JAMA Health Forum最新文献

{"title":"The Public Health Damage-and Personal Toll-of Federal Worker Layoffs.","authors":"Benjamin D Sommers","doi":"10.1001/jamahealthforum.2025.2652","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.2652","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e252652"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121177","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":"Cutting the NIH-The $8 Trillion Health Care Catastrophe.","authors":"David M Cutler, Edward Glaeser","doi":"10.1001/jamahealthforum.2025.2791","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.2791","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e252791"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174557","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":"Projected Outcomes of Removing Fluoride From US Public Water Systems.","authors":"Sung Eun Choi, Lisa Simon","doi":"10.1001/jamahealthforum.2025.1166","DOIUrl":"10.1001/jamahealthforum.2025.1166","url":null,"abstract":"<p><strong>Importance: </strong>Fluoridation of public water systems has been a cornerstone of public health efforts in the US but has come under increasing scrutiny due to concerns of neurotoxicity.</p><p><strong>Objective: </strong>To determine the cost-effectiveness of cessation of public water fluoridation and associations with oral health outcomes among US children.</p><p><strong>Design, setting, and participants: </strong>A cost-effectiveness analysis was conducted to estimate changes in total tooth decay, quality-adjusted life-years (QALYs), and costs associated with removal of fluoride in public water system during 5- and 10-year periods. A microsimulation model of oral health outcomes was constructed based on oral health and water fluoridation data of US children from age 0 to 19 years in a nationally representative sample from the US National Health and Nutrition Examination Survey (NHANES), 2013 to 2016. Sensitivity analyses were conducted to assess the robustness of the simulation results to variation in model input parameters. Data analysis was conducted from November 15, 2024, to February 3, 2025.</p><p><strong>Exposure: </strong>Cessation of public water fluoridation in the US.</p><p><strong>Main outcomes: </strong>Changes in dental caries prevalence; total number of decayed teeth and dental fluorosis; QALYs; and costs.</p><p><strong>Results: </strong>The simulation model was informed by NHANES data of 8484 participants (mean [SD] age, 9.6 (0.1) years; 4188 [weighted percentage, 49.0%] female). In the base-case scenario of eliminating fluoridation, dental caries prevalence and total number of decayed teeth were estimated to increase by 7.5 (95% uncertainty interval [UI], 6.3 to 8.5) percentage points and by 25.4 million (95% UI, 23.3-27.6 million) cases, with a loss of 2.9 million (95% UI, -3.2 to -2.6 million) QALYs at a cost of $9.8 billion (95% UI, $8.7 to $10.8 billion) over 5 years. Sensitivity analyses estimating less efficacy from fluoridation found lower but still substantial harms. Estimates increased for a 10-year horizon compared to a 5-year horizon. Increased tooth decay would disproportionately affect publicly insured and uninsured children compared to those with private dental insurance.</p><p><strong>Conclusions and relevance: </strong>This cost-effectiveness analysis found that cessation of public water fluoridation would increase tooth decay and health system costs in the US. Despite concerns regarding toxic effects associated with high levels of fluoride, this model demonstrates the substantial ongoing benefits of water fluoridation at safe levels currently recommended by the US Environmental Protection Agency, the National Toxicity Program, and the Centers for Disease Control and Prevention.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e251166"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12125645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188541","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":"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":"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":"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":"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":"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":"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}