JAMA Network Open最新文献

{"title":"Smoking and Complications After Cancer Surgery: A Systematic Review and Meta-Analysis.","authors":"Clement Wong, Siti Khadijah Binti Mohamad Asfia, Paul S Myles, John Cunningham, Elizabeth M Greenhalgh, Emma Dean, Sally Doncovio, Lisa Briggs, Nicholas Graves, Nikki McCaffrey","doi":"10.1001/jamanetworkopen.2025.0295","DOIUrl":"10.1001/jamanetworkopen.2025.0295","url":null,"abstract":"<p><strong>Importance: </strong>Surgical cancer treatments may be delayed for patients who smoke over concerns for increased risk of complications. Quantifying risks for people who had recently smoked can inform any trade-offs of delaying surgery.</p><p><strong>Objective: </strong>To investigate the association between smoking status or smoking cessation time and complications after cancer surgery.</p><p><strong>Data sources: </strong>Embase, CINAHL, Medline COMPLETE, and Cochrane Library were systematically searched for studies published from January 1, 2000, to August 10, 2023.</p><p><strong>Study selection: </strong>Observational and interventional studies comparing the incidence of complications in patients undergoing cancer surgery who do and do not smoke.</p><p><strong>Data extraction and synthesis: </strong>Two reviewers screened results and extracted data according to the Meta-Analyses of Observational Studies in Epidemiology (MOOSE) reporting guidelines. Data were pooled with a random-effects model and adjusted analysis was performed.</p><p><strong>Main outcomes and measures: </strong>The odds ratio (OR) of postoperative complications (of any type) for people who smoke currently vs in the past (4-week preoperative cutoff), currently smoked vs never smoked, and smoked within shorter (2-week cutoff) and longer (1-year cutoff) time frames.</p><p><strong>Results: </strong>The meta-analyses across 24 studies with a pooled sample of 39 499 participants indicated that smoking within 4 weeks preoperatively was associated with higher odds of postoperative complications compared with ceasing smoking for at least 4 weeks (OR, 1.31 [95% CI, 1.10-1.55]; n = 14 547 [17 studies]) and having never smoked (OR, 2.83 [95% CI, 2.06-3.88]; n = 9726 [14 studies]). Within the shorter term, there was no statistically significant difference in postoperative complications between people who had smoked within 2 weeks preoperatively and those who had stopped between 2 weeks and 3 months in postoperative complications (OR, 1.19 [95% CI, 0.89-1.59]; n = 5341 [10 studies]), although the odds of complications among people who smoked within a year of surgery were higher compared with those who had quit smoking for at least 1 year (OR, 1.13 [95% CI, 1.00-1.29]; N = 31 238 [13 studies]). The results from adjusted analyses were consistent with the key findings.</p><p><strong>Conclusions and relevance: </strong>In this systematic review and meta-analysis of smoking cessation and complications after cancer surgery, people with cancer who had stopped smoking for at least 4 weeks before surgery had fewer postoperative complications than those smoking closer to surgery. High quality, intervention-based evidence is needed to identify the optimal cessation period and inform clinicians on the trade-offs of delaying cancer surgery.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250295"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11889474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572985","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":"Nicotine Exposure From Smoking Tobacco and Vaping Among Adolescents.","authors":"David Hammond, Jessica L Reid, Maciej L Goniewicz, Ann McNeill, Richard J O'Connor, Danielle Corsetti, Ashleigh C Block, Leonie S Brose, Deborah Robson","doi":"10.1001/jamanetworkopen.2024.62544","DOIUrl":"10.1001/jamanetworkopen.2024.62544","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;It remains unknown whether nicotine intake among youths who vape is lower, comparable, or higher than among youths who smoke.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To examine potential differences in biomarkers of exposure to nicotine (1) between adolescents who smoke tobacco, vape, both vape and smoke (dual use), or do not use; (2) between adolescents in 3 countries; and (3) by nicotine content and form in the vaping product last used among adolescents who exclusively vaped.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This population-based, observational cross-sectional study invited adolescents aged 16 to 19 years in Canada, England, and the US who had previously completed national surveys to participate in a biomarker study based on their vaping and smoking status. Participants completed questionnaires and self-collected urine samples between September 2019 and January 2022. Analyses were conducted in February 2023 and between January and June 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Vaping, tobacco smoking, dual use, or no use in the past 7 days.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Urine concentration of cotinine, trans-3'-hydroxycotinine (3OH-cotinine), and total nicotine equivalents (TNE-2; molar sum of cotinine and 3OH-cotinine), normalized for creatinine concentration.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among the 364 participants (mean [SD] age, 17.6 [1.1] years; 203 females [55.8%]) who provided usable urine samples and completed questionnaires, no differences in TNE-2 concentration were observed between adolescents who exclusively vaped (n = 73; geometric mean [SD], 3.10 [16.69] nmol/mg creatinine), exclusively smoked (n = 68; geometric mean [SD], 3.78 [18.00] nmol/mg creatinine), or both vaped and smoked (n = 77; geometric mean [SD], 6.07 [19.08] nmol/mg creatinine) in the past week, adjusting for creatinine concentration, age, sex, country, and cannabis use. All vaping and/or smoking groups had higher concentrations of TNE-2 than no use (n = 146; geometric mean [SD], 0.19 [1.14] nmol/mg creatinine; P &lt; .001 for all contrasts). Among adolescents who exclusively vaped (n = 73), TNE-2 concentrations were not significantly different between those who reported using products containing more than 20 mg/mL nicotine (n = 33; geometric mean [SD], 4.35 [18.25] nmol/mg creatinine) and containing 20 mg/mL nicotine or less (n = 28; geometric mean [SD], 5.13 [15.64] nmol/mg creatinine). Reported use of vaping products containing nicotine salts (n = 23) was associated with higher concentration of TNE-2 (geometric mean [SD], 10.78 [18.03] nmol/mg creatinine) than reported use of products without nicotine salts (n = 29; geometric mean [SD], 2.72 [15.42] nmol/ng creatinine; P = .03) or reporting \"don't know\" (n = 14; geometric mean [SD], 1.55 [15.01] nmol/ng creatinine; P = .009). Similar patterns of exposure were observed for cotinine and 3OH-cotinine.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/stro","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e2462544"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11904731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Path From Intracranial Pressure to Clinical Outcomes in Pediatric Traumatic Brain Injury.","authors":"Jennifer C Laws, Patrick M Kochanek, Michael S Wolf","doi":"10.1001/jamanetworkopen.2025.0446","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.0446","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250446"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604801","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":"Cardiovascular Health and Biomarkers of Neurodegenerative Disease in Older Adults.","authors":"Anisa Dhana, Charles S DeCarli, Klodian Dhana, Pankaja Desai, Ted K S Ng, Denis A Evans, Kumar B Rajan","doi":"10.1001/jamanetworkopen.2025.0527","DOIUrl":"10.1001/jamanetworkopen.2025.0527","url":null,"abstract":"<p><strong>Importance: </strong>Cardiovascular health (CVH), defined by the American Heart Association as Life's Simple 7 to promote a healthy lifestyle and manage vascular risk factors, has been associated with a low risk of Alzheimer disease and less vascular dementia. However, the association between CVH and biomarkers of neurodegeneration remains less understood.</p><p><strong>Objective: </strong>To investigate the association of CVH with serum biomarkers of neurodegeneration, including neurofilament light chain (NfL) and total tau (t-tau).</p><p><strong>Design, setting, and participants: </strong>This cohort study was conducted within the biracial, population-based Chicago Health and Aging Project (CHAP) of adults aged 65 years or older between 1993 and 2012. Participants who had measured serum NfL and t-tau levels and data on all components of the CVH score were included. The statistical analysis was conducted from April 10 to September 26, 2024.</p><p><strong>Exposure: </strong>The CVH score includes 7 components: a healthy diet; regular exercise; normal body mass index; nonsmoking status; and the absence of dyslipidemia, diabetes, and hypertension. The scores were divided into 3 groups from lowest to highest CVH (0-6 points, 7-9 points, and 10-14 points).</p><p><strong>Main outcomes and measures: </strong>The main outcome was the association of CVH score with serum biomarkers of NfL and t-tau as measured using linear regression and mixed-effects models.</p><p><strong>Results: </strong>A total of 1018 CHAP participants were included in the analysis (mean [SD] age, 73.1 [6.1] years; 625 female [61.4%]; 610 Black or African American [59.9%] and 408 White [40.1%]). Participants with a high CVH score (ie, 10-14 points) were predominantly White (151 [64.3%]) and had a higher education (mean [SD], 13.6 [3.7] years). Compared with participants with low CVH scores (ie, 0-6 points), those with CVH scores of 10 to 14 points had significantly lower serum levels of NfL (relative difference, -18.9%; β = -0.091; SE, 0.025). A higher CVH score was associated with a slower annual increase in NfL levels as participants aged (relative difference in rate, -1.7%; β = -0.008; SE, 0.004). Cardiovascular health was not associated with serum levels of t-tau.</p><p><strong>Conclusions and relevance: </strong>These findings suggest that promoting CVH in older adults may help alleviate the burden of neurodegenerative diseases, particularly among Black adults, who are known to experience a higher prevalence of cardiovascular disease.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250527"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11897837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604940","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":"Estimated Cancer Risk in Females Who Meet the Criteria to Exit Cervical Cancer Screening.","authors":"Shalini L Kulasingam, Inge M C M de Kok, Abhinav Mehta, Erik E L Jansen, Mary Caroline Regan, James W Killen, Stephen Sy, Ran Zhao, Karen Canfell, Jane J Kim, Megan A Smith, Nicole G Campos","doi":"10.1001/jamanetworkopen.2025.0479","DOIUrl":"10.1001/jamanetworkopen.2025.0479","url":null,"abstract":"<p><strong>Importance: </strong>Cervical screening guidelines in the US recommend that most females can exit routine screening at age 65 years following 2 recent consecutive negative cotest results (concurrent human papillomavirus and cytology tests). However, empirical data on the subsequent risks of cancer and cancer death in this subgroup of females are limited.</p><p><strong>Objective: </strong>To estimate the risks of cervical cancer and cervical cancer death among females who meet the cotesting criteria to exit screening.</p><p><strong>Design, setting, and participants: </strong>In this decision analytical comparative modeling study, 4 decision analytical models from the Cancer Intervention and Surveillance Modeling Network-Cervical modeling consortium that fit common US epidemiological data targets were validated against published estimates of 3- and 5-year risks of cervical intraepithelial neoplasia grade 3 (CIN3) among females meeting exit criteria at Kaiser Permanente Northern California (KPNC).</p><p><strong>Main outcomes and measures: </strong>Age-conditional and cumulative risks of cervical cancer and cervical cancer death at ages 65, 70, 75, 80, and 85 years were estimated by performing a comparative modeling analysis of the 4 models to estimate the risks of cervical cancer and cervical cancer death after exiting screening.</p><p><strong>Results: </strong>All models estimated a 5-year risk of CIN3 that was within the range of empirical data from KPNC. Projections of the cumulative and age-conditional risks of cervical cancer and cervical cancer death increased with time since exiting screening. The cumulative risks of cervical cancer and cervical cancer death by age 70 years were estimated to range from 0.001% to 0.003% and from 0% to 0.001%, respectively. The cumulative risks of cervical cancer and cervical cancer death by age 85 years ranged from 0.026% to 0.081% and from 0.005% to 0.038%, respectively, across models. Results were sensitive to assumptions about screening test sensitivity and incidence of high-risk human papillomavirus.</p><p><strong>Conclusions and relevance: </strong>In this decision analytical comparative modeling study, a low risk of cervical cancer and cervical cancer death was estimated among females who fulfilled the US criteria to exit screening with cotesting; however, the risks increased with age and/or time since screening exit. The findings suggest that future guidelines should consider acceptable risk levels when defining screening modality and exit age requirements.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250479"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11904717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605063","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":"Strategies to Assess Risk for Hereditary Cancer in Primary Care Clinics: A Cluster Randomized Clinical Trial.","authors":"Elizabeth M Swisher, Heather M Harris, Sarah Knerr, Tesla N Theoryn, Barbara M Norquist, Jeannine Brant, Brian H Shirts, Faith Beers, DaLaina Cameron, Emerson J Dusic, Laurie A Riemann, Beth Devine, Michael L Raff, Rabindra Kadel, Howard J Cabral, Catharine Wang","doi":"10.1001/jamanetworkopen.2025.0185","DOIUrl":"10.1001/jamanetworkopen.2025.0185","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Best practices for improving access to assessment of hereditary cancer risk in primary care are lacking.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To compare 2 population-based engagement strategies for identifying primary care patients with a family or personal history of cancer and offering eligible individuals genetic testing for cancer susceptibility.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;The EDGE (Early Detection of Genetic Risk) clinical trial cluster-randomized 12 clinics from 2 health care systems in Montana, Wyoming, and Washington state to 1 of 2 engagement approaches for assessment of hereditary cancer risk in primary care. The study population included 95 623 English-speaking patients at least 25 years old with a primary care visit during the recruitment window between April 1, 2021, and March 31, 2022.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Intervention: &lt;/strong&gt;The intervention comprised 2 risk assessment engagement approaches: (1) point of care (POC), conducted by staff immediately preceding clinical appointments, and (2) direct patient engagement (DPE), where letter and email outreach facilitated at-home completion. Patients who completed risk assessment and met prespecified criteria were offered genetic testing via a home-delivered saliva testing kit at no cost.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Primary outcomes were the proportion of patients with a visit who (1) completed the risk assessment and (2) completed genetic testing. Logistic regression models were used to compare the POC and DPE approaches, allowing for overdispersion and including clinic as a design factor. An intention-to-treat analysis was used to evaluate primary outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Over a 12-month window, 95 623 patients had a primary care visit across the 12 clinics. Those who completed the risk assessment (n = 13 705) were predominately female (64.7%) and aged between 65 and 84 years (39.6%). The POC approach resulted in a higher proportion of patients completing risk assessment than the DPE approach (19.1% vs 8.7%; adjusted odds ratio [AOR], 2.68; 95% CI, 1.72-4.17; P &lt; .001) but a similar proportion completing testing (1.5% vs 1.6%; AOR, 0.96; 95% CI, 0.64-1.46; P = .86). Among those eligible for testing, POC test completion was approximately half of that for the DPE approach (24.7% vs 44.7%; AOR, 0.49; 95% CI, 0.37-0.64; P &lt; .001). The proportion of tested patients identified with an actionable pathogenic variant was significantly lower for the POC approach than the DPE approach (3.8% vs 6.6%; AOR, 0.61; 95% CI, 0.44-0.85; P = .003).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this cluster randomized clinical trial of risk assessment delivery, POC engagement resulted in a higher rate of assessment of hereditary cancer risk than the DPE approach but a similar rate of genetic testing completion. Using a combination of engagement strategies may be the optimal approach for greater reach and impa","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250185"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11889468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572988","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":"Changes in Respiratory Viral Testing Before and After the COVID-19 Pandemic.","authors":"Todd W Lyons, Caroline G Kahane","doi":"10.1001/jamanetworkopen.2025.0168","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.0168","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250168"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567180","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":"Naloxone Knowledge, Carrying, Purchase, and Use.","authors":"Mireille Jacobson, David Powell","doi":"10.1001/jamanetworkopen.2024.62698","DOIUrl":"10.1001/jamanetworkopen.2024.62698","url":null,"abstract":"<p><strong>Importance: </strong>Widespread naloxone access is a key policy response to the opioid crisis. Naloxone availability is typically estimated from pharmacy sales, which exclude naloxone provided by community organizations, hospitals, and clinics, or sold over-the-counter.</p><p><strong>Objective: </strong>To estimate naloxone knowledge, carrying, purchase, and use among US adults.</p><p><strong>Design, setting, and participants: </strong>This survey study included noninstitutionalized adults aged 18 years and older from a national sample and a sample self-reporting opioid dependence. Respondents answered online questions between June 7 and June 29, 2024, about naloxone knowledge, carrying, purchase, and use.</p><p><strong>Exposures: </strong>Opioid misuse, risk of overdose, risk of overdose by person known to respondent.</p><p><strong>Main outcomes and measures: </strong>Naloxone knowledge, prevalence of naloxone carrying, purchase, and administration.</p><p><strong>Results: </strong>The survey included 1515 individuals from a national sample (median [IQR] age, 45 [33-58] years; 770 women [50.8%]; 215 Black [14.2%], 1087 White [71.8%]) and 512 who self-reported opioid dependence. In the national sample, 50 respondents (3.3%) reported opioid dependence, yielding 562 respondents reporting opioid dependence (median [IQR] age, 41 [35-48] years; 404 female [70.2%]; 17 Black [3.0%], 494 White [87.9%]). Overall, 1164 respondents-700 (46.2%) in the national sample and 500 (89.0%) reporting opioid dependence-had heard of naloxone and correctly identified its purpose. One hundred sixty participants (10.6%) in the national sample and 340 participants (60.5%) in the sample reporting opioid dependence reported carrying naloxone. Among those reporting they were \"very likely to overdose,\" 22 respondents (31.0%) in the national sample and 31 (73.8%) with opioid dependence reported carrying naloxone. Among those who know someone very likely to overdose, 43 participants (25.4%) in the national sample and 190 participants (70.1%) reporting opioid dependence reported carrying naloxone. Among those who ever carried naloxone, 108 (42.4%) in the national sample and 97 (22.6%) reporting opioid dependence had ever purchased naloxone. Overall, 128 respondents (8.4%) in the national sample and 267 respondents (47.5%) reporting opioid dependence reported administering naloxone to someone else while 93 (6.1%) in the national sample and 221 (39.3%) reporting opioid dependence reported being administered naloxone.</p><p><strong>Conclusions and relevance: </strong>In this survey study of naloxone, most respondents reporting opioid dependence correctly identified naloxone's purpose and carried it. Most naloxone carried was not purchased, suggesting a need for new ways, including rapid online surveys, to monitor naloxone possession.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e2462698"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542113","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":"Emergency Care, Hospitalization Rates, and Floods.","authors":"Zachary S Wettstein, Canada Parrish, Amber K Sabbatini, Matthew H Rogers, Edmund Seto, Jeremy J Hess","doi":"10.1001/jamanetworkopen.2025.0371","DOIUrl":"10.1001/jamanetworkopen.2025.0371","url":null,"abstract":"<p><strong>Importance: </strong>Flooding is a major environmental hazard, with events increasing in intensity and frequency in the context of climate change. Floods cause significant health and economic impacts, particularly among vulnerable populations, including older adults. However, comprehensive analyses of the health consequences of flooding remain limited.</p><p><strong>Objective: </strong>To evaluate the morbidity and health care costs among Medicare beneficiaries associated with flood exposure in the US.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study analyzed emergency department (ED) use and unplanned hospitalization among Medicare beneficiaries 65 years or older living in zip code tabulation areas (ZCTAs) that were exposed to large-scale flood events from January 1, 2008, to December 31, 2017. This analysis was conducted from April 3 to December 15, 2023.</p><p><strong>Exposure: </strong>The primary exposure was the presence of a flood as recorded in the Multisourced Flood Inventories, a spatially distributed flood database.</p><p><strong>Main outcomes and measures: </strong>A conditional fixed-effects regression approach was used to explore the incidence of all-case and cause-specific ED visits and hospitalizations before and after floods. The primary outcomes measured were the incident rate ratios (IRRs) and associated 95% CIs. Attributable risk percentages and estimated attributable excess visits were calculated. Stratified analyses were performed for evaluation of effect modification. Health care costs associated with these events were measured and standardized to 2017 US dollars.</p><p><strong>Results: </strong>Among 11 801 527 Medicare beneficiaries 65 years or older (mean [SD] age, 74.4 [7.6] years; 56.3% female), the rate of all-cause ED visits and hospital admissions increased by 4.8% (IRR, 1.05; 95% CI, 1.04-1.05) and 7.4% (IRR, 1.07; 95% CI, 1.07-1.08) after flood exposure, respectively. The mean ZCTA-level cost was $3230 (95% CI, $3198-$3261) per ED visit and $11 310 (95% CI, $11 252-$11 367) for hospitalizations. The national costs to the Medicare system were estimated to be $69 275 429 (95% CI, $63 010 840-$76 315 210) for ED visits and $191 409 579 (95% CI, $172 782 870-$206 181 300) for hospitalizations. Stratified analyses highlighted greater impacts for certain demographic groups, including adults older than 85 years, and specific seasonal patterns.</p><p><strong>Conclusions and relevance: </strong>In this cohort study of Medicare beneficiaries 65 years or older, flood exposure was associated with increased health care use and costs, underscoring the need for targeted public health strategies and improved disaster preparedness, especially for older adults. These findings contribute to a more comprehensive understanding of the health-related costs of flooding and can be used to inform future climate change resilience and health care planning.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e250371"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11894485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584860","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":"Time From Onset to Diagnosis of Alpha-Gal Syndrome.","authors":"Caroline K Maki, Eleanor F Saunders, Marissa L Taylor, Scott P Commins, Lance A Waller, Johanna S Salzer","doi":"10.1001/jamanetworkopen.2024.61729","DOIUrl":"10.1001/jamanetworkopen.2024.61729","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 3","pages":"e2461729"},"PeriodicalIF":10.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11894482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585628","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}