JAMA Network Open最新文献

{"title":"Maternal Disability and Emergency Department Use for Infants.","authors":"Hilary K Brown, Yona Lunsky, Kinwah Fung, Maria Santiago-Jimenez, Andi Camden, Eyal Cohen, Joel G Ray, Natasha R Saunders, Deanna Telner, Catherine E Varner, Simone N Vigod, Jennifer Zwicker, Astrid Guttmann","doi":"10.1001/jamanetworkopen.2025.8549","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.8549","url":null,"abstract":"<p><strong>Importance: </strong>Infants have among the highest rates of emergency department (ED) visits of all age groups. Women with disabilities experience significant social disparities, may experience barriers accessing child primary care, and may seek care in the ED.</p><p><strong>Objective: </strong>To compare ED use among newborns and infants (hereafter infants) of women with or without disabilities, overall and by timing and acuity of the ED visit.</p><p><strong>Design, setting, and participants: </strong>This population-based cohort study analyzed data for all live-born infants in Ontario, Canada, born to women with or without a disability from April 1, 2008, to March 31, 2021. Data were analyzed March 2023 to October 2024.</p><p><strong>Exposure: </strong>Maternal physical, sensory, or intellectual or developmental disability or multiple disabilities status was ascertained using diagnostic algorithms applied to health care encounters before delivery.</p><p><strong>Main outcomes and measures: </strong>The main outcome was any ED visit between an infant's hospitalization discharge date and their first birthday, and by timing and acuity. Cox proportional hazards regression was used to generate hazard ratios (HRs) for the association between maternal disability and the main outcome, adjusted for sociodemographic characteristics and infant sex and year of birth.</p><p><strong>Results: </strong>Of 1 596 932 total infants, there were 139 698 (8.7%) born to women with a physical disability, 48 112 (3.0%) to women with a sensory disability, 2547 (0.2%) to women with an intellectual or developmental disability, and 10 312 (0.6%) to women with multiple disabilities. The remaining 1 396 263 infants (87.4%) were born to a woman without a recognized disability. Among women without a disability, 558 965 infants (40.0%) had an ED visit in the first year of life (incidence rate, 1.11 per 1000 person-days). Compared with this referent group, infants born to a woman with a disability of a physical (46.9%; 1.30 visits per 1000 person-days; adjusted HR [AHR], 1.14 [95% CI, 1.13-1.15]), sensory (45.2%; 1.25 visits per 1000 person-days; AHR, 1.09 [95% CI, 1.07-1.10]), or intellectual or developmental (55.4%; 1.55 visits per 1000 person-days; AHR, 1.24 [95% CI, 1.17-1.30]) nature or with multiple disabilities (51.0%; 1.42 visits per 1000 person-days; AHR, 1.18 [95% CI, 1.15-1.22]) were more likely to have an ED visit. Similar patterns were observed for ED visits at fewer than 28 days from delivery, from 28 to 365 days, and for ED visits for high-acuity, moderate-acuity, and low-acuity reasons.</p><p><strong>Conclusions and relevance: </strong>In this population-based cohort study, infants of women with disabilities were more likely to use the ED, indicating a need for accessible family supports and improved early child primary care access.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e258549"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003826","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":"Machine Learning Multimodal Model for Delirium Risk Stratification.","authors":"Joseph I Friedman, Prathamesh Parchure, Fu-Yuan Cheng, Weijia Fu, Satyanarayana Cheertirala, Prem Timsina, Ganesh Raut, Katherine Reina, Josiane Joseph-Jimerson, Madhu Mazumdar, Robert Freeman, David L Reich, Arash Kia","doi":"10.1001/jamanetworkopen.2025.8874","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.8874","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Automating the identification of risk for developing hospital delirium with models that use machine learning (ML) could facilitate more rapid prevention, identification, and treatment of delirium. However, there are very few reports on the performance of ML models for delirium risk stratification in live clinical practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To report on development, operationalization, and validation of a multimodal ML model for delirium risk stratification in live clinical practice and its associations with workflow and clinical outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This quality improvement study developed an ML model supported by automated electronic medical records to stratify the risk of non-intensive care unit delirium in live clinical practice using the Confusion Assessment Method as the diagnostic reference standard, with an iterative model update method. Data from patients aged at least 60 years admitted to non-intensive care units at Mount Sinai Hospital between January 2016 and January 2020 were used to train and test the ML model presented. The model was validated in live clinical practice from March 2023 to March 2024. Analysis of the model's associations with workflow and clinical outcomes was conducted retrospectively in 2024, comparing hospitalized patients prior to deployment of any model version (pre-ML cohort) and during model clinical deployment (post-ML cohort).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Outcomes of interest were area under the receiver operating characteristic curve, monthly delirium detection rates, median length of hospital stay, and daily doses of opiate, benzodiazepine, and antipsychotic medications administered.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The overall sample included 32 284 inpatient admissions (mean [SD] age, 73.56 (9.67) years, 15 157 [46.9%] women). A total of 25 261 inpatient admissions of older patients with both medical and surgical primary diagnoses represented the combined model testing and training cohort (median age, 73.37 [66.42-81.36] years) and live clinical deployment validation cohort (median [IQR] age, 72.11 [62.26-78.97] years), while 7023 inpatient admissions of older patients with both medical and surgical primary diagnoses represented the combined pre-ML (median [IQR] age, 74.00 [68.00-81.00] years) and post-ML (median [IQR] age, 75.33 [68.34-82.91] years) cohorts. The model presented is a fusion of electronic medical record patient data features and clinical note features processed by natural language processing. The results of model validation in live clinical practice included an area under the curve of 0.94 (95% CI, 0.93-0.95). Median (IQR) monthly delirium detection rates of inpatients assessed for delirium with the Confusion Assessment Method increased from 4.42% (95% CI, 3.70%-5.14%) in the pre-ML cohort to 17.17% (95% CI, 15.54%-18.80%) in the post-ML cohort (P &lt; .001). Post-ML vs pre-ML ","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e258874"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12059973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001084","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":"Teen Drivers, Older Cars, and Advanced Driver Assistance Systems-Bridging the Safety Gap.","authors":"Elizabeth A Walshe","doi":"10.1001/jamanetworkopen.2025.8952","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.8952","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e258952"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998497","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":"Oral Microbiome Profile of the US Population.","authors":"Anil K Chaturvedi, Emily Vogtmann, Jianxin Shi, Yukiko Yano, Martin J Blaser, Nicholas A Bokulich, J Gregory Caporaso, Maura L Gillison, Barry I Graubard, Xing Hua, Autumn G Hullings, Lisa Kahle, Rob Knight, Shilan Li, Jody McLean, Vaishnavi Purandare, Yunhu Wan, Neal D Freedman, Christian C Abnet","doi":"10.1001/jamanetworkopen.2025.8283","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.8283","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;The oral microbiome likely plays key roles in human health. Yet, population-representative characterizations are lacking.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To characterize the composition, diversity, and correlates of the oral microbiome in US adults.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cross-sectional study analyzed data from the population-representative National Health and Nutrition Examination Survey (NHANES) from 2009 to 2012. Microbiome data were made publicly available in 2024. NHANES participants were aged 18 to 69 years and provided oral rinse samples in 1 of 2 consecutive NHANES cycles (2009-2010 and 2011-2012).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Demographic, socioeconomic, behavioral, anthropometric, metabolic, and clinical characteristics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Oral microbiome measures, characterized through 16S ribosomal RNA gene sequencing, included α diversity (observed amplicon sequence variants [ASVs], Faith phylogenetic diversity, Shannon-Weiner Index, and Simpson Index); β diversity (unweighted UniFrac, weighted UniFrac, and Bray-Curtis dissimilarity); and prevalence and relative abundance at phylum level through genus level. Analyses accounted for the NHANES complex sample design.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;This study included 8237 US adults aged 18 to 69 years, representing 202 314 000 individuals (102 813 000 men [50.8%]; mean [SD] age, 42.3 [14.4] years; 9.3% self-reported as Mexican American, 12.1% as non-Hispanic Black, 64.7% as non-Hispanic White, 5.9% as other Hispanic, and 8.1% as other non-Hispanic individuals). The oral microbiome encompassed 37 bacterial phyla, 99 classes, 212 orders, 446 families, and 1219 genera. Five phyla (Firmicutes, Actinobacteria, Bacteroidetes, Proteobacteria, and Fusobacteria) and 6 genera (Veillonella, Streptococcus, Prevotella 7, Rothia, Actinomyces, and Gemella) were present in nearly all US adults (weighted prevalence, &gt;99%). These genera were the most abundant, accounting for 65.7% of total abundance. Observed ASVs showed a quadratic pattern with age (peak at 30 years), were similar by sex, significantly lower among non-Hispanic White individuals, and increased with greater body mass index (BMI), alcohol use, and periodontal disease severity. All covariates together accounted for a modest proportion of oral microbiome variability as measured by β diversity: R2 = 8.7% (95% CI, 8.4%-9.1%) for unweighted UniFrac, R2 = 7.2% (95% CI, 6.6%-7.7%) for weighted UniFrac, and R2 = 6.3% (95% CI, 3.1%-6.7%) for Bray-Curtis matrices. By contrast, relative abundance of a few genera explained a high percentage of variability in β diversity for weighted UniFrac: Aggregatibacter (R2 = 22.4%; 95% CI, 22.1%-22.8%), Lactococcus (R2 = 21.6%; 95% CI, 20.9%-22.3%), and Haemophilus (R2 = 18.4%; 95% CI, 18.1%-18.8%). Prevalence and relative abundance of numerous genera were associated with age, race and ethnicity, smokin","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e258283"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009869","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":"Dedicated AI Expert System vs Generative AI With Large Language Model for Clinical Diagnoses.","authors":"Mitchell J Feldman, Edward P Hoffer, Jared J Conley, Jaime Chang, Jeanhee A Chung, Michael C Jernigan, William T Lester, Zachary H Strasser, Henry C Chueh","doi":"10.1001/jamanetworkopen.2025.12994","DOIUrl":"10.1001/jamanetworkopen.2025.12994","url":null,"abstract":"<p><strong>Importance: </strong>Large language models (LLMs) have not yet been compared with traditional diagnostic decision support systems (DDSSs) on unpublished clinical cases.</p><p><strong>Objective: </strong>To compare the performance of 2 widely used LLMs (ChatGPT, version 4 [hereafter, LLM1] and Gemini, version 1.5 [hereafter, LLM2]) with a DDSS (DXplain [hereafter, DDSS]) on 36 unpublished general medicine cases.</p><p><strong>Design, setting, and participants: </strong>This diagnostic study, conducted from October 6, 2023, to November 22, 2024, looked for the presence of the known case diagnosis in the differential diagnoses of the LLMs and DDSS after data from previously unpublished clinical cases from 3 academic medical centers were entered. The systems' performance was assessed both with and without laboratory test data. Each case was reviewed by 3 physicians blinded to the case diagnosis. Physicians identified all clinical findings as well as the subset deemed relevant to making the diagnosis for mapping to the DDSS's controlled vocabulary. Two other physicians, also blinded to the diagnoses, entered the data from these cases into the DDSS, LLM1, and LLM2.</p><p><strong>Exposures: </strong>All cases were entered into each LLM twice, with and without laboratory test results. For the DDSS, each case was entered 4 times: for all findings and for findings relevant to the diagnosis, each with and without laboratory test results. The top 25 diagnoses in each resulting differential diagnosis were reviewed.</p><p><strong>Main outcomes and measures: </strong>Presence or absence of the case diagnosis in the system's differential diagnosis and, when present, in which quintile it appeared in the top 25 diagnoses.</p><p><strong>Results: </strong>Among 36 patient cases of various races and ethnicities, genders, and ages (mean [SD] age, 51.4 [16.4] years), in the version with all findings but no laboratory test results, the DDSS listed the case diagnosis in its differential diagnosis more often (56% [20 of 36]) than LLM1 (42% [15 of 36]) and LLM2 (39% [14 of 36]), although this difference did not reach statistical significance (DDSS vs LLMI, P = .09; DDSS vs LLM2, P = .08). All 3 systems listed the case diagnosis in most cases if laboratory test results were included (all findings DDSS, 72% [26 of 36]; LLM1, 64% [23 of 36]; and LLM2, 58% [21 of 36]).</p><p><strong>Conclusions and relevance: </strong>In this diagnostic study comparing the performance of a traditional DDSS and current LLMs on unpublished clinical cases, in most cases, every system listed the case diagnosis in their top 25 diagnoses if laboratory test results were included. A hybrid approach that combines the parsing and expository linguistic capabilities of LLMs with the deterministic and explanatory capabilities of traditional DDSSs may produce synergistic benefits.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e2512994"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12123466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173747","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":"Enhancing Multicenter Trials With the Trial Innovation Network's Initial Consultation Process.","authors":"Paul A Harris, Consuelo H Wilkins, Karen Lane, Gordon R Bernard, Jonathan D Casey, Daniel E Ford, Salina P Waddy, Ken L Wiley, Terri L Edwards, Nichol McBee, Dixie D Thompson, Mary Stroud, Emily Serdoz, Nan Kennedy, Sarah J Nelson, Michelle Jones, Lindsay M Eyzaguirre, Leslie R Boone, Jessica Baird, Colleen Lawrence, Elizabeth Holthouse, Sarah K Cook, Maeve Tischbein, Natalya Amrine, Tiffany Chen, Jodie Cohen, LaShondra Deyampert, Natalie Dilts, Delicia Burts, Amna Baig, Joseph Christodoulou, Mariela Rodriguez, Edgar R Miller, James F Casella, W Andrew Mould, J Michael Dean, Daniel K Benjamin, Harry P Selker, Marisha E Palm, Lori Poole, Jeri S Burr, Sara Hassani, Angeline Nanni, Meghan Hildreth, Daniel F Hanley","doi":"10.1001/jamanetworkopen.2025.12926","DOIUrl":"10.1001/jamanetworkopen.2025.12926","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e2512926"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12123472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173754","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":"Psychiatric Health Risks in North Korean Refugee Youths Resettled in South Korea.","authors":"Rugyeom Lee, Sang Min Lee, Minha Hong, In-Hwan Oh","doi":"10.1001/jamanetworkopen.2025.12941","DOIUrl":"10.1001/jamanetworkopen.2025.12941","url":null,"abstract":"<p><strong>Importance: </strong>Migrant and refugee populations are increasing globally, and children and adolescents in these populations are particularly susceptible to mental disorders. North Korean refugee (NKR) youths now living in South Korea share a culture, language, and history with South Korean (SK) youths, making these 2 groups suitable for studying the environmental factors in psychiatric health.</p><p><strong>Objective: </strong>To compare the risk of developing mental illness and individual psychiatric disorders among NKR youths and SK youths.</p><p><strong>Design, setting, and participants: </strong>This cohort study obtained data from Korea's National Health Insurance Service claims database from 2005 to 2021. Participants were aged 1 to 18 years between 2007 and 2010 who had no prior psychiatric claims, whether as outpatients or inpatients. Children and adolescents of the SK general population matched 1:10 on sex and age were compared with the NKR youth population. Statistical analyses were performed from August 2024 to March 2025.</p><p><strong>Main outcomes and measures: </strong>Risk, presented as hazard ratio (HR), of developing psychiatric disorders in NKR youths compared with SK youths. This risk was assessed using a Cox proportional hazards regression model and Kaplan-Meier time-to-event probabilities.</p><p><strong>Results: </strong>In total, 1618 NKR youths (810 males [50.1%]; mean [SD] age, 9.48 [4.62] years) and 308 927 SK youths (194 331 females [62.9%]; mean [SD] age, 11.80 [4.72] years) were included in this study. NKR youths showed a significantly higher risk of developing psychiatric disorders (HR, 1.29; 95% CI, 1.17-1.43) compared with SK youths. Individual psychiatric disorder risks were higher for NKR youths, including posttraumatic stress disorder (HR, 2.33; 95% CI, 1.34-4.06; P = .003), attention-deficit/hyperactivity disorder (HR, 1.67; 95% CI, 1.32-2.11; P < .001), bipolar affective disorders (HR, 1.61; 95% CI, 1.20-2.15; P < .001), major depressive disorder (HR, 1.53; 95% CI, 1.33-1.75; P < .001), and anxiety (HR, 1.25; 95% CI, 1.11-1.42; P < .001).</p><p><strong>Conclusions and relevance: </strong>In this cohort study, compared with SK youths, NKR youths showed a significantly higher risk of developing psychiatric disorders overall and individual psychiatric disorders, such as posttraumatic stress disorder, attention-deficit/hyperactivity disorder, bipolar disorder, major depressive disorder, and anxiety. This finding is important for establishing medical and educational service plans and policies for the increasing number of refugee youths in South Korea.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e2512941"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12123469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173775","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":"Declining Interhospital Transfers-A Symptom of Strained Hospital Capacity.","authors":"Laura G Burke, Colin D Stack, Jennifer V Pope","doi":"10.1001/jamanetworkopen.2025.12306","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.12306","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e2512306"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159131","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":"Somatic Tumor Next-Generation Sequencing in US Veterans With Metastatic Prostate Cancer.","authors":"Luca F Valle, Jiannong Li, Heena Desai, Ryan Hausler, Candace Haroldsen, Monica Chatwal, Matthias Ojo, Michael J Kelley, Timothy R Rebbeck, Brent S Rose, Matthew B Rettig, Nicholas G Nickols, Isla P Garraway, Kosj Yamoah, Kara N Maxwell","doi":"10.1001/jamanetworkopen.2025.9119","DOIUrl":"10.1001/jamanetworkopen.2025.9119","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;National guidelines recommend next-generation sequencing (NGS) of tumors in patients diagnosed with metastatic prostate cancer (mPCa) to identify potential actionable alterations. Non-Hispanic Black men are poorly represented in precision oncology cohorts, and therefore differences in alterations frequencies between non-Hispanic Black and White men remain poorly characterized.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To describe the spectrum and frequency of alterations in PCa-related genes and pathways, as well as associations with self-identified race and ethnicity and overall survival in US veterans.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This retrospective cohort study compared alteration frequencies between non-Hispanic Black and White men who underwent NGS testing from January 23, 2019, to November 2, 2023, adjusted by NGS analyte and clinicopathologic covariates. The analytic data file was locked on December 8, 2023. NGS testing was performed through the Department of Veterans Affairs (VA) National Precision Oncology Program, part of the largest near-equal access integrated health care system in the US.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Pathogenic alterations identified by NGS testing with a commercially available NGS platform.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcome consisted of alteration frequencies in individual genes, actionable targets, and canonical prostate cancer pathways. Associations between alteration frequency and race and ethnicity as well as survival were also examined.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 5015 veterans with mPCa who underwent NGS were included (1784 non-Hispanic Black [35.6%] and 3231 non-Hispanic White [64.4%]; mean [SD] age, 67.4 [9.0] years). Non-Hispanic Black veterans were younger, had higher prostate-specific antigen levels at diagnosis, were less likely to report Agent Orange exposure, and resided in more deprived neighborhoods compared with non-Hispanic White veterans. Nine of the top 10 most commonly altered genes were the same in non-Hispanic Black and non-Hispanic White veterans; however, the frequencies of alterations varied by race and ethnicity. Non-Hispanic Black race and ethnicity was associated with higher odds of genomic alterations in SPOP (odds ratio [OR], 1.7; 95% CI, 1.2-2.6) as well as immunotherapy targets (OR, 1.7; 95% CI, 1.1-2.5) including high microsatellite instability status (OR, 3.1; 95% CI, 1.1-9.4). Furthermore, non-Hispanic Black race and ethnicity was associated with lower odds of genomic alterations in the AKT/PI3K pathway (OR, 0.6; 95% CI, 0.4-0.7), androgen receptor axis (OR, 0.7; 95% CI, 0.5-0.9), and tumor suppressor genes (OR, 0.7; 95% CI, 0.5-0.8). Cox proportional hazards modeling stratified by race and ethnicity found that alterations in tumor suppressor genes, including TP53, were associated with shorter overall survival in both non-Hispanic Black (hazards ratio [HR], 1.54; 95% CI, ","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e259119"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024379","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":"Intrinsic Capacity Across 15 Countries in the Survey of Health, Aging, and Retirement in Europe.","authors":"Meimei Chen, Katja Hanewald, Yafei Si, Yuanyuan Gu, John R Beard","doi":"10.1001/jamanetworkopen.2025.9792","DOIUrl":"10.1001/jamanetworkopen.2025.9792","url":null,"abstract":"<p><strong>Importance: </strong>Intrinsic capacity (IC) is a core component of the World Health Organization's healthy aging framework. Yet, despite multiple validations of IC across various settings, there is still a lack of longitudinal cross-national analysis.</p><p><strong>Objective: </strong>To validate the IC construct, describe variance between key demographic groups, and create population centile curves across 15 countries using data from the Survey of Health, Aging, and Retirement in Europe (SHARE).</p><p><strong>Design, setting, and participants: </strong>In this population-based multicenter cohort study, data from SHARE wave 5 (January to November 30, 2013) were analyzed, and subsequent care dependence in wave 6 (January to November 30, 2015) was determined. Adults 50 years and older from SHARE wave 5 with at least 1 available measure and follow-up data in SHARE wave 6 were included. Data analyses were conducted between December 11, 2022, and June 7, 2024.</p><p><strong>Exposure: </strong>SHARE waves 5 and 6.</p><p><strong>Main outcomes and measures: </strong>Changes in activities of daily living (ADL) and instrumental activities of daily living (IADL). Methods included structural equation modeling, bifactor analysis, and path analysis. Construct validity was tested through multiple linear regression and validity of estimates through mediation analysis. Centile curves were established using the generalized additive models for location, scale, and shape.</p><p><strong>Results: </strong>The sample included 64 872 eligible participants aged 50 to 104 years, with a mean (SD) age of 67.24 (10.01) years, of whom 35 976 (55.46%) were women. The bifactor confirmatory factor analysis model achieved good fit (comparative fit index, 0.986; Tucker-Lewis index, 0.981), suggesting an IC structure consisting of 1 general factor and 5 subdomains. Mediation analysis indicated that IC was associated with subsequent declining performance in ADL (standard coefficient [SD], -0.213 [0.002]; P < .001) and IADL (standard coefficient [SD], -0.209 [0.002]; P < .001) after adjusting for age, gender, educational attainment, socioeconomic status, and country. Socioeconomic status was associated with IC both within and between countries. Centile curves for IC by gender and country (5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles) were constructed.</p><p><strong>Conclusions and relevance: </strong>Results of this cohort study of older adults suggest that IC was a valid and reliable measure that effectively captured individual-level aspects of functional ability. The centile curves developed during the study suggest that IC has the potential to serve as a benchmark for health status in older populations.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e259792"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013186","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}