Jama-Journal of the American Medical Association最新文献

{"title":"Over-the-Counter Progestin-Only Oral Contraceptives.","authors":"Erin Fleurant, Mugdha Mokashi, Melissa A Simon","doi":"10.1001/jama.2023.17781","DOIUrl":"10.1001/jama.2023.17781","url":null,"abstract":"This JAMA Patient Page describes progestin-only oral contraceptive pills, which recently have been approved to be sold over the counter.","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":" ","pages":"1810"},"PeriodicalIF":120.7,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10298723","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":"Fitness Trackers to Guide Advice on Activity Prescription.","authors":"I-Min Lee, Sarah K Keadle, Charles E Matthews","doi":"10.1001/jama.2023.19332","DOIUrl":"10.1001/jama.2023.19332","url":null,"abstract":"This Viewpoint discusses whether older self-report questionnaire studies and newer studies of fitness-tracking devices reach different conclusions about the dose of physical activity needed for health.","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":" ","pages":"1733-1734"},"PeriodicalIF":120.7,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41179431","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":"Incomplete Reporting of Results.","authors":"","doi":"10.1001/jama.2023.19501","DOIUrl":"10.1001/jama.2023.19501","url":null,"abstract":"","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":" ","pages":"1805"},"PeriodicalIF":120.7,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10594168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49694104","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":"Study: Carbohydrate Quality Matters for Body Weight.","authors":"Emily Harris","doi":"10.1001/jama.2023.20629","DOIUrl":"10.1001/jama.2023.20629","url":null,"abstract":"","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":" ","pages":"1723"},"PeriodicalIF":120.7,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50159338","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":"Updated Numbers Show No Progress in Reducing Global Preterm Births.","authors":"Emily Harris","doi":"10.1001/jama.2023.20636","DOIUrl":"10.1001/jama.2023.20636","url":null,"abstract":"","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":" ","pages":"1724"},"PeriodicalIF":120.7,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50159339","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":"Donor Immune Cells May Reduce or Eliminate Need for Immunosuppressants.","authors":"Emily Harris","doi":"10.1001/jama.2023.20635","DOIUrl":"10.1001/jama.2023.20635","url":null,"abstract":"","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":" ","pages":"1724"},"PeriodicalIF":120.7,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50159365","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":"Intravenous Vitamin C for Patients Hospitalized With COVID-19: Two Harmonized Randomized Clinical Trials.","authors":"Neill K J Adhikari, Madiha Hashmi, Bharath Kumar Tirupakuzhi Vijayaraghavan, Rashan Haniffa, Abi Beane, Steve A Webb, Derek C Angus, Anthony C Gordon, Deborah J Cook, Gordon H Guyatt, Lindsay R Berry, Elizabeth Lorenzi, Paul R Mouncey, Carly Au, Ruxandra Pinto, Julie Ménard, Sheila Sprague, Marie-Hélène Masse, David T Huang, Daren K Heyland, Alistair D Nichol, Colin J McArthur, Angelique de Man, Farah Al-Beidh, Djillali Annane, Matthew Anstey, Yaseen M Arabi, Marie-Claude Battista, Scott Berry, Zahra Bhimani, Marc J M Bonten, Charlotte A Bradbury, Emily B Brant, Frank M Brunkhorst, Aidan Burrell, Meredith Buxton, Maurizio Cecconi, Allen C Cheng, Dian Cohen, Matthew E Cove, Andrew G Day, Lennie P G Derde, Michelle A Detry, Lise J Estcourt, Elizabeth O Fagbodun, Mark Fitzgerald, Herman Goossens, Cameron Green, Alisa M Higgins, Thomas E Hills, Christopher Horvat, Nao Ichihara, Devachandran Jayakumar, Salmaan Kanji, Muhammad Nasir Khoso, Patrick R Lawler, Roger J Lewis, Edward Litton, John C Marshall, Daniel F McAuley, Anna McGlothlin, Shay P McGuinness, Zoe K McQuilten, Bryan J McVerry, Srinivas Murthy, Rachael L Parke, Jane C Parker, Luis Felipe Reyes, Kathryn M Rowan, Hiroki Saito, Nawal Salahuddin, Marlene S Santos, Christina T Saunders, Christopher W Seymour, Manu Shankar-Hari, Timo Tolppa, Tony Trapani, Alexis F Turgeon, Anne M Turner, Andrew A Udy, Frank L van de Veerdonk, Ryan Zarychanski, François Lamontagne","doi":"10.1001/jama.2023.21407","DOIUrl":"10.1001/jama.2023.21407","url":null,"abstract":"<p><strong>Importance: </strong>The efficacy of vitamin C for hospitalized patients with COVID-19 is uncertain.</p><p><strong>Objective: </strong>To determine whether vitamin C improves outcomes for patients with COVID-19.</p><p><strong>Design, setting, and participants: </strong>Two prospectively harmonized randomized clinical trials enrolled critically ill patients receiving organ support in intensive care units (90 sites) and patients who were not critically ill (40 sites) between July 23, 2020, and July 15, 2022, on 4 continents.</p><p><strong>Interventions: </strong>Patients were randomized to receive vitamin C administered intravenously or control (placebo or no vitamin C) every 6 hours for 96 hours (maximum of 16 doses).</p><p><strong>Main outcomes and measures: </strong>The primary outcome was a composite of organ support-free days defined as days alive and free of respiratory and cardiovascular organ support in the intensive care unit up to day 21 and survival to hospital discharge. Values ranged from -1 organ support-free days for patients experiencing in-hospital death to 22 organ support-free days for those who survived without needing organ support. The primary analysis used a bayesian cumulative logistic model. An odds ratio (OR) greater than 1 represented efficacy (improved survival, more organ support-free days, or both), an OR less than 1 represented harm, and an OR less than 1.2 represented futility.</p><p><strong>Results: </strong>Enrollment was terminated after statistical triggers for harm and futility were met. The trials had primary outcome data for 1568 critically ill patients (1037 in the vitamin C group and 531 in the control group; median age, 60 years [IQR, 50-70 years]; 35.9% were female) and 1022 patients who were not critically ill (456 in the vitamin C group and 566 in the control group; median age, 62 years [IQR, 51-72 years]; 39.6% were female). Among critically ill patients, the median number of organ support-free days was 7 (IQR, -1 to 17 days) for the vitamin C group vs 10 (IQR, -1 to 17 days) for the control group (adjusted proportional OR, 0.88 [95% credible interval {CrI}, 0.73 to 1.06]) and the posterior probabilities were 8.6% (efficacy), 91.4% (harm), and 99.9% (futility). Among patients who were not critically ill, the median number of organ support-free days was 22 (IQR, 18 to 22 days) for the vitamin C group vs 22 (IQR, 21 to 22 days) for the control group (adjusted proportional OR, 0.80 [95% CrI, 0.60 to 1.01]) and the posterior probabilities were 2.9% (efficacy), 97.1% (harm), and greater than 99.9% (futility). Among critically ill patients, survival to hospital discharge was 61.9% (642/1037) for the vitamin C group vs 64.6% (343/531) for the control group (adjusted OR, 0.92 [95% CrI, 0.73 to 1.17]) and the posterior probability was 24.0% for efficacy. Among patients who were not critically ill, survival to hospital discharge was 85.1% (388/456) for the vitamin C group vs 86.6% (490/566) for the con","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":" ","pages":"1745-1759"},"PeriodicalIF":63.1,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10600726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50159367","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":"Topical Therapies for Atopic Dermatitis.","authors":"Amy Z Xu, Jason T Alexander","doi":"10.1001/jama.2023.17719","DOIUrl":"10.1001/jama.2023.17719","url":null,"abstract":"This JAMA Clinical Guidelines Synopsis summarizes the American Academy of Dermatology’s 2023 guidelines for topical-therapy management of adults with atopic dermatitis.","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":" ","pages":"1791-1792"},"PeriodicalIF":120.7,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54232363","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":"Screening and Preventive Interventions for Oral Health in Adults: US Preventive Services Task Force Recommendation Statement.","authors":"Michael J Barry, Wanda K Nicholson, Michael Silverstein, David Chelmow, Tumaini Rucker Coker, Esa M Davis, Katrina E Donahue, Carlos Roberto Jaén, Li Li, Gbenga Ogedegbe, Lori Pbert, Goutham Rao, John M Ruiz, James Stevermer, Joel Tsevat, Sandra Millon Underwood, John B Wong","doi":"10.1001/jama.2023.21409","DOIUrl":"10.1001/jama.2023.21409","url":null,"abstract":"<p><strong>Importance: </strong>Oral health is fundamental to health and well-being across the life span. Dental caries (cavities) and periodontal disease (gum disease) are common and often untreated oral health conditions that affect eating, speaking, learning, smiling, and employment potential. Untreated oral health conditions can lead to tooth loss, irreversible tooth damage, and other serious adverse health outcomes.</p><p><strong>Objective: </strong>The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate screening and preventive interventions for oral health conditions in adults.</p><p><strong>Population: </strong>Asymptomatic adults 18 years or older.</p><p><strong>Evidence assessment: </strong>The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for oral health conditions (eg, dental caries or periodontal disease) performed by primary care clinicians in asymptomatic adults. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of preventive interventions for oral health conditions (eg, dental caries or periodontal disease) performed by primary care clinicians in asymptomatic adults.</p><p><strong>Recommendations: </strong>The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of routine screening performed by primary care clinicians for oral health conditions, including dental caries or periodontal-related disease, in adults. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of preventive interventions performed by primary care clinicians for oral health conditions, including dental caries or periodontal-related disease, in adults. (I statement).</p>","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":" ","pages":"1773-1779"},"PeriodicalIF":120.7,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71489104","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":"Screening, Referral, Behavioral Counseling, and Preventive Interventions for Oral Health in Adults: A Systematic Review for the US Preventive Services Task Force.","authors":"Roger Chou, Shelley S Selph, Christina Bougatsos, Chad Nix, Azrah Ahmed, Jessica Griffin, Eli Schwarz","doi":"10.1001/jama.2023.20685","DOIUrl":"10.1001/jama.2023.20685","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Dental caries and periodontal disease are common adult oral health conditions and potentially amenable to primary care screening and prevention.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To systematically review the evidence on primary care screening and prevention of dental caries and periodontal disease in adults to inform the US Preventive Services Task Force.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data sources: &lt;/strong&gt;MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews (to October 3, 2022); surveillance through July 21, 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study selection: &lt;/strong&gt;Diagnostic accuracy studies of primary care screening instruments and oral examination; randomized and nonrandomized trials of screening and preventive interventions; cohort studies on primary care oral health screening and preventive intervention harms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data extraction and synthesis: &lt;/strong&gt;One investigator abstracted data; a second checked accuracy. Two investigators independently rated study quality. Diagnostic accuracy data were pooled using a bivariate mixed-effects binary regression model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Dental caries, periodontal disease, morbidity, quality of life, harms; and diagnostic test accuracy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Five randomized clinical trials, 5 nonrandomized trials, and 6 observational studies (total 3300 participants) were included. One poor-quality trial (n = 477) found no difference between oral health screening during pregnancy vs no screening in caries, periodontal disease, or birth outcomes. One study (n = 86) found oral health examination by 2 primary care clinicians associated with low sensitivity (0.42 and 0.56) and high specificity (0.84 and 0.87) for periodontal disease and with variable sensitivity (0.33 and 0.83) and high specificity (0.80 and 0.93) for dental caries. Four studies (n = 965) found screening questionnaires associated with a pooled sensitivity of 0.72 (95% CI, 0.57-0.83) and specificity of 0.74 (95% CI, 0.66-0.82) for periodontal disease. For preventive interventions no study evaluated primary care counseling or dental referral, and evidence from 2 poor-quality trials (n = 178) of sealants, and 1 fair-quality and 4 poor-quality trials (n = 971) of topical fluorides, was insufficient. Three fair-quality trials (n = 590) of persons with mean age 72 to 80 years found silver diamine fluoride solution associated with fewer new root caries lesions or fillings vs placebo (mean reduction, -0.33 to -1.3) and decreased likelihood of new root caries lesion (2 trials; adjusted odds ratio, 0.4 [95% CI, 0.3-0.7]). No trial evaluated primary care-administered preventive interventions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;Screening questionnaires were associated with moderate diagnostic accuracy for periodontal disease. Research is needed to determine benefits and harms of oral health primary care screening and preventive inter","PeriodicalId":54909,"journal":{"name":"Jama-Journal of the American Medical Association","volume":" ","pages":"1780-1790"},"PeriodicalIF":120.7,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71489138","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}