JAMA Network Open最新文献

{"title":"Error in Conflict of Interest Disclosures.","authors":"","doi":"10.1001/jamanetworkopen.2025.41219","DOIUrl":"10.1001/jamanetworkopen.2025.41219","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2541219"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12508983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251032","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":"Self-Help App for Depression in People With Intellectual Disabilities: A Randomized Clinical Trial.","authors":"Swantje Borsutzky, Lina Hannah Paul, Lara Rolvien, Steffen Moritz","doi":"10.1001/jamanetworkopen.2025.36364","DOIUrl":"10.1001/jamanetworkopen.2025.36364","url":null,"abstract":"<p><strong>Importance: </strong>Individuals with intellectual disabilities (IDs) are at increased risk for mental health problems, including depression. However, access to effective therapeutic interventions is often limited.</p><p><strong>Objective: </strong>To evaluate the feasibility, acceptance, and efficacy of a self-help smartphone app designed to reduce depressive symptoms and improve self-esteem and quality of life in individuals with IDs.</p><p><strong>Design, setting, and participants: </strong>In this 2-arm randomized clinical trial, adults with IDs and depressive symptoms were enrolled online in Germany between April 1 and August 10, 2023. Of the 135 individuals who accessed the survey, 99 met the eligibility criteria. Participants were recruited via social media, third parties (eg, care institutions), and workplaces. Data were collected at baseline and after the intervention. Statistical analyses included complete case and intention-to-treat (ITT) approaches.</p><p><strong>Intervention: </strong>Participants were randomly assigned (1:1) to either the intervention group using a smartphone app in easy-to-read German mainly on cognitive behavioral therapy or a waiting list control group. Participants in both groups continued to receive care as usual, which may include routine psychosocial support, daily structure provided by caregivers, and access to general health services.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was a reduction in depressive symptoms, measured by the Glasgow Depression Scale for People With a Learning Disability. Secondary outcomes were improvements in self-esteem, quality of life, and participant satisfaction.</p><p><strong>Results: </strong>Among the 99 participants (mean [SD] age, 34.9 [12.6] years; 54 [54.5%] female), 92 completed the postintervention assessment. The intervention group showed a significant reduction in depressive symptoms compared with the control group in ITT analyses (F1,97 = 7.52; P = .007; ηp2 = 0.072; medium effect size), as well as significant improvements in quality of life (F1,97 = 5.09; P = .03; ηp2 = 0.050; small to medium effect size) and in self-esteem (F1,97 = 17.94; P < .001; ηp2 = 0.156; large effect size). Complete case analyses yielded consistent results on most outcome measures. High satisfaction ratings were reported.</p><p><strong>Conclusions and relevance: </strong>In this randomized clinical trial, a self-guided smartphone app demonstrated efficacy in reducing depressive symptoms and enhancing quality of life and self-esteem among individuals with IDs. The findings suggest that smartphone-based interventions can provide effective support for this underserved population.</p><p><strong>Trial registration: </strong>German Clinical Trials Register Identifier: DRKS00030858.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2536364"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12511992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251063","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":"Rapid vs Standard Induction to Injectable Extended-Release Buprenorphine: A Randomized Clinical Trial.","authors":"Rajinder Shiwach, Bernard Le Foll, Hannu Alho, Kelly E Dunn, Stephanie Strafford, Yue Zhao, Robert L Dobbins","doi":"10.1001/jamanetworkopen.2025.37319","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.37319","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Standard induction (SI) using transmucosal buprenorphine-naloxone is challenging in individuals who inject opioids, use high doses of opioids, or use synthetic opioids (eg, fentanyl).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To compare the effectiveness and safety of rapid induction (RI; single 4-mg dose of buprenorphine-naloxone) vs SI (≥7 days of buprenorphine-naloxone) followed by extended-release buprenorphine injection.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This multicenter, open-label randomized clinical trial was conducted from October 26, 2021, to January 19, 2024, at 28 outpatient treatment centers in the US and Canada. Treatment-seeking participants with moderate or severe opioid use disorder who inject opioids, use high doses of opioids, or use fentanyl were studied.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;Participants were randomized 2:1 to RI or SI before 300-mg injection of extended-release buprenorphine.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary end point, retention rate difference at injection 2 (1 week after injection 1), was estimated by a bayesian approach. Posterior probability was estimated for noninferiority of RI to SI (RI - SI &gt;-10%) and superiority (RI - SI &gt;0%). Adverse events (AEs), including investigator-assessed opioid withdrawal symptoms, were reported. Subgroup analyses compared participants with positive or negative fentanyl urine drug screen results.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Analyses included 729 randomized participants (mean [SD] age, 40.7 [10.4] years; 406 [55.7%] male) who initiated transmucosal buprenorphine per protocol, including 474 in the RI arm and 255 in the SI arm. A total of 560 participants received extended-release buprenorphine injection 1 (409 [86.3%] in the RI arm and 151 [59.2%] in the SI arm), and 452 received injection 2 (314 [66.2%] in the RI arm and 138 [54.1%] in the SI arm). At injection 2, RI was noninferior with higher retention than SI (difference, 11.8%; 95% credible interval [CrI], 4.3%-19.0%; posterior probability greater than 0 was 99.9%). Similarly, among participants with a positive test result for fentanyl, the retention rate differential in favor of RI was 14.8% (95% CrI, 6.5%-23.7%; posterior probability greater than 0 was greater than 99.9%). AE incidence was not statistically different between RI and SI participants (202 [42.6%] vs 93 [35.5%]; difference, 6.1%; 95% CrI, -1.3% to 13.4%). Up to injection 2, most AEs were associated with opioid withdrawal.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this multicenter randomized clinical trial, RI had higher retention than SI overall and in patients who tested positive for fentanyl through extended-release buprenorphine injection 2. Administration of injection 2 after 1 week was well tolerated and minimized time below target therapeutic levels of 2 ng/mL or greater compared with injection after 1 month.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Trial registration: &lt;/strong&gt;Clinica","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2537319"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145286299","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":"Gemcitabine and Cisplatin Plus Polymeric Micellar Paclitaxel and Survival in Advanced Biliary Tract Cancer: A Randomized Clinical Trial.","authors":"Hyehyun Jeong, Changhoon Yoo, Ilhwan Kim, Jung Hun Kang, Jae Ho Jeong, Kwonoh Park, Sang-Bo Oh, Inkeun Park, Sun Jin Sym, Jaekyung Cheon, Hyewon Ryu, Jun Eul Hwang, Ji Sung Lee, Baek-Yeol Ryoo, Kyu-Pyo Kim","doi":"10.1001/jamanetworkopen.2025.34560","DOIUrl":"10.1001/jamanetworkopen.2025.34560","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Limited prospective data exist on the role of adding taxane to standard chemotherapy in the first-line treatment of advanced biliary tract cancers, especially in the Asian population, where biliary tract cancers are most prevalent.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess the efficacy and safety of polyethoxylated castor oil-free polymeric micelle formulation of paclitaxel (hereafter, polymeric micellar paclitaxel), in combination with gemcitabine and cisplatin in patients with untreated advanced biliary tract cancers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This open-label, phase 3 randomized clinical trial was conducted across 7 centers in South Korea from September 1, 2019, to October 31, 2022. Patients were eligible if they had previously untreated, locally advanced unresectable, recurrent, or metastatic adenocarcinoma of the bile duct, were aged 19 to 79 years, had an Eastern Cooperative Oncology Group Performance Status of 0 to 2, and had measurable or evaluable lesions according to Response Evaluation Criteria in Solid Tumorsversion 1.1.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;Patients were randomized to receive either polymeric micellar paclitaxel, 100 mg/m2; gemcitabine, 800 mg/m2; and cisplatin, 25 mg/m2; on days 1 and 8 or gemcitabine, 1000 mg/m2, and cisplatin, 25 mg/m2, on days 1 and 8 every 21 days. A total of 9 cycles were planned for both groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary end point was overall survival. Secondary end points included investigator-assessed and blinded independent central review-assessed progression-free survival, objective response rate, and safety.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 150 patients (median [range] age, 65 [41-79] years; 87 [58%] male) were randomly assigned to the study (74 in the gemcitabine and cisplatin combined with polymeric micellar paclitaxel group and 76 in the gemcitabine and cisplatin group). The study was prematurely terminated due to slow patient accrual. The median (IQR) follow-up duration was 10.4 (6.5-16.7) months. The median overall survival was 12.0 (95% CI, 9.9-15.8) months in the gemcitabine and cisplatin combined with polymeric micellar paclitaxel group and 11.1 (95% CI, 9.7-13.5) months in the gemcitabine and cisplatin group (hazard ratio, 0.94; 95% CI, 0.63-1.41; P = .76). Both blinded independent central review-assessed and investigator-assessed progression-free survival as well as the objective response rates did not differ significantly between the 2 groups. No unanticipated safety signals were observed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this randomized clinical trial, gemcitabine and cisplatin combined with polymeric micellar paclitaxel did not improve survival compared with gemcitabine and cisplatin combined in patients with previously untreated advanced biliary tract cancer. This study provides further evidence regarding the limitations of intensified chemother","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2534560"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12489695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199488","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":"Where Do the Children Go?-Learning From Medicaid Data.","authors":"Jeffrey S Schiff, Susan Kennedy","doi":"10.1001/jamanetworkopen.2025.36244","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.36244","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2536244"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238879","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":"Cost-Utility Analysis of Accelerated and Standard Strategies for Renal Replacement Therapy Initiation.","authors":"Jeff Round, Ilke Akpinar, Charles Yan, Natasha Patel, Sasha van Katwyk, Carmel Montgomery, Ron Wald, Sean M Bagshaw","doi":"10.1001/jamanetworkopen.2025.35343","DOIUrl":"10.1001/jamanetworkopen.2025.35343","url":null,"abstract":"<p><strong>Importance: </strong>Little is known about the long-term costs and outcomes related to strategies for timing of initiation of kidney replacement therapy (KRT) in critically ill patients with severe acute kidney injury (AKI).</p><p><strong>Objective: </strong>To estimate the cost-utility and cost-effectiveness of accelerated KRT initiation compared with standard KRT initiation in critically ill patients with AKI.</p><p><strong>Design, setting, and participants: </strong>In this economic evaluation, a state-transition model was developed using data from the Standard vs Accelerated Initiation of Renal Replacement Therapy in AKI (STARRT-AKI) trial, a multicenter, multinational randomized clinical trial of critically ill patients with severe AKI conducted between October 2015 and September 2019. Trial data were linked to administrative health databases in Alberta, Canada, to estimate costs and long-term clinical outcomes. The model included 4 health states: no chronic kidney disease, severe chronic kidney disease, KRT dependent, and dead. Costs are reported in 2024 Canadian dollars. Data were analyzed from February 2022 to November 2024.</p><p><strong>Exposure: </strong>Initiation of KRT.</p><p><strong>Main outcomes and measures: </strong>The primary outcome for the economic evaluation was cost per quality-adjusted life-year (QALY) gained. The QALY is a combined measure of patient quality of life and length of life. Expected costs, QALYs, incremental cost-effectiveness ratio (ICER), and incremental net monetary benefit (INMB) were estimated on the basis of 5000 Monte Carlo simulations.</p><p><strong>Results: </strong>A total of 146 patients from the STARRT-AKI trial were included in the analysis, with 73 patients (mean [SD] age, 59.67 [14.5] years; 52 men [71.3%]) randomized to receive accelerated initiation and 73 patients (mean [SD] age, 61.88 [12.9] years; 48 men [65.8%]) randomized to receive standard initiation. Standard initiation was more costly per patient than accelerated initiation (mean [SD], $251 370 [$155 801] vs $231 518 [$183 302]) but generated more QALYs (mean [SD] 7.49 [2.03] QALYs vs 6.64 [1.76] QALYs). The ICER of standard initiation compared with accelerated initiation was $23 208, with an INMB of $22 648 (95% credible interval, $15 980-$29 316) when assuming a willingness to pay per QALY of $50 000.</p><p><strong>Conclusions and relevance: </strong>The findings of this economic evaluation suggest that standard KRT initiation may be cost-effective in a Canadian setting, but this finding was sensitive to postdischarge cost trajectories and regional variation in KRT dependence.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2535343"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212650","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":"Incretin Mimetics and Cardiovascular Events-The Evolving Comparative Effectiveness Landscape.","authors":"Patrick J O'Connor, Romain Neugebauer","doi":"10.1001/jamanetworkopen.2025.37304","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.37304","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2537304"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280216","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":"Immunity to Streptococcus pyogenes and Common Respiratory Viruses at Age 0 to 4 Years After COVID-19 Restrictions.","authors":"Kitt Dokal, Samuel Channon-Wells, Catherine Davis, Diego Estrada-Rivadeneyra, Kristin K Huse, Amelia Lias, Shea Hamilton, Rebecca L Guy, Theresa Lamagni, Sam Nichols, Andrew Taylor, Philipp K A Agyeman, Amutha Anpananthar, Romain Basmaci, Enitan D Carrol, Michael J Carter, Tisham De, Marien I de Jonge, Marieke Emonts, Leire Estramiana Elorrieta, Katy Fidler, Mojca Kolnik, Taco W Kuijpers, Federico Martinon-Torres, Henriette Moll, Marine Mommert-Tripon, Samira Neshat, Maggie Nyirenda-Nyang'wa, Sean O'Riordan, Daniel R Owens, Nazima Pathan, Stephane Paulus, Mark J Peters, Marko Pokorn, Andrew J Pollard, Irene Rivero-Calle, Pablo Rojo, Lorenza Romani, Prita Rughani, Luregn J Schlapbach, Nina A Schweintzger, Ching-Fen Shen, Artur Sulik, Maria Tsolia, Effua Usuf, Michiel van der Flier, Clementien Vermont, Ulrich von Both, Paul Wellman, Victoria J Wright, Shunmay Yeung, Dace Zavadska, Aubrey J Cunnington, Colin Fink, Jethro Herberg, Myrsini Kaforou, Shiranee Sriskandan, Michael Levin, Tom Parks","doi":"10.1001/jamanetworkopen.2025.37808","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.37808","url":null,"abstract":"<p><strong>Importance: </strong>The upsurge in invasive disease caused by Streptococcus pyogenes among children reported in several European countries during 2022 to 2023 has not been fully explained.</p><p><strong>Objective: </strong>To evaluate whether changes in the circulation of common respiratory pathogens associated with the introduction of nonpharmaceutical interventions (NPIs) during the COVID-19 pandemic were associated with acquisition of immunity to S pyogenes and common respiratory viruses.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study recruited children with suspected infection and afebrile control participants at hospitals in 10 European countries. Data were collected before (September 2016 to March 2020) and after (April 2020 to July 2023) the introduction of NPIs.</p><p><strong>Main outcomes and measures: </strong>Molecular detection of bacterial and viral pathogens on throat swabs and age-stratified total serum immunoglobin G (IgG) reactivity to S pyogenes cell wall extract from 2 strains, respiratory syncytial virus (RSV), 5 influenza viruses, 4 common cold coronaviruses, and SARS-CoV-2, measured by immunoassay.</p><p><strong>Results: </strong>Throat swabs from 1942 children aged 0 to 4 years were tested for respiratory pathogens (1449 recruited before introduction of NPIs [median (IQR) age, 19.7 (8.2-38.1) months; 798 (55.1%) male]; 493 recruited after [median (IQR) age, 20.7 (9.7-38.1) months; 269 (54.7%) male]). A decrease in detection of S pyogenes, RSV, common cold coronaviruses, and influenza viruses was observed between March 2020 to July 2021, corresponding to the maximal period of NPIs. Antibodies to S pyogenes were measured in 252 children recruited before NPIs and 200 thereafter. Antibodies to viral antigens were measured in 230 children before NPIs and 92 thereafter. Total IgG to S pyogenes and RSV was significantly lower in children aged 3 to 4 years recruited after NPI introduction compared with those recruited before (S pyogenes emm1 strain: after, 67 participants; median [IQR] 0.13 [0.44-0.44] relative units [RU]; before, 87 participants; median [IQR] 0.35 [0.10-0.65] RU; P = .007. RSV: after, 30 participants; median [IQR] 49.6 [31.1-120.7] mesoscale units [MU]/1000; before, 76 participants; median [IQR] 141.8 [78.1-423.1] MU/1000; P < .001). No such differences were observed for children aged 0 to 2 years or for individual influenza viruses or SARS-CoV-2.</p><p><strong>Conclusions and relevance: </strong>In this cross-sectional study, there was a significant reduction in serum antibodies to S pyogenes and RSV in children aged 3 to 4 years after introduction of NPIs. Equivalent to approximately a 1-year delay in acquisition of immunity, these data suggest a putative biological basis for the 2022 to 2023 upsurge in severe S pyogenes infections in this age group.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2537808"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292184","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":"The Emergency Department as a Public Health Lever-Infrastructure to Drive Intent to Action.","authors":"Anish K Agarwal, Raina M Merchant","doi":"10.1001/jamanetworkopen.2025.37664","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.37664","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2537664"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292296","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":"Affirmative Action Repeal and Racial and Ethnic Diversity in US Medical School Admissions.","authors":"Natalie Florescu, Andrea Lin, Samantha Temucin, Lisa Rae","doi":"10.1001/jamanetworkopen.2025.35020","DOIUrl":"10.1001/jamanetworkopen.2025.35020","url":null,"abstract":"<p><strong>Importance: </strong>In June 2023, the US Supreme Court's decision in Students for Fair Admissions v. Harvard University effectively overturned affirmative action, raising concerns about the future of diversity in medical education. A diverse physician workforce is crucial for advancing health care equity and improving patient outcomes.</p><p><strong>Objective: </strong>To evaluate the association between the Supreme Court's ruling and the racial and ethnic composition of students matriculating into Doctor of Medicine (MD) and Doctor of Osteopathic Medicine (DO) programs.</p><p><strong>Design, setting, and participants: </strong>Cross-sectional analysis of comprehensive publicly available data on medical school applications and matriculation by race and ethnicity from 2020 to 2024. Data were obtained from the Association of American Medical Colleges (AAMC) and the American Association of Colleges of Osteopathic Medicine (AACOM) to compare across MD and DO programs. Five application cycles were analyzed, with 4 representing preruling trends.</p><p><strong>Main outcome and measure: </strong>Change in the racial and ethnic composition of matriculating medical students following the Students for Fair Admissions v. Harvard University decision.</p><p><strong>Results: </strong>From 2020 to 2025, there were a mean (SD) of 55 037 (4315) applicants and 22 750 (349) matriculants to MD institutions and 214 163 (17 243) applicants and 9019 (274) matriculants to DO institutions. Significant disparities in application and matriculation patterns were observed across both program types, with persistent underrepresentation among American Indian or Alaska Native, Black, Hispanic, Native Hawaiian, and multiracial applicants. Between the 2023 to 2024 and 2024 to 2025 academic years, MD matriculation declined by 11.6% for Black students (χ21 = 40.59; P < .001) and 10.8% for Hispanic students (χ21 = 45.87; P < .001), respectively. DO programs showed broader underrepresentation. Compared with White and Asian applicants, all other racial groups were significantly underrepresented in both applications and matriculation.</p><p><strong>Conclusions and relevance: </strong>These declines threaten progress toward health care equity. Medical schools must explore alternative admissions strategies, such as holistic review processes that account for structural barriers. Without such efforts, reduced diversity in medical education may worsen existing health disparities.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2535020"},"PeriodicalIF":9.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12514628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274687","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}