JAMA Network Open最新文献

{"title":"Errors in Figures, Table, and Supplement.","authors":"","doi":"10.1001/jamanetworkopen.2026.43550","DOIUrl":"10.1001/jamanetworkopen.2026.43550","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2643550"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207023","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":"Clinical Outcomes After Recovered, Positive, and Negative Pulse Oximetry Screening Results Among Newborns.","authors":"Lassi Karppi, Panu Kiviranta, Ulla Sankilampi","doi":"10.1001/jamanetworkopen.2026.39860","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.39860","url":null,"abstract":"<p><strong>Importance: </strong>Pulse oximetry screening (POS) detects critical congenital heart defects (CCHDs) and other neonatal morbidities, but the clinical significance of initially abnormal results that normalize on repeat testing remains unclear.</p><p><strong>Objective: </strong>To assess the prevalence and clinical implications of positive, recovered, and negative early POS results in asymptomatic newborns.</p><p><strong>Design, setting, and participants: </strong>This population-based cohort study included asymptomatic neonates born at 35 weeks' gestation or later who underwent early POS at 2 to 6 hours of age at a tertiary-level university hospital in Eastern Finland between January 1, 2012, and December 31, 2019. Data were analyzed from August 2025 to August 2026.</p><p><strong>Exposure: </strong>Positive POS result or indeterminate POS result that normalized to a negative POS result (recovered) with repeat testing.</p><p><strong>Main outcomes and measures: </strong>Primary outcomes were neonatal intensive care unit (NICU) admission and continued hospitalization at 7 days; secondary outcomes included diagnostic investigations and neonatal morbidities. Associations between POS screening results and outcomes were examined using modified Poisson regression adjusted for maternal age, parity, body mass index, and cigarette smoking during pregnancy and newborn sex, gestational age, and birth weight Z score.</p><p><strong>Results: </strong>The cohort included 16 599 newborns born at 35 weeks' gestation or later who underwent early POS at 2 to 6 hours of age (8349 [50.3%] female; mean [SD] gestational age, 39.8 [1.3] weeks). POS results were negative in 16 160 newborns (97.4%), recovered in 208 (1.3%), and positive in 231 (1.4%). Compared with a negative POS result, a recovered or positive POS result was associated with higher risk of NICU admission (adjusted risk ratio [ARR], 5.62 [95% CI, 4.58-6.91] and 13.04 [95% CI, 11.77-14.44], respectively) and continued hospitalization at 7 days (ARR, 4.70 [95% CI, 3.07-7.19] and 11.97 [95% CI, 9.26-15.47], respectively). Recovered POS was also associated with greater risk of antibiotic exposure before 72 hours of life (ARR, 5.45 [95% CI, 3.94-7.52]) and need for respiratory support (ARR, 10.16 [3.53-29.21]) compared with a negative result. Respiratory disease was more common in newborns with recovered than negative POS results (27 [13.0%] vs 214 [1.3%]), as were sepsis (10 [4.8%] vs 127 [0.8%]) and hypoglycemia (17 [8.2%] vs 565 [3.5%]). No CCHD occurred among newborns with recovered POS.</p><p><strong>Conclusions and relevance: </strong>In this cohort study of neonates born at 35 weeks' gestation or later, those with initially indeterminate POS results that normalized on repeat testing had increased risks of treatable neonatal conditions and hospital care but not of CCHD. Further prospective studies should investigate whether targeted assessment of these newborns could reduce morbidity and prolonge","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2639860"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149238437","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":"Error in Author Affiliations.","authors":"","doi":"10.1001/jamanetworkopen.2026.44193","DOIUrl":"10.1001/jamanetworkopen.2026.44193","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2644193"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13684478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227948","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":"More Than Telemedicine Is Needed to Support Families of Injured Children Before Interhospital Transfer.","authors":"Margaret Samuels-Kalow, Kenneth A Michelson","doi":"10.1001/jamanetworkopen.2026.36555","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.36555","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2636555"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149238555","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":"Error in Supplement 2.","authors":"","doi":"10.1001/jamanetworkopen.2026.44280","DOIUrl":"10.1001/jamanetworkopen.2026.44280","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2644280"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13681201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224048","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":"Organ Preservation in Rectal Adenocarcinoma-A Growing Practice With Promise and Pitfalls.","authors":"Charles Liu, Mukta K Krane, Ira L Leeds","doi":"10.1001/jamanetworkopen.2026.40202","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.40202","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2640202"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149286719","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":"Error in Results, Figure, and Table.","authors":"","doi":"10.1001/jamanetworkopen.2026.46589","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.46589","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2646589"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149286930","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":"Operational Challenges During Public Health Emergencies in Safety-Net Hospitals.","authors":"Tara Kirk Sell, Vanessa Grégoire, Madisen S Neufeld, Rachel R Adler, Geoffrey Gosselin, Alysa Pomer, Biak L Tial, Joel S Weissman, Eric Goralnick","doi":"10.1001/jamanetworkopen.2026.40799","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.40799","url":null,"abstract":"<p><strong>Importance: </strong>Safety-net hospitals (SNHs) serve as essential public health hubs, providing direct clinical care and critical social services to vulnerable populations, yet gaps persist in their ability to reliably deliver these essential services during disasters.</p><p><strong>Objective: </strong>To identify common challenges faced by SNHs and actionable approaches described by participants to strengthen future emergency response capacity at these critical institutions.</p><p><strong>Design, setting, and participants: </strong>For this qualitative study, from April through November 2025, key informant interviews were conducted with individuals across SNHs selected to represent a spectrum of SNH types. Thematic analysis of site-level case studies was used to identify cross-cutting and context-specific patterns across 5 domains: load balancing, staffing needs, supply chain, crisis standards of care (CSC), and health care coalitions (HCCs).</p><p><strong>Main outcomes and measures: </strong>Stakeholder perspectives of pandemic preparedness, response, and recovery were evaluated to understand strategies to mitigate future health care disasters.</p><p><strong>Results: </strong>Analysis of interviews with 69 individuals from 10 SNH sites identified systemic vulnerabilities across all 5 domains in SNHs. SNHs rarely succeeded in transferring critically ill patients without extensive staff time spent setting up the transfer. SNHs often experienced severe workforce disruptions from limited staff pools and nurse attrition, leaving them dependent on temporary staff at higher costs. Just-in-time personal protective equipment procurement and constricted manufacturing supply chains created supply crises. Few SNHs implemented full CSC, but many worked to find creative solutions to prevent more extensive changes in care standards. Opinions on written CSC were mixed, with some preferring structured frameworks and others preferring flexibility. Experiences with HCCs varied widely, with SNHs embedded in well-resourced HCCs reporting better coordination and support.</p><p><strong>Conclusions and relevance: </strong>In this qualitative study of SNH preparedness and response, findings indicated that SNHs faced challenges with load balancing, supply chain, staffing, CSC, and HCCs. To address such challenges in the future, SNHs, regional coalitions, and the federal government should implement sustainable changes that can be rapidly brought to bear in an emergency. Potential solutions may have outsized benefit for SNHs; however, such solutions must be designed to be accessible to SNHs and feasible in these settings.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2640799"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149286729","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":"Simpson's Paradox, Amyloid Paradox, and Racial Differences.","authors":"Chengjie Xiong, Jingqin Luo, Ruijin Lu, Sarah Hartz, Walter Kukull, Suzanne E Schindler, Joyce E Balls-Berry, Jason Hassenstab, David A Wolk, Carey E Gleason, Sterling C Johnson, Reisa Sperling, Keith Johnson, Erik D Roberson, Krista L Moulder, Emily Gremminger, Folasade Agboola, Elizabeth A Grant, Russ Hornbeck, Parinaz Massoumzadeh, Sarah Keefe, Donna Dierker, Shaney Flores, David M Holtzman, Tammie Benzinger, John C Morris","doi":"10.1001/jamanetworkopen.2026.40868","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.40868","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;The underlying mechanisms for the paradox of higher prevalence of dementia but lower prevalence of amyloid positivity in self-identified Black US residents than White US residents remain unknown and are important for designing and analyzing prevention and treatment trials of Alzheimer disease.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess whether the age of mean amyloid onset (AMAO) explains the paradox of the reported racial differences in dementia and amyloid positivity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This was a retrospective, multicenter, longitudinal cohort study with harmonized amyloid positron emission tomography (PET) and clinical data from self-identified Black and White individuals who were middle-aged or older across 5 academic institutes in the US conducting studies of memory and aging. The study was conducted from June 2020 to March 2026.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Self-identified race, vascular comorbidities, sex, age, educational attainment, and apolipoprotein E ε4 carrier status.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Amyloid PET centiloid and cognition measured as a global cognitive composite constructed by averaging z scores across at least 6 cognitive tests in self-identified Black and White participants. Both cross-sectional and longitudinal analyses were conducted to compare racial groups in amyloid burden and cognition. Data were also analyzed using propensity score-matching of 2:1 (White:Black) by main covariates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 2653 participants (mean [SD] age, 69.0 [8.8] years; 1574 [59.3%] female), 406 (15.3%) were Black and 2247 (84.7%) were White. Black participants had a delayed AMAO compared with White participants in the unmatched (83.86 [95% CI, 76.55-91.35] years vs 71.38 [95% CI, 67.74-73.17] years; difference, 12.48 [95% CI, 5.03-22.28 years) and covariate-matched (85.17 [95% CI, 80.16-91.38] years vs 72.61 [95% CI, 70.79-74.55] years; difference, 12.57 [95% CI, 7.25-19.54] years) analyses. Although Black participants had a lower overall prevalence of amyloid positivity than White participants (24.1% vs 31.7%, P = .002), they had a higher prevalence of amyloid positivity than White participants in almost every interval of expected years to amyloid onset (EYAO, defined as participants' simple chronological age minus the group-specific AMAO), hence Simpson's paradox, (eg, -15 to -10 years for Black minus White prevalence in the unmatched cohort, 15.30 percentage points [95% Wilson CI, 0.06-0.26]). No significant racial differences were found in the longitudinal rate of amyloid accumulation after adjusting for the covariates either before the AMAO (eg, unmatched cohort Black minus White difference in slope per year, -0.28 [95% CI, -0.64 to 0.08]; P = .13) or after the AMAO (eg, unmatched cohort Black minus White difference in slope, -1.23 [95% CI, -3.05 to 0.60]; P = .17). Black participants had a higher prevalence of vas","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2640868"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149286781","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 and Immigration Status Among US Adults.","authors":"Qaidar Alizai, Lorenza Arena, Areesh Mevawalla, Rida Ejaz, Jethro Wang Zih-Shou, Meher Angez, Abdulaziz Elemosho, Charalampos M Charalampous, Timothy M Pawlik","doi":"10.1001/jamanetworkopen.2026.40261","DOIUrl":"10.1001/jamanetworkopen.2026.40261","url":null,"abstract":"<p><strong>Importance: </strong>The Affordable Care Act (ACA) expanded insurance coverage, while the 2018 Public Charge Rule Proposal (PCRP) raised concerns about immigration-related barriers to health care access.</p><p><strong>Objective: </strong>To evaluate changes in insurance coverage, health care use, and medical expenditures among immigrant and US-born adults across ACA expansion and post-PCRP eras, stratified by poverty status.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study used nationally representative Medical Expenditure Panel Survey (2010-2023) data for US adults aged 19 to 64 years with available data on nativity, family income, insurance coverage, use, and expenditures. Income less than 138% of the federal poverty level was considered low income; 138% or higher was considered not low. Data were analyzed from April 1, 2026, to April 15, 2026.</p><p><strong>Exposures: </strong>Policy era, categorized as pre-ACA expansion (2010-2013), post-ACA expansion (2014-2018), and post-PCRP (2019-2023), and nativity, categorized as immigrant or US-born.</p><p><strong>Main outcomes and measures: </strong>Primary outcomes were person-year measures of insurance coverage, health care use, and annual medical expenditures adjusted to constant 2023 US dollars. Survey-weighted multivariable models estimated adjusted changes across eras and tested differences by nativity.</p><p><strong>Results: </strong>Complete-case adjusted analyses included 237 175 person-year observations from 126 724 unique adults, including 67 076 female adults (50.8%) and 59 648 male adults (49.2%), with a survey-weighted mean (SD) age of 40.8 (13.2) years; the analytic sample included 56 561 low-income and 180 614 non-low-income person-year observations. Among adults with low income, post-PCRP insurance coverage was higher among US-born adults (adjusted odds ratio [AOR], 2.84; 95% CI, 2.55-3.17) and immigrants (AOR, 2.29; 95% CI, 1.98-2.65), with smaller relative gains for immigrants. Post-PCRP total expenditures increased among US-born adults with low income (β = $1684.60; 95% CI, $883.10-$2486.20) but not among immigrants with low income (β = $220.20; 95% CI, -$680.10-$1120.50). Among adults without low income, post-PCRP total expenditures increased among US-born adults (β = $1788.60; 95% CI, $1487.70-$2089.50) and immigrants (β = $974.10; 95% CI, $517.50-$1430.70).</p><p><strong>Conclusions and relevance: </strong>In this serial cross-sectional study of US adults aged 19 to 64 years, immigrants had lower insurance coverage, health care use, and medical expenditures than US-born adults. Coverage was higher in later eras, but coverage gains and expenditure growth were smaller among immigrants with low income, suggesting that insurance expansion alone may be insufficient to address nativity-related differences in health care access and spending.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2640261"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13695072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244482","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}