JAMA Network Open最新文献

{"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}

{"title":"Emotion-Focused Behavioral Weight Loss Treatment for Adolescents: A Randomized Clinical Trial.","authors":"Kerri N Boutelle, Michael A Manzano, Ellen K Pasquale, David R Strong, Rebecca S Bernard, Kyung E Rhee, Dawn M Eichen, Alec Miller, Carol B Peterson","doi":"10.1001/jamanetworkopen.2026.39867","DOIUrl":"10.1001/jamanetworkopen.2026.39867","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Family-based behavioral treatment (FBT) efficacy decreases in adolescence, a developmental period of gradual maturation and increasing autonomy during which emotion regulation skills develop.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the feasibility and efficacy of FBT alone compared with FBT plus emotion regulation across 6 months of treatment and 12 months of follow-up on adolescent weight change, emotion regulation, emotional eating, and parent weight change.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This parallel-group randomized clinical trial of adolescents 13 to 16 years of age with body mass index (BMI) in the 85th percentile or higher but less than the 99.9th percentile was conducted from August 29, 2019, to January 4, 2024, at 2 university clinics. Central randomization was completed by a statistician, and outcome assessors were blinded to treatment condition. The majority of treatments and assessments were delivered remotely via video conference due to the COVID-19 pandemic.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;FBT plus emotion regulation vs traditional FBT skills alone for weight loss. FBT included nutrition and physical activity education, behavior change strategies, and parenting skills. Both treatments had 6 months of adolescent and parent groups and behavior coaching sessions. The combined group included FBT skills and added dialectical behavior therapy and emotion-focused therapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The main outcomes were adolescent weight (body mass index [BMI] z score (BMIz) and BMI as a percentage of the 95th BMI percentile [%BMIp95]), emotion regulation skills (measured by Difficulties in Emotion Regulation Scale [DERS] scores), emotional eating behaviors (measured by Emotional Eating Scale [EES] scores), parent weight, and feasibility and acceptability of treatment. Primary outcome analyses used an intention-to-treat approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 166 (FBT plus emotion regulation = 84; FBT = 82) dyads (adolescents: mean [SD] age, 14.3 [1.2] years; 95 [57%] female; mean [SD] BMIz, 2.2 [0.6]; mean [SD] %BMIp95, 120.4 [21.4]; parents: mean [SD] age, 45.3 [6.5] years; 141 [85%] female; mean [SD] BMI, 32.6 [7.0]) were assessed at baseline, midtreatment, posttreatment, and 6- and 12-month follow-up visits. There were no statistically significant differences in posttreatment weight loss among adolescents receiving FBT plus emotion regulation compared with FBT (difference in BMIz, 0.03 [95% CI, -0.05 to 0.10]). However, adolescents in FBT plus emotion regulation did not regain as much weight at the 12-month follow-up (difference in BMIz, -0.09 [95% CI, -0.17 to -0.02]). At the 12-month follow-up, 4% (95% CI, 1%-12%) of adolescents in FBT and 22% (95% CI, 8%-48%) of adolescents in FBT plus emotion regulation lost a clinically significant amount of weight (≥0.20 BMIz). At 12 months' follow-up, parent weight (difference in BMI, 0.","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2639867"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13691656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244522","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":"Telehealth Provision and Travel for Abortion Care in States With Total Bans.","authors":"Rachel K Jones, Abigail R A Aiken, Isaac Maddow-Zimet","doi":"10.1001/jamanetworkopen.2026.40018","DOIUrl":"10.1001/jamanetworkopen.2026.40018","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2640018"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13691651/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244613","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":"Future Research on and Implementaion of the Bergen 4-Day Treatment.","authors":"Eric A Storch, Caitlin M Pinciotti","doi":"10.1001/jamanetworkopen.2026.39264","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.39264","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2639264"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224111","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":"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":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess the prevalence and clinical implications of positive, recovered, and negative early POS results in asymptomatic newborns.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Positive POS result or indeterminate POS result that normalized to a negative POS result (recovered) with repeat testing.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;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":"Clinician Communication Behaviors and Perceived Health Care Discrimination Among Black Patients.","authors":"Ebiere D Okah, Nao Hagiwara, Kelly Robinson, Elijah Johnson, Abbie Begnaud Muckler","doi":"10.1001/jamanetworkopen.2026.41656","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.41656","url":null,"abstract":"<p><strong>Importance: </strong>Perceived racial discrimination has been shown to be associated with lower medication adherence and poorer health outcomes among Black patients. Individuals perceive discrimination when they (1) observe negative behaviors and (2) attribute these behaviors to racial bias; effectively reducing racial discrimination, therefore, entails limiting actions that patients most readily attribute to bias.</p><p><strong>Objective: </strong>To examine behaviors associated with Black patients' attribution of negative behaviors by health care workers to racial discrimination.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional survey study was conducted at 15 health-oriented events in Minneapolis and St Paul, Minnesota, in 2025. A convenience sample of non-Hispanic Black adults older than 40 years was recruited. Participants who experienced negative behaviors by health care workers were included.</p><p><strong>Exposures: </strong>Self-reported experiences of 10 negative behaviors and level of trust in the health care system.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was attribution of negative behaviors to racial discrimination (ARD). Logistic regressions were used to examine associations between experiencing individual behaviors, sum of negative behaviors, and trust in the health care system with ARD.</p><p><strong>Results: </strong>A total of 284 adults were recruited, and 152 who experienced negative behaviors were included. Six observations were removed owing to missing data on patients' attribution for these behaviors, resulting in a final analytic sample of 146 participants (mean [SD] age, 58.7 [10.9] years; 116 female [79.5%]); 109 participants (74.7%) attributed negative behaviors to racial bias. Greater exposure to negative behaviors was associated with higher odds of ARD (odds ratio [OR], 1.42; 95% CI, 1.14-1.76). Having concerns dismissed (OR, 3.49; 95% CI, 1.57-7.79), being spoken to in a cold or impersonal manner (OR, 5.04; 95% CI, 1.82-13.90), and being stereotyped (OR, 4.22; 95% CI, 1.63-10.93) were directly associated with ARD. Trust in the health care system was not significantly associated with ARD (OR, 0.69; 95% CI, 0.46-1.04). In a multivariable analysis, total negative behaviors remained associated with ARD (OR, 1.39; 95% CI, 1.12-1.73), and trust did not.</p><p><strong>Conclusions and relevance: </strong>In this cross-sectional study of communication behaviors attributed to racial discrimination, experiencing dismissiveness, relational coldness, and stereotyping were associated with Black patients' attribution of negative behaviors to racial bias. Interventions targeting these behaviors may reduce patients' experience of health care discrimination.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2641656"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149297583","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":"Ambient Temperature and Heart Failure Hospitalizations in Older Adults in the US.","authors":"Nathaniel Kuhrt, Ashwaghosha Parthasarathi, Daniel I Bisno, Kevin Josey, Poonam Gandhi, Melanie Rua, David Robinson, Emily Wo, Aayush Visaria, Lizbeth Gomez, Ehimare Akhabue, Maya Guglin, Soko Setoguchi","doi":"10.1001/jamanetworkopen.2026.41051","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.41051","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;The U-shaped association between ambient temperature and cardiovascular mortality is well established. However, limited knowledge exists about the association between ambient temperature and heart failure (HF) hospitalizations, particularly among older adults in the US. Understanding this association is essential to informing climate adaptation strategies and health policies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess the association between daily ambient temperature exposure and HF hospitalization among Medicare beneficiaries both nationally and by climate region.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This time-stratified case-crossover study included older adults (aged ≥65 years) hospitalized for HF between January 1, 2007, and December 31, 2022, based on Medicare claims data. Cases were defined as emergency department visits leading to HF hospitalization with up to 4 controls, or nonevent days, matched for the same patient on day of week, month, and year. The data analysis was performed between June 2025 and August 2026.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Daily mean ambient temperature derived from the Parameter-Elevation Relationships on Independent Slopes Model linked through residential zip code.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The association between mean temperature exposure and HF hospitalization was estimated nationally and by 9 climate regions (Central, East North Central, Northeast, Northwest, South, Southeast, Southwest, West, West North Central) using conditional logit for distributed lag nonlinear models (reference, 75 °F). A 14-day lag was used for mean temperatures less than 75 °F and 0-day lag for mean temperatures greater than 75 °F.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 1 517 756 HF hospitalizations from 996 312 patients (mean [SD] age, 78.0 [8.2] years, 60.3% female) were identified. Colder ambient temperatures were associated with increased HF hospitalizations nationally. At the regional fifth percentile temperature compared with 75 °F, the largest associations were observed in the West North Central (n = 17 286 [1.1%]; odds ratio [OR], 1.62; 95% CI, 1.25-2.11), West (n = 107 911 [7.1%]; OR, 1.40; 95% CI, 1.28-1.53), Southwest (n = 30 536 [2.0%]; OR, 1.34; 95% CI, 1.11-1.62), and Northwest (n = 33 353 [2.2%]; OR, 1.34; 95% CI, 1.08-1.65) regions. Temperatures greater than 75 °F were not associated with increased HF hospitalization.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;This study found that among Medicare beneficiaries, colder ambient temperatures were associated with increased HF hospitalizations, whereas warmer temperatures were not. The U-shaped temperature-cardiovascular risk association described for cardiovascular mortality and other cardiovascular outcomes did not apply for HF hospitalizations among older adults in the US. These findings suggest that ongoing region-specific surveillance of heat- and cold-related HF hospitalization r","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2641051"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149297595","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 Functioning Before Mental Health Disclosure to a Retail Bank.","authors":"Anna Trendl, Georgina Bremner, Judith Harrison, David J Llewellyn, David Leake","doi":"10.1001/jamanetworkopen.2026.41077","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2026.41077","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Financial functioning is an important dimension of mental health, affecting independence and overall functioning. However, there is uncertainty about how financial functioning evolves over time and across mental health conditions, with current evidence largely relying on survey or experimental data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate whether financial functioning differs in the period preceding mental health disclosure to a bank and whether differences are shared or condition specific.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;In this case-control study, deidentified banking records from a major UK bank were used to compare financial indicators between individuals with a bank-disclosed mental health condition between January 2019 and August 2025 and controls, matched 1:3. Analyses were conducted between July 2025 and March 2026.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Bank-recorded mental health disclosures mapped to diagnostic groupings of mental, behavioral, and neurodevelopmental conditions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;A total of 331 monthly financial indicators were used to capture financial functioning. A 2-stage bayesian hierarchical model examined how variation in case-control differences was distributed across financial indicators, conditions, and their interaction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The case group comprised 18 428 individuals with mental health disclosures (mean [SD] age, 41.5 [13.9] years; 10 357 women [56%]) and the control group included 64 229 individuals (mean [SD] age, 40.9 [14.5] years; 36 052 women [56%]). Differences in financial functioning were evident up to 36 months before disclosure. Compared with controls, posterior mean estimates for cases showed higher welfare-related income (disability benefits: 0.80; 95% credible interval [CrI], 0.78-0.83), greater financial distress (credit scores: -0.52 [95% CrI, -0.55 to -0.49]; overdraft use: 0.49 [95% CrI, 0.47-0.52]), and more frequent bank interaction (eg, telephone banking use: 0.56 [95% CrI, 0.53-0.58]). Additional differences included higher cash use and reduced spending on self-care and recreational activities among cases (standardized differences ≤0.4 SD units). Variance decomposition indicated that most variation was attributable to differences across financial indicators (SD, 0.11; 88% of total variance), with negligible variation explained by condition (SD, 0.01; &lt;1%) and a small contribution from interaction effects (SD, 0.04; 12%), indicating broadly consistent patterns across conditions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this case-control study of bank customers, those who disclosed a mental health condition differed from controls across a range of financial indicators preceding the disclosure, with similar patterns across conditions. The findings suggest that banking data may provide objective measures of financial functioning to inform support strategies in b","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2641077"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149297634","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":"Combat Injury, Limb Loss, Traumatic Brain Injury, and Psychosocial Outcomes Among Military Personnel.","authors":"Daniel Dyball, Cheryl R Z See, Alexander N Bennett, Susie Schofield, Grace Blissitt, Lydia Orton, Harriet Kemp, Christopher J Boos, Anthony M J Bull, David J Sharp, Neil S N Graham, Simon Wessely, Howard Burdett, Nicola T Fear","doi":"10.1001/jamanetworkopen.2026.37592","DOIUrl":"10.1001/jamanetworkopen.2026.37592","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Given the burden and rising number of injuries from recent conflict zones such as Ukraine and the Middle East, understanding the long-term health outcomes of those with physical traumatic injuries is critical.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To investigate psychosocial outcomes among UK military personnel who sustained physical combat injuries during deployments to Afghanistan and how traumatic amputation and traumatic brain injury (TBI) are associated with these outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cohort study used data from a prospective cohort (Armed Services Trauma and Rehabilitation Outcome [ADVANCE]) that includes a group of participants who sustained physical combat injuries and a frequency-matched, demographically similar uninjured group. Data were assessed a median of 11 (IQR, 10-13) years following injury at the UK Defense Medical Rehabilitation Centre (Stanford Hall) from August 2018 to August 2023. Data were analyzed from March 2024 to July 2026.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Physical combat injury, including injury profiles with and without limb loss or with deployment-related TBI of varying severity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Psychometrically validated self-report questionnaire data indicating probable alcohol misuse, generalized anxiety, depression, posttraumatic stress disorder (PTSD), or mental health multimorbidity (MHM).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 1047 participants were included in the analysis (median age, 37 [IQR, 34-41] years; 100% male). A total of 523 had sustained combat injuries (141 with limb loss and 382 without, 225 with any TBI, 144 with mild TBI, and 81 with moderate to severe TBI), and 524 were in the uninjured group. Among nonofficers who sustained physical combat injuries, increases in the risk of reporting probable generalized anxiety (adjusted risk ratio [ARR], 1.92 [95% CI], 1.40-2.95]), depression (ARR, 1.78 [95% CI, 1.37-2.44]), PTSD (ARR, 2.00 [95% CI, 1.39-3.00]), and mental health multimorbidity (ARR, 2.05 [95% CI, 1.35-3.16]) were observed compared with participants who were not injured. Limb loss resulted in only small or inconclusive differences in the risk of reporting any mental health outcomes (lowest ARR for generalized anxiety, 1.24 [95% CI, 0.65-2.15]; highest ARR for MHM, 1.36 [95% CI, 0.63-2.59]), whereas greater risk was observed in those injured without limb loss (lowest ARR for depression, 1.95 [95% CI, 1.47-2.67]; highest ARR for MHM, 2.32 [95% CI, 1.52-3.60]). Injuries with mild TBI also resulted in greater risk (lowest ARR for depression, 2.31 [95% CI, 1.63-3.29]; highest ARR for MHM, 2.63 [95% CI, 1.62-4.80]), whereas moderate to severe TBI resulted in smaller elevations with greater uncertainty (lowest ARR for generalized anxiety, 1.52 [95% CI, 0.72-2.78]; highest ARR for MHM, 2.25 [95% CI, 1.11-4.21]). Co-occurring TBI increased observed risks in those injured with and wi","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 10","pages":"e2637592"},"PeriodicalIF":11.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13643579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109767","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}