JAMA Internal Medicine最新文献

{"title":"Timing of Initiation of Methadone Take-Home Dosing.","authors":"Md Belal Hossain, Jeong Eun Min, Megan Kurz, Shaun Seaman, Paxton Bach, Mohammad Ehsanul Karim, Julie Bruneau, Maria Eugenia Socias, Paul Gustafson, Robert Platt, Sander Greenland, Bohdan Nosyk","doi":"10.1001/jamainternmed.2026.3904","DOIUrl":"https://doi.org/10.1001/jamainternmed.2026.3904","url":null,"abstract":"<p><strong>Importance: </strong>Daily witnessed ingestion in community-based pharmacies is standard practice for methadone maintenance treatment for opioid use disorder in British Columbia, Canada. Whether this practice, compared with take-home methadone, may pose a barrier to sustained retention in treatment and its lifesaving benefits is not known.</p><p><strong>Objective: </strong>To assess the different initiation times of methadone take-home doses in terms of time to all-cause mortality and methadone discontinuation, defined as a gap in prescribed doses lasting 5 or more days.</p><p><strong>Design, setting, and participants: </strong>This cohort study using principles of target trial emulation used observational data from British Columbia, Canada, 2010-2022. Both incident (no history of opioid agonist treatment [OAT]) and prevalent new-user (no OAT within the past month) designs were used. The study included individuals aged 18 years or older who completed OAT induction, were not pregnant or incarcerated, and had no history of cancer treatment or palliative care. Data analyses were conducted from March 5, 2025, to May 29, 2026.</p><p><strong>Exposure: </strong>Exposure strategies were (1) no take-home dosing, (2) take-home dose initiation within 0 to 4 weeks after completing induction, (3) take-home dose initiation within 5 to 12 weeks after completing induction, (4) take-home dose initiation within 13 to 24 weeks after completing induction, and (5) take-home dose initiation within 25 to 52 weeks after completing induction.</p><p><strong>Main outcomes and measures: </strong>Outcomes were time to all-cause mortality and methadone discontinuation. A clone-censor-weight approach was used to estimate the 78-week adjusted risk difference (ARD).</p><p><strong>Results: </strong>A total of 9788 incident users (median age, 34.1 [IQR, 27.2-44.1] years; 32.8% female) and 31 658 prevalent new users (median age, 36.9 [IQR, 29.7-46.2] years; 33.3% female) were included. Compared with no take-home dosing in prevalent new-user analysis, ARDs for the mortality outcome were -0.87 (95% CI, -1.51 to -0.23) for take-home dose initiation within 0 to 4 weeks after completing induction, -0.98 (95% CI, -1.62 to -0.33) for take-home dose initiation within 5 to 12 weeks after completing induction, -0.82 (95% CI, -1.59 to -0.06) for take-home dose initiation within 13 to 24 weeks after completing induction, and -0.31 (95% CI, -1.05 to 0.44) for take-home dose initiation within 25 to 52 weeks after completing induction. Compared with no take-home dosing in prevalent new-user analysis, the discontinuation outcome ARDs were -2.04 (95% CI, -3.99 to -0.10) for take-home dose initiation within 0 to 4 weeks after completing induction, -5.29 (95% CI, -6.82 to -3.76) for take-home dose initiation within 5 to 12 weeks after completing induction, -5.97 (95% CI, -7.16 to -4.78) for take-home dose initiation within 13 to 24 weeks after completing induction, and -4.39 (95% CI, -5.37","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":26.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912070","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":"Initiation of Take-Home Medication Dosing and Methadone Maintenance Treatment Effectiveness.","authors":"Paul J Joudrey","doi":"10.1001/jamainternmed.2026.3912","DOIUrl":"https://doi.org/10.1001/jamainternmed.2026.3912","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":26.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911958","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":"Rebuilding Trust in Medicine Requires Structural Change.","authors":"Ilana B Richman, Raegan W Durant, Giselle Corbie","doi":"10.1001/jamainternmed.2026.3822","DOIUrl":"https://doi.org/10.1001/jamainternmed.2026.3822","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":26.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912010","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":"Menopausal Hormone Therapy and Cardiovascular Risk in Midlife Women With Vasomotor Symptoms.","authors":"Ziyuan Wang, Sonja A Swanson, Maria M Brooks, Emma Barinas-Mitchell, Marnie Bertolet, Jared W Magnani, Rebecca C Thurston, Samar R El Khoudary","doi":"10.1001/jamainternmed.2026.2922","DOIUrl":"https://doi.org/10.1001/jamainternmed.2026.2922","url":null,"abstract":"<p><strong>Importance: </strong>Vasomotor symptoms in perimenopause are associated with increased future cardiovascular (CVD) risk. Most clinical trials on menopausal hormone therapy (MHT) and CVD risk have focused on postmenopausal women, with limited study of the perimenopausal period when hormonal fluctuations and symptoms are greatest. Moreover, these trials were not designed to evaluate CVD risk with MHT among women with vasomotor symptoms.</p><p><strong>Objective: </strong>To estimate the effect of MHT on CVD risk among perimenopausal and recently postmenopausal women with vasomotor symptoms and assess the extent to which timing of MHT use relative to menopause and race and ethnicity modify this effect.</p><p><strong>Design, setting, and participants: </strong>Cohort data from the Study of Women's Health Across the Nation (SWAN, 1997-2017)-a multiethnic, multicenter, longitudinal study of the menopause transition-were used to emulate a sequence of target trials. Eligible participants were women who self-reported any vasomotor symptoms (ie, hot flashes and/or night sweats over the past 2 weeks) and who were CVD-free, with no prior MHT use. Data were analyzed from January 2023 to December 2025.</p><p><strong>Exposure: </strong>MHT use (systemic estrogen with/without progestogens, verified from medication containers).</p><p><strong>Main outcomes and measures: </strong>CVD events (myocardial infarction, stroke, heart failure, and revascularization) were self-reported. CVD-related death was recorded from death certificates.</p><p><strong>Results: </strong>Of 2737 women who reported any vasomotor symptoms, 755 initiated MHT (mean [SD] age, 53.7 [4.6] years) over the 20-year follow-up period, during which 224 fatal and nonfatal CVD events occurred. Overall, the estimated adjusted hazard ratio (aHR) of CVD events for MHT initiation vs noninitiation was 0.78 (95% CI, 0.62-0.98). The estimated aHR was 0.73 (95% CI, 0.58-0.93) and 1.53 (95% CI, 0.66-3.52) among women initiating MHT 10 or fewer years vs more than 10 years from the onset of menopause, respectively (P value for interaction: .02). Race and ethnicity modified the MHT initiation effect, with Black women showing protective effect (aHR, 0.51; 95% CI, 0.33-0.81), while no clear effects were observed in White women or women of other races (P value for interaction = .007).</p><p><strong>Conclusions and relevance: </strong>The presented results are pooled from all target trials and found that MHT initiation during perimenopause or recently postmenopausal women with vasomotor symptoms was estimated to reduce CVD risk by 22%. Benefits were more pronounced in Black women and women who initiated MHT within 10 years of menopause onset. However, all estimates warrant caution given the potential for residual confounding. Given the inconsistency of the cardiovascular benefits and the need to consider overall risk-benefit balance, these findings should not be used to support MHT for CVD prevention.</p>","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":26.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911940","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 the Text.","authors":"","doi":"10.1001/jamainternmed.2026.4839","DOIUrl":"https://doi.org/10.1001/jamainternmed.2026.4839","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":26.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911949","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":"Chronic Obstructive Pulmonary Disease-Related Years of Life Lost as a Prognostic Signal-Reply.","authors":"Surya P Bhatt, Yifei Sun, Elizabeth C Oelsner","doi":"10.1001/jamainternmed.2026.4368","DOIUrl":"10.1001/jamainternmed.2026.4368","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":26.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911955","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":"ECG Artifact Masking Complete Heart Block.","authors":"Soorya Suresh, Hannah Joyke Chawang, Jamshed Nayer","doi":"10.1001/jamainternmed.2026.3780","DOIUrl":"https://doi.org/10.1001/jamainternmed.2026.3780","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":26.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911961","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":"Primary Aldosteronism.","authors":"Emily P Marogi, Lisa Dubrofsky, Robert J Weber","doi":"10.1001/jamainternmed.2026.4155","DOIUrl":"https://doi.org/10.1001/jamainternmed.2026.4155","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":26.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912046","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":"Menopausal Hormone Therapy and Cardiovascular-Laying the Foundation for Future Trials.","authors":"Regina Castaneda, Stephanie S Faubion","doi":"10.1001/jamainternmed.2026.2877","DOIUrl":"https://doi.org/10.1001/jamainternmed.2026.2877","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":""},"PeriodicalIF":26.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912082","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":"Acetaminophen Use in Pregnancy and Neurodevelopmental Outcomes-Reassuring Evidence From a Matched-Sibling Study.","authors":"Brian K Lee, Viktor H Ahlqvist","doi":"10.1001/jamainternmed.2026.2223","DOIUrl":"10.1001/jamainternmed.2026.2223","url":null,"abstract":"","PeriodicalId":14714,"journal":{"name":"JAMA Internal Medicine","volume":" ","pages":"1111-1113"},"PeriodicalIF":26.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345414","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}