JAMA Network Open最新文献

{"title":"A Survey About Mass Shootings Is the Tip of the Iceberg.","authors":"Megan L Ranney","doi":"10.1001/jamanetworkopen.2025.0288","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.0288","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250288"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572909","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":"A Virtual Cardiometabolic Health Program Among African Immigrants in the US: A Pilot Cluster-Randomized Clinical Trial.","authors":"Oluwabunmi Ogungbe, Thomas Hinneh, Ruth-Alma N Turkson-Ocran, Loretta Owusu, Baridosia Kumbe, Erin M Spaulding, Serina Gbaba, Adeline Assani-Uva, Jasmine Mensah, Yvette Yeboah-Kordieh, Aminata Sinyan, Margaret Ampofo, Faith Oyedepo, Yvonne Commodore-Mensah","doi":"10.1001/jamanetworkopen.2024.62559","DOIUrl":"10.1001/jamanetworkopen.2024.62559","url":null,"abstract":"<p><strong>Importance: </strong>Black persons, including immigrants, in the US disparately experience poor cardiometabolic health (CMH). Limited research on the effect of lifestyle interventions that improve CMH among African immigrant populations is available.</p><p><strong>Objective: </strong>To test the effectiveness of a culturally adapted, virtual lifestyle intervention on control of blood pressure (BP) and hemoglobin A1c (HbA1c) levels among African immigrants with CMH risk factors.</p><p><strong>Design, setting, and participants: </strong>Afro-DPP (Diabetes Prevention Program), a pilot cluster-randomized clinical trial, evaluated the effectiveness of a multicomponent CMH intervention. The study took place in 2 churches with predominantly African immigrant congregations in the Baltimore-Washington, DC, metropolitan area from January 1, 2022, to July 31, 2023. Participants were adults aged 25 to 75 years with at least 2 CMH risk factors who self-identified as African immigrants and belonged to the participating churches. Analyses followed the intention-to-treat principle.</p><p><strong>Intervention: </strong>Participants received a 6-month culturally adapted lifestyle intervention based on the National DPP curriculum, delivered via virtual group sessions by a lifestyle coach of African origin. The delayed intervention began 6 months later with a follow-up time of 6 months. The intervention also included remote BP and weight monitoring.</p><p><strong>Main outcome and measures: </strong>Primary outcomes were changes in systolic and diastolic BP and HbA1c levels from baseline to 6 months. Secondary outcomes included reduced body weight and body mass index (BMI; calculated as weight in kilograms divided by height in meters squared).</p><p><strong>Results: </strong>The analytic population included 60 participants (mean [SD] age, 50.6 [11.9] years; 40 [66.7%] women). In the first intervention group (n = 30), systolic BP decreased by 9.2 (95% CI, 2.5-15.9) mm Hg, diastolic BP by 6.1 (95% CI, 2.1-10.0) mm Hg, body weight by 4.9 (95% CI, 1.0-8.7) kg, and BMI by 1.1 (95% CI, 0.4-1.7) at 6 months. In the delayed intervention group (n = 30), systolic BP decreased by 11.4 (95% CI, 2.4-20.5) mm Hg, diastolic BP by 10.3 (95% CI, 5.4-15.2) mm Hg, and body weight by 3.3 (95% CI, 0.01-6.5) kg, while BMI increased by 0.3 (95% CI, -1.5 to 2.0).</p><p><strong>Conclusions and relevance: </strong>Trial findings indicate that interventions incorporating cultural adaptation and virtual components could help address CMH disparities in this population.</p><p><strong>Trial registration: </strong>ClincalTrials.gov Identifier NCT05144737.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e2462559"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11880947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541961","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 a Language-Concordant, Culturally Tailored Inpatient Lactation Program.","authors":"Nikita S Kalluri, Elena Padilla-Garza, Tessa Kehoe, Chloe Andrews, Julianna Schantz-Dunn, Jennifer Riley, Mary Pomerleau, Anne Cc Lee, Sarbattama Sen","doi":"10.1001/jamanetworkopen.2025.0274","DOIUrl":"10.1001/jamanetworkopen.2025.0274","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Benefits of breastfeeding are extensive, but racial and ethnic disparities persist. Mama Sana (Spanish for healthy mother) is a bilingual, culturally tailored program that aims to reduce breastfeeding inequities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To examine differences in lactation support and breastfeeding outcomes among Spanish-speaking Hispanic birthing parents who participated in Mama Sana compared with a historical control (pre-Mama Sana) group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;In this cohort study, patients who participated in the Mama Sana program during their delivery hospitalization from January 2022 to September 2023 were compared with a historical control group who delivered prior to the implementation of the program (July 2019 to December 2021). The study took place at an academic medical center in Boston with a high-risk obstetric service. Data were analyzed from January to September 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Beginning in January 2022, a bilingual native Spanish-speaker licensed as a registered dietitian and certified lactation counselor provided lactation support to participants during their delivery hospitalization with follow-up phone calls after discharge (until 6 months post partum).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcome was exclusive breastfeeding at discharge. Secondary outcomes included any breastfeeding at discharge, any breastfeeding and exclusive breastfeeding at 6 weeks post partum, and change in maternal body mass index (BMI). Process measures included inpatient lactation consult placement and receipt of any and language-concordant lactation support. The χ2 test was used to analyze outcomes, process measures, and balancing measures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In this study, 417 patients were included (Mama Sana group, 175 patients; mean [SD] age, 28.9 [6.1] years; pre-Mama Sana group: 242 patients; mean [SD] age, 29.8 [6.1] years). Sociodemographic characteristics including age and BMI were similar between groups. Mama Sana participants were less likely to be multiparous or to have diabetes compared with the pre-Mama Sana group. At hospital discharge, 36 of 175 Mama Sana participants (20.6%) were exclusively breastfeeding compared with 39 of 242 pre-Mama Sana (16.1%) (adjusted risk difference [aRD], 2.5%; 95% CI, -1.2 to 6.4). Significantly more Mama Sana participants engaged in any breastfeeding prior to hospital discharge (172 of 175 [98.3%] vs 222 of 242 [91.7%]; aRD, 7.1%; 95% CI, 2.8% to 11.5%) and at the 6 week postpartum visit (81 of 102 [79.4%] vs 109 of 170 [64.1%]; aRD, 15.6%; 95% CI, 4.8% to 26.4%) compared with the pre-Mama Sana group. More Mama Sana participants had a lactation consult placed (109 of 175 [62.3%] vs 108 of 242 [44.6%]; P &lt; .001) and received lactation support in Spanish (175 of 175 [100%] vs 49 of 242 [20.3%]; P &lt; .001) than those in the pre-Mama Sana group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions an","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250274"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11889473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572977","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":"Tele-Buprenorphine Initiations for Opioid Use Disorder Without In-Person Relationships.","authors":"Emma E McGinty, Yimin Ge, Jiani Yu, Kayla N Tormohlen, Matthew D Eisenberg","doi":"10.1001/jamanetworkopen.2025.0001","DOIUrl":"10.1001/jamanetworkopen.2025.0001","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250001"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542160","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":"Connectome-Based Predictive Modeling of PTSD Development Among Recent Trauma Survivors.","authors":"Ziv Ben-Zion, Alexander J Simon, Matthew Rosenblatt, Nachshon Korem, Or Duek, Israel Liberzon, Arieh Y Shalev, Talma Hendler, Ifat Levy, Ilan Harpaz-Rotem, Dustin Scheinost","doi":"10.1001/jamanetworkopen.2025.0331","DOIUrl":"10.1001/jamanetworkopen.2025.0331","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;The weak link between subjective symptom-based diagnostics for posttraumatic psychopathology and objective neurobiological indices hinders the development of effective personalized treatments.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To identify early neural networks associated with posttraumatic stress disorder (PTSD) development among recent trauma survivors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This prognostic study used data from the Neurobehavioral Moderators of Posttraumatic Disease Trajectories (NMPTDT) large-scale longitudinal neuroimaging dataset of recent trauma survivors. The NMPTDT study was conducted from January 20, 2015, to March 11, 2020, and included adult civilians who were admitted to a general hospital emergency department in Israel and screened for early PTSD symptoms indicative of chronic PTSD risk. Enrolled participants completed comprehensive clinical assessments and functional magnetic resonance imaging (fMRI) scans at 1, 6, and 14 months post trauma. Data were analyzed from September 2023 to March 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Traumatic events included motor vehicle incidents, physical assaults, robberies, hostilities, electric shocks, fires, drownings, work accidents, terror attacks, or large-scale disasters.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Connectome-based predictive modeling (CPM), a whole-brain machine learning approach, was applied to resting-state and task-based fMRI data collected at 1 month post trauma. The primary outcome measure was PTSD symptom severity across the 3 time points, assessed with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Secondary outcomes included Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) PTSD symptom clusters (intrusion, avoidance, negative alterations in mood and cognition, hyperarousal).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 162 recent trauma survivors (mean [SD] age, 33.9 [11.5] years; 80 women [49.4%] and 82 men [50.6%]) were included at 1 month post trauma. Follow-up assessments were completed by 136 survivors (84.0%) at 6 months and by 133 survivors (82.1%) at 14 months post trauma. Among the 162 recent trauma survivors, CPM significantly predicted PTSD severity at 1 month (ρ = 0.18, P &lt; .001) and 14 months (ρ = 0.24, P &lt; .001) post trauma, but not at 6 months post trauma (ρ = 0.03, P = .39). The most predictive edges at 1 month included connections within and between the anterior default mode, motor sensory, and salience networks. These networks, with the additional contribution of the central executive and visual networks, were predictive of symptoms at 14 months. CPM predicted avoidance and negative alterations in mood and cognition at 1 month, but it predicted intrusion and hyperarousal symptoms at 14 months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this prognostic study of recent trauma survivors, individual differences in large-scale neural ne","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250331"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11894499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585799","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":"Transitioning to Intravenous Tenecteplase for the Treatment of Acute Ischemic Stroke.","authors":"Lina Palaiodimou, Georgios Tsivgoulis","doi":"10.1001/jamanetworkopen.2025.0555","DOIUrl":"10.1001/jamanetworkopen.2025.0555","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250555"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604823","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":"Short-Term Safety and Effectiveness for Tenecteplase and Alteplase in Acute Ischemic Stroke.","authors":"Justin F Rousseau, Jeremy M Weber, Brooke Alhanti, Jeffrey L Saver, Steven R Messé, Lee H Schwamm, Gregg C Fonarow, Kevin N Sheth, Eric E Smith, Michael T Mullen, Gisele Sampaio Silva, Brian Mac Grory, Ying Xian, Steven J Warach","doi":"10.1001/jamanetworkopen.2025.0548","DOIUrl":"10.1001/jamanetworkopen.2025.0548","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Tenecteplase is an alternative to alteplase for emergency treatment of acute ischemic stroke. However, limited data are available comparing their clinical effectiveness in routine clinical practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To compare short-term effectiveness and safety outcomes for patients with ischemic stroke treated with intravenous tenecteplase vs alteplase.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This comparative effectiveness study used data prospectively collected from July 1, 2020, through June 30, 2022, from the Get With The Guidelines-Stroke registry.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Consecutive patients with ischemic stroke treated with either tenecteplase or alteplase within 4.5 hours from last known well time were included.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary end point was functional independence on discharge (modified Rankin Scale [mRS] score, 0-2). Secondary effectiveness end points included disability free at discharge (mRS score, 0-1), discharge home, and independent ambulation at discharge. Safety end points included symptomatic intracranial hemorrhage (sICH) within 36 hours and combined in-hospital mortality or hospice discharge. Generalized linear mixed models were fit to evaluate associations between exposure to tenecteplase (vs alteplase) and end points after adjustment for demographic, clinical, and hospital-level variables. Adjusted odds ratios (AORs) with 95% CIs were computed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 79 550 patients treated with intravenous thrombolysis, the mean (SD) age was 68.6 (14.8) years, 38 596 (48.5%) were female, and the median National Institutes of Health Stroke Scale (NIHSS) score was 7 (IQR, 4-13). Of these patients, 9465 (11.9%) received tenecteplase (mean [SD] age, 69.6 [14.7] years; median NIHSS score, 7 [IQR, 4-14]; 4504 [47.6%] female) and 70 085 (88.1%) received alteplase (mean [SD] age, 68.5 [14.8] years; median NIHSS score, 7 [IQR, 4-13]; 34 092 [48.6%] female). After adjustment for covariates, no significant differences were found between tenecteplase and alteplase in effectiveness or safety outcomes for the overall cohort, including functional independence at discharge (AOR, 1.00; 95% CI, 0.93-1.07), sICH (AOR, 0.96; 95% CI, 0.83-1.11), and in-hospital mortality or hospice discharge (AOR, 0.98; 95% CI, 0.89-1.07), but significant improvement was found in discharge home (AOR, 1.26; 95% CI, 1.03-1.53), in-hospital mortality (AOR, 0.63; 95% CI, 0.47-0.85), and composite in-hospital mortality or hospice discharge (AOR, 0.78; 95% CI, 0.62-0.97) among those who were eligible for but did not undergo endovascular thrombectomy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;This large, nationwide comparative effectiveness study using data from routine clinical practice demonstrated similar effectiveness and safety outcomes with tenecteplase compared with alteplase in patients with acute ischemic stroke. T","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250548"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11904722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604800","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 Double Burden of Food and Water Insecurity-Implications for Health, Equality, and Policy.","authors":"Suman Chakrabarti","doi":"10.1001/jamanetworkopen.2025.1278","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.1278","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e251278"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663584","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":"Financial Rewards for Smoking Cessation During Pregnancy and Birth Weight: A Meta-Analysis.","authors":"David Tappin, Jiyoung Lee, Alex McConnachie, Loren Kock, Stephen T Higgins, Sarah H Heil, Ivan Berlin, Steven J Ondersma, Frank Kee, Ira Bernstein, Linda Bauld","doi":"10.1001/jamanetworkopen.2025.0214","DOIUrl":"10.1001/jamanetworkopen.2025.0214","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Offering pregnant women financial rewards to stop smoking is associated with a more than 2-fold increase in smoking cessation and is cost-effective; however, it is possible that the association is the result of gaming of the outcome measure (eg, not smoking for 24 hours before outcome measurement using a carbon monoxide breath test). Birth weight is an outcome measure that is independent of the rewards process.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To examine birth weight change associated with offering financial rewards for smoking cessation to pregnant women, and to estimate the average expected birth weight change for neonates born to those who quit smoking because of the rewards.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data sources: &lt;/strong&gt;Medline, American Psychological Association PsycInfo, Embase, Cochrane (the Cochrane Central Register of Controlled Trials, the Cochrane Tobacco Addiction Group Specialized Register, and the Cochrane Database of Systematic Reviews), and PubMed were searched from their inception until December 5, 2023, for published reports of trials of incentives for abstinence from substance use among pregnant women.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study selection: &lt;/strong&gt;Only trials using an experimental design allowing treatment effects to be attributed to the reward intervention were included. For this review update, potentially relevant studies retrieved were screened by a reviewer.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data extraction and synthesis: &lt;/strong&gt;Data were pooled using both fixed-effects and random-effects models. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcomes were mean (SD) birth weight, birth weight for gestational age z score, and numbers of newborns with low birth weight (&lt;2.5 kg) and who were small for gestational age (&lt;10th percentile).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Fixed-effects intention-to-treat analysis including 8 trials (2351 participants)-2 trials from the UK (1475 participants), 1 trial from France (407 participants), and 5 trials from the US (469 participants)-estimated a statistically significant mean 46.30 g (95% CI, 0.05 to 92.60 g) birth weight increase associated with adding financial rewards for smoking cessation. Complier average causal effects analysis (2239 participants) estimated a mean 206.00 g (95% CI, -69.12 to 481.14 g) increase for neonates born to smokers who quit because of rewards, but the increase was not statistically significant. There was no association with low birth weight or birth weight adjusted for gestational age, although fewer neonates were born small for gestational age, particularly if cessation was associated with rewards (complier average causal effects risk difference -17.70%; 95% CI, -34.90% to -0.42%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this meta-analysis, neonates were significantly heavier when pregnant women were offered the addition of fina","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250214"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567183","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":"Therapy Dogs for Anxiety in Children in the Emergency Department: A Randomized Clinical Trial.","authors":"Heather P Kelker, Huma K Siddiqui, Alan M Beck, Jeffrey A Kline","doi":"10.1001/jamanetworkopen.2025.0636","DOIUrl":"10.1001/jamanetworkopen.2025.0636","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Prior evidence suggests that the use of therapy dogs in emergency care reduces anxiety in adults, but no trial has tested the use of therapy dogs in emergency care of children.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To examine whether adjunctive use of therapy dogs in standard child-life therapy reduces child-reported and parent-reported child anxiety in a pediatric emergency department (ED).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This randomized clinical trial was conducted from February 1, 2023, to June 30, 2024, at an academic pediatric ED. Children (aged 5-17 years) with suspected moderate to high anxiety were included.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Intervention: &lt;/strong&gt;All participants received standard child-life therapy, and the intervention group was randomly assigned to have exposure to a therapy dog and handler for approximately 10 minutes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Anxiety was measured using the 0- to 10-point FACES scale (with 0 indicating no anxiety and 10 indicating very severe anxiety) and salivary cortisol concentrations. Measurements were obtained at baseline (T0), 45 minutes (T1), and 120 minutes (T2) for both child and parents.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 80 patients (mean [SD] age, 10.9 [3.8] years; 45 [56%] female) were enrolled (40 in the control group and 40 in the intervention group). At T0, the mean (SD) FACES scores were 5.4 (2.8) for child report and 6.4 (2.4) for parent report; the means were not different between groups. From T0 to T1, child-reported anxiety changed by a mean (SD) of -1.5 (3.4) points in the control group vs -2.7 (2.5) points in the intervention group (P = .02, Mann-Whitney U test); similarly, mean (SD) parent-estimated child anxiety changed by -1.8 (2.7) points in the control group vs -3.2 (2.3) points in the intervention group (P = .008). A total of 9 children (23%) in the control group had a greater than 2.5-point decrease in FACES score vs 18 (46%) in intervention group (P = .04, Fisher test). At T2, mean (SD) child-reported FACES scores decreased to 3.6 (3.4) points in the control group and 3.0 (2.7) points in the intervention group (P = .70). A total of 14 control participants (35%) received ketamine, midazolam, lorazepam, or droperidol vs 7 (18%) in the intervention group (P = .08, Fisher test). Child and parent salivary cortisol decreased from T0 to T1 in both groups but was not different between groups. Parental salivary cortisol was significantly consistently higher than their children's salivary cortisol (P &lt; .001, unpaired t test, for comparisons of child vs parent at T0 and T1 in both groups).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;This study of adjunctive use of therapy dogs in standard child-life therapy found a modest but significantly greater reduction in both child-reported and parental-reported child anxiety in the pediatric ED for the intervention vs control group. These findings support the use of t","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250636"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624722","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}