JAMA Health Forum最新文献

{"title":"Cell Phone Bans in a National Sample of US Public School Principals.","authors":"Jonathan Cantor, Ryan K McBain, Aaron Kofner, Fang Zhang, Alyssa Burnett, Joshua Breslau, Melissa Kay Diliberti, Ateev Mehrotra, Bradley D Stein, Hao Yu","doi":"10.1001/jamahealthforum.2025.4229","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.4229","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 10","pages":"e254229"},"PeriodicalIF":11.3,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"JAMA Health Forum.","authors":"","doi":"10.1001/jamahealthforum.2024.4968","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2024.4968","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 10","pages":"e244968"},"PeriodicalIF":11.3,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"US Antibiotic Importation and Supply Chain Vulnerabilities.","authors":"Mariana P Socal, Yunxiang Sun, Jeromie M Ballreich, Jennifer Dailey Lambert, Tinglong Dai, Maqbool Dada","doi":"10.1001/jamahealthforum.2025.3871","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.3871","url":null,"abstract":"<p><strong>Importance: </strong>The US has faced persistent antibiotic shortages over the past decade, compromising patient care, public health, and national security. Understanding the global sources of US antibiotic imports is critical to inform policies to improve supply chain resilience.</p><p><strong>Objective: </strong>To identify the global sources of US antibiotic imports, focusing on finished dosage forms (FDFs) and active pharmaceutical ingredients (APIs) between 1992 and 2024.</p><p><strong>Design and setting: </strong>This cross-sectional study of US antibiotic importation records used data from USA Trade Online from January 1992 to July 2024. Data included import volumes, costs, and the originating country.</p><p><strong>Main outcomes and measures: </strong>Trends in annual import volumes for antibiotic FDFs and APIs (metric tons), spending and price per kilogram (inflation-adjusted dollars), and market concentration measured by the Herfindahl-Hirschman Index (HHI). An HHI less than 1500 indicates an unconcentrated (ie, competitive) market, 1500 to 2500 indicates a moderate concentration, and greater than 2500 indicates high concentration.</p><p><strong>Results: </strong>The final sample included 50 FDF-originating countries and 52 API-originating countries. Compared with the annual volume of US antibiotic FDF imports in 1992, the annual volume in 2024 increased 2595.0%, while the annual volume of API imports remained relatively stable. Mean inflation-adjusted importation prices for FDFs decreased from $1836.03 per kg in 1992 to $177.44 per kg in 2024. For APIs, mean prices decreased from $351.74 per kg in 2003 to $65.69 per kilogram in 2024. From 2020 to 2024, India was the leading originating country for FDFs (31.9% of the total imported volume and 18.2% of the total imported cost), followed by Italy (13.4% of the total volume and 22.4% of the total cost). China was the leading originating country for APIs (62.6% of the total imported volume and 28.7% of the total cost), followed by Bulgaria (16.1% of the total volume and 3.8% of the total cost). Italy was the originating country for 2.6% of API imported volume but accounted for 27.9% of the importation costs. HHI revealed that FDF importation has become unconcentrated since 2020 (HHI, 1500-2500), while API importation markets are highly concentrated (2024 HHI, >5000).</p><p><strong>Conclusions and relevance: </strong>This study found that US antibiotic importation relies on diversified global sources for FDFs but primarily on China for APIs. Policies to strengthen domestic production and diversify sourcing are critical to mitigate supply chain vulnerabilities. Improved traceability and targeted strategies for specific antibiotics are recommended to safeguard public health and national security.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 10","pages":"e253871"},"PeriodicalIF":11.3,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrated Clinical-Social Care and Boundaries of Health Care.","authors":"Vincent Guilamo-Ramos, Marco Thimm-Kaiser, Adam Benzekri, Kody H Kinsley","doi":"10.1001/jamahealthforum.2025.3627","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.3627","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 10","pages":"e253627"},"PeriodicalIF":11.3,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Disparities in Premature Mortality.","authors":"Omar Karlsson, Dean T Jamison, Gavin Yamey, Sarah Bolongaita, Wenhui Mao, Angela Y Chang, Ole F Norheim, Osondu Ogbuoji, Stéphane Verguet","doi":"10.1001/jamahealthforum.2025.3479","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.3479","url":null,"abstract":"<p><strong>Importance: </strong>Persistent disparities in mortality across countries suggest uneven improvements in living standards and access to life-extending health technologies, as well as context-specific obstacles. Studies have analyzed cross-country inequality in mortality but have not widely contextualized those disparities in terms of developmental progress relative to a frontier representing a level of mortality achievable with broad access to the best health-enhancing technology and living standards available.</p><p><strong>Objective: </strong>To examine probability of premature death (PPD)-defined as probability of dying before 70 years of age-across countries and regions, benchmarking progress as years behind the lowest country-level PPD (the frontier).</p><p><strong>Design and setting: </strong>This cross-sectional study used aggregate-level data from the 2024 United Nations World Population Prospects and Human Mortality Database to calculate PPD across 7 global regions and the 30 most populous countries. Data were analyzed from May to September 2025.</p><p><strong>Main outcome and measures: </strong>The primary outcomes were PPD and the number of years behind the lowest country-level PPD.</p><p><strong>Results: </strong>The frontier PPD fell from 57% to 12% from 1900 to 2019. Sub-Saharan Africa's PPD in 2019 was 52%, corresponding to the 1916 frontier PPD. However, sub-Saharan Africa had converged toward the frontier by over 40 years since 2000, when it had a 65% PPD. China has been converging toward the frontier since 1970, having been 93 years behind the frontier PPD in 1970 (with a 60% PPD) and 35 years behind in 2019 (21% PPD). The US has diverged away from the frontier, having been 29 years behind in 1970 (38% PPD) and 38 years in 2019 (22% PPD). Of the regions included, the North Atlantic (Western Europe and Canada) was the closest to the frontier, being 13 years behind in 2019 (15% PPD). The US, Central and Eastern Europe, and sub-Saharan Africa were the furthest above the 2019 PPD Preston curve (ie, they had a greater PPD than predicted by their per capita gross domestic product).</p><p><strong>Conclusions and relevance: </strong>In this cross-sectional study, disparities in PPD were likely to reflect major inequality in access to health-enhancing technologies and living standards, as well as context-specific obstacles. Technological and medical advancements leading to universal health benefits need to be rapidly and fairly disseminated.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 10","pages":"e253479"},"PeriodicalIF":11.3,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What the Trump Administration Can Do in the Short-Term to Address the Long-Term Care Crisis.","authors":"Stuart M Butler","doi":"10.1001/jamahealthforum.2025.5322","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.5322","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 10","pages":"e255322"},"PeriodicalIF":11.3,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subspecialization of Surgical Specialties in the US.","authors":"René Karadakic, David C Chan, Bruce E Landon, Nancy L Keating, Christopher Manz, Jukka-Pekka Onnela, Thomas C Tsai, Yuhua Zhang, Michael L Barnett","doi":"10.1001/jamahealthforum.2025.3192","DOIUrl":"10.1001/jamahealthforum.2025.3192","url":null,"abstract":"<p><strong>Importance: </strong>Subspecialists-physicians with narrower clinical focus-play an increasing role in US health care, particularly in surgery, where most trainees now pursue fellowship training. Yet little is known about the degree of subspecialization among practicing surgeons and the evolving role of surgical generalists.</p><p><strong>Objective: </strong>To quantify trends in surgical subspecialization and examine the geographic distribution of subspecialists and the procedural scope of surgical generalists.</p><p><strong>Design, setting, and participants: </strong>A retrospective cohort study using 100% Medicare Part B data from 2000, 2010, and 2021, including all fee-for-service beneficiaries treated by physicians in general surgery, neurosurgery, ophthalmology, orthopedic surgery, and otolaryngology was caried out. A novel classification method combining k-means clustering, large language models, and expert validation to distinguish subspecialists from surgical generalists based on procedural claims was used. The analysis was undertaken in 2023 and 2024.</p><p><strong>Main outcomes and measures: </strong>The number of distinct subspecialties, the share of subspecialists in each surgical specialty, their geographic distribution across hospital referral regions (HRRs), and the association between subspecialist supply and procedural diversity among generalists.</p><p><strong>Results: </strong>Overall, more than 70 000 surgeons were included. The share of subspecialists increased from 38% in 2000 to 58% in 2021, reflecting the growth of recognized subspecialties (from 24 to 33) and expansion of existing ones. Subspecialization rates varied by specialty, rising from 9% to 28% in otolaryngology and from 66% to 77% in neurosurgery. While subspecialist supply per 100 000 fee-for-service beneficiaries remained stable, the mean number of surgical generalists per 100 000 declined from 105 to 50. A 10% increase in subspecialist supply in an HRR was associated with a 0.94% decrease (95% CI, -0.15% to -0.41%) in the number of unique procedures performed by generalist surgeons.</p><p><strong>Conclusions and relevance: </strong>This cohort study found that subspecialization has considerably reshaped the surgical workforce, concentrating care among subspecialists while narrowing the procedural scope of generalist surgeons. These shifts raise concerns about access to generalist care, particularly in regions with declining generalist supply, and suggest the need for policies that consider both specialization and geographic equity in surgical workforce planning.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 9","pages":"e253192"},"PeriodicalIF":11.3,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12449727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mitigating the Dangers of Medicaid Churn Among Dual-Eligible Beneficiaries.","authors":"Eric T Roberts, José F Figueroa","doi":"10.1001/jamahealthforum.2025.3307","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.3307","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 9","pages":"e253307"},"PeriodicalIF":11.3,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New and Recurring Food Insecurity During and After the COVID-19 Pandemic.","authors":"Elise Sheinberg, Noura E Insolera, Nour M Hammad, Alessandra Uriarte, Christine M Weston, Melissa N Laska, Julia A Wolfson, Cindy W Leung","doi":"10.1001/jamahealthforum.2025.3603","DOIUrl":"10.1001/jamahealthforum.2025.3603","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 9","pages":"e253603"},"PeriodicalIF":11.3,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12413649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward a Strategy to Improve National Mental Health.","authors":"Sandro Galea","doi":"10.1001/jamahealthforum.2025.2102","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.2102","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 9","pages":"e252102"},"PeriodicalIF":11.3,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}