hyun Young Park, Sung-Il Sohn, Sungwook Yu, Jun Hong Lee, Dong Hoon Shin, Eung-Gyu Kim, Hye Sun Lee, Kyung-Yul Lee","doi":"10.1001/jamanetworkopen.2025.0398","DOIUrl":"10.1001/jamanetworkopen.2025.0398","url":null,"abstract":"<p><strong>Importance: </strong>Cytochrome P450 2C19 (CYP2C19) genotypes influence the antiplatelet effectiveness of clopidogrel by affecting its conversion to its active metabolite. However, evidence from prospective trials regarding the effects of CYP2C19 genotypes on the role of clopidogrel preventing cardiovascular events among patients with acute ischemic stroke remains limited.</p><p><strong>Objective: </strong>To investigate the association of the CYP2C19 genotypes with the clinical prognosis of patients with acute ischemic stroke treated with clopidogrel.</p><p><strong>Design, setting, and participants: </strong>A prospective, nonrandomized clinical trial was conducted from September 1, 2019, to January 27, 2023, at 37 clinical sites in South Korea. Patients who received clopidogrel within 72 hours of experiencing an acute ischemic stroke were included.</p><p><strong>Interventions: </strong>Patients were classified using CYP2C19 genotyping into carrier and noncarrier of CYP2C19 loss-of-function (LOF) allele. Clopidogrel treatment was maintained throughout the study period.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the difference in the risk of cardiovascular events (including ischemic or hemorrhagic stroke, myocardial infarction, or cardiovascular death) within 6 months after an ischemic stroke between patients who were carriers or noncarriers of the CYP2C19 LOF allele. The primary safety outcomes were the differences in all-cause mortality and the occurrence of major bleeding. Intention-to-treat analysis was performed.</p><p><strong>Results: </strong>Overall, 2925 patients were enrolled in the PLATELET trial. The mean (SD) age of the participants was 65.3 (12.4) years, and 1928 (66.3%) were men. Among these patients, 15 were excluded. Of the remaining 2910 patients, 61.3% were classified as poor or intermediate metabolizers and 38.7% as extensive metabolizers. The primary outcome occurred more frequently in carriers of the LOF CYP2C19 allele than in noncarriers (2.7% [49 of 1785] vs 1.6% [18 of 1125]; log-rank P = .048). No significant differences were observed between CYP2C19 LOF allele carriers and noncarriers regarding the occurrence of major bleeding (0.6% [11 of 1785] vs 0.8% [9 of 1125]; P = .56) and all-cause mortality (0.3% [5] vs 0.1% [1]; P = .27).</p><p><strong>Conclusions and relevance: </strong>In this prospective nonrandomized clinical trial, carriers of the CYP2C19 LOF allele genotype exhibited a higher likelihood of experiencing cardiovascular events.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT04072705.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e250398"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11971672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780086","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":"Postpandemic Surges Proving the Mettle of Group A Streptococcus-Rising to the Occasion.","authors":"Anthony R Flores","doi":"10.1001/jamanetworkopen.2025.2872","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.2872","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e252872"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752738","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":"Kawasaki Disease and Anti-Inflammatory Doses of Aspirin-A Complicated Relationship.","authors":"Matthew D Elias","doi":"10.1001/jamanetworkopen.2025.3073","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.3073","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e253073"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772459","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":"Invasive Group A Streptococcal Infection in Children, 1992-2023.","authors":"Halima Dabaja-Younis, Christopher Kandel, Karen Green, Jennie Johnstone, Zoe Zhong, Caroline Kassee, Vanessa Allen, Irene Armstrong, Mahin Baqi, Kevin Barker, Ari Bitnun, Sergio Borgia, Aaron Campigotto, Sumon Chakrabarti, Wayne L Gold, Alyssa Golden, Ian Kitai, Julianne Kus, Liane Macdonald, Irene Martin, Matthew Muller, Jeya Nadarajah, Krystyna Ostrowska, Daniel Ricciuto, David Richardson, Medina Saffie, Manal Tadros, Gregory Tyrrell, Monali Varia, Huda Almohri, Shiva Barati, Gloria Crowl, Lubna Farooqi, Maxime Lefebvre, Angel Xinliu Li, Nadia Malik, Mare Pejkovska, Asfia Sultana, Tamara Vikulova, Kazi Hassan, Agron Plevneshi, Allison McGeer","doi":"10.1001/jamanetworkopen.2025.2861","DOIUrl":"10.1001/jamanetworkopen.2025.2861","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;The resurgence of invasive group A streptococcal (iGAS) infections and progress in GAS vaccine development emphasize the importance of understanding current trends in the epidemiology of iGAS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To describe the epidemiology of pediatric iGAS over a 32-year period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This case series uses population-based surveillance data for iGAS in Toronto and Peel Region, Canada, including emm typing from Canada's National Microbiology Laboratory and population data from Statistics Canada. All children (age &lt;18 years) with iGAS from January 1, 1992, to December 31, 2023, were included. Data were analyzed from July 15, 2023, to September 1, 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Outcomes of interest were disease incidence over time and by age; variation in clinical presentation, disease severity, outcomes and infecting emm types; and antimicrobial resistance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Overall, 498 iGAS cases (300 [60.2%] male; median [IQR] age, 5.1 [2.7-8.6] years) occurred, including 151 (30.7%) in children with comorbidities. The most common presentations were soft tissue infection (140 cases [28.1%]) and bacteremia without focus (131 cases [26.3%]). iGAS incidence increased from 1.8 events per 100 000 population per year in 1992 to 2011 to 2.4 events per 100 000 population per year in 2012 to 2019 (incidence rate ratio, 1.3 [95% CI, 1.1-1.6]), with the increase occurring in GAS infections of the respiratory tract. Incidence declined to 1.2 events per 100 000 population per year in 2020 and 0.5 events per 100 000 population per year in 2021 before increasing to 6.0 events per 100 000 population per year in 2023. In 2022 to 2023, 18 of 56 children with iGAS (32.0%) had a viral respiratory coinfection. Varicella-associated iGAS cases declined from 23 of 137 children (16.8%) in 1992 to 2001 to 2 of 223 children (0.9%) in 2012 to 2023 (P &lt; .001), after routine varicella vaccination implementation in 2004. Streptococcal toxic shock syndrome occurred in 29 children (5.8%), necrotizing fasciitis in 12 children (2.4%); 10 children (2.0%) died. The most common emm types were emm1 (182 of 471 isolates [38.6%]), emm12 (75 isolates [15.9%]), and emm4 (31 isolates [6.6%]). The M1UK subtype was first identified in 2019 and comprised 32 of 46 emm1 isolates (70.0%) from 2019 to 2023. Compared with other emm types, emm1 was more likely to be associated with pneumonia (odds ratio [OR], 1.99 [95% CI, 1.16-3.40]), bone and joint infections (OR, 1.70 [95% CI, 1.08-2.68]), and intensive care unit admission (OR, 1.67 [95% CI, 1.03-2.68]); emm4 was more likely to be associated with bacteremia without focus (OR, 6.10 [95% CI, 2.83-13.16]). Overall, 437 isolates (92.8%) were of emm types included in the 30-valent GAS vaccine.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;This case series found that pediatric iGAS incidence increased in sou","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e252861"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752757","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":"Social Risk and Acute Health Care Utilization Among Insured Adults.","authors":"Morgan Clennin, Mario Schootman, Emma L Tucher, Liza M Reifler, Suma Vupputuri, Meagan Brown, John Adams, Stacie L Daugherty","doi":"10.1001/jamanetworkopen.2025.4253","DOIUrl":"10.1001/jamanetworkopen.2025.4253","url":null,"abstract":"<p><strong>Importance: </strong>Millions of Americans are impacted by adverse social risk factors such as financial strain, housing instability, and food insecurity. A better understanding of if and how these factors are associated with acute care utilization is needed.</p><p><strong>Objective: </strong>To examine the association between exposure to social risk factors and emergency department (ED) visits and hospitalizations among a sample of insured adults.</p><p><strong>Design, setting, and participants: </strong>This cohort study used US health data from a national initiative that employed a multistage, stratified sampling framework across 8 regional markets of an integrated health care delivery system. Eligible participants were insured adults who responded to health surveys. Population-based samples were taken proportionate to the sex and age distribution of each market.</p><p><strong>Exposures: </strong>Validated survey questions captured social risk exposure (positive screening for financial strain, housing instability, and/or food insecurity) during the past year; across 2 survey waves (2020, 2022). Self-reported social risk was categorized into mutually exclusive risk levels, social risk vs no social risk.</p><p><strong>Main outcomes and measures: </strong>Primary outcome was acute health care utilization defined as time to the first event (ED visit, hospitalization) observed following the first survey completion (January 2020 to July 2023). Weighted Cox proportional hazards regression examined the association between social risk and subsequent care utilization, adjusting for demographic and clinical covariates.</p><p><strong>Results: </strong>The analytic cohort included 9785 survey respondents. The weighted cohort data (mean age, 48.4 years [95% CI, 47.9-48.9 years]) included 54.1% female respondents (95% CI, 52.3%-55.9%); 14.6% of the sample were Asian (95% CI, 13.3%-16.0%), 8.1% Black (95% CI, 7.3%-9.1%), 27.1% Hispanic (95% CI, 25.5%-28.8%), and 43.6% non-Hispanic White (95% CI, 41.2%-44.7%); and 50.3% reported exposure to 1 or more social risk factor. During the follow-up period (median [IQR], 3.48 [3.01-3.50] years), 25.4% (95% CI, 22.9%-28.1%) and 10.3% (95% CI, 8.9%-11.9%) of the cohort experienced an ED visit and hospitalization, respectively. Utilization rates varied by level of social risk exposure. Respondents who reported any social risk had a 21% higher risk of an ED visit compared with those with no social risk exposure (adjusted hazard ratio [HR], 1.21 [95% CI, 1.03-1.41]). Social risk was not associated with hospitalizations (adjusted HR, 1.05 [95% CI, 0.84-1.32]).</p><p><strong>Conclusions and relevance: </strong>In this cohort of 9785 adults, the significant association between social risk and time to first ED event warrants future study to determine if improved social risk are associated with lower ED utilization.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e254253"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752773","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":"What's Missing From Value-Based Care-Accounting for the Costs and Benefits of Quality Improvement.","authors":"Donald E Casey","doi":"10.1001/jamanetworkopen.2025.2510","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.2510","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e252510"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763875","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":"Implementation of an Organization-Based Couples Health Promotion Program to Improve Physician Well-Being.","authors":"Jessica M Gold, Tait D Shanafelt, Hanhan Wang, Jo Townson, Sherilyn Stolz, Nikitha Menon, Mickey Trockel","doi":"10.1001/jamanetworkopen.2025.3218","DOIUrl":"10.1001/jamanetworkopen.2025.3218","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Physicians work long, often unpredictable hours and experience multiple work-related stressors, which may adversely affect their personal relationships.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess the associations of a couples' workshop for physicians and their partners with burnout, self-valuation, and impact of work on personal relationships (IWPR).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;In this cohort study, participants were grouped into an immediate intervention group and a delayed intervention control group, which were later compared. The participants in the intervention group gathered at a resort near Stanford University in October 2022, whereas the participants in the control group were invited to participate in a May 2023 workshop. Invited participants included Stanford Medicine physicians and their partners. Eligible physicians worked in a department or division considered frontline during the COVID-19 pandemic or had unfavorable IWPR scores on an institution-wide survey. The data were analyzed from June 14, 2024, to October 1, 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Intervention: &lt;/strong&gt;The intervention group participated in a 2-day workshop for couples and were offered 3 evening sessions. All sessions emphasized positive psychology principles and incorporated didactic, reflection, and unstructured content focused on strengthening relationships.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The main outcome was IWPR score, measured at baseline (immediately preceding the workshop for the intervention group and at registration for the control group) and 6 months later. IWPR was measured with a survey asking 4 questions about how work had affected personal relationships during the past year, and the responses included not at all true, somewhat true, moderately true, very true, and completely true (with scores assigned as 0, 1, 2, 3, and 4, respectively). Other outcome measures included burnout and self-valuation (with a lower score being favorable for burnout and a higher score being favorable for self-valuation).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 47 intervention group participants and 69 control group participants, 22 (46.8%) and 40 (57.9%), respectively, were women (P = .32). Paired assessments (at baseline and 6 months) were completed by 38 of 47 (80.9%) physicians in the intervention group and 53 of 69 (76.8%) in the control group. Between baseline and 6-month follow-up, participants in the intervention group showed a mean (SD) improvement of 1.59 (2.66) points (Cohen d = 0.54 [95% CI, 0.23-0.85]; P &lt; .001) in IWPR, 1.22 (1.47) points (Cohen d = 0.68 [95% CI, 0.39-0.98]; P &lt; .001) in burnout, and -1.25 points (2.09) (Cohen d = 0.68 [95% CI, -0.97 to -0.25]; P &lt; .001) in self-valuation. Statistically significant changes in these measures were not observed in the control participants. In mixed-effects modeling comparing the intervention and control groups, being in the intervention group was associ","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e253218"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11971666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780152","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":"Neighborhood Disadvantage, Individual Experiences of Racism, and Breast Cancer Survival.","authors":"Etienne X Holder, Mollie E Barnard, Nuo N Xu, Lauren E Barber, Julie R Palmer","doi":"10.1001/jamanetworkopen.2025.3807","DOIUrl":"10.1001/jamanetworkopen.2025.3807","url":null,"abstract":"<p><strong>Importance: </strong>Due to the legacy of structural racism in the United States, Black US residents are more likely to live in disadvantaged neighborhoods regardless of individual socioeconomic status. Black women are also more likely to die from their breast cancer.</p><p><strong>Objective: </strong>To investigate whether neighborhood disadvantage and individual experiences of racism are associated with breast cancer mortality among Black US women.</p><p><strong>Design, setting, and participants: </strong>Prospective follow-up study conducted within the Black Women's Health Study (BWHS), a nationwide cohort study of 59 000 self-identified Black females enrolled in 1995 and followed up by biennial questionnaires. BWHS participants diagnosed with breast cancer at stages I to III and who survived 12 months after initial diagnosis were included (n = 2290). Deaths and cause of death were identified through linkage with the National Death Index.</p><p><strong>Exposures: </strong>Geocoded participant addresses were linked with US Census Bureau and American Community Survey data to create neighborhood-level indices reflecting relative disadvantage. Data on experiences of racism were obtained from questionnaires.</p><p><strong>Main outcomes and measures: </strong>Breast cancer-specific and all-cause mortality. Hazard ratios (HRs) and 95% CIs were estimated from multivariable Cox proportional hazards regression models.</p><p><strong>Results: </strong>There were 305 breast cancer-specific deaths among 2290 women with invasive breast cancer (mean [SD] age at diagnosis, 56.7 [10.9] years) who were followed up for a median (IQR) of 10.5 (5.6-16.1) years. The mortality rate was 14.26 (95% CI, 11.01-17.51) per 1000 person-years for those living in the most disadvantaged neighborhoods and 8.82 (95% CI, 6.55-11.09) per 1000 person-years for those living in the least disadvantaged neighborhoods (HR, 1.47; 95% CI, 1.02-2.12). HRs for women living in areas of extreme economic deprivation (vs privilege) and for women who reported experiences of racism in at least 2 institutional spheres (vs none) were also greater than 1, but not statistically significant (extreme economic deprivation vs privilege: HR, 1.19; 95% CI, 0.88-1.61; racism in 2 spheres vs none: HR, 1.28; 95% CI, 0.96-1.73).</p><p><strong>Conclusions and relevance: </strong>In this cohort of Black women, living in disadvantaged neighborhoods was associated with a higher mortality from breast cancer, even after accounting for stage at diagnosis, treatments, and individual-level lifestyle factors. Community-level interventions to reduce environmental stressors and improve conditions in disadvantaged neighborhoods, including access to high-quality cancer care, may be critical to reducing racial disparities in breast cancer survival.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e253807"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795212","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}