JAMA Network Open最新文献

{"title":"What Matters About What Matters Most.","authors":"Mary E Tinetti, Brenda S Nettles","doi":"10.1001/jamanetworkopen.2025.35775","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.35775","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2535775"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232669","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":"Memantine to Treat Social Impairment in Youths With Autism Spectrum Disorder: A Randomized Clinical Trial.","authors":"Gagan Joshi, Atilla Gönenc, Maura DiSalvo, Stephen V Faraone, Tolga Atilla Ceranoglu, Amy M Yule, Mai Uchida, Christopher J McDougle, Janet Wozniak","doi":"10.1001/jamanetworkopen.2025.34927","DOIUrl":"10.1001/jamanetworkopen.2025.34927","url":null,"abstract":"<p><strong>Importance: </strong>Pharmacologic interventions for addressing social impairments in autism spectrum disorder (ASD) are lacking. Proton magnetic resonance spectroscopy (1H-MRS) studies in individuals with ASD have documented altered glutamate levels in the pregenual anterior cingulate cortex (pgACC).</p><p><strong>Objectives: </strong>To evaluate the safety and efficacy of memantine for treating social impairments in youths with ASD and to explore pgACC glutamate levels as a potential biomarker for treatment response.</p><p><strong>Design, setting, and participants: </strong>This 12-week, placebo-controlled, double-blind, parallel-design randomized clinical trial was conducted between January 20, 2015, and July 11, 2018. The study population comprised youths aged 8 to 17 years with ASD without intellectual disability (IQ≥85) recruited from ambulatory psychiatry clinics at an academic institution. Age- and sex-matched healthy control participants provided reference data for pgACC glutamate levels. Data analysis was conducted between January 7, 2020, and December 19, 2024.</p><p><strong>Interventions: </strong>Participants with ASD were randomized to memantine or placebo, with dose titration up to 20 mg/d. 1H-MRS scans were acquired to assess pgACC glutamate levels.</p><p><strong>Main outcomes and measures: </strong>Response was defined a priori as (1) a 25% or greater reduction in informant-rated Social Responsiveness Scale-Second Edition total scores and (2) a clinician-rated Clinical Global Impression-Improvement subscale (anchored for ASD) score of 2 or less. The association between pgACC glutamate levels and treatment response was explored using receiver operating characteristic (ROC) curve analysis.</p><p><strong>Results: </strong>This study included 42 youths with ASD who initiated treatment (mean [SD] age, 13.2 [2.6] years; 32 males [76.2%]). Of these youths, 35 were included in the intention-to-treat efficacy analysis (n = 16 treated with memantine and 19 with placebo), and 33 completed the trial (n = 16 treated with memantine and 17 with placebo). Significantly more memantine-treated participants met the response criteria compared with placebo-treated participants (9 of 16 [56.2%] vs 4 of 19 [21.0%]; odds ratio, 4.8 [95% CI, 1.1-21.2]; P = .03). Memantine was well tolerated and did not have significantly more adverse events compared with placebo. Mean (SD) pgACC glutamate levels were significantly higher in youths with ASD vs healthy control participants (95.5 [14.6] IU vs 76.6 [17.7] IU; standardized mean difference, -1.2 [95% CI, -1.8 to -0.6]; P < .001). Abnormally elevated pgACC glutamate levels (≥1 SD above that of healthy control participants) were observed in 20 of 37 participants (54.0%) with ASD and were associated with more treatment responders to memantine than placebo (8 of 10 [80.0%] vs 2 of 10 [20.0%]; odds ratio, 16.0 [95% CI, 1.8-143.2]; P = .007). ROC curve analysis indicated that pgACC glutamate levels were h","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2534927"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12489667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199505","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":"Implementation of Group Physical Therapy for Knee Osteoarthritis: A Cluster Randomized Clinical Trial.","authors":"Kelli D Allen, Sara Webb, Cynthia J Coffman, Livia Anderson, Graham Cummin, Connor Drake, Matthew Tucker, Amy Webster, Nina Sperber, Leah L Zullig, Jaime M Hughes, Lindsay A Ballengee, Lauren M Abbate, Helen Hoenig, Natalie Fullenkamp, Courtney H Van Houtven, Susan N Hastings","doi":"10.1001/jamanetworkopen.2025.35038","DOIUrl":"10.1001/jamanetworkopen.2025.35038","url":null,"abstract":"<p><strong>Importance: </strong>Group-based physical therapy (PT) for knee osteoarthritis is an effective, efficient strategy for delivering care, but little is known about optimal strategies for implementing new clinical programs like group PT.</p><p><strong>Objective: </strong>To compare 2 implementation support approaches-foundational support and a combination of foundational support and more intensive enhanced support involving individual external facilitation-for delivering group PT.</p><p><strong>Design, setting, and participants: </strong>This cluster randomized clinical trial was conducted from January 31, 2022, to March 18, 2024, in outpatient PT departments at Department of Veterans Affairs (VA) Healthcare sites that agreed to deliver group PT to patients with symptomatic knee osteoarthritis. Sites were randomized to receive foundational or enhanced implementation support for delivering 6 sessions of group PT over 12 months that included exercise and educational content.</p><p><strong>Interventions: </strong>The foundational support approach included self-guided tools and monthly learning collaborative calls. The enhanced support approach added tailored support (eg, external facilitation) for sites that did not meet a priori benchmarks for adoption at 6 months or sustainment at 9 months.</p><p><strong>Main outcomes and measures: </strong>Site-level implementation outcomes were measured during months 7 to 12 and included penetration (primary outcome, assessed as the mean number of patients enrolled per month) and fidelity (mean number of classes attended per patient, out of a maximum of 6). Generalized linear models were used to examine differences in implementation outcomes between the enhanced and foundational support arms.</p><p><strong>Results: </strong>Nineteen sites (10 enhanced support, 9 foundational support) enrolling across 3 cohorts delivered group PT to 144 patients (68 enhanced support, 76 foundational support) during months 7 to 12. Patients were predominantly male (130 [90.3%]), with a mean (SD) age of 67 (9.2) years. Mean penetration estimates were 1.0 (95% CI, 0.2-1.7) patients enrolled per month for the enhanced support and 1.0 (95% CI, 0.1-1.9) for the foundational support arm, with an estimated mean difference between arms of -0.1 (95% CI, -1.1 to 1.0) patients enrolled (P = .92). Mean fidelity estimates were 5.0 (95% CI, 4.3-5.7) classes attended per patient in the enhanced support arm and 4.1 (95% CI, 3.2-4.9) in the foundational support arm, with an estimated mean difference between arms of 0.9 (95% CI, 0.0-1.9) classes per patient (P = .06).</p><p><strong>Conclusions and relevance: </strong>In this cluster randomized clinical trial, an enhanced implementation support approach for delivering group PT did not outperform foundational support. Penetration was modest, illustrating the challenge of fostering referrals.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT05282927.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2535038"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12492051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206430","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 Determinants of Self-Reported Health in Vulnerable Populations During a Polycrisis in Lebanon.","authors":"Rindala Fayyad, Marie-Elizabeth Ragi, Hala Ghattas, Stephen J McCall","doi":"10.1001/jamanetworkopen.2025.29733","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.29733","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;In the context of a polycrisis, which is characterized by multiple interconnected and mutually reinforcing crises, humanitarian and health needs increase. It is therefore crucial to identify social determinants impacting health and well-being of vulnerable populations to better inform appropriate interventions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess the association between social determinants and pain frequency, self-rated health, and depression over time among vulnerable populations during a polycrisis in Lebanon.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;In this population-based longitudinal cohort study, data were collected in Sin-El-Fil, a suburb of Beirut, Lebanon, in 4 waves: June 28 to October 26, 2022; September 8 to December 22, 2022; January 24 to April 28, 2023; and April 8 to July 5, 2024. Data for this analysis were extracted from a parent study around populations at high risk of COVID-19 infections, morbidity, and mortality and included a sample of Syrian refugees and migrants, pregnant women, older adults, and people of low socioeconomic status. Participants were selected via a multistage stratified sampling design. For this substudy, only individuals residing in neighborhoods with socioeconomic deprivation were considered.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Food insecurity, nationality, wealth, educational level, and sex.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The outcomes were pain frequency (days per week), self-rated health (poor or fair, good, or very good or excellent), and depression (measured using the Patient Health Questionnaire-9). Survey-weighted generalized linear regression models were fitted for each outcome-exposure pair, and odds ratios (ORs) and 95% CIs were computed to report mean marginal estimates and time-specific estimates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study included 1986 individuals at baseline (mean [SD] age, 44.7 [17.4] years); 1055 (53.1%) were female, 664 (33.4%) were Syrian refugees or migrants, 1025 (51.6%) had no high school degree, and 1451 (73.1%) had food insecurity. The exposure variables were significantly associated with elevated odds of reporting more pain, worse self-rated health, and more depression over time, with mean marginal ORs ranging from 1.03 (95% CI, 1.01-1.06) for worse self-rated health among women compared with men to 1.50 (95% CI, 1.46-1.55) for worse self-rated health among people with vs without food insecurity. The sole exception was for participant sex and depression, between which there was no association (OR, 0.99; 95% CI, 0.97-1.02).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this cohort study, Syrian refugees and migrants, women, and individuals with food insecurity, lower wealth, and less education compared with other residents within the low socioeconomic status areas reported worse physical and mental health challenges, suggesting they carried an additional burden of disadvantage. The find","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2529733"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251083","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":"Trainee-Physician Milestones Ratings and Patient Experience Surveys in Early Unsupervised Practice.","authors":"Jenny X Chen, Deirdre Mylod, Yuezhou Jing, Madeleine Kerschner, Bruce Trock, Steve Meth, Kenji Yamazaki, Sean O Hogan, Misop Han","doi":"10.1001/jamanetworkopen.2025.36380","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.36380","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Milestones ratings have been used to assess resident physicians for more than a decade, but little is known as to whether there are posttraining implications of ratings for patient experiences.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To investigate the association of residents' Milestones ratings of professionalism and interpersonal and communication skills (ICS) with patient experience survey results in the first year of unsupervised practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This retrospective cohort study included physicians who completed residency training at Accreditation Council for Graduate Medical Education-accredited programs between July 1, 2015, and June 30, 2019, and subsequently worked at facilities that collected Clinician & Group-Consumer Assessments of Healthcare Providers and Systems Surveys (CG-CAHPS). Milestones ratings from adult primary care training programs (internal medicine, family medicine, and obstetrics and gynecology) and patient survey data were linked for physicians who had more than 30 CG-CAHPS results in their first year of unsupervised practice. Physician characteristics (sex and specialty), CG-CAHPS patient respondent demographics (sex, race, and language spoken at home), and a CG-CAHPS question about a facility-related experience were collected for multivariable linear regression analyses. Data were analyzed from February 1, 2024 to April 10, 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Mean professionalism and ICS scores in Milestones evaluations collected 6 months before the end of training. Physicians were categorized into those with higher (≥3.5) or lower (&lt;3.5) mean scores.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;CG-CAHPS Top Box scores for 6 questions pertaining to physician behaviors and the overall clinician rating. (Top Box scores denote the percentage of patients who selected the most favorable response option.).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 1349 physicians (753 [55.8%] aged 26-30 years; 804 [59.6%] female) were included in the analysis. Higher mean professionalism or ICS Milestones ratings were associated with higher Top Box scores across all CG-CAHPS questions pertaining to physician-related experiences (eg, adjusted mean difference in physician's knowledge of the patient's medical history: professionalism, 2.9 [95% CI, 1.4-4.5] percentage points; P &lt; .001; ICS, 3.2 [95% CI, 1.5-4.9] percentage points; P &lt; .001) as well as overall physician ratings (adjusted mean difference: professionalism, 2.9 [95% CI, 1.4-4.3] percentage points; P &lt; .001; ICS, 3.5 [95% CI, 2-5.1] percentage points; P &lt; .001) in multivariable linear regression models.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this cohort study of physicians who completed residency in adult primary care specialties, those with higher mean professionalism and ICS Milestones ratings in training received better patient experience survey ratings in their first year of uns","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2536380"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251089","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 Formulary Coverage of Nonprotected Class Drugs Granted FDA Accelerated Approval.","authors":"Shelley A Jazowski, Stacie B Dusetzina","doi":"10.1001/jamanetworkopen.2025.36089","DOIUrl":"10.1001/jamanetworkopen.2025.36089","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2536089"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12505173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238858","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":"Pregnancy Preferences and Incident Pregnancy in the US.","authors":"Brooke W Bullington, Isabel Muñoz, W John Boscardin, Corinne H Rocca","doi":"10.1001/jamanetworkopen.2025.36697","DOIUrl":"10.1001/jamanetworkopen.2025.36697","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Examining associations of pregnancy and childbearing desires with incident pregnancy is vital to understanding whether individuals attain their reproductive preferences. Much of the existing population-based research is limited by simplistic measurement of pregnancy desires and retrospective study designs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess the prospective association of pregnancy preferences with incident pregnancy and to investigate the degree to which people's attainment of their pregnancy preferences differs by sociodemographic characteristics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cohort study used longitudinal data from the Surveys of Women, state-representative prospective studies of reproductive-aged females from 9 US states (Alabama, Arizona, Delaware, Iowa, Maryland, New Jersey, Ohio, South Carolina, and Wisconsin). Participants were recruited between November 2016 and July 2020 and followed up for 2 to 3 years, depending on the state. Eligible participants were aged 18 to 44 years and female. Analyses included participants who, at the start of each 1-year observation period, could experience pregnancy (ie, not pregnant, no tubal ligation, and not infertile). Data were analyzed from May 2024 to April 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;The primary exposure was preferences about a potential pregnancy within 3 months and childbearing within 1 year, measured using the Desire to Avoid Pregnancy (DAP) scale. Scores were categorized into low, midrange, and high desire to avoid pregnancy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome and measures: &lt;/strong&gt;The primary outcome was self-reported incident pregnancy over the year after completing the DAP scale. Differences in incident pregnancy were examined within DAP score grouping by sociodemographic characteristics using model-estimated probabilities of pregnancy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The sample included 9565 unique participants (3256 participants [weighted percentage, 48%] aged &lt;30 years) who contributed 18 603 annual longitudinal observations. A majority of participants were nulliparous (4066 participants [weighted percentage, 51%]) or lived with a romantic partner (5952 participants [weighted percentage, 59%]). An estimated 3% (95% CI, 2%-4%) of participants with high DAP scores reported pregnancy over a year, compared with 8% (95% CI, 7%-9%) of those with midrange DAP scores and 25% (95% CI, 23%-27%) of those with low DAP scores. The association of DAP score with pregnancy differed by age, parity, prior-year birth, cohabitation with partner, education level, employment, and racial and ethnic identity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this population-based cohort study of reproductive-aged females, realization of pregnancy preferences varied by sociodemographic characteristics, highlighting reproductive inequities. These results may be used to inform public health efforts to provide contraception, abortion, pr","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2536697"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251045","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":"Health Care Costs Associated With Norovirus at the Veterans Health Administration.","authors":"Jordan E Cates, Richard E Nelson, Ying Suo, Umesh D Parashar, Cynthia A Lucero-Obusan, Mark Holodniy, Sara A Mirza","doi":"10.1001/jamanetworkopen.2025.36600","DOIUrl":"10.1001/jamanetworkopen.2025.36600","url":null,"abstract":"<p><strong>Importance: </strong>Norovirus is the leading cause of acute gastroenteritis among all ages in the US. Older adults, including veterans, are a potential target group for future vaccination and therapeutics, and more data are needed on the economic burden of norovirus among this population.</p><p><strong>Objective: </strong>To quantify the outpatient, emergency department (ED), and inpatient health care costs associated with laboratory-confirmed norovirus episodes among veterans seeking care in the Veterans Health Administration (VHA).</p><p><strong>Design, setting, and participants: </strong>This economic evaluation used VHA electronic health record and health care cost data between January 1, 2010, and December 31, 2024, with costs adjusted to 2024 dollars. Participants were veterans (aged ≥18 years) with norovirus who sought care from VHA clinics and hospitals nationwide. Norovirus episodes were categorized as outpatient, ED, or inpatient.</p><p><strong>Exposure: </strong>Norovirus episodes laboratory-confirmed by polymerase chain reaction assays.</p><p><strong>Main outcomes and measures: </strong>Outpatient, ED, and inpatient costs for encounters or admissions within 2 days of the norovirus-positive test result. Costs were extrapolated to the expected number of annual norovirus episodes with and without laboratory confirmation in the VHA using published incidence rates.</p><p><strong>Results: </strong>A total of 7768 norovirus episodes from 7520 patients (median [IQR] age, 62 [45-74] years; 6862 males [88%]; median [IQR] Charlson Comorbidity Index [CCI], 1 [0-4]) were included in the analysis. There were 3520 outpatient, 2018 ED, and 2230 inpatient norovirus episodes, with respective median (IQR) costs of $640 ($207-$1291), $2203 ($1596-$2989), and $14 083 ($8045-$26 672). Median (IQR) inpatient costs were higher among older age groups ($12 777 [$7297-$23 737], $16 075 [$9291-$29 311], and $18 566 [$10 676-$33 582] for those aged 45-64 years, 65-84 years, and ≥85 years, respectively) than younger adults ($7751 [$4768-$14 984] and $9394 [$5474-$15 830] for those aged 18-24 years and 25-44 years, respectively; P < .001). Median (IQR) inpatient costs were also higher across CCI categories, with the highest for CCI of 5 or higher ($18 508 [$10 445-$35 900]). The overall extrapolated annual cost to the VHA was $28 438 556.</p><p><strong>Conclusions and relevance: </strong>This study found norovirus to be a substantial economic burden in the VHA. Developing targeted interventions, such as vaccines and antivirals, for this population may result in cost savings.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2536600"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251058","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":"All-Cause and Cause-Specific Mortality Among Patients With Narcolepsy.","authors":"Chih-Wei Hsu, Yen-Shan Yang, Yang-Chieh Brian Chen, Liang-Jen Wang, Mu-Hong Chen, Yao-Hsu Yang, Chih-Sung Liang, Edward Chia-Cheng Lai","doi":"10.1001/jamanetworkopen.2025.36771","DOIUrl":"10.1001/jamanetworkopen.2025.36771","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Narcolepsy is a sleep disorder potentially affecting mortality, yet evidence on this association remains sparse.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To examine whether narcolepsy is associated with an increased risk of all-cause and cause-specific mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This retrospective cohort study used data from the Taiwan National Health Insurance Research Database (NHIRD) from 2001 to 2021, with patients followed up until death or December 31, 2022. Patients were aged 6 years or older with 2 or more narcolepsy diagnoses from psychiatrists or neurologists. Controls were selected from the NHIRD as a population-based sample. Controls without narcolepsy were matched in a 1:4 ratio on sex and birth date (±6 months). Sibling controls were siblings without narcolepsy. Statistical analysis was performed from January to April 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Clinical narcolepsy diagnosis, confirmed via NHIRD records (International Classification of Diseases, Ninth Revision, Clinical Modification code 347 or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification code G47.4).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcome was all-cause mortality, measured as hazard ratios (HRs) using Cox proportional hazards regression, adjusted for birth year, sex, income, urbanization, and Charlson Comorbidity Index. Secondary outcomes included cause-specific mortality (natural, unnatural, accidents, suicides).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 3187 patients with narcolepsy (mean [SD] age, 29.5 [16.1] years; 1674 male patients [52.5%]) and 12 748 controls (mean [SD] age, 29.5 [16.1] years; 6696 male patients [52.5%]), 132 patients with narcolepsy and 456 controls died. Psychiatric comorbidities, especially depression (1167 of 3187 [36.6%] vs 861 of 12 748 [6.8%]) and anxiety (1054 of 3187 [33.1%] vs 853 of 12 748 [6.7%]), were more common in the narcolepsy group than in the control group. Crude all-cause mortality rates were 44.3 per 10 000 person-years among patients with narcolepsy and 38.1 per 10 000 person-years among controls. All-cause mortality was not increased among patients with narcolepsy (HR, 0.96; 95% CI, 0.79-1.17). There was no increase among patients with narcolepsy in cause-specific mortality for natural causes (HR, 0.90; 95% CI, 0.73-1.11), unnatural causes, (HR, 1.41; 95% CI, 0.83-2.40), accidents (HR, 1.37; 95% CI, 0.64-2.95), and suicides (HR, 1.41; 95% CI, 0.62-3.22). The sibling cohort analysis similarly demonstrated no significantly increased risk among patients with narcolepsy of all-cause mortality (HR, 1.14; 95% CI, 0.63-2.06) or cause-specific mortality from natural causes (HR, 0.66; 95% CI, 0.28-1.56), unnatural causes (HR, 2.08; 95% CI, 0.87-4.98), accidents (HR, 1.61; 95% CI, 0.48-5.37), or suicides (HR, 3.43; 95% CI, 0.88-13.28).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relev","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2536771"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251116","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":"Cannabis Education-A Professional and Moral Obligation for Physicians.","authors":"Darshan H Mehta","doi":"10.1001/jamanetworkopen.2025.36224","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.36224","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2536224"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238626","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}