JAMA Health Forum最新文献

{"title":"Why a Planned Reorganization of the FDA Creates Major Challenges.","authors":"Scott Gottlieb, Mark B McClellan","doi":"10.1001/jamahealthforum.2025.2326","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.2326","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e252326"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058053","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":"How Anti-DEI Policies Adversely Affect Mental Health.","authors":"Ruth S Shim","doi":"10.1001/jamahealthforum.2025.2163","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.2163","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e252163"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055523","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":"Estimates of Illicit Opioid Use in the US.","authors":"David Powell, Mireille Jacobson","doi":"10.1001/jamahealthforum.2025.0809","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.0809","url":null,"abstract":"<p><strong>Importance: </strong>Illicit opioids, particularly illicitly manufactured fentanyl (IMF), are major contributors to overdose deaths in the US. Understanding the prevalence and characteristics of illicit opioid use is crucial for addressing the opioid crisis.</p><p><strong>Objective: </strong>To estimate the prevalence of illicit opioid use, including IMF, and initial opioid exposure among those reporting illicit opioid use.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study was conducted using an online survey with targeted demographic quotas from June 10, 2024, to June 17, 2024. A total of 1515 participants aged 18 years and older from the US completed the survey. The analysis was conducted between June 30, 2024, and February 13, 2025.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was self-reported illicit opioid use within the past 12 months. Secondary outcomes included initial exposure to opioids and perceived likelihood of overdose. Logistic regression was used to analyze associations with demographic and geographic factors.</p><p><strong>Results: </strong>A total of 1515 respondents completed the survey, including 770 female individuals (50.8%), 20 American Indian or Alaska Native (1.3%), 101 Asian or Pacific Islander (6.7%), 215 Black (14.2%), 1087 White (81.7%), and 24 multiracial (1.6%); 186 (12.3%) were aged 18 to 24, 242 (16.0%) 25 to 34, 327 (21.6%) 35 to 44, 280 (18.5%) 45 to 54, 281 (18.5%) 55 to 64, 139 (9.2%) 65 to 74, and 60 (4.0%) 75 to 84 years. Among this sample, 166 (10.96%; 95% CI, 9.38%-12.52%) reported nonprescription opioid use within the past 12 months, including 114 (7.52%; 95% CI, 6.20%-8.85%) of the 1515 respondents reporting IMF use. Among those reporting nonprescription opioid use within the past 12 months, 65 (39.16%; 95% CI, 31.73%-46.58%) reported that their first opioid use involved opioids prescribed to them, whereas 60 (36.14%; 95% CI, 28.84%-43.45%) reported that their first use involved prescription opioids not prescribed to them. Only 41 (24.70%; 95% CI, 18.14%-31.26%) answered that their first exposure involved illicit opioids. Seventy-one (4.69%; 95% CI, 3.62%-5.75%) of all respondents reported that it was very likely they would have an overdose due to opioid use. This rate increased to 33.33% (95% CI, 24.68%-41.99%) among those who had used IMF within the past 12 months. Illicit opioid use was higher among men, Black respondents, and younger age groups.</p><p><strong>Conclusions and relevance: </strong>The findings of this cross-sectional study indicate a higher prevalence of illicit opioid use than previously reported, highlighting the need for more timely and accurate data to inform policy and intervention strategies. Enhanced data collection efforts are essential for understanding and mitigating the opioid crisis.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e250809"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009370","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":"Racial, Ethnic, and Sex Differences in Need and Receipt of Support for Social Needs Among Veterans.","authors":"David A Frank, Lauren E Russell, Gregory T Procario, Sarah M Leder, Jennifer L McCoy, Shane Lamba, Ernest M Moy, Leslie R M Hausmann","doi":"10.1001/jamahealthforum.2025.0992","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.0992","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Health-related social needs, downstream manifestations of social determinants or drivers of health, impact patients' health and well-being. To develop equity-driven social care interventions, health care systems must apply an intersectional equity lens when assessing patients' social needs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate racial, ethnic, and sex differences in social needs and receipt of support among veterans receiving health care in the Veterans Health Administration (VHA).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;A cross-sectional survey study of VHA primary care patients seen in January or February 2023 was carried out in a national sample of veterans, stratified by race and ethnicity (Black, Hispanic, White), and sex (male, female). Participants were invited by mail to complete a survey online or by mail. Of those invited (N = 38 759), 7095 (18.3%) responded. Data collection occurred from March 2, 2023, through May 9, 2023. Analyses were conducted from February 15, 2024, through July 16, 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Intersection of self-identified race, ethnicity, and sex.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Age-adjusted prevalence ratio (aPR) of reported need for and receipt of support across 13 social need domains.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Analyses included 6611 respondents representing 939 467 veterans (unweighted No. of participants [weighted %]; 1089 [4.1%] Black women; 1144 [19.4%] Black men; 941 [1.6%] Hispanic women; 1281 [11.3%] Hispanic men; 805 [5.3%] White women; 1351 [58.4%] White men). After age adjustment, compared with White men, Black men had significantly higher aPRs of need for support in all domains except childcare and employment (aPRs ranged from 1.35 [95% CI, 1.09-1.69] for social isolation to 2.73 [95% CI, 1.89-3.95] for managing discrimination). Hispanic women had higher aPRs in 8 domains: childcare (aPR, 2.78; 95% CI, 1.19-6.48), discrimination (aPR, 2.69; 95% CI, 1.68-4.29), internet (aPR, 1.81; 95% CI, 1.17-2.79), housing (aPR, 1.81; 95% CI, 1.10-2.99), legal issues (aPR, 1.70; 95% CI, 1.02-2.84), loneliness (aPR, 1.67; 95% CI, 1.28-2.18), food (aPR, 1.55; 95% CI, 1.03-2.35), and social isolation (aPR, 1.40; 95% CI, 1.05-1.87). Black women had higher aPRs for discrimination (aPR, 2.68; 95% CI, 1.82-3.95), legal issues (aPR, 2.04; 95% CI, 1.40-2.97), food (aPR, 1.74; 95% CI, 1.28-2.37), loneliness (aPR, 1.60; 95% CI, 1.28-2.01), paying for basics (aPR, 1.57; 95% CI, 1.15-2.14), and social isolation (aPR, 1.48; 95% CI, 1.18-1.87). Hispanic men had higher aPRs for housing (aPR, 1.88; 95% CI, 1.18-3.02), legal issues (aPR, 1.81; 95% CI, 1.14-2.86), internet (aPR, 1.56; 95% CI, 1.13-2.16), and loneliness (aPR, 1.44; 95% CI, 1.10-1.88). White women had higher aPRs for childcare (aPR, 3.37; 95% CI, 1.36-8.35) and discrimination (aPR, 1.60; 95% CI, 1.03-2.50). There was 1 significant difference in receiving support: Black women","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e250992"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12048852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044266","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":"JAMA Health Forum.","authors":"","doi":"10.1001/jamahealthforum.2024.4963","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2024.4963","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e244963"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055525","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":"Optimizing Informed Consent-A Call to Action.","authors":"Nancy E Kass, Ann Meeker-O'Connell, Stephanie R Morain, Matthew A Crane","doi":"10.1001/jamahealthforum.2025.0824","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.0824","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e250824"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005693","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":"A Path Forward for Strengthening SNAP Nutrition Policy-Making the US Healthy Again.","authors":"Cindy W Leung, Julia A Wolfson","doi":"10.1001/jamahealthforum.2025.1115","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.1115","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e251115"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082001","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":"The Domestic Consequences of Defunding Global Health.","authors":"Joseph Amon, Joshua M Sharfstein","doi":"10.1001/jamahealthforum.2025.2462","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.2462","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e252462"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082048","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":"The Ongoing, and Heightened, Threat to Health Insurance Coverage in the US.","authors":"Sandro Galea","doi":"10.1001/jamahealthforum.2025.1155","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.1155","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e251155"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082050","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 Adoption of Value-Based Health Care Initiatives Within Health Systems: A Scoping Review.","authors":"Ayooluwa O Douglas, Senthujan Senkaiahliyan, Caroline A Bulstra, Carol Mita, Che L Reddy, Rifat Atun","doi":"10.1001/jamahealthforum.2025.0746","DOIUrl":"10.1001/jamahealthforum.2025.0746","url":null,"abstract":"<p><strong>Importance: </strong>Health systems worldwide are facing several contextual challenges threatening their sustainability, including aging populations with complex health care needs, workforce shortages, and persistent health disparities, which are driving health care costs. Optimizing health systems to respond to contextual challenges and offer quality care for all requires innovative frameworks like value-based health care (VBHC) and high-value health systems (HVHS) frameworks that focus on improving patient outcomes while minimizing costs.</p><p><strong>Objective: </strong>To examine how value-based initiatives have been introduced in health systems worldwide.</p><p><strong>Evidence review: </strong>A comprehensive literature search was conducted across MEDLINE/PubMed, Embase, Health Business Elite, and Web of Science Core Collection. The search included controlled vocabulary terms relevant to VBHC and covered publications between January 1, 2007, and July 7, 2023. After title and abstract screening, followed by full-text review, experimental, observational, and case studies that examined the implementation of the VBHC framework or its elements were included. Articles that focused solely on insurance, cost-effectiveness analysis, theoretical models without implementation, nonempirical studies (eg, reviews, commentaries), and gray literature (eg, news articles) were excluded.</p><p><strong>Findings: </strong>Of 11 948 articles initially identified for potential inclusion, the final sample included 50 initiatives, with 47 from high-income countries, 2 from upper-middle-income countries, and 1 from a lower-middle-income country. The review revealed that VBHC adoption remains confined to the departmental or institutional level, with few examples of systemwide or national implementation. Although many initiatives integrated various elements of the VBHC framework and components of the HVHS model, none achieved full implementation of all aspects.</p><p><strong>Conclusions and relevance: </strong>This scoping review showed that since its formal introduction in 2006, VBHC has been widely recognized as a strategy for improving health system performance, but large-scale adoption will require a strategic shift toward integrating value-based components at national and regional levels. These findings highlight the need for research on effective implementation models, particularly in lower-resource settings, to guide policymakers and health system leaders in scaling VBHC and transitioning toward HVHS.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e250746"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12084849/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082041","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}