JAMA Network Open最新文献

{"title":"Enterovirus D68-Associated Respiratory Illness in Children.","authors":"Benjamin R Clopper, Adriana S Lopez, Leah A Goldstein, Terry Fei Fan Ng, Ariana P Toepfer, Mary A Staat, Elizabeth P Schlaudecker, Leila C Sahni, Julie A Boom, Jennifer E Schuster, Rangaraj Selvarangan, Natasha B Halasa, Laura S Stewart, John V Williams, Marian G Michaels, Geoffrey A Weinberg, Peter G Szilagyi, Eileen J Klein, Janet A Englund, Meredith L McMorrow, Heidi L Moline, Claire M Midgley","doi":"10.1001/jamanetworkopen.2025.9131","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.9131","url":null,"abstract":"<p><strong>Importance: </strong>Enterovirus D68 (EV-D68) typically causes mild to severe acute respiratory illness (ARI). Testing and surveillance for EV-D68 in the US are limited, and important epidemiologic gaps remain.</p><p><strong>Objective: </strong>To characterize the epidemiology and clinical severity of EV-D68 among US children seeking care for ARI from 2017 to 2022, using a multisite, active, systematic surveillance network.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study collected data from the New Vaccine Surveillance Network, an active, prospective, population-based surveillance system of emergency departments (EDs) and hospitals at 7 US academic medical centers. Children with ARI and EV-D68-positive results were enrolled during platform-wide EV-D68 testing periods (July to October 2017, July to November 2018, July to November 2020, and July 2021 to December 2022). Included children were aged younger than 18 years, reported 1 or more qualifying ARI symptoms, with a symptom duration less than 14 days at enrollment. Data were analyzed from in October 2024.</p><p><strong>Exposures: </strong>Laboratory-confirmed EV-D68 infection, including overall infections or those without viral codetection.</p><p><strong>Main outcomes and measures: </strong>Trends and characteristics of EV-D68, including demographics, underlying conditions, and clinical severity by health care setting, were explored. Among hospitalized children with EV-D68-positive results without viral codetection, multivariable logistic regression was used to examine factors associated with receipt of (1) supplemental oxygen or (2) intensive care.</p><p><strong>Results: </strong>From 2017 to 2022, 976 children with EV-D68-positive results were identified (median [IQR] age, 47 [18-63] months; 391 [40.1%] female); most were enrolled in 2018 (382 children) and 2022 (533 children). Among these, 856 had no viral codetection, of which 320 were discharged home from the ED (median [IQR] age, 33 [16-59] months; 180 male [56.3%]; 237 [74.1%] with no reported underlying conditions) and 536 were hospitalized (median [IQR] age, 40 [19-69] months; 330 male [61.6%]; 268 [50.0%] with no reported underlying conditions). Among those hospitalized, 199 (37.1%) reported a history of asthma or reactive airway disease (RAD) and 77 (14.4%) reported a condition other than asthma or RAD. Having an underlying condition other than asthma or RAD was associated with increased odds of receiving supplemental oxygen (adjusted odds ratio, 2.72; 95% CI, 1.43-5.18) or intensive care admission (adjusted odds ratio, 3.09; 95% CI, 1.72-5.56); neither age group nor history of asthma or RAD were associated with oxygen receipt or intensive care admission.</p><p><strong>Conclusions and relevance: </strong>In this cross-sectional study of children with medically attended EV-D68 infections, EV-D68 was associated with severe disease in otherwise healthy children of all ages, and children wit","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e259131"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12062906/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967617","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":"Radical Treatment for Prostate Cancer in Men With Limited Life Expectancy in Sweden.","authors":"Eugenio Ventimiglia, Rolf Gedeborg, Johan Styrke, Andri Wilberg Orrason, Pär Stattin, Marcus Westerberg","doi":"10.1001/jamanetworkopen.2025.8572","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.8572","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e258572"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12056566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990857","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":"Strategies to Advance Drug Repurposing for Rare Diseases.","authors":"Dongzhe Hong, Aaron S Kesselheim","doi":"10.1001/jamanetworkopen.2025.8339","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.8339","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e258339"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013158","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":"Use of Biologics During Pregnancy Among Patients With Autoimmune Conditions.","authors":"Celeste L Y Ewig, Yanning Wang, Nicole E Smolinski, Thuy Nhu Thai, Sonja A Rasmussen, Almut G Winterstein","doi":"10.1001/jamanetworkopen.2025.10504","DOIUrl":"10.1001/jamanetworkopen.2025.10504","url":null,"abstract":"<p><strong>Importance: </strong>Continuation of biologics in patients with an autoimmune condition who become pregnant involves weighing consequences of pregnancy-related changes in disease severity and potential teratogenic effects of medications. Characterization of biologic treatment patterns during pregnancy may provide insight into maternal and fetal risks and benefits.</p><p><strong>Objective: </strong>To describe the utilization pattern of biologics in pregnant individuals with autoimmune conditions.</p><p><strong>Design, setting, and participants: </strong>This cohort study used data from Merative MarketScan Research Databases, which contain administrative claims of commercially insured individuals in the US. Pregnant patients aged 16 to 55 years with an autoimmune condition and biologic use 6 months before conception between January 1, 2011, and December 31, 2022, were included. The data were analyzed between October 15, 2024, and February 28, 2025.</p><p><strong>Exposure: </strong>Use of biologics for autoimmune disease after conception.</p><p><strong>Main outcomes and measures: </strong>The proportion of patients who used biologics for Crohn disease, ulcerative colitis, psoriasis or psoriatic arthritis, rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus, and multiple sclerosis was assessed, and the association between underlying autoimmune disease and use of biologics during pregnancy was measured using multivariable logistic regression.</p><p><strong>Results: </strong>A total of 6131 pregnant patients (median [IQR] age, 32 [29-36] years) with an autoimmune condition were included. The most prevalent conditions were Crohn disease (1372 patients [25.6%]) and rheumatoid arthritis (1295 patients [24.1%]). Of all patients, 4393 (71.6%; 95% CI, 70.5%-72.8%) used biologics at least once during pregnancy. Among pregnancies with live birth outcomes, biologic use declined throughout gestation, with 2981 patients (68.6% [95% CI, 67.2%-70.0%]), 2555 patients (58.8% [95% CI, 57.3%-60.3%]), and 2113 patients (48.6% [95% CI, 47.1%-50.1%]) using biologics during the first, second, and third trimesters, respectively, and 3350 patients (77.1% [95% CI, 75.8%-78.3%]) using them post partum. Compared with pregnant patients with rheumatoid arthritis, those with Crohn disease (odds ratio [OR], 7.88 [95% CI, 5.93-10.47]) and ulcerative colitis (OR, 5.35 [95% CI, 3.73-7.66]) were more likely to use biologics, while those with psoriasis or psoriatic arthritis (OR, 0.65 [95% CI, 0.52-0.80]) were less likely.</p><p><strong>Conclusions and relevance: </strong>In this cohort study, a decline in the use of biologics for autoimmune disease was observed during the pregnancy period that rebounded only partially thereafter. Notable variations in use across autoimmune conditions suggest that indication-specific risk-benefit assessments of biologic use are needed.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e2510504"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078000","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":"Overweight or Obesity and Outcomes in Children With Acute Lymphoblastic Leukemia.","authors":"Elena J Ladas, Haiyang Sheng, Uma H Athale, Barbara L Asselin, Luis A Clavell, Peter D Cole, Yael Flamand, Jean-Marie Leclerc, Caroline Laverdiere, Bruno Michon, Stephen E Sallan, Lewis B Silverman, Jennifer J G Welch, Song Yao, Kara M Kelly","doi":"10.1001/jamanetworkopen.2025.9952","DOIUrl":"10.1001/jamanetworkopen.2025.9952","url":null,"abstract":"<p><strong>Importance: </strong>There are conflicting data on the association of overweight or obesity with clinical outcomes in childhood acute lymphoblastic leukemia (ALL). The duration of exposure to overweight or obesity may be a better indicator of the risk of poorer outcomes.</p><p><strong>Objective: </strong>To determine the association of the duration of overweight or obesity with treatment-related toxic effects, minimal residual disease, relapse, and survival in childhood ALL.</p><p><strong>Design, setting, and participants: </strong>In this prospective cohort study, fluctuations in z scores of body mass index (BMI) for age from diagnosis to the end of treatment (EOT) were examined in 794 children registered on a Dana Farber Cancer Institute ALL Consortium protocol from May 31, 2005, to December 15, 2011. Height and weight were abstracted from the medical record for classification of BMI z scores at diagnosis through EOT and into survivorship. Data were analyzed from July 1 to 31, 2024.</p><p><strong>Main outcomes and measures: </strong>The duration of overweight or obesity was defined as having overweight or obesity at 2 or more time points and compared with having overweight or obesity at no more than 1 time point. Kaplan-Meier survival curves were generated to examine association of overweight or obesity with overall survival (OS), event-free survival (EFS), and cumulative incidence of relapse.</p><p><strong>Results: </strong>Among the 794 patients included in the analysis, the mean age at diagnosis was 6.7 (range, 1.0-17.9) years, with 441 (55.5%) being male, 136 (17.1%) Hispanic, and 553 (69.6%) non-Hispanic. The prevalence of overweight or obesity increased from 234 of 793 (29.5%) at diagnosis to 346 of 715 (48.4%) by EOT. Having overweight or obesity at baseline or developing overweight or obesity during induction was not associated with treatment-related toxic effects or higher minimal residual disease. Children with overweight or obesity at 2 or more time points experienced inferior OS (3-year OS, 93.8% vs 98.0%; P = .01), increased relapse (3-year relapse rate, 10.5% vs 5.8%; P = .02), and lower EFS (3-year EFS, 89.0% vs 93.7%; P = .02), compared with children with overweight or obesity at no more than 1 time point. Multivariable Cox proportional hazards regression models revealed an association between increased risk of death (hazard ratio [HR], 3.49; 95% CI, 1.28-9.51; P = .01) and relapse (HR, 1.92; 95% CI, 1.07-3.46; P = .03) among children with overweight or obesity at 2 or more time points.</p><p><strong>Conclusions and relevance: </strong>In this prospective cohort study of children with ALL, longer duration of overweight or obesity was associated with lower OS and EFS and higher rates of relapse, underscoring the need for interventions targeting overweight or obesity during treatment of children with ALL.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e259952"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12079296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010341","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":"Causes of Death Among US Medical Residents.","authors":"Nicholas A Yaghmour, William E Bynum, Frederic W Hafferty, Karen D Könings, Thomas Richter, Timothy P Brigham, Thomas J Nasca","doi":"10.1001/jamanetworkopen.2025.9238","DOIUrl":"10.1001/jamanetworkopen.2025.9238","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;From 2000 to 2014, the leading causes of medical resident death in the United States were neoplastic diseases and suicide.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To examine whether US medical resident rates of death have changed since 2014 and whether causes of resident death differ by specialty.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;In this cross-sectional study, residents and fellows who were enrolled in Accreditation Council for Graduate Medical Education (ACGME)-accredited training programs and who died from January 2015 to December 2021 were submitted to the National Death Index to obtain causes of death. These decedents were compared with residents and fellows who died between January 2000 and December 2014. Data were analyzed between July 2024 to March 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Death while actively enrolled in an ACGME-accredited residency and fellowship training program.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcome was the difference in rates of death for US residents and fellows between 2 time periods, 2000 to 2014 and 2015 to 2021. Poisson regression modeling was used to calculate incidence rate ratios (IRRs) with 95% CIs for this comparison. Rates were also compared across specialties. Secondary outcomes included comparing trainee decedents with age- and gender-matched peers in the general population and querying differences in causes of death by specialty from 2000 through 2021.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Between 2015 and 2021, 370 778 residents and fellows participated in 961 755 person-years of training. In that same period, 161 residents (50 [31.1%] female; median [IQR] age, 31 [29-35] years) died during training. Forty-seven residents (29.2%) died by suicide, 28 (17.4%) by neoplastic diseases, 22 (13.7%) from other medical and surgical diseases, 22 (13.7%) from accidents, and 21 (13.0%) from accidental poisoning. The highest number of resident suicides occurred during the first quarter of the first year. The death rate from neoplastic diseases decreased since 2000 to 2014 (IRR, 0.59; 95% CI, 0.38-0.90). Rates of other causes remained unchanged. Resident death rates from 2000 to 2021, including rates of death by suicide, were lower than age- and gender-matched peers across causes. The highest specialty suicide rate was for pathology (19.76 deaths per 100 000 person-years). The highest death rate from neoplastic diseases was psychiatry (9.67 deaths per 100 000 person-years). The highest death rate from accidental poisoning was anesthesiology (15.46 deaths per 100 000 person-years).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this cross-sectional study comparing rates of US medical resident deaths from 2000 to 2014 with rates observed in 2015 to 2021, the rate of resident deaths from neoplastic diseases decreased, while the rates of death from all other causes remained unchanged. Nevertheless, the number of residents who died by suicid","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e259238"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12079293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019297","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":"The Future of Agitation Interventions May Be Predictive.","authors":"Scott Zeller","doi":"10.1001/jamanetworkopen.2025.8939","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.8939","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e258939"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062355","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":"Racial and Socioeconomic Disparities in California Ambulance Patient Offload Times.","authors":"Vadim M Shteyler, Madeline Feldmeier, Richard Julian G Bagay, Dustin Ballard, Christopher Colwell, Renee Y Hsia","doi":"10.1001/jamanetworkopen.2025.10325","DOIUrl":"10.1001/jamanetworkopen.2025.10325","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Patient demographic and socioeconomic characteristics are associated with differential delays in access to emergency care. However, less is known about the association between demographic, socioeconomic, and emergency medical services (EMS) agency factors and ambulance patient offload times (APOT), a critical measure of timely access to emergency care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To determine the association between ambulance offload times and demographic, socioeconomic, and EMS agency factors, uncover disparities in offload delays, and investigate factors associated with long APOT.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This retrospective cohort study was conducted using offload data from the California EMS Authority and local EMS agencies (LEMSA), population data from the US Census Bureau, and demographic and socioeconomic data from the Centers for Disease Control and Prevention's Social Vulnerability Index. California local EMS agencies participated from January 1, 2021, to June 30, 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;A total of 30 community demographic, socioeconomic, and LEMSA factors were assessed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The main outcome was weighted mean APOT, calculated from APOT measures obtained from the California Emergency Medical Services Authroity and LEMSAs. The association between APOT and area demographic and socioeconomic characteristics was assessed using linear regression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In this retrospective study from January 1, 2021, to June 30, 2023, 5 913 399 offloads were observed across 34 California LEMSAs with median (IQR) of 0.3% (0.2%-0.4%) American Indian or Alaska Native residents, 7.1% (4.7%-1.5%) Asian residents, 2.2% (1.6%-4.9%) Black residents, 33.1% (22.5%-48.7%) Hispanic or Latino residents, 0.3% (0.2%-0.4%) Native Hawaiian or Pacific Islander residents, 4.1% (3.1%-4.9%) multiracial, and 0.4% (0.4%-0.5%) residents in the additional race category; 17.2% (14.7%-22.8%) residents living below 150% of the poverty line; and 15.7% (13.5%-20.1%) aged 65 years or older. The weighted mean (SD) APOT across California was 42.8 (27.3) minutes; the median (IQR) across LEMSAs was 27.0 (15.5-48.3) minutes. Sequential unadjusted linear regressions of the 30 characteristics revealed 11 that were significantly associated with APOT. Least absolute shrinkage and selection operator penalization identified Black race, being aged 65 years or older, and total offloads (all log-transformed) as the variables most associated with APOT. A 3.3% absolute increase in Black residents, from 1.6% (25th percentile) to 4.9% (75th percentile), was associated with an unadjusted 17.4-minute (95% CI 10.3-24.5) increase in APOT. This increase remained significant, at 11.75 (95% CI 1.9-21.6) minutes, after adjustments for demographic, socioeconomic, and LEMSA characteristics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;This cohort study of 5","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e2510325"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077954","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 Media Use and Depressive Symptoms During Early Adolescence.","authors":"Jason M Nagata, Christopher D Otmar, Joan Shim, Priyadharshini Balasubramanian, Chloe M Cheng, Elizabeth J Li, Abubakr A A Al-Shoaibi, Iris Y Shao, Kyle T Ganson, Alexander Testa, Orsolya Kiss, Jinbo He, Fiona C Baker","doi":"10.1001/jamanetworkopen.2025.11704","DOIUrl":"10.1001/jamanetworkopen.2025.11704","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;In 2023, the US Surgeon General issued the Advisory on Social Media and Youth Mental Health, identifying critical research gaps that preclude evidence-based guidance given that most studies of social media and mental health have been cross-sectional rather than longitudinal and have focused on young adults or older adolescents rather than on younger adolescents.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate longitudinal associations between social media use (time spent on social media) and depressive symptoms across 4 annual waves spanning a 3-year follow-up period from late childhood to early adolescence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;In this prospective cohort study using data from the Adolescent Brain Cognitive Development Study across 21 study sites from October 2016 to October 2018, children aged 9 to 10 years at baseline were assessed across 4 waves (baseline, year 1, year 2, and year 3), with year-3 follow-up through 2022. Sample sizes varied across waves and measures due to attrition and missing data. Analyses retained all available data at each wave. Data were analyzed from January 2024 to March 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Self-reported time spent on social media at baseline to 3-year follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Reciprocal associations between social media use and depressive symptoms (Child Behavior Checklist) at baseline and at 1, 2, and 3 years of follow-up were assessed using longitudinal, cross-lagged structural equation panel models. Covariates included sex, race and ethnicity, household income, and parental educational level.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;At baseline, the sample included 11 876 participants (mean [SD] age, 9.9 [0.6] years), of whom 6196 (52.2%) were male. After adjusting for stable between-person differences and covariates, within-person increases in social media use above the person-level mean were associated with elevated depressive symptoms from year 1 to year 2 (β, 0.07; 95% CI, 0.01-0.12; P = .01) and from year 2 to year 3 (β, 0.09; 95% CI, 0.04-0.14; P &lt; .001), whereas depressive symptoms were not associated with subsequent social media use at any interval. The final random-intercept cross-lagged panel model demonstrated a good fit (comparative fit index, 0.977; Tucker-Lewis index, 0.968; root mean square error of approximation, 0.031 [90% CI, 0.029-0.033]). Between-person differences in social media use were not associated with depressive symptoms (β, -0.01; 95% CI, -0.04 to 0.02; P = .46) after accounting for demographic and family-level factors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this cohort study of 11 876 children and adolescents, reporting higher than person-level mean social media use in years 1 and 2 after baseline was associated with greater depressive symptoms in the subsequent year. The findings suggest that clinicians should provide anticipatory guidance regarding social me","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e2511704"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110334","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":"Substance Use Screening, Brief Intervention, and Referral to Treatment Among Youth-Serving Clinicians.","authors":"Kathleen Ragan-Burnett, Lyna Schieber, Andrew Terranella, Christina Mikosz","doi":"10.1001/jamanetworkopen.2025.11579","DOIUrl":"10.1001/jamanetworkopen.2025.11579","url":null,"abstract":"<p><strong>Importance: </strong>Despite decreasing substance use by adolescents in recent years, overdose rates continue to rise. Morbidity and mortality from substance use is preventable if detected; however, screening practices among youth-serving clinicians are unknown.</p><p><strong>Objective: </strong>To describe youth-serving clinicians' screening, brief intervention, and referral to treatment practices for substance use disorders (SUDs) among adolescents.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study used DocStyles data from September 5 to October 12, 2023, on clinical practice settings in the US. Responding clinicians included family physicians, internal medicine physicians, pediatricians, nurse practitioners, and physician assistants.</p><p><strong>Exposure: </strong>Delivery of services to youths aged 17 years or younger.</p><p><strong>Main outcomes and measures: </strong>Screening, brief intervention, and referral to treatment practices, including screening frequency and type of screening tool used, and screening at every well visit using a screening tool were assessed using descriptive statistics and multivariable logistic regression.</p><p><strong>Results: </strong>Of 1047 youth-serving clinicians (mean [SD] age, 45.3 [11.4] years; 555 male [53.0%]), 467 (44.6%) were family physicians, 250 (23.9%) were pediatricians, 132 (12.6%) were internal medicine physicians, 107 (10.2%) were nurse practitioners, and 91 (8.7%) were physician assistants (survey response rate, 57%). Median years in practice was 13 (IQR, 7-23 years). Most clinicians (634 [60.6%]) reported that skills in SUD diagnosis were relevant to their practice, and 800 (76.4%) reported seeing at least 1 adolescent with an SUD monthly. A majority of clinicians (596 [56.9%]) reported screening for SUDs at every well visit, with a high proportion of pediatricians reporting screening at every well visit (173 of 250 [69.2%]). Clinicians who screened at every well visit were more likely to use a screening tool (odds ratio, 1.87 [95% CI, 1.44-2.44]). Only 411 clinicians (39.3%) reported screening at every well visit using a screening tool; 321 clinicians (30.7%) offered all components of screening, brief intervention, and referral to treatment practice. Clinicians who reported seeing 5 or more adolescents with an SUD per month had a higher odds of screening with a standardized tool at every annual well visit (adjusted odds ratio, 2.19 [95% CI, 1.30-3.71]).</p><p><strong>Conclusions and relevance: </strong>These findings suggest that while most clinicians report screening youths for SUDs at least sometimes, a substantial proportion screened only intermittently. Efforts to improve screening rates through education and systems-based practice changes may facilitate offering anticipatory guidance and SUD treatment in all youth-serving clinical settings.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e2511579"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110505","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}