JAMA Network Open最新文献

{"title":"Anti-PD-1 Therapy and Long-Term Toxic Effects Among Patients With Melanoma.","authors":"Roma A Kankaria, Reilly Fankhauser, Andrea Boutros, Marlies Pinzon, Kun Bai, Sheau-Chiann Chen, Christian B Agbisit, Alissa Kalyan, Aleigha Lawless, Georgina V Long, Ryan J Sullivan, Janice M Mehnert, Suthee Rapisuwon, Justin M Balko, Matteo S Carlino, Alexander M Menzies, Douglas B Johnson","doi":"10.1001/jamanetworkopen.2026.37199","DOIUrl":"10.1001/jamanetworkopen.2026.37199","url":null,"abstract":"<p><strong>Importance: </strong>Adjuvant anti-programmed cell death protein 1 (anti-PD-1) treatment improves outcomes in high-risk resected melanoma but causes chronic immune-related adverse events (irAEs) in more than 40% of patients. Risk factors associated with chronic vs acute irAEs remain lacking.</p><p><strong>Objective: </strong>To identify factors and possible candidate inflammatory pathways associated with the development of chronic nonendocrine irAEs.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study was conducted from January 1, 2015, to December 31, 2024, at 7 institutions in the US and Australia. Patients had stage III to IV melanoma treated with adjuvant anti-PD-1 therapy and more than 12 months of follow-up after discontinuation of anti-PD-1 treatment.</p><p><strong>Exposures: </strong>Potential risk factors (age, sex, time to irAE onset, corticosteroid exposure, time to corticosteroid initiation, peak corticosteroid dose, and anti-PD-1 treatment status) for chronic irAEs.</p><p><strong>Main outcomes and measures: </strong>Incidence, type, and risk factors for chronic (persisting ≥3 months after anti-PD-1 therapy cessation) irAEs and cytokine levels at 12 months after immune checkpoint inhibitor initiation were assessed.</p><p><strong>Results: </strong>Among 303 patients (median age at anti-PD-1 therapy initiation, 64 years [IQR, 55-72 years]; 184 men [61%]), 220 (73%) developed acute irAEs and 146 (48%) developed chronic irAEs. The most common chronic irAEs were hypothyroidism (45 of 146 [31%]), arthritis (25 of 146 [17%]), and dermatitis (17 of 146 [12%]). Chronic irAEs had later onset (median, 153.0 days [IQR, 67.0-294.0 days] vs 99.0 days [IQR, 32.2-228.8 days]; P = .006) and more frequent corticosteroid exposure (35% [34 of 96] vs 24% [48 of 204]; P = .03) compared with nonchronic irAEs. For exploratory risk factor analysis of 300 nonendocrine irAE events, corticosteroid treatment and onset time had a significant interaction; corticosteroid-treated patients with earlier-onset irAEs had higher odds of developing chronic irAEs (odds ratio, 3.00; 95% CI, 1.45-6.22), adjusted for age, sex, and anti-PD-1 therapy continuation. Eight different cytokines had higher circulating plasma levels among patients with chronic irAEs after false discovery rate (FDR) adjustment (including VEGFA and CCL19), and 19 cytokines had significantly higher circulating plasma levels prior to FDR adjustment. No cytokine levels were higher among controls.</p><p><strong>Conclusions and relevance: </strong>In this cohort study of patients with melanoma treated with adjuvant anti-PD-1 therapy, chronic irAEs were common, persistent, and associated with elevated circulating cytokines, suggesting possible candidate inflammatory pathways for future validation. Later irAE onset and corticosteroid-treated irAEs were associated with chronicity of irAEs. Given the long-term survival of these patients, monitoring and managing chr","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2637199"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109660","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":"Depression and Anxiety Risk in Children With Intellectual Developmental Disorder.","authors":"Jimin Clara Park, Ruby Charak, Megan N Baber, Srinivasa B Gokarakonda, Angela L Scott, Kyung Mee Kim, Chung Eun Lee, In Young Cho, Ga Eun Nam, Kyungdo Han","doi":"10.1001/jamanetworkopen.2026.38681","DOIUrl":"10.1001/jamanetworkopen.2026.38681","url":null,"abstract":"<p><strong>Importance: </strong>Population-based pediatric data on depression and anxiety incidence among children with intellectual developmental disorder (IDD), particularly in Asian populations, are limited.</p><p><strong>Objective: </strong>To investigate associations between IDD and depression and anxiety incidence and evaluate moderating factors.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study used linked data from South Korea's National Health Insurance Service database and National Disability Registry from 2004 to 2020. Children aged 2 to 17 years with newly registered IDD were matched 1:3 by sex and birth year to children without developmental disorders. Follow-up continued until 2023. Data were analyzed from April 20 to July 9, 2025.</p><p><strong>Exposure: </strong>Intellectual developmental disorder among children and adolescents.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was incident depression and anxiety as defined by International Statistical Classification of Disease, Tenth Revision codes. Hazard ratios (HRs) and 95% CIs for developing depression or anxiety were estimated using multivariable-adjusted Cox proportional hazards regression models.</p><p><strong>Results: </strong>Among 236 132 children (mean [SD] age, 9.3 [4.3] years; 64.2% male), 59 033 (25.0%) had IDD. Among children with IDD, 20.1% were diagnosed with depression and 21.9% with anxiety at least 1 year after baseline. Compared with children without developmental disorders, children with IDD had higher risk of depression (HR, 2.18 [95% CI, 2.13-2.24]) and anxiety (HR, 1.85 [95% CI, 1.80-1.89]) after adjusting for sex, age, income level, residential location, and comorbidity burden. Compared with children without developmental disorders, risks of depression and anxiety, respectively, were higher among male children (adjusted HR [AHR], 2.46 [95% CI, 2.39-2.54] and 2.06 [95% CI, 2.00-2.12]), younger children (aged 2-5 years: AHR, 2.83 [95% CI, 2.66-3.01] and 2.41 [95% CI, 2.27-2.55]; aged 6-8 years: AHR, 2.51 [95% CI, 2.40-2.64] and 2.12 [95% CI, 2.02-2.22]), urban residents (AHR, 2.36 [95% CI, 2.25-2.48] and 1.97 [95% CI, 1.88-2.06]), and children with a mild comorbidity burden (Charlson Comorbidity Index score of 1) (AHR, 2.32 [95% CI, 2.22-2.43] and 1.98 [95% CI, 1.90-2.07]). Stratification by sex, younger age, and mild comorbidity burden consistently showed higher risks of depression and anxiety across both sexes with IDD compared with children without developmental disorders (all P < .001 for interaction). In males with IDD, rural residence was associated with higher depression risk (AHR, 2.71 [95% CI, 2.56-2.86]) and urban residence with higher anxiety risk (AHR, 2.15 [95% CI, 2.04-2.28]). In females with IDD, depression and anxiety, respectively, were associated with lower income (AHR, 2.08 [95% CI, 1.86-2.34] and 1.76 [95% CI, 1.59-1.96]) and urban residence (AHR, 2.03 [95% CI, 1.88-2.20] and ","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2638681"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170091","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":"Bringing Cardiac Rehabilitation Closer to Patients.","authors":"Rod S Taylor","doi":"10.1001/jamanetworkopen.2026.38972","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.38972","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2638972"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182001","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":"Food Insecurity in Medical Residents and Fellows.","authors":"Julie L Oyler, Amber Bird","doi":"10.1001/jamanetworkopen.2026.40734","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.40734","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2640734"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149267647","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":"Maternal Vaccination vs Nirsevimab Use and Respiratory Syncytial Virus Infection Among Full-Term Infants.","authors":"Karen B Jacobson, Andrew J Watson, Lauren D Liao, Sally C Stephens, Maqdooda Merchant, Ousseny Zerbo, Nicola P Klein","doi":"10.1001/jamanetworkopen.2026.36760","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.36760","url":null,"abstract":"<p><strong>Importance: </strong>Since 2023, infants can be protected from respiratory syncytial virus (RSV) through a vaccine (RSVpreF) for pregnant persons or a monoclonal antibody (nirsevimab) for infants.</p><p><strong>Objective: </strong>To assess the relative product effectiveness (rPE) of maternal RSVpreF vs infant nirsevimab against RSV infection and hospitalization among infants born in the 2023 to 2025 RSV seasons.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study included full-term infants born at Kaiser Permanente Northern California (KPNC), an integrated health care system with approximately 40 000 births each year, from December 3, 2023, to March 30, 2024, or September 29, 2024, to March 15, 2025. Infants protected by RSVpreF were matched to infants protected with nirsevimab with optimal full matching (up to 1:5), adjusting for birth week, sex, and maternal factors. Each group was also compared with infants with no protection, matching unprotected infants to both RSVpreF and nirsevimab infants (up to 1:10).</p><p><strong>Exposures: </strong>Maternal RSVpreF at 32 to 36 weeks' gestation or infant nirsevimab through age 7 days.</p><p><strong>Main outcomes and measures: </strong>Polymerase chain reaction (PCR)-confirmed RSV and RSV hospitalization (PCR-confirmed RSV 10 days before to 7 days after hospitalization) in infants aged 8 to 180 days or through RSV season end (April 30 in both seasons). rPE was estimated from age 8 to 180 days using restricted mean time lost.</p><p><strong>Results: </strong>Of 15 124 matched infants (7729 [51.1%] male) in the primary analysis, 146 (0.97%) had RSV infection (106 of 11 293 [0.94%] in RSVpreF group and 40 of 3831 [1.04%] in nirsevimab group) and 12 (0.08%) were hospitalized (7 [0.06%] in RSVpreF group and 5 [0.13%] in nirsevimab group). The rPE of RSVpreF vs nirsevimab was -5.3% (95% CI, -44.8% to 23.4%) against infection and 61.5% (95% CI, -10.8% to 86.7%) against hospitalization. Compared with no protection, RSVpreF rPE was 69.3% (95% CI, 59.9% to 76.6%) against infection and 86.4% (95% CI, 66.4% to 94.5%) against hospitalization; nirsevimab rPE was 65.2% (95% CI, 51.0%-75.4%) and 73.8% (95% CI, 33.4%-89.7%), respectively.</p><p><strong>Conclusion: </strong>In this cohort study of infants born in the 2023 to 2024 and 2024 to 2025 RSV seasons, no statistically significant difference between maternal RSVpreF and infant nirsevimab in RSV infection or hospitalization was detected. Compared with no protection, both products were associated with fewer infections and hospitalizations. This study supports current US guidelines for either maternal RSVpreF or infant nirsevimab to protect all infants from RSV.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2636760"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13695842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149267662","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":"Fecal Immunochemical Test Outreach for Colorectal Cancer Screening in Community Health Centers: A Randomized Clinical Trial.","authors":"Maria Elena Martinez, Scott Roesch, Valesca Largaespada, Jesse N Nodora, Borsika A Rabin, Sheila F Castañeda, Jennifer Covin, Kristine Ortwine, Yesenia Preciado-Hidalgo, Nicole Howard, James Schultz, Nannette Stamm, Michael T Halpern, Samir Gupta","doi":"10.1001/jamanetworkopen.2026.39013","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.39013","url":null,"abstract":"<p><strong>Importance: </strong>Colorectal cancer (CRC) screening is suboptimal among people in traditionally underserved populations, many of whom receive primary care at federally qualified health centers (FQHCs). Mailed fecal immunochemical test (FIT) outreach improves screening, especially in underserved populations, but questions remain about impact over time.</p><p><strong>Objective: </strong>To evaluate the effectiveness of centralized annual mailed FIT outreach delivered over 3 years to increase CRC screening in FQHCs.</p><p><strong>Design, setting, and participants: </strong>This cluster randomized clinical trial was conducted between June 1, 2021, and May 31, 2024. Sixteen clinics from 2 FQHCs in Southern California were randomly assigned to mailed FIT outreach or usual care for patients aged 50 to 75 years and not up to date with screening.</p><p><strong>Intervention: </strong>Intervention components followed best practices for mailed FIT outreach and included educational primers, FIT kits, and telephone reminders.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the proportion of individuals up to date with any CRC screening after 3 years of intervention (point prevalence); screening at 2 years was a secondary outcome. Due to a resource constraint-related protocol modification, mailed FIT outreach began earlier in year 3, such that some individuals who completed screening in year 2 were not yet due for repeat FIT.</p><p><strong>Results: </strong>Among 16 clinics serving 20 250 patients, 6 clinics serving 8334 individuals at baseline (4435 aged 55-64 years [53.2%]; 4896 female [58.7%]; 341 Asian [4.1%], 238 Black [2.9%], 2390 Hispanic [28.7%], and 4371 non-Hispanic White [52.4%]) were randomized to intervention and 10 clinics serving 11 916 individuals at baseline (6443 aged 55-64 years [54.1%]; 7250 female [60.8%]; 699 Asian [5.9%], 355 Black [3.0%], 4635 Hispanic [38.9%], and 4436 non-Hispanic White [37.2%]) were randomized to usual care. At year 3, screening was 39.4% (95% CI, 36.3% to 42.6%) in intervention clinics vs 36.5% (95% CI, 31.2% to 42.2%) in usual care clinics, which was not a statistically significant difference (2.9 percentage points; 95% CI, -3.2 to 9.0 percentage points). At year 2, screening was 37.8% (95% CI, 35.2% to 40.4%) in intervention clinics vs 27.0% (95% CI, 21.8% to 32.9%) in usual care clinics (difference, 10.8 percentage points; 95% CI, 4.9 to 16.7 percentage points).</p><p><strong>Conclusions and relevance: </strong>This study's findings suggest that centralized mailed FIT outreach could increase CRC screening in FQHCs serving populations with persistent disparities, although maintaining intervention fidelity and providing ongoing implementation support over time are needed for consistent impact.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT04941300.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2639013"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149238615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Direct Oral Anticoagulant Use for Cancer-Associated Venous Thromboembolism.","authors":"Romain Varnier, François Bettega, Aurélie Moskal, Sabine Mainbourg, Mylène Wespiser, Adrien Rousseau, Marie Viprey","doi":"10.1001/jamanetworkopen.2026.40377","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.40377","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Direct oral anticoagulants (DOAC) are recommended for selected patients with cancer-associated venous thromboembolism, but their implementation remains heterogeneous.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To describe temporal trends in DOAC initiation for cancer-associated venous thromboembolism in France and to identify factors associated with their use.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This nationwide population-based cohort study included adults without recorded contraindications to DOACs and a first treated venous thromboembolism episode between January 1, 2016, and December 31, 2022. Data were collected from the French National Health Data System, a nationwide claims database covering approximately 99% of the population. Analysis was performed from January to August 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Patients were classified into active cancer and no active cancer groups. Covariates included calendar period, patient characteristics, cancer type and treatment, venous thromboembolism characteristics, and initial prescriber setting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcome was DOAC initiation within 30 days after the index venous thromboembolism event. Bayesian structural time series models assessed temporal changes across 2016 to 2018, 2019 to 2020, and 2021 to 2022. Multivariable logistic regression identified factors associated with DOAC initiation among patients with active cancer.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 683 184 patients with incident treated venous thromboembolism (median [IQR] age, 67 [53-77] years; 347 421 female [51.0%]), 91 954 patients (13.5%) had active cancer while 591 230 (86.5%) had VTE not associated with active cancer. DOAC use increased from 15.3% (95% CI, 15.0%-15.7%) in 2016 to 2018 to 32.6% (95% CI, 32.1%-33.2%) in 2021 to 2022 among patients with active cancer, and from 63.5% (95% CI, 63.3%-63.7%) to 81.1% (95% CI, 80.9%-81.2%) among patients without active cancer. DOAC initiation increased beyond expected secular trends in patients with active cancer, with relative increases of 20.5% (95% credible interval, 13.0%-27.8%) in 2019 to 2020 and 41.3% (95% credible interval, 32.9%-50.2%) in 2021 to 2022. DOAC initiation was less frequent among patients with comorbidities, history of bleeding, gastrointestinal or gynecologic cancer, active brain metastases, or systemic treatment, and when the initial prescriber was a hospital-based physician rather than a general practitioner.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this cohort study of patients with incident venous thromboembolism, DOAC use increased substantially in patients with active cancer but remained lower than in patients without active cancer and varied across clinical and care-setting characteristics. This lower uptake may reflect both delayed implementation of recent evidence and the need to individualize anticoagulant selection in complex situations.&lt;/p","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2640377"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244604","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":"Perceptions of Safety and Fear of Seeking Emergency Care After 2025 Anti-Immigrant Policies.","authors":"Omeed Miraftab-Salo, Anna Claire Fernandez, Jasmanpreet Kaur, Jacob Perez, Mireya Arreguin, Anita N Chary, Stephen Chen, Megan Benavides, Jessica Amezcua, Jazmin Plascencia, Josh Perez, Therese Santiago, Claudia Tang, Kelly Gocke, Anneka Hooft, Riham Alwan, Robert M Rodriguez, Melanie F Molina","doi":"10.1001/jamanetworkopen.2026.36728","DOIUrl":"10.1001/jamanetworkopen.2026.36728","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2636728"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13639772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109813","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":"Anticoagulation Outcomes in Nursing Home Residents With Atrial Fibrillation and ADL Disability.","authors":"Qiaoxi Chen, Daniel Singer, Chun-Ting Yang, Kevin T Pritchard, Dae Hyun Kim, Kueiyu Joshua Lin","doi":"10.1001/jamanetworkopen.2026.37533","DOIUrl":"10.1001/jamanetworkopen.2026.37533","url":null,"abstract":"<p><strong>Importance: </strong>Long-term nursing home residents with atrial fibrillation (AF) and activities of daily living (ADL) disability are at high risk of bleeding and death, making the net benefit of anticoagulation uncertain.</p><p><strong>Objective: </strong>To compare the association of oral anticoagulant (OAC) use vs nonuse with ischemic stroke and major bleeding in long-term nursing home residents with AF and ADL disability.</p><p><strong>Design, setting, and participants: </strong>This cohort study used US Medicare claims linked with the Minimum Data Set (January 1, 2013, to December 31, 2022). Nursing home residents with nonvalvular AF and impairment in 3 or more ADLs were included. Three cohorts comparing use of apixaban, rivaroxaban, or warfarin with nonuse were constructed using incidence-density sampling.</p><p><strong>Exposures: </strong>Initiation of apixaban, rivaroxaban, or warfarin use.</p><p><strong>Main outcomes and measures: </strong>Primary outcomes were ischemic stroke, major bleeding, and their composite. Propensity score (PS) matching balanced 111 covariates. Adjusted rate ratios (ARRs) with 95% CIs were estimated. Tipping-point analyses assessed the relative weighting ischemic stroke vs major bleeding required to favor anticoagulation. Direct active-comparator analyses compared apixaban with rivaroxaban and warfarin.</p><p><strong>Results: </strong>The study comprised 26 940 nursing home residents (median [IQR] age, 82 [74,88] years; 17 504 [65.0%] female), including PS-matched cohorts of 7600 residents receiving apixaban, 2654 receiving rivaroxaban, and 3216 receiving warfarin. Compared with nonuse, use of all OACs was associated with lower rates of ischemic stroke (apixaban: ARR, 0.53; 95% CI, 0.38-0.73; rivaroxaban: ARR, 0.48; 95% CI, 0.27-0.87; warfarin: ARR, 0.47; 95% CI, 0.25-0.88) and higher rates of major bleeding (apixaban: ARR, 1.62; 95% CI, 1.29-2.03; rivaroxaban: ARR, 2.68; 95% CI, 1.84-3.93; warfarin: ARR, 3.02; 95% CI, 2.15-4.25). Only apixaban was not associated with a higher composite outcome (ARR, 1.08; 95% CI, 0.90-1.30), whereas rivaroxaban (ARR, 1.62; 95% CI, 1.20-2.18) and warfarin (ARR, 1.99; 95% CI, 1.50-2.63) were associated with higher rates. Findings were consistent across frailty strata, although stroke reduction with apixaban was attenuated among frail individuals. Tipping-point analyses indicated a more favorable benefit-risk balance for apixaban than for rivaroxaban or warfarin.</p><p><strong>Conclusions and relevance: </strong>Among nursing home residents with AF and ADL disability, OAC use was associated with lower ischemic stroke but higher major bleeding rates than nonuse. Apixaban demonstrated the most favorable benefit-risk profile among the OACs evaluated. These findings may inform individualized anticoagulation decisions.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2637533"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13639757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109647","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":"Family-Centered Care and Outcomes of Child Flourishing and Family Resilience and Connection.","authors":"Anna E Austin, Christine K Thang, Sasha S Svendsen","doi":"10.1001/jamanetworkopen.2026.31265","DOIUrl":"10.1001/jamanetworkopen.2026.31265","url":null,"abstract":"<p><strong>Importance: </strong>Family-centered care is an approach to pediatric health care that recognizes the essential role of the family in ensuring child health and well-being, seeks to establish collaborative partnerships among the child, family, and health care team, and provides a framework for implementing trauma-informed care. However, the association between receiving family-centered care and key measures of child and family well-being, including among families with a history of trauma and adversity, is unknown.</p><p><strong>Objectives: </strong>To examine associations between family-centered care and child flourishing and family resilience and connection among US children and to assess whether associations differ by the child's history of adverse childhood experiences (ACEs).</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study used 2021 to 2024 National Survey of Children's Health data from children aged 6 to 17 years. Analyses were conducted in September to December 2025.</p><p><strong>Exposure: </strong>Caregiver report of receipt of family-centered care by the child's physician or other health care practitioners in the past 12 months.</p><p><strong>Main outcomes and measures: </strong>Child flourishing and family resilience and connection based on caregiver response to established measures.</p><p><strong>Results: </strong>This study assessed 110 984 children (mean [SD] age, 11.5 [0.02], years; 57 302 [51.0%] male and 53 682 [49.0%] female) who had a health care visit in the past 12 months. Adjusted for potential confounders, the prevalence of child flourishing was 8.6 percentage points higher (prevalence difference [PD], 0.086; 95% CI, 0.072-0.101), and the prevalence of family resilience and connection was 8.2 percentage points higher (PD, 0.082; 95% CI, 0.069-0.096) for those who received family-centered care compared with those who did not. Among children with and without ACEs, the prevalence of child flourishing (with ACES: PD, 0.112; 95% CI, 0.089-0.132; without ACEs: PD, 0.068; 95% CI, 0.049-0.087) and family resilience and connection (with ACEs: PD, 0.105; 95% CI, 0.085-0.125; without ACEs: PD, 0.0563; 95% CI, 0.043-0.081) was higher for those who received family-centered care compared with those who did not, with larger estimates among children with ACEs than children without ACEs.</p><p><strong>Conclusions and relevance: </strong>Results from this cross-sectional study found that family-centered care was associated with a higher prevalence of child flourishing and family resilience and connection, particularly among those with a history of adversity. These results suggest that family-centered care offers a practical and measurable way for health care professionals to promote well-being for all children and families but particularly for children with a history of ACEs.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2631265"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13639759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109747","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}