JAMA Network Open最新文献

{"title":"Hospital-Acquired Pressure Ulcers and Long-Term Motor Score Recovery in Patients With Acute Cervical Spinal Cord Injury.","authors":"Marcel A Kopp, Felix W Finkenstaedt, Oliver Schweizerhof, Ulrike Grittner, Peter Martus, Ralf Watzlawick, David Brienza, Vieri Failli, Yuying Chen, Michael J DeVivo, Jan M Schwab","doi":"10.1001/jamanetworkopen.2024.44983","DOIUrl":"10.1001/jamanetworkopen.2024.44983","url":null,"abstract":"<p><strong>Importance: </strong>Pressure ulcers (PUs) are (1) prevalent secondary complications after spinal cord injury (SCI), (2) present with elevated systemic inflammatory tone, and (3) may interfere with healing processes underlying neurological recovery (disrepair).</p><p><strong>Objective: </strong>To investigate whether PUs acquired during initial hospitalization are associated with neurological and functional long-term outcome and survival after SCI.</p><p><strong>Design, setting, and participants: </strong>Multicenter cohort study at 20 centers of the prospective SCI Model Systems (SCIMS) Database (Birmingham, AL). Patients with acute traumatic cervical SCI with relevant motor impairment (ie, American Spinal Injury Association [ASIA] impairment scale [AIS] A, B, and C) were enrolled from January 1996 to September 2006 and followed up until June 2016. Data were analyzed from April 2021 to September 2024.</p><p><strong>Exposures: </strong>PUs acquired during surgical or first rehabilitative SCI care.</p><p><strong>Main outcomes and measures: </strong>The change in the ASIA motor score at 1 year after SCI was the primary end point. Secondary end points included the recovery of functional independence measure (FIM) motor score at 1 year after SCI and mortality up to 10 years. ASIA and FIM motor score were analyzed applying linear mixed models with random intercept adjusted for baseline neurological level, AIS, and sociodemographic factors. Mortality was analyzed using Cox regression.</p><p><strong>Results: </strong>The study included 1282 patients with a mean (SD) age of 38.0 (15.7) years and consisted of 1028 (80.2%) male patients. Regarding race and ethnicity, 349 of 1249 (27.9%) were African American patients, 1139 of 1273 (89.5%) were non-Hispanic patients, and 834 of 1249 (66.8%) were White patients. During initial hospitalization, 594 patients (45.7%) acquired PUs. Exposure to PUs was associated with impaired motor recovery 1 year after SCI compared with unexposed patients (-9.1 ASIA motor score points; 95% CI, -12.3 to -6.0; P < .001). In addition, PUs were associated with lower recovery of physical independence 1 year after SCI (-8.3 FIM motor score points; 95% CI: -11.1 to -5.5; P < .001). Cox regression confirmed PUs as a risk marker for death up to 10 years after SCI (hazard ratio, 1.41; 95% CI, 1.09 to 1.82; P = .01).</p><p><strong>Conclusions and relevance: </strong>In this cohort study, PUs acquired during initial hospitalization after SCI were independently associated with poor long-term neurofunctional outcome. PUs constitute a modifiable factor associated with risk for worse long-term disability (recovery confounder) and elevated mortality.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2444983"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11624580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785688","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":"Traumatic Brain Injury and Risk of Incident Comorbidities.","authors":"Cathra Halabi, Saef Izzy, Anthony M DiGiorgio, Hunter Mills, Farid Radmanesh, John K Yue, Habibeh Ashouri Choshali, Gundolf Schenk, Sharat Israni, Ross Zafonte, Geoffrey T Manley","doi":"10.1001/jamanetworkopen.2024.50499","DOIUrl":"10.1001/jamanetworkopen.2024.50499","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Traumatic brain injury (TBI) is associated with chronic medical conditions. Evidence from diverse clinical administrative datasets may improve care delivery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To characterize post-TBI risk of incident neuropsychiatric and medical conditions in a California health care system administrative database and validate findings from a Massachusetts dataset.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;In this cohort study, prospective longitudinal cohorts using data from 5 University of California health care settings between 2013 and 2022 were studied. Patients aged 18 years and older with mild (mTBI) or moderate to severe TBI (msTBI) were included. Unexposed individuals were propensity matched by age, race and ethnicity, sex, University of California site, insurance coverage, area deprivation index (ADI) score, and duration from index date to most recent clinical encounter. Patients with study comorbidities of interest before the index date were excluded. Data were analyzed August to October 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;TBI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;International Classification of Diseases, Ninth Revision (ICD-9) and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes were used to identify patients with TBI and patients with up to 22 comorbidities within neurological, psychiatric, cardiovascular, and endocrine umbrella groupings. Cox proportional hazard models were used to generate yearly hazard ratios (HRs) from 6 months up to 10 years after a TBI. Models were further stratified by age and ADI score.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study consisted of 20 400 patients (9264 female [45.4%]; 1576 Black [7.7%], 3944 Latinx [19.3%], and 10 480 White [51.4%]), including 5100 patients with mTBI (median [IQR] age, 36.0 [25.0-51.0] years), 5100 patients with msTBI (median [IQR age, 35.0 [25.0-52.0] years), and 10 200 matched patients in the control group (median [IQR] age, 36.0 [25.0-51.0] years). By ADI score quintile, there were 2757 unexposed patients (27.0%), 1561 patients with mTBI (30.6%), and 1550 patients with msTBI (30.4%) in the lowest (1-2) quintiles and 1523 unexposed patients (14.9%), 769 patients with mTBI (15.1%), and 804 patients with msTBI (15.8%) in the highest quintiles (9-10). TBI of any severity was associated with increased risk of nearly all conditions (mTBI HRs ranged from 1.30; 95% CI, 1.07-1.57 for hypothyroidism to 4.06; 95% CI, 3.06-5.39 for dementia, and msTBI HRs ranged from 1.35; 95% CI, 1.12-1.62 for hypothyroidism to 3.45; 95% CI, 2.73-4.35 for seizure disorder). Separate age and ADI stratifications revealed patient populations at increased risk, including middle-age adults (ages 41-60 years), with increased risk of suicidality (mTBI: HR, 4.84; 95% CI, 3.01-7.78; msTBI: HR, 4.08; 95% CI, 2.51-6.62). Suicidality risk persisted for patients with mTBI in the ","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2450499"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11638795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813267","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":"Development and Validation of a Smartphone Application for Neonatal Jaundice Screening.","authors":"Alvin Jia Hao Ngeow, Aminath Shiwaza Moosa, Mary Grace Tan, Lin Zou, Millie Ming Rong Goh, Gek Hsiang Lim, Vina Tagamolila, Imelda Ereno, Jared Ryan Durnford, Samson Kei Him Cheung, Nicholas Wei Jie Hong, Ser Yee Soh, Yih Yann Tay, Zi Ying Chang, Ruiheng Ong, Li Ping Marianne Tsang, Benny K L Yip, Kuok Wei Chia, Kelvin Yap, Ming Hwee Lim, Andy Wee An Ta, Han Leong Goh, Cheo Lian Yeo, Daisy Kwai Lin Chan, Ngiap Chuan Tan","doi":"10.1001/jamanetworkopen.2024.50260","DOIUrl":"10.1001/jamanetworkopen.2024.50260","url":null,"abstract":"<p><strong>Importance: </strong>This diagnostic study describes the merger of domain knowledge (Kramer principle of dermal advancement of icterus) with current machine learning (ML) techniques to create a novel tool for screening of neonatal jaundice (NNJ), which affects 60% of term and 80% of preterm infants.</p><p><strong>Objective: </strong>This study aimed to develop and validate a smartphone-based ML app to predict bilirubin (SpB) levels in multiethnic neonates using skin color analysis.</p><p><strong>Design, setting, and participants: </strong>This diagnostic study was conducted between June 2022 and June 2024 at a tertiary hospital and 4 primary-care clinics in Singapore with a consecutive sample of neonates born at 35 or more weeks' gestation and within 21 days of birth.</p><p><strong>Exposure: </strong>The smartphone-based ML app captured skin images via the central aperture of a standardized color calibration sticker card from multiple regions of interest arranged in a cephalocaudal fashion, following the Kramer principle of dermal advancement of icterus. The ML model underwent iterative development and k-folds cross-validation, with performance assessed based on root mean squared error, Pearson correlation, and agreement with total serum bilirubin (TSB). The final ML model underwent temporal validation.</p><p><strong>Main outcomes and measures: </strong>Linear correlation and statistical agreement between paired SpB and TSB; sensitivity and specificity for detection of TSB equal to or greater than 17mg/dL with SpB equal to or greater than 13 mg/dL were assessed.</p><p><strong>Results: </strong>The smartphone-based ML app was validated on 546 neonates (median [IQR] gestational age, 38.0 [35.0-41.0] weeks; 286 [52.4%] male; 315 [57.7%] Chinese, 35 [6.4%] Indian, 169 [31.0%] Malay, and 27 [4.9%] other ethnicities). Iterative development and cross-validation was performed on 352 neonates. The final ML model (ensembled gradient boosted trees) incorporated yellowness indicators from the forehead, sternum, and abdomen. Temporal validation on 194 neonates yielded a Pearson r of 0.84 (95% CI, 0.79-0.88; P < .001), 82% of data pairs within clinically acceptable limits of 3 mg/dL, sensitivity of 100%, specificity of 70%, positive predictive value of 10%, negative predictive value of 100%, positive likelihood ratio of 3.3, negative likelihood ratio of 0, and area under the receiver operating characteristic curve of 0.89 (95% CI, 0.82-0.96).</p><p><strong>Conclusions and relevance: </strong>In this diagnostic study of a new smartphone-based ML app, there was good correlation and statistical agreement with TSB with sensitivity of 100%. The screening tool has the potential to be an NNJ screening tool, with treatment decisions based on TSB (reference standard). Further prospective studies are needed to establish the generalizability and cost-effectiveness of the screening tool in the clinical setting.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2450260"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807092","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":"Pediatric Emergency Care Coordinator Presence and Pediatric Care Quality Measures.","authors":"Margaret E Samuels-Kalow, Rebecca E Cash, Kenneth A Michelson, Courtney Benjamin Wolk, Katherine E Remick, Stephanie S Loo, Maeve F Swanton, Elizabeth R Alpern, Kori S Zachrison, Carlos A Camargo","doi":"10.1001/jamanetworkopen.2024.51111","DOIUrl":"10.1001/jamanetworkopen.2024.51111","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Higher pediatric readiness has been associated with improved quality and outcomes of care for children. Pediatric emergency care coordinators (PECCs) are a component of pediatric readiness, but the specific association between PECCs and quality-of-care measures is undefined.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To examine the association between PECC presence and emergency department (ED) performance as reflected by quality-of-care measures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cohort study of ED patients 18 years or younger used data across 8 states, combining the 2019 National Emergency Department Inventory-USA, 2019 State Emergency Department Database and State Inpatient Database, 2020 Supplemental National Emergency Department Inventory PECC Survey, and the 2021 National Pediatric Readiness Project Survey. This analysis was conducted from February 15, 2023, to July 9, 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Presence of a PECC.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Hospitals were stratified by presence of pediatric resources (ie, pediatric intensive care and inpatient units), with exclusion of children's hospitals and comparison between pediatric-resourced and non-pediatric-resourced (unable to admit children, no pediatric intensive care unit) hospitals. The 7 measures chosen were length of stay longer than 1 day for discharged patients, left against medical advice or without completing treatment, death in the ED, return visits within 3 days, return visits with admission within 3 days, use of chest radiography in patients with asthma, and use of head computed tomography for patients with head trauma. For each stratum, multilevel generalized linear models were constructed to examine the association between PECC presence and process and utilization measure performance, adjusted for patient-level factors (age, sex, race and ethnicity, insurance, and complex chronic conditions) and ED-level factors (visit volume, patient census, and case mix [race and ethnicity, insurance, and complex chronic conditions]).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;There were 4 645 937 visits from pediatric patients (mean [SD] age, 7.8 [6.1] years; 51% male and 49% female) to 858 hospitals, including 849 non-freestanding pediatric hospitals, in the analytic sample. Highly resourced pediatric centers were most likely to have a PECC (52 of 59 [88%]) compared with moderately resourced (54 of 156 [35%]) and non-pediatric-resourced hospitals (66 of 519 [13%]). Among the 599 non-pediatric-resourced hospitals, PECC presence was associated with decreased rates of computed tomography in head trauma (adjusted odds ratio [AOR], 0.76; 95% CI, 0.66-0.87); in the pediatric-resourced hospitals, the AOR was 0.85 (95% CI, 0.73-1.00). For patients with asthma, PECC was associated with decreased chest radiography rates among pediatric-resourced hospitals (AOR, 0.77; 95% CI, 0.66-0.91) but not non-pediatric-resourced hospitals (","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2451111"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846626","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":"Perspectives on Diversion of Medications From Safer Opioid Supply Programs.","authors":"Michelle Olding, Katherine Rudzinski, Rose Schmidt, Gillian Kolla, Danielle German, Andrea Sereda, Carol Strike, Adrian Guta","doi":"10.1001/jamanetworkopen.2024.51988","DOIUrl":"10.1001/jamanetworkopen.2024.51988","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Safer supply programs were implemented in Canada to provide pharmaceutical-grade alternatives to the toxic unregulated drug supply. While research shows clinical benefits and reduced overdose mortality among safer supply patients, medication diversion remains a concern.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To examine provider (prescribing clinicians and allied health professionals) and patient perspectives on diversion of opioids prescribed in safer supply programs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;In 2021, qualitative interviews and sociodemographic questionnaires were conducted with patients and providers across 4 safer supply programs in Ontario, Canada. Interviews with 21 providers (physicians, nurse practitioners, and allied health professionals) and 52 patients examined experiences implementing safer supply or receiving care. Initial data analysis was conducted from December 2021 to March 2022, and the subanalysis focused on diversion was conducted from December 2023 to March 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Participation in safer supply program as a patient or provider.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Data about diversion were coded, extracted, and thematically analyzed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 52 patient participants, 29 (55.8%) were men and 23 (44.2%) were women; 1 was Black (1.9%), 9 (17.3%) were Indigenous, 1 was Latino (1.9%), and 41 (78.8%) were White; and the mean (SD) age was 46.5 (9.6) years. Of 21 provider participants, 6 (28.6%) were men, 13 (61.9%) were women, and 2 (9.5%) were nonbinary; and the mean (SD) age was 37.6 (7.6) years. Participants characterized diversion as a spectrum ranging from no diversion, to occasional medication sharing and loss, to selling all prescribed doses of safer supply (considered rare and easy to detect). Most patients reported they consumed all or most of their prescribed medications and rarely shared or sold their doses. However, providers and patient participants shared that people might share, trade, and/or sell some of their medications with other opioid-using people for multiple reasons. Most prominent reasons for diversion were (1) compassionate sharing with intimate partners and friends to manage withdrawal and overdose risk; (2) selling or trading medications to address their own unmet substance use needs (eg, high opioid tolerance); and (3) medication loss due to poverty, homelessness, and associated vulnerabilities to theft and coercion. Programs used nonpunitive urine drug screening practices and patient self-report to monitor medication use. When diversion was identified, providers described using nonjudgmental conversations to understand patients' needs and develop mitigation strategies that addressed underlying reasons for diversion, including changing doses and medications prescribed to better match patients' needs, enrolling eligible intimate partners, and developing safety plans to mitigate ","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2451988"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846630","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":"Optimal Stopping Ages for Colorectal Cancer Screening.","authors":"Matthias Harlass, Ronit R Dalmat, Jessica Chubak, Rosita van den Puttelaar, Natalia Udaltsova, Douglas A Corley, Christopher D Jensen, Nicholson Collier, Jonathan Ozik, Iris Lansdorp-Vogelaar, Reinier G S Meester","doi":"10.1001/jamanetworkopen.2024.51715","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2024.51715","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Prior studies have shown that the benefits, harms, and costs of colorectal cancer (CRC) screening at older ages are associated with a patient's sex, health, and screening history. However, these studies were hypothetical exercises and not directly informed by data on CRC risk.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To identify the optimal stopping ages for CRC screening by sex, comorbidity, and screening history from a cost-effectiveness perspective.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This economic evaluation first validated the MISCAN-Colon (Microsimulation Screening Analysis-Colon) model against community-based CRC incidence and mortality rates for 2 subcohorts of the PRECISE (Optimizing Colorectal Cancer Screening Precision and Outcomes in Community-Based Populations) cohort. Subsequently, different CRC screening scenarios were simulated in older individuals. Cohorts of US adults aged 76 to 90 years varied by sex and comorbidity status (none, low, moderate, or severe). Statistical and sensitivity analyses were performed from March 2023 to May 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;CRC screening histories including fecal immunochemical test (FIT) or colonoscopy, such as a negative colonoscopy result from 10, 15, 20, 25, or 30 years before the index age; 1 to 5 negative FIT results within 5 years of the index age, with different patterns of recency; or a combination of negative colonoscopy and negative FIT results.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The main outcomes included estimated lifetime clinical outcomes, incremental costs, and quality-adjusted life-years gained (QALYG) associated with 1 additional FIT or colonoscopy. Optimal stopping age for screening, defined as the oldest age for which the incremental cost-effectiveness ratio was still below the willingness-to-pay threshold of $100 000 per QALYG, was evaluated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The first of the 2 PRECISE subcohorts used in validating the simulation model included 25 974 adults (15 060 females [58.0%]; 54.7% aged 76 to 80 years) with a negative colonoscopy result 10 years before the index date. The second subcohort consisted of 118 269 adults (67 058 females [56.7%]; 90.5% aged 76 to 80 years) with a negative FIT result 1 year before the index date. Older age, male sex, higher comorbidity levels, and recent CRC screenings were associated with reduced incremental benefit and cost-effectiveness of additional screening. For the reference cohort of 76-year-old females without comorbidities and a negative colonoscopy result 10 years before the index age, 1 additional colonoscopy cost $38 226 per QALYG. For cohorts with otherwise equivalent characteristics, associated costs increased to $1 689 945 per QALYG for females at age 90 years without comorbidities and a negative colonoscopy results 10 years before the index age, $51 604 per QALYG for males at age 76 years without comorbidities and a negative colonoscop","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2451715"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854269","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":"Symptoms Prior to Diagnosis of Multiple Sclerosis in Individuals Younger Than 18 Years.","authors":"Manas K Akmatov, Jonas Graf, Claudia Kohring, David Ellenberger, Jörg Bätzing, Helen Tremlett, Jakob Holstiege","doi":"10.1001/jamanetworkopen.2024.52652","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2024.52652","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;A growing body of literature suggests the presence of a prodromal period with nonspecific signs and symptoms before onset of multiple sclerosis (MS).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To systematically assess diseases and symptoms diagnosed in the 5 years before a first MS- or central nervous system (CNS) demyelinating disease-related diagnostic code in pediatric patients compared with controls without MS and controls with another immune-mediated disorder, juvenile idiopathic arthritis (JIA).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This population-based, matched case-control study included children and adolescents (aged &lt;18 years) in Germany with statutory health insurance from January 2010 to December 2020. The study population consisted of 3 groups: case individuals with MS, control individuals without MS, and control individuals with JIA. Data were analyzed from November 2023 to April 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Diagnoses coded according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, German Modification (ICD-10-GM).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome and measures: &lt;/strong&gt;The main outcome was incident cases of MS, defined as the first confirmed diagnosis of MS (ICD-10-GM code G35) in 1 quarter between 2013 and 2020 and at least 1 additional diagnosis in the following quarters. In total, 163 ICD-10-GM codes before a first MS diagnosis were assessed using univariable and multivariable logistic regression analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study population consisted of 1091 children and adolescents with MS, 10 910 without MS, and 1068 with JIA. Of the children and adolescents with MS, 788 (72.2%) were female. Mean (SD) age at disease diagnosis was 15.7 (1.7) years. Nine ICD-10-GM codes were present more frequently among children and adolescents with MS in the 5 years before their first MS diagnosis than among controls without MS: obesity (adjusted odds ratio [AOR], 1.70; 95% CI, 1.42-2.02), disorders of eye refraction and accommodation (AOR, 1.26; 95% CI, 1.09-1.47), visual disturbances (AOR, 1.31; 95% CI, 1.10-1.55), gastritis and duodenitis (AOR, 1.35; 95% CI, 1.08-1.70), patella disorders (AOR, 1.47; 95% CI, 1.13-1.90), heartbeat abnormalities (AOR, 1.94; 95% CI, 1.27-2.96), flatulence (AOR, 1.43; 95% CI, 1.01-2.01), skin sensation disturbances (AOR, 12.93; 95% CI, 8.98-18.62), as well as dizziness and giddiness (AOR, 1.52; 95% CI, 1.22-1.89). Four of these ICD-10-GM codes were significantly more prevalent in children and adolescents with MS than in controls with JIA: obesity (AOR, 3.19; 95% CI, 2.03-5.02), refraction and accommodation disorders (AOR, 3.08; 95% CI, 2.33-4.08), visual disturbances (AOR, 1.62; 95% CI, 1.13-2.33), and skin sensation disturbances (AOR, 27.70; 95% CI, 6.52-117.64).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this population-based, matched case-control study, children and adolescents wi","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2452652"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894500","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":"Dental Clinic Deserts in the US: Spatial Accessibility Analysis.","authors":"Md Shahinoor Rahman, Jeffrey C Blossom, Ichiro Kawachi, Renuka Tipirneni, Hawazin W Elani","doi":"10.1001/jamanetworkopen.2024.51625","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2024.51625","url":null,"abstract":"<p><strong>Importance: </strong>Little is known about the spatial accessibility to dental clinics across the US.</p><p><strong>Objective: </strong>To map the spatial accessibility of dental clinics nationally and to examine the characteristics of counties and US Census block groups with dental care shortage areas.</p><p><strong>Design, setting, and participants: </strong>Cross-sectional study of US dental clinics in 2023 using data from the IQVIA national practitioners' database, which includes 205 762 active dentists. Data were analyzed from November 2023 to April 2024.</p><p><strong>Exposures: </strong>Socioeconomic characteristics of block groups and counties including rurality, area deprivation, racial and ethnic segregation, and uninsured population.</p><p><strong>Main outcomes and measures: </strong>Enhanced 2-step floating catchment area method with a 30-minute drive time impedance was used to calculate the accessibility score to dental clinics at the block group level. The outcomes were dental clinic shortage areas and inequality in access to dental clinics.</p><p><strong>Results: </strong>Nearly 1.7 million people in the US (0.5%) lacked access to dental clinics within a 30-minute drive. This included 0.9 million male (52.2%), 1.2 million White (71.0%), 52 636 Black (3.0%), and 176 885 Hispanic (10.2%) individuals. Approximately 24.7 million people (7.5%) lived in dental care shortage areas (defined as <1 dentist per 5000 population). There was a significant difference in spatial accessibility scores between rural and urban areas, with 1 dentist for every 3850 people in rural areas and 1 dentist for every 1470 people in urban areas. Additionally, there were 387 counties with significant disparities in access to dental clinics. Rural block groups (23.9 percentage points [pp]; 95% CI, 23.6-24.3), block groups with higher levels of Black (1.5 pp; 95% CI, 1.3-1.7) and Hispanic (4.5 pp; 95% CI, 4.3-4.8) segregation, and block groups with the highest levels of area deprivation (5.5 pp; 95% CI, 5.1-5.9) were more likely to experience dental care shortages compared with urban block groups and those with lower levels of segregation and area deprivation. Moreover, rural counties (11.3 pp; 95% CI, 8.9-13.7), counties with a high uninsured population (3.0 pp; 95% CI, 1.5-4.4), and counties with high levels of deprivation (5.8 pp; 95% CI, 2.1-9.5) were more likely to have inequality in access to dental clinics.</p><p><strong>Conclusions and relevance: </strong>In this cross-sectional study of US dental clinics, there was geographic shortage and maldistribution of the dental workforce. These findings can support dental workforce planning efforts at the federal and state levels to encourage dentists to practice in underserved areas to reduce disparities in access to dental care.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2451625"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877277","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":"Race, Ethnicity, and Sleep in US Children.","authors":"Yijie Wang, Zhenqiang Zhao, Youchuan Zhang, Jinjin Yan, Meng-Run Zhang, Elizabeth Jelsma, Shadane Johnson, Heining Cham, Margarita Alegría, Tiffany Yip","doi":"10.1001/jamanetworkopen.2024.49861","DOIUrl":"10.1001/jamanetworkopen.2024.49861","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Although racial and ethnic disparities are well documented in children's mean levels of sleep, particularly duration, evidence is mixed for sleep variability, an important sleep dimension of growing interest. Most research has also focused on comparisons of Black and White children, with limited attention to sleep variability disparities among other racially and ethnically minoritized groups such as Asian, Latinx, and multiracial children.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To investigate racial and ethnic disparities in children's mean levels of sleep and variability of sleep across multiple dimensions and diverse racial and ethnic groups using actigraphy data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cross-sectional study used data from the Adolescent Brain Cognitive Development (ABCD) study, a national cohort study, from 21 study sites across the US. ABCD participants were recruited at baseline (2016-2018) using a multistage, stratified, probability sampling method. The current study used a subsample with reliable actigraphy data collected at 2-year follow-up (2018-2020). Data analysis occurred from July 2023 to October 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Parent-reported race and ethnicity at baseline. Sociodemographic, health, and contextual covariates of sleep were also included.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Actigraphy-assessed mean levels of sleep and sleep variability across multiple dimensions (duration, bedtime, risetime, efficiency, and latency) over 3 weeks.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The analytic sample included 3868 children (mean [SD] age, 11.50 [0.67] years; 1913 female [49.5%]), of whom 104 (2.7%) were Asian, 347 (9.0%) were Black or African American, 801 (20.7%) were Latinx, 356 (9.2%) were multiracial, and 2260 (58.4%) were White. Asian, Black, Latinx, and multiracial children exhibited shorter sleep duration and later bedtime than White children. Importantly, compared with White children, bedtime variability was greater among Asian (β = 0.04; 95% CI, 0.01 to 0.07; P = .02), Black (β = 0.11 95% CI, 0.08 to 0.15; P &lt; .001), Latinx (β = 0.08; 95% CI, 0.05 to 0.12; P &lt; .001), and multiracial children (β = 0.08; 95% CI, 0.05 to 0.11; P &lt; .001). Similarly, risetime variability was greater among Asian (β = 0.04; 95% CI, 0.01 to 0.07; P = .01), Black (β = 0.08; 95% CI, 0.04 to 0.12; P &lt; .001), and Latinx (β = 0.06; 95% CI, 0.02 to 0.10; P &lt; .01) children in comparison with White children. Black children exhibited the most profound disparities across mean levels (duration and bedtime) and variability of sleep (duration, bedtime, risetime, and efficiency) than other groups. Asian and multiracial children also exhibited some disparities sleep duration, efficiency, and efficiency variability, when compared with Latinx children.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this cross-sectional study of children's sleep disparities, racially and ethni","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2449861"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142800740","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":"Urinary Metal Levels, Cognitive Test Performance, and Dementia in the Multi-Ethnic Study of Atherosclerosis.","authors":"Arce Domingo-Relloso, Katlyn E McGraw, Susan R Heckbert, Jose A Luchsinger, Kathrin Schilling, Ronald A Glabonjat, Irene Martinez-Morata, Melanie Mayer, Yongmei Liu, Alexis C Wood, Jeff Goldsmith, Kathleen M Hayden, Mohamad Habes, Ilya M Nasrallah, R Nick Bryan, Tanweer Rashid, Wendy S Post, Jerome I Rotter, Priya Palta, Linda Valeri, Timothy M Hughes, Ana Navas-Acien","doi":"10.1001/jamanetworkopen.2024.48286","DOIUrl":"10.1001/jamanetworkopen.2024.48286","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Metals are established neurotoxicants, but evidence of their association with cognitive performance at low chronic exposure levels is limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To investigate the association of urinary metal levels, individually and as a mixture, with cognitive tests and dementia diagnosis, including effect modification by apolipoprotein ε4 allele (APOE4).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;The multicenter prospective cohort Multi-Ethnic Study of Atherosclerosis (MESA) was started from July 2000 to August 2002, with follow-up through 2018. A total of 6303 MESA participants were included. Data analysis was performed from October 12, 2023, to June 13, 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Urine samples were collected at baseline (2000-2002), and arsenic, cadmium, cobalt, copper, lead, manganese, tungsten, uranium, and zinc levels were measured in 2020-2022.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Digit Symbol Coding (DSC) (n = 3819) (possible score range, 0-133), Cognitive Abilities Screening Instrument (CASI) (n = 3918) (possible score range, 0-100), and Digit Span (DS) (n = 4176) (possible score range, 0-30) cognitive tests were administered in 2010-2012; higher scores of each test indicate increasing levels of positive response.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 6303 participants were followed up for dementia diagnosis through 2018. The median age at baseline was 60 (IQR, 53-70) years, and 3303 participants (52.4%) were female. The median cognitive scores were 51 (IQR, 38-64) for DSC, 90 (IQR, 84-95) for CASI, and 15 (IQR, 12-18) for DS. There were 559 cases of dementia through the follow-up period. Inverse associations with DSC were identified: mean differences in z scores per IQR increase in metal levels were -0.03 (95% CI, -0.07 to 0.00) for arsenic, -0.05 (95% CI, -0.09 to -0.004) for cobalt, -0.05 (95% CI, -0.07 to -0.02) for copper, -0.04 (95% CI, -0.08 to -0.001) for uranium, and -0.03 (95% CI, -0.06 to -0.01) for zinc. Among 1058 APOE4 carriers, manganese was also inversely associated with DSC. The joint mean difference of DSC comparing percentile 95th with the 25th of the 9-metal mixture was -0.30 (95% CI, -0.47 to -0.14) for APOE4 carriers and -0.10 (95% CI, -0.19 to -0.01) for noncarriers. Arsenic, cadmium, cobalt, copper, tungsten, uranium, and zinc were individually associated with dementia, with hazard ratios per IQR of metal ranging from 1.15 (95% CI, 1.03-1.29) for tungsten to 1.46 (95% CI, 1.06-2.02) for uranium. The joint hazard ratio of dementia comparing percentiles 95th with the 25th of the 9-metal mixture was 1.71 (95% CI, 1.24-3.89), with no significant difference by APOE4 status.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this study, participants with higher concentrations of metals in their urine, compared with those with lower concentrations, had worse performance on cognitive tests and greater likelihood of developing","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 12","pages":"e2448286"},"PeriodicalIF":10.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11612832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768947","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}