JAMA Network Open最新文献

{"title":"Zero Suicide Model Implementation and Suicide Attempt Rates in Outpatient Mental Health Care.","authors":"Brian K Ahmedani, Robert B Penfold, Cathrine Frank, Julie E Richards, Christine Stewart, Jennifer M Boggs, Karen J Coleman, Stacy Sterling, Bobbi Jo H Yarborough, Gregory Clarke, Michael Schoenbaum, Erika M Aguirre-Miyamoto, Lee J Barton, Hsueh-Han Yeh, Joslyn Westphal, Sarah McDonald, Arne Beck, Rinad S Beidas, Laura Richardson, Jacqueline M Ryan, Edward T Buckingham, Stuart Buttlaire, Cambria Bruschke, Jean Flores, Gregory E Simon","doi":"10.1001/jamanetworkopen.2025.3721","DOIUrl":"10.1001/jamanetworkopen.2025.3721","url":null,"abstract":"<p><strong>Importance: </strong>Suicide is a major public health concern, and as most individuals have contact with health care practitioners before suicide, health systems are essential for suicide prevention. The Zero Suicide (ZS) model is the recommended approach for suicide prevention in health systems, but more evidence is needed to support its widespread adoption.</p><p><strong>Objective: </strong>To examine suicide attempt rates associated with implementation of the ZS model in outpatient mental health care within 6 US health systems.</p><p><strong>Design, setting, and participants: </strong>This quality improvement study with an interrupted time series design used data collected from January 2012 through December 2019, from patients aged 13 years or older who received mental health care at outpatient mental health specialty settings within 6 US health systems located in 5 states: California, Oregon, Washington, Colorado, and Michigan. Analyses were conducted from January through December 2024.</p><p><strong>Exposure: </strong>The ZS model was implemented in 4 health systems at different points during the observation period (2012-2019) and compared with health systems that implemented the model before the observation period (postimplementation). Implementation included suicide risk screening, assessment, brief intervention (safety plan, means safety protocol), and behavioral health treatment.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was a measure of standardized monthly suicide attempt rates captured using health system records and government mortality records. Suicide death rates were also measured as a secondary outcome.</p><p><strong>Results: </strong>There was a median of 309 107 (range, 55 354-451 837) unique patients per month. In 2017, there were 317 939 eligible individuals (63.2% female). Baseline suicide attempt rates were at least 30 to 40 per 100 000 individuals at each implementation site and decreased to less than 30 per 100 000 individuals at 3 sites by 2019. Decreases in suicide attempt rates were observed at 3 intervention health systems after site-specific implementation: health systems A and B had decreases of 0.7 per 100 000 individuals per month and C, 0.1 per 100 000 individuals per month. System D evidenced a similar suicide attempt rate after implementation (before implementation: median rate: 35.0 [range, 11.0-50.3] per 100 000 patients per month; after implementation: median rate: 34.3 [range, 18.5-42.0] per 100 000 patients per month). The 2 postimplementation health systems maintained low or declining suicide attempt rates throughout the observation period. The rate at system Y decreased by 0.3 per 100 000 individuals per month across the observation period. The rate at system Z began at 11 per 100 000 individuals per month and declined by 0.03 per 100 000 individuals per month during the observation period. Two systems evidenced reductions in the suicide death rate after implementa","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e253721"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795335","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":"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":"Reporting of Noninferiority Margins on ClinicalTrials.gov: A Systematic Review.","authors":"Camille Reinaud, Sandra Mavoungou, David Hajage, Chloé Lieng, Deivanes Rajendrabose, Diane Ferreira, Jules Blanchard, Agathe Turpin, Agnès Dechartres","doi":"10.1001/jamanetworkopen.2025.3569","DOIUrl":"10.1001/jamanetworkopen.2025.3569","url":null,"abstract":"<p><strong>Importance: </strong>The noninferiority margin is a key methodological parameter in noninferiority trials that affects both sample size calculation and interpretation of results.</p><p><strong>Objective: </strong>To assess (1) the reporting of the noninferiority margin on ClinicalTrials.gov, including when it was reported; (2) the consistency of the noninferiority margin between registration and publication; and (3) the reporting of the noninferiority margin at registration in a sample of recent trials.</p><p><strong>Evidence review: </strong>This systematic review was conducted in 2 stages. Stage 1 involved identifying all noninferiority trials registered on ClinicalTrials.gov with a primary completion date of January 1, 2010, to January 1, 2015, and searching for corresponding publications. Stage 2 included all noninferiority trials registered between January 1, 2022, and June 30, 2023. Two reviewers independently and manually extracted methodological characteristics related to the noninferiority design for each trial at registration and, when available, in results posted on ClinicalTrials.gov and in publications. The time points for reporting the noninferiority margin were at registration, during the patient enrollment phase (between start date and primary completion date), after the primary completion date, or in results posted.</p><p><strong>Findings: </strong>Among the 266 trials completed between 2010 and 2015, only 8 (3.0%) reported the noninferiority margin at registration. The noninferiority margin was reported after registration for 31 of 266 trials (11.7%), with 11 (4.1%) reporting it during the patient enrollment phase and 20 (7.5%) reporting it after the primary completion date. Of the 132 trials with results posted on ClinicalTrials.gov, 79 (59.8%) reported the noninferiority margin. A corresponding publication was found for 208 trials, with 196 (94.2%) reporting the noninferiority margin. For 5 trials reporting the margin at both registration and in publication, the noninferiority margin was consistent in both sources. Among the 327 noninferiority trials first posted between 2022 and 2023, 30 (9.2%) reported the noninferiority margin at registration.</p><p><strong>Conclusions and relevance: </strong>In this systematic review, the reporting of the noninferiority margin on ClinicalTrials.gov was low. Mandatory reporting of the design and the noninferiority margin at registration could enhance the transparency and favor more reliable results.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e253569"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795285","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":"Sociodemographic Characteristics of Infants Receiving Nirsevimab.","authors":"Salomé Boutin, Marion Bertrand, Jérémie F Cohen, Mahmoud Zureik, Martin Chalumeau, Marie-Joëlle Jabagi","doi":"10.1001/jamanetworkopen.2025.4341","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.4341","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e254341"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811380","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":"Patient- and Community-Level Characteristics Associated With Respiratory Syncytial Virus Vaccination.","authors":"Diya Surie, Katharine A Yuengling, Basmah Safdar, Adit A Ginde, Ithan D Peltan, Samuel M Brown, Manjusha Gaglani, Shekhar Ghamande, Robert L Gottlieb, Cristie Columbus, Nicholas M Mohr, Kevin W Gibbs, David N Hager, Mary O'Rourke, Michelle N Gong, Amira Mohamed, Nicholas J Johnson, Jay S Steingrub, Akram Khan, Abhijit Duggal, Jennifer G Wilson, Nida Qadir, Steven Y Chang, Christopher Mallow, Laurence W Busse, Jamie Felzer, Jennie H Kwon, Matthew C Exline, Ivana A Vaughn, Mayur Ramesh, Adam S Lauring, Emily T Martin, Jarrod M Mosier, Estelle S Harris, Adrienne Baughman, Sydney A Swan, Cassandra A Johnson, Paul W Blair, Nathaniel M Lewis, Sascha Ellington, Rachel E Rutkowski, Yuwei Zhu, Wesley H Self, Fatimah S Dawood","doi":"10.1001/jamanetworkopen.2025.2841","DOIUrl":"10.1001/jamanetworkopen.2025.2841","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;In 2023, the first respiratory syncytial virus (RSV) vaccines were recommended for US adults 60 years or older, but few data are available about which patients were most likely to receive vaccine to inform future RSV vaccine outreach efforts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess patient- and community-level characteristics associated with RSV vaccine receipt and patient knowledge and attitudes related to RSV disease and RSV vaccines.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;During the first season of RSV vaccine use from October 1, 2023, to April 30, 2024, adults 60 years or older hospitalized with RSV-negative acute respiratory illness were enrolled in this cross-sectional study from 26 hospitals in 20 US states. Sociodemographic and clinical data were abstracted from health records, and structured interviews were conducted for knowledge and attitudes about RSV disease and RSV vaccines.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Age, sex, race and ethnicity, pulmonary disease, immunocompromised status, long-term care facility residence, medical insurance, social vulnerability index (SVI), and educational level.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The exposures were identified a priori as possible factors associated with RSV vaccine receipt and were entered into a modified Poisson regression model accounting for state clustering, to assess for association with RSV vaccine receipt. Knowledge and attitudes were summarized with frequencies and proportions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 6746 hospitalized adults 60 years or older, median age was 73 (IQR, 66-80) years and 3451 (51.2%) were female. Among the 6599 patients with self-reported race and ethnicity, 699 (10.6%) were Hispanic, 1288 (19.5%) were non-Hispanic Black, 4299 (65.1%) were non-Hispanic White, and 313 (4.7%) were other race or ethnicity. There were 700 RSV-vaccinated (10.4%) and 6046 unvaccinated (89.6%) adults. Among 3219 unvaccinated adults who responded to RSV knowledge questions, 1519 (47.2%) had not heard of RSV or were unsure; 2525 of 3218 (78.5%) were unsure if they were eligible for RSV vaccine or thought they were not. In adjusted analyses, characteristics associated with RSV vaccination were being 75 years or older (adjusted risk ratio [ARR], 1.23; 95% CI, 1.10-1.38, P &lt; .001), being male (ARR, 1.15; 95% CI, 1.01-1.30; P = .04), and having pulmonary disease (ARR, 1.39; 95% CI, 1.16-1.67; P &lt; .001), immunocompromised status (ARR, 1.30; 95% CI, 1.14-1.48; P &lt; .001), low (ARR, 1.47; 95% CI, 1.18-1.83, P &lt; .001) or moderate (ARR, 1.47; 95% CI, 1.21-1.79; P &lt; .001) SVI, and educational level consisting of 4 or more years of college (ARR, 2.91; 95% CI, 2.14-3.96; P &lt; .001), at least some college or technical training (ARR, 1.85; 95% CI, 1.35-2.53; P &lt; .001), or grade 12 education or General Educational Development (ARR, 1.44; 95% CI, 1.03-2.00; P = .03). RSV vaccination was less likely among residents of long-ter","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e252841"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752760","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":"Uterine Fibroid Diagnosis by Race and Ethnicity in an Integrated Health Care System.","authors":"Susanna D Mitro, Wendy Dyer, Catherine Lee, Ameek Bindra, Lana Wang, Miranda Ritterman Weintraub, Monique M Hedderson, Eve Zaritsky","doi":"10.1001/jamanetworkopen.2025.5235","DOIUrl":"10.1001/jamanetworkopen.2025.5235","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Uterine fibroids are benign tumors that can cause severe symptoms. Fibroid burden among Asian or Pacific Islander individuals, particularly in specific subgroups, remains largely unexamined.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To describe fibroid diagnosis rates by race and ethnicity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This retrospective cohort study (January 2009 to December 2022) used data from electronic health records of the Kaiser Permanente Northern California (KPNC) integrated health care system. Eligible participants included female (sex assigned at birth) KPNC members aged 18 to 54 years with at least 12 months of continuous membership, no prior fibroid diagnosis, and no history of hysterectomy. Data were analyzed January to September 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Race and ethnicity was categorized into 9 groups: Black (African American, other Black [ie, any Black race or ethnicity not otherwise specified], and unknown Black race or ethnicity), East Asian (Chinese, Japanese, and Korean), Hispanic (Hispanic or Latino), South Asian (Asian Indian, Bangladeshi, East Indian, Nepali, Sri Lankan, and any South Asian ethnicity not otherwise specified), Southeast Asian (Filipino, Vietnamese, and other Southeast Asian [ie, any Southeast Asian ethnicity not otherwise specified]), White (White or White Middle Eastern), other Asian or Pacific Islander (Native Hawaiian or Pacific Islander, multiethnic Asian, and other or unspecified Asian ethnicity [ie, any Asian ethnicity not otherwise specified]), other races and ethnicities (American Indian or Alaska Native and multiracial), and unknown race or ethnicity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Incident fibroid diagnosis was identified using diagnostic codes. Poisson regression models were used to calculate incidence rates of fibroid diagnosis by racial and ethnic group, standardized to the 2022 US female population. Incidence rate ratios (IRRs) and 95% CIs compared incidence within each racial and ethnic group with White participants.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 1 917 794 patients were included (median [IQR] percentage, 7% [6%-7%] Black; 5% [5%-6%] East Asian; 22% [21%-23%] Hispanic; 3% [2%-3%] South Asian; 7% [7%-8%] Southeast Asian; 42% [39%-45%] White; 8% [6%-10%] other Asian or Pacific Islander; 2% [2%-2%] of other races and ethnicities; 4% [4%-5%] unknown or missing race and ethnicity), and 84 206 patients (4.4%) received a first fibroid diagnosis during the study period. Compared with White patients, there was a higher rate of fibroid diagnosis among Southeast Asian (IRR, 1.29; 95% CI, 1.26-1.33), East Asian (IRR, 1.47; 95% CI, 1.43-1.51), and South Asian patients (IRR, 1.71; 95% CI, 1.65-1.78). Black (IRR, 3.11; 95% CI, 3.05-3.17) and Hispanic patients (IRR, 1.37; 95% CI, 1.34-1.39) also had elevated rates of fibroid diagnosis. All Asian patients were less likely than other groups to have ICD-9 or ICD-10","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e255235"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763874","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":"App-Based Physical Activity Intervention Among Women With Prior Hypertensive Pregnancy Disorder: A Randomized Clinical Trial.","authors":"Lili L Kókai, Diarmaid Ó Ceallaigh, Anne I Wijtzes, Jeanine E Roeters van Lennep, Johannes J Duvekot, Martin S Hagger, John Cawley, Alex Burdorf, Kirsten I M Rohde, Hans van Kippersluis","doi":"10.1001/jamanetworkopen.2025.2656","DOIUrl":"10.1001/jamanetworkopen.2025.2656","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Insufficient moderate to vigorous physical activity (MVPA) is a risk factor for cardiovascular disease (CVD). Effective interventions are needed to bridge the intention-behavior gap and increase MVPA, especially among women with prior hypertensive pregnancy disorder (HPD).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To test the effectiveness of two 8-week app-based MVPA interventions (motivation and action) that were based on the integrated behavior change (IBC) model and used evidence-based behavior change techniques from behavioral sciences.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This randomized clinical trial (RCT) included women with prior HPD. A purpose-built app was tested from October 2021 to March 2022, with follow-up immediately after the intervention (week 9), 3 months later (week 21), and 12 months later (week 61). The study ended in May 2023. Data were analyzed from March 31, 2022, to June 9, 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Intervention: &lt;/strong&gt;All participants received a wearable fitness tracker and a purpose-built physical activity intervention app and were randomized to 1 of 3 groups (control, motivation, or action): The control group received information on CVD, MVPA, and HPD; the motivation group received the same information as well as motivational interviewing-based counseling; and the action group received the same information as well as behavior change techniques that targeted all processes in the IBC model (motivational, volitional, automatic): motivational interviewing-based counseling, action and coping planning, commitment, positive psychology, and mindfulness-based stress reduction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcome was MVPA (in minutes per week). Treatment effects were estimated using available case ordinary least-squares regression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 619 women participated in this study: 205 in the control group, 209 in the motivation group, and 205 in the action group. Their mean (SD) age was 38.9 (7.3) years; 386 of 577 participants (67%) had a bachelor's degree or more and 550 of 577 (95%) were living with a child or children. The mean (SD) weekly MVPA for all 3 groups went from a high baseline of 242 (190) minutes to 197 (208) minutes immediately post intervention. No significant postintervention treatment effects on MVPA were observed for the action group (week 9 treatment effect, -17 [95% CI, -58 to 23] min/wk) or the motivation group (week 9 treatment effect, -3 [95% CI, -58 to 51] min/wk), despite the action intervention positively influencing motivational and volitional processes. The app and intervention components were all evaluated positively by participants.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this clinical trial of 2 app-based MVPA interventions among 619 women with prior HPD, no treatment effects on MVPA were observed. Possible explanations include (1) the importance of automatic processes in det","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e252656"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763935","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":"Increased Utilization of Overtime and Agency Nurses and Patient Safety.","authors":"Patricia Pittman, Hong-Lun Tiunn, Qian Luo, Michael Herron, Drew Tatum, John Martin","doi":"10.1001/jamanetworkopen.2025.2875","DOIUrl":"10.1001/jamanetworkopen.2025.2875","url":null,"abstract":"<p><strong>Importance: </strong>The use of nurse overtime and agency nurses has increased in recent years, making it important to understand the opportunities and limits of these alternative staffing strategies on patient safety outcomes.</p><p><strong>Objective: </strong>To examine the association between overtime and agency nurse staffing hours and hospital patient safety.</p><p><strong>Design, setting, and participants: </strong>This quality improvement study used data from 70 US hospitals, from January 2019 through December 2022. Participants included patients and nurse staff across the 70 hospitals.</p><p><strong>Exposure: </strong>The use of overtime and agency nursing.</p><p><strong>Main outcomes and measures: </strong>The main outcomes were 10 of the US Agency for Healthcare Research and Quality's patient safety indicators and their associations with regular, overtime, and agency nursing hours per patient day: pressure ulcers, iatrogenic pneumothorax, in-hospital fall with hip fracture, perioperative hemorrhage or hematoma, postoperative acute kidney injury requiring dialysis, postoperative respiratory failure, perioperative thromboembolism, postoperative sepsis, postoperative wound dehiscence, and accidental puncture or laceration. A baseline Poisson regression model and a structural breakpoint analysis were used to identify safety thresholds. Pairwise interactions between staffing intensity variables and hospital bed size were also included. Adjustments were made for the COVID-19 hospital census, patient case mix, and hospital characteristics.</p><p><strong>Results: </strong>The sample included 46 hospitals in the South, 20 in the West, and 4 in the Northeast; 48 hospitals were urban, 32 hospitals had fewer than 200 beds, 26 had between 200 and 399 beds, and 12 had 400 or more beds. The average use of nurse overtime and agency nurse hours exceeded safe thresholds for pressure ulcers by 140.0% for agency staffing and by 63.6% for overtime, representing a 6.44% increase associated with excess agency nurse hours and a 2.09% increase for excess use of overtime. There also was a statistically significant association of agency hours with postsurgery hemorrhage or hematoma rates, but no breakpoint threshold. There were no significant associations with other outcomes.</p><p><strong>Conclusions and relevance: </strong>These findings suggest that both nurse overtime and nurse agency hours are associated with increased rates of pressure ulcers, a measure that is one of the most sensitive to nursing care. In future research, hospitals could use their own data to track safe thresholds.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e252875"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763940","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":"Packaging of Cannabis Edibles, Health Warning Recall, and Perceptions Among Young Adults.","authors":"Michael Cooper, Yuyan Shi","doi":"10.1001/jamanetworkopen.2025.3117","DOIUrl":"10.1001/jamanetworkopen.2025.3117","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Cannabis edibles have increased in popularity, particularly among young adults and in states with recreational cannabis legalization. Little is known about the association of cannabis packaging regulations with health warning recall and perceptions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate whether features of packaging are associated with ability to recall health warnings as well as perceptions of cannabis edible products among young adults.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cross-sectional study was conducted from October 6 to 18, 2023, in 23 states and Washington, DC, that legalized recreational cannabis. Participants included young adults aged 18 to 29 years, including cannabis users and nonusers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;In the between-individual 3 (packaging styles) × 3 (health claims) × 7 (health warning themes) full-factorial randomized online experiment, participants viewed an image of the packaging of cannabis edible products with random variations in package styles (plain, normal branded, and youth-appealing packaging), health claims (none, pain relief, and sleep aid), and health warning themes (long-lasting effects, pregnancy-related harms, driving impairment, mental health problems, harms to youths, harms of high potency products, and delayed effects).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Five self-reported outcomes, including warning recall (ability to correctly recall the warning label shown), product appeal rating, relative harm, adult-oriented appearance, and target age group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Participants comprised 4500 young adults aged 18 to 29 years, including 3000 cannabis users and 1500 nonusers. These participants included 2287 men (50.8%); 1095 participants (24.3%) were aged 18 to 20 years, and 1905 (42.3%) were aged 21 to 25 years. Compared with normal branded packaging, plain packaging was associated with increased odds of correct warning recall (correct rate, 52.9%; odds ratio [OR], 1.47 [95% CI, 1.27-1.70]), decreased appeal ratings (mean appeal rating, 5.2 of 10; OR, 0.70 [95% CI, 0.61-0.80]), and increased perceived relative harm (mean harm rating, 2.6 of 5; OR, 1.48 [95% CI, 1.27-1.74]). Compared with normal branded packaging, youth-appealing packaging was associated with increased appeal ratings (OR, 1.40 [95% CI, 1.20-1.64]), particularly among younger adults aged 18 to 20 years. Compared with no health claims, the pain relief and sleep aid claims were associated with increased appeal ratings (pain relief: OR, 1.31 [95% CI, 1.17-1.46]; sleep aid: OR, 1.36 [95% CI, 1.24-1.50]), particularly among past-year nonusers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;Results of this cross-sectional study of the features of cannabis edible packaging suggested that requiring plain packaging, prohibiting youth-appealing features, and regulating unsubstantiated health claims may improve warning recall and accurate harm","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 4","pages":"e253117"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772412","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":"Mindfulness vs Cognitive Behavioral Therapy for Chronic Low Back Pain Treated With Opioids: A Randomized Clinical Trial.","authors":"Aleksandra E Zgierska, Robert R Edwards, Bruce Barrett, Cindy A Burzinski, Robert N Jamison, Yoshio Nakamura, Mary F Henningfield, Wen-Jan Tuan, Chan Shen, Nalini Sehgal, Robert P Lennon, Huamei Dong, Vernon M Chinchilli, Yuxin Liu, Alyssa Turnquist, Anthony R Schiefelbein, Elizabeth A Jacobs, Christin Veasley, Penney Cowan, Eric L Garland","doi":"10.1001/jamanetworkopen.2025.3204","DOIUrl":"10.1001/jamanetworkopen.2025.3204","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Chronic low back pain (CLBP) can necessitate opioid therapy. Effective approaches to reduce CLBP's symptoms and opioid-related harms are needed. Cognitive behavioral (CBT) and mindfulness-based (MBT) therapies may be useful but have not been well-studied for opioid-treated CLBP.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To compare the effectiveness of MBT vs CBT in opioid-treated CLBP, hypothesizing MBT's superiority.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;In this 12-month community partner-informed, partially masked, multisite, randomized clinical trial, participants at primary and specialty care clinics and community settings were randomly assigned (1:1) to MBT or CBT groups. Participants included English-fluent adults (21 years or older), without prior MBT or CBT training, and with moderate-to-severe CLBP (average score ≥3 on the Brief Pain Inventory [BPI]; functional limitation score ≥20 on the Oswestry Disability Index [ODI]), treated with an opioid dosage of at least 15 mg/d of morphine milligram equivalents (MME) for at least 3 months. Outcome data were collected from July 1, 2017, to November 23, 2022. Analysis used the intention-to-treat approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;Manual-based MBT or CBT interventions consisting of 8 weekly therapist-led group sessions and at-home practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes and measures: &lt;/strong&gt;Self-reported coprimary (average pain severity, 0-10 [BPI]; functional limitations, 0-100 [ODI]) and secondary (mental and physical health-related quality of life [QOL] on the Medical Outcomes Study 12-Item Short Form Health Survey and opioid dose in MME per day, Timeline Followback) outcomes compared at 6 and 12 months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 6024 screened individuals, 2926 were ineligible, 2328 were eligible, and 770 were enrolled, including 385 in the MBT and 385 in the CBT groups. Of these, 434 participants (56.4%) were female, 647 (84.0%) identified as non-Hispanic ethnicity, and 630 (81.8%) identified as White race; mean (SD) age was 57.8 (11.3) years. The mean (SD) BPI average pain score was 6.1 (1.6) (moderate pain) and the mean (SD) ODI functional limitation score was 47.2 (14.0) (moderate functional limitations), with reduced physical (mean [SD], 28.5 [8.3]) and mental (mean [SD], 42.5 [11.8]) health-related QOL on the SF-12 and high opioid dosage (mean [SD], 177 [1041] MME/d). Over time, each group significantly improved their outcomes, without serious adverse effects. The intention-to-treat linear mixed-effects model analysis did not detect significant between-group differences at 6 and 12 months for pain (0.21 [95% CI, -0.05 to 0.48; P = .12] and 0.13 [95% CI, -0.13 to 0.40; P = .33], respectively) or function (0.07 [95% CI, -1.80 to 1.93; P = .94], and 0.27 [95% CI, -1.59 to 2.12; P = .78], respectively) and indicated MBT's noninferiority relative to CBT on primary outcomes.&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":"8 4","pages":"e253204"},"PeriodicalIF":10.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794389","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}