JAMA Network Open最新文献

Reproductive Shifts and Ovarian Cancer Risk in Women Aged 40 Years or Older. 40岁及以上女性的生殖转移与卵巢癌风险

IF 9.7 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

JAMA Network Open

Pub Date : 2026-02-02 DOI: 10.1001/jamanetworkopen.2025.56840

Jin-Hwi Kim, In-Sun Hwang, Su-Jeong Lee, Chan-Joo Kim, Sung-Jong Lee, Kyungdo Han

Importance: Reproductive factors are associated with ovarian cancer risk, but their influence may differ across menopausal status and birth cohorts.Objective: To examine the associations between reproductive factors and ovarian cancer risk stratified by menopausal status and birth cohort.Design, setting, and participants: This nationwide population-based cohort study obtained data from the National Health Insurance Service (NHIS), a single-payer system covering 97% of the population in South Korea. Women aged 40 years or older who underwent NHIS health screening in 2009 and had reproductive, clinical, and other data were included and followed up until ovarian cancer diagnosis, death, or December 31, 2022. Data were analyzed in March 2025.Exposures: Age at menarche, parity, breastfeeding duration, oral contraceptive use, age at menopause, total reproductive span, and hormone replacement therapy use.Main outcomes and measures: Incident ovarian cancer identified from NHIS claims with International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes C56, C57, and C48 and confirmed through the Rare/Intractable Disease Registry (code V193). Cox proportional hazards regression models estimated hazard ratios (HRs) and 95% CIs.Results: A total of 2 285 774 women (932 637 [40.8%] premenopausal, 1 353 137 [59.2%] postmenopausal; mean [SD] age, 54.9 [10.85] years) were included in the final analytic cohort. The mean (SD) follow-up duration overall was 10.7 (2.99) years, and 10 729 ovarian cancer cases were identified during follow-up. Early menarche (aged ≤12 vs >16 years) was associated with higher ovarian cancer risk in both premenopausal women (HR, 1.37; 95% CI, 1.16-1.61) and postmenopausal women (HR, 1.24; 95% CI, 1.00-1.54). Parity of 2 or more births was associated with lower risk in both groups (HR, 0.68 [95% CI, 0.58-0.79] and 0.71 [95% CI, 0.60-0.85]). Breastfeeding for 12 months or longer and oral contraceptive use for 1 year or longer were associated with lower risk in premenopausal women but not postmenopausal women (HR, 0.86 [95% CI, 0.77-0.96] and 0.75 [95% CI, 0.61-0.93]). Among postmenopausal women, later menopause (at age ≥55 years; HR, 1.36 [95% CI, 1.11-1.66]), longer reproductive span (≥40 years; HR, 1.21 [95% CI, 1.09-1.34]), and hormone replacement therapy use for 2 to 5 years (HR, 1.20 [95% CI, 1.07-1.34]) were associated with higher risk. Parity-related risk reduction was attenuated in the 1960s birth cohort (HR, 1.07; 95% CI, 0.52-2.19; P for interaction = .36).Conclusions and relevance: This cohort study found that reproductive factors were associated with ovarian cancer risk, with distinct patterns across menopausal status and birth cohorts. These findings highlight the need for tailored prevention strategies in aging, low-fertility

重要性：生殖因素与卵巢癌风险相关，但其影响可能因绝经状态和出生队列而异。目的：探讨按绝经期和出生队列分层的生殖因素与卵巢癌风险的关系。设计、环境和参与者：这项基于全国人口的队列研究获得了国民健康保险服务（NHIS）的数据，这是一个覆盖韩国97%人口的单一付款人系统。在2009年接受NHIS健康筛查并有生殖、临床和其他数据的40岁或以上的女性被纳入并随访至卵巢癌诊断、死亡或2022年12月31日。数据分析时间为2025年3月。暴露：初潮年龄、胎次、母乳喂养持续时间、口服避孕药的使用、绝经年龄、总生殖期和激素替代疗法的使用。主要结局和措施：从NHIS声明中确定的卵巢癌事件，国际疾病和相关健康问题统计分类，第十版代码C56、C57和C48，并通过罕见/难治性疾病登记处（代码V193）确认。Cox比例风险回归模型估计了风险比（hr）和95% ci。结果：最终分析队列共纳入2 285 774名女性（绝经前932 637名[40.8%]，绝经后1 353 137名[59.2%]，平均[SD]年龄54.9[10.85]岁）。平均（SD）随访时间为10.7（2.99）年，随访期间发现10 729例卵巢癌病例。绝经前妇女（HR, 1.37; 95% CI, 1.16-1.61）和绝经后妇女（HR, 1.24; 95% CI, 1.00-1.54）的早期初潮（年龄≤12岁vs年龄≤16- 16岁）与卵巢癌风险较高相关。两组胎次均为2胎或2胎以上与较低的风险相关（相对危险度分别为0.68 [95% CI, 0.58-0.79]和0.71 [95% CI, 0.60-0.85]）。绝经前妇女母乳喂养12个月或更长时间和口服避孕药使用1年或更长时间与较低的风险相关，而绝经后妇女与此无关（HR, 0.86 [95% CI, 0.77-0.96]和0.75 [95% CI, 0.61-0.93]）。在绝经后妇女中，绝经时间较晚（≥55岁；HR, 1.36 [95% CI, 1.11-1.66]）、生育时间较长（≥40年；HR, 1.21 [95% CI, 1.09-1.34]）和使用激素替代治疗2 - 5年（HR, 1.20 [95% CI, 1.07-1.34]）与较高的风险相关。在1960年代出生队列中，与胎次相关的风险降低有所减弱（HR, 1.07; 95% CI, 0.52-2.19；相互作用的P = 0.36）。结论和相关性：该队列研究发现生殖因素与卵巢癌风险相关，在绝经期和出生队列中具有不同的模式。这些发现强调了在老龄化、低生育率人群中制定量身定制的预防策略的必要性。

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引用次数: 0

Stage at Diagnosis and International Survival Variation in Childhood Tumors in the BENCHISTA Study. 在BENCHISTA研究中，儿童肿瘤的诊断阶段和国际生存差异。

IF 9.7 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

JAMA Network Open

Pub Date : 2026-02-02 DOI: 10.1001/jamanetworkopen.2025.56747

Laura Botta, Fabio Didonè, Angela Lopez-Cortes, Adela Cañete Nieto, Emmanuel Desandes, Lisa L Hjalgrim, Zsuzsanna Jakab, Charles A Stiller, Bernward Zeller, Simon Bailey, Nathalie Gaspar, Filippo Spreafico, Sandra J Strauss, Gemma Gatta, Kathy Pritchard-Jones

Importance: Understanding the reasons for variations in population-level survival differences in childhood cancer is important to guide improvement efforts. Collaboration between population-based cancer registries (CRs) to apply the international consensus Toronto guidelines to record tumor stage at diagnosis is a key first step.Objective: To test whether survival probabilities by tumor stage vary internationally, using 6 childhood solid tumors as exemplars.Design, setting, and participants: The International Benchmarking of Childhood Cancer Survival by Stage (BENCHISTA) population-based retrospective cohort study included all incident cases of neuroblastoma, Wilms tumor, medulloblastoma, osteosarcoma, Ewing sarcoma of bone, and rhabdomyosarcoma diagnosed between January 1, 2014, and December 31, 2017, with 3-year follow-up for survival. A total of 73 CRs from 27 countries (23 European as well as Australia, Brazil, Canada, and Japan) constituted the dataset. Analyses were conducted from June 2023 to December 2024.Main outcomes and measures: Three-year overall survival (OS) by stage for each tumor type, with comparisons between countries grouped into 5 predefined European areas. Multivariable Cox and logistic models estimated each area's hazard or odds ratio of death compared with Central Europe (Austria, Belgium, France, Germany, Switzerland, and the Netherlands), adjusted by age group and stage.Results: A total of 9883 cases were included; 4452 (45%) were girls and overall median (IQR) age was 54 (22-122) months; stage completeness was 93% (9199 of 9883). Three-year OS rates were as follows: Wilms tumor, 95% (95% CI, 94%-96%); neuroblastoma, 83% (95% CI, 81%-84%); medulloblastoma, 79% (95% CI, 77%-81%); Ewing sarcoma, 78% (95% CI, 75%-80%); rhabdomyosarcoma, 77% (95% CI, 74%-79%); and osteosarcoma, 75% (95% CI, 73%-77%). Geographical variations in age-adjusted OS were found for neuroblastoma, medulloblastoma, Ewing sarcoma, and rhabdomyosarcoma. Following additional adjustment for stage, differences were no longer significant for neuroblastoma (in the UK and Ireland) and rhabdomyosarcoma (in Eastern Europe) while becoming significant for neuroblastoma in Eastern Europe (hazard ratio, 1.36; 95% CI, 1.05-1.76) and medulloblastoma in Southern Europe (hazard ratio, 1.42; 95% CI, 1.03-1.94). However, no mitigation of survival variation was observed for Ewing sarcoma in the UK and Ireland (hazard ratio, 2.06; 95% CI, 1.39-3.04) and Eastern Europe (hazard ratio, 1.87; 95% CI, 1.22-2.86) as well as for medulloblastoma in Eastern Europe (hazard ratio, 1.68; 95% CI, 1.13-2.49).Conclusions and relevance: In this BENCHISTA cohort study of 6 solid tumors, international variation in population-level OS was associated with differences in tumor stage distribution for some cancer types and regions. Additional factors are sug

重要性：了解儿童癌症人群生存差异差异的原因对指导改善工作非常重要。基于人群的癌症登记处（CRs）之间的合作，应用国际共识的多伦多指南来记录肿瘤诊断阶段是关键的第一步。目的：以6例儿童实体瘤为例，探讨不同肿瘤分期生存率在国际间是否存在差异。设计、环境和参与者：基于人群的儿童癌症分期国际基准（BENCHISTA）回顾性队列研究包括2014年1月1日至2017年12月31日期间诊断的所有神经母细胞瘤、肾母细胞瘤、髓母细胞瘤、骨肉瘤、骨尤文氏肉瘤和横纹肌肉瘤病例，并进行了3年的生存随访。该数据集由来自27个国家（23个欧洲国家以及澳大利亚、巴西、加拿大和日本）的73个cr组成。分析时间为2023年6月至2024年12月。主要结局和衡量指标：每种肿瘤类型的分期三年总生存率（OS），并比较了5个预定义的欧洲地区的国家之间的比较。多变量Cox和logistic模型估计了每个地区与中欧（奥地利、比利时、法国、德国、瑞士和荷兰）相比的死亡风险或优势比，并根据年龄组和阶段进行了调整。结果：共纳入病例9883例；4452例（45%）为女孩，总中位（IQR）年龄为54（22-122）个月；阶段完成度为93%（9199 / 9883）。三年总生存率如下：Wilms肿瘤，95% (95% CI, 94%-96%)；神经母细胞瘤，83% (95% CI, 81%-84%)；髓母细胞瘤，79% (95% CI, 77%-81%)；尤文氏肉瘤，78% (95% CI, 75%-80%)；横纹肌肉瘤，77% (95% CI, 74%-79%)；骨肉瘤占75% （95% CI, 73%-77%）。神经母细胞瘤、髓母细胞瘤、尤文氏肉瘤和横纹肌肉瘤的年龄调整OS存在地理差异。在进一步调整阶段后，神经母细胞瘤（英国和爱尔兰）和横纹肌肉瘤（东欧）的差异不再显著，而东欧的神经母细胞瘤（风险比，1.36;95% CI, 1.05-1.76）和南欧的髓母细胞瘤（风险比，1.42;95% CI, 1.03-1.94）的差异变得显著。然而，在英国和爱尔兰（风险比，2.06;95% CI, 1.39-3.04）和东欧（风险比，1.87;95% CI, 1.22-2.86）以及东欧的髓母细胞瘤（风险比，1.68;95% CI, 1.13-2.49）中没有观察到生存变异的缓解。结论及相关性：在这项包含6个实体瘤的BENCHISTA队列研究中，人群水平OS的国际差异与某些癌症类型和地区的肿瘤分期分布差异有关。建议进一步调查的其他因素。该结果对国家卫生系统监测早期诊断工作具有重要意义，并支持CRs和临床医生之间的合作，以维持多伦多指南的标准化使用，以提高对儿童癌症生存变化的理解。

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引用次数: 0

Counseling and Cardiovascular Disease Risk Factor Control in Long-Term Cancer Survivors: A Randomized Clinical Trial. 长期癌症幸存者的心理咨询和心血管疾病危险因素控制：一项随机临床试验

IF 9.7 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

JAMA Network Open

Pub Date : 2026-02-02 DOI: 10.1001/jamanetworkopen.2025.55863

Eric J Chow, Yan Chen, Yutaka Yasui, Laura-Mae Baldwin, Melissa M Hudson, Tammy M Muller, Paul C Nathan, Siu L Ngai, Timothy J D Ohlsen, Claire Snyder, Karen L Syrjala, Emily S Tonorezos, Gregory T Armstrong, Kevin C Oeffinger

Importance: Survivors of childhood cancer have an increased risk of cardiovascular disease (CVD). However, many survivors at high risk do not receive recommended CVD screening tests as young adults.Objective: To assess whether a survivorship care plan (SCP)-based counseling intervention improves CVD risk factor control in high-risk survivors.Design, setting, and participants: The Communicating Health Information and Improving Coordination With Primary Care (CHIIP) Study was a randomized clinical trial that enrolled eligible participants from the Childhood Cancer Survivor Study cohort in 9 US metropolitan areas between August 2017 and April 2020, with follow-up completed July 2022. Participants included adult survivors of childhood cancer exposed to cardiotoxic cancer therapies with undertreated CVD risk factors (hypertension, dyslipidemia, and glucose intolerance defined by standard guidelines); of 1840 survivors approached, 842 consented to participate, and 347 met all eligibility requirements and were randomized after a baseline home assessment. Data analysis was completed March 18, 2025.Intervention: The intervention consisted of a single remote session to review measurements and a SCP with personalized CVD risk information and to develop a CVD risk factor management plan, with a booster session 4 months later. Enhanced care controls received measurements with abnormal findings noted and written encouragement to follow up with their primary care clinician (PCC). PCCs received all materials sent to participants.Main outcomes and measures: Blood pressure, lipid profile, and glucose and hemoglobin A1c levels collected by a trained home examiner at baseline and 1-year follow-up, with undertreatment defined by standard guidelines.Results: A total of 347 cancer survivors (mean [SD] age, 40.5 [9.4] years; 182 [52.4%] male) were randomized, 175 to the intervention group and 172 to the enhanced care control group. Of these, 194 participants (53.0%) participants had undertreated hypertension at baseline; 180 (51.9%), undertreated dyslipidemia; and 170 (49.0%) undertreated glucose intolerance. After 1 year, 45 of 173 surviving intervention participants (26.0%) and 52 of 172 enhanced care control participants (30.2%) had less undertreatment, with lower percentages for each condition vs baseline. Although the intervention did not reduce undertreatment compared with the control condition (odds ratio, 1.31; 95% CI, 0.84-2.05), greater engagement was associated with less undertreatment at 1 year among intervention participants (odds ratio, 0.31; 95% CI, 0.18-0.72). The intervention group had improved PCC documentation of CVD risk vs controls after 1 year (14.8% improvement vs 0.9%; P = .002).Conclusions and relevance: In this randomized clinical trial of long-term survivors of childhood cancer, the

重要性：儿童癌症幸存者患心血管疾病（CVD）的风险增加。然而，许多高风险的幸存者在年轻时没有接受推荐的心血管疾病筛查试验。目的：评估以生存护理计划（SCP）为基础的咨询干预是否能改善高危幸存者心血管疾病危险因素的控制。设计、环境和参与者：沟通健康信息和改善初级保健协调（CHIIP）研究是一项随机临床试验，于2017年8月至2020年4月在美国9个大都市地区招募了儿童癌症幸存者研究队列的合格参与者，随访于2022年7月完成。参与者包括暴露于心脏毒性癌症治疗的儿童期癌症成年幸存者，其心血管疾病危险因素治疗不足（标准指南定义的高血压、血脂异常和葡萄糖耐受不良）；在1840名幸存者中，842人同意参与，347人符合所有资格要求，并在基线家庭评估后随机分组。数据分析于2025年3月18日完成。干预：干预包括单次远程会议，以回顾测量结果和具有个性化心血管疾病风险信息的SCP，并制定心血管疾病风险因素管理计划，4个月后进行一次加强会议。加强护理组接受测量，并记录异常发现，并书面鼓励随访其初级保健临床医生（PCC）。pccc收到了发给参与者的所有材料。主要结果和测量：血压、血脂、血糖和血红蛋白A1c水平由训练有素的家庭检查人员在基线和1年随访时收集，标准指南定义治疗不足。结果：共纳入347例癌症幸存者（平均[SD]年龄40.5[9.4]岁，男性182例[52.4%]），干预组175例，强化护理对照组172例。其中，194名参与者（53.0%）在基线时高血压治疗不足；180例（51.9%），未充分治疗的血脂异常；170例（49.0%）葡萄糖耐受不良。1年后，173名幸存的干预参与者中有45名（26.0%）和172名强化护理对照组中的52名（30.2%）治疗不足的情况有所减少，每种情况的百分比都低于基线。虽然与对照组相比，干预并没有减少治疗不足（优势比，1.31;95% CI, 0.84-2.05），但在干预参与者中，参与程度越高，1年后治疗不足的情况越少（优势比，0.31;95% CI, 0.18-0.72）。干预组与对照组相比，1年后心血管疾病风险的PCC记录有所改善（14.8% vs 0.9%; P = 0.002）。结论和相关性：在这项儿童癌症长期幸存者的随机临床试验中，除了简单地向幸存者和前列腺癌患者提供心血管疾病风险评估外，增加基于幸存者的自我管理咨询并没有减少治疗不足。未来应该研究降低高危幸存者心血管疾病风险的其他策略。试验注册：ClinicalTrials.gov标识符：NCT03104543。

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引用次数: 0

Extraintestinal Invasive Escherichia coli Infections in the US. 美国肠外侵袭性大肠杆菌感染。

IF 9.7 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

JAMA Network Open

Pub Date : 2026-02-02 DOI: 10.1001/jamanetworkopen.2025.57201

Heather N Grome, Joshua M Brandenburg, Alyssa G Kent, Latasha Curtis, Ruben E Raymond, Uzma Ansari, Amy S Gargis, Susannah L McKay, Erin Parker, Jennifer Driscoll, Karlie Hoetzer, Helen Johnston, Daniel R McKenzie, Paulina A Rebolledo, Emily Luckman, Lucy E Wilson, Marco Garcia, Jennifer Zipprich, Marisa R Hoffman, Kristina G Flores, Julia Tellerman, Ghinwa Dumyati, Shannon O'Brien, Daniel B Muleta, Olivia Denzie, Alice Y Guh

Importance: Extraintestinal invasive Escherichia coli infections are a leading cause of sepsis and hospitalization, further complicated by increasing rates of antimicrobial resistance.

Objective: To describe the US epidemiology of invasive E coli infections and their clinical and molecular features.

Design, setting, and participants: This cohort study used active laboratory- and population-based surveillance data from 9 US sites with a total population of more than 7.2 million people for invasive E coli in normally sterile body sites, collected from June to August 2023 from medical records and isolate characterization. Data were analyzed from November 2023 to February 2024.

Exposures: Laboratory-confirmed identification of any E coli organism isolated from a normally sterile body site obtained from a resident of the surveillance area.

Main outcomes and measures: Outcomes of interest were population-based and site-specific incidence rate estimates of E coli infections, demographic and clinical characteristics, antimicrobial susceptibility profiles, and predicted O serotypes by in silico serotyping.

Results: Among 1345 cases of E coli infection in 1334 unique case-patients, the median (IQR) age was 68 (55-79) years, and 762 case-patients (57.1%) were female; 1223 infections (90.9%) were from blood and 122 infections (9.1%) were from other sterile sites. The overall estimated annual incidence rate was 74.7 per 100 000 population (surveillance site range, 51.4-96.0 per 100 000 population). Estimated incidence rates were higher among cases in patients aged 60 years or older compared with younger patients (225.0 vs 30.6 per 100 000 population), although rates were similar for females and males aged 60 years or older (224.5 vs 224.0 per 100 000 population). The most common underlying medical condition reported was diabetes (457 patients [34.0%]). Pyelonephritis (267 infections [19.9%]) and lower urinary tract infections (495 infections [36.8%]) were the most frequently associated infection types. In total, 1279 cases (95.1%) were hospitalized for less than 30 days after isolate collection; 106 case-patients (7.9%) died. Overall, 185 infections (13.8%) were due to extended-spectrum β-lactamase-producing E coli; 275 of 1061 isolates (25.9%) were resistant to ciprofloxacin and 370 of 1286 (28.8%) were resistant to trimethoprim-sulfamethoxazole. Of 846 sequenced isolates, the most prevalent O serotypes were O25B (137 isolates [16.2%]), O2 (93 isolates [11.0%]), and O6 (84 isolates [9.9%]).

Conclusions and relevance: This cohort study using population-based public health surveillance data identified a substantial burden of invasive E coli disease, especially in older people, with high rates of antimicrobial resistance. These results can help inform national public health prevention efforts.

重要性：肠外侵袭性大肠杆菌感染是败血症和住院的主要原因，并因抗菌素耐药性的增加而进一步复杂化。目的：了解美国侵袭性大肠杆菌感染的流行病学特征及其临床和分子特征。设计、环境和参与者：该队列研究使用了来自美国9个站点的主动实验室和基于人群的监测数据，这些站点的人口总数超过720万人，这些数据来自2023年6月至8月从医疗记录和分离物鉴定中收集的正常无菌身体部位的侵袭性大肠杆菌。数据分析时间为2023年11月至2024年2月。接触：从监测区域居民的正常无菌身体部位分离出经实验室确认的任何大肠杆菌。主要结局和测量：关注的结局是基于人群和特定地点的大肠杆菌感染发生率估计、人口统计学和临床特征、抗菌药物敏感性概况，以及通过计算机血清分型预测的O血清型。结果：1334例独特病例中1345例大肠杆菌感染中位（IQR）年龄为68（55 ~ 79）岁，女性762例（57.1%）；血液感染1223例（90.9%），其他无菌场所感染122例（9.1%）。总体估计年发病率为每10万 万人74.7例（监测点范围为每10万 万人51.4-96.0例）。与年轻患者相比，60岁及以上患者的估计发病率更高（每100 000人口225.0 vs 30.6），尽管60岁及以上女性和男性的发病率相似（每100 000人口224.5 vs 224.0）。最常见的基础疾病是糖尿病（457例[34.0%]）。肾盂肾炎（267例，19.9%）和下尿路感染（495例，36.8%）是最常见的相关感染类型。1279例（95.1%）患者在采集后住院时间少于30天；死亡106例（7.9%）。总的来说，185例感染（13.8%）是由广谱β-内酰胺酶产生的大肠杆菌引起的；1061株中有275株对环丙沙星耐药，占25.9%；1286株中有370株对甲氧苄啶-磺胺甲恶唑耐药，占28.8%。在846株测序菌株中，最常见的O血清型为O25B（137株[16.2%]）、O2（93株[11.0%]）和O6（84株[9.9%]）。结论和相关性：这项基于人群的公共卫生监测数据的队列研究确定了侵袭性大肠杆菌疾病的巨大负担，特别是在老年人中，具有高抗菌素耐药性。这些结果有助于为国家公共卫生预防工作提供信息。

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引用次数: 0

The Role of Peer Navigators After Nonfatal Opioid Overdose-Context, Evidence, and Future Directions. 非致命性阿片类药物过量后同伴导航员的作用——背景、证据和未来方向。

IF 9.7 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

JAMA Network Open

Pub Date : 2026-02-02 DOI: 10.1001/jamanetworkopen.2025.55780

Scott G Weiner, Kathryn F Hawk

引用次数: 0

Behavioral Activation and Mindfulness Interventions in Reducing Loneliness and Improving Well-Being in Older Adults: The HEAL-HOA Randomized Clinical Trial. 行为激活和正念干预在减少老年人孤独感和改善幸福感中的作用：heala - hoa随机临床试验。

IF 9.7 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

JAMA Network Open

Pub Date : 2026-02-02 DOI: 10.1001/jamanetworkopen.2025.57170

Vivien Foong Yee Tang, Da Jiang, Jojo Yan Yan Kwok, Dannii Yuen-Lan Yeung, Namkee G Choi, Lisa M Warner, Rainbow Tin Hung Ho, Kee-Lee Chou

Importance: Late-life loneliness is a serious public health concern, yet the long-term efficacy and mechanisms of interventions to alleviate it remain underexplored.Objective: To evaluate the 12-month effectiveness of lay counselor-delivered, telephone-based behavioral activation and mindfulness interventions in reducing loneliness and enhancing well-being among at-risk older adults and to examine whether social isolation mediates these effects.Design, setting, and participants: The Helping Alleviate Loneliness in Hong Kong Older Adults (HEAL-HOA) was a 3-arm, assessor-blinded randomized clinical trial conducted from April 1, 2021, to April 28, 2024. Eligible participants 65 years or older who were living alone, digitally excluded, lonely, and experiencing financial hardship were recruited from public housing estates, community centers, academies for older adults, and word of mouth. Participants were randomized 1:1:1 to receive telephone-delivered behavioral activation (Tele-BA), telephone-delivered mindfulness (Tele-MF), or telephone-delivered befriending (Tele-BF [attention control]).Interventions: Participants received eight 30-minute sessions delivered by trained lay counselors via telephone for 4 weeks.Main outcomes and measures: The primary outcome was loneliness, measured using the UCLA Loneliness Scale (UCLA-LS) and the De Jong Gierveld Loneliness Scale (DJGL). Secondary outcomes included perceived stress, social support, sleep quality, life satisfaction, anxiety, depressive symptoms, and psychological well-being. Social isolation was examined as a mediator. Outcomes were assessed at baseline and at 1, 3, 6, and 12 months of follow-up.Results: Of 4152 individuals screened, 1151 participants (mean [SD] age, 76.6 [7.8] years; 843 [73.2%] female; 965 [83.8%] with ≥1 chronic illness) were randomized (Tele-BA, 335 [29.1%]; Tele-MF, 460 [40.0%]; Tele-BF, 356 [30.9%]). Intention-to-treat analyses using linear mixed-effects models showed significant between-group changes in loneliness at 12 months for Tele-BA (UCLA-LS: mean difference [MD], -0.73; 95% CI, -1.29 to -0.16; P = .01; DJGL: MD, -0.13; 95% CI, -0.23 to -0.03; P = .01) and Tele-MF (UCLA-LS: MD, -0.72; 95% CI, -1.24 to -0.20; P = .003) compared with Tele-BF. Secondary outcomes, including sleep quality, psychological well-being, and life satisfaction, also improved significantly. Social isolation at 6 months partially mediated the effect on loneliness (UCLA-LS) for both interventions at 12 months (accounting for 0.13 [13.5%] and 0.18 [18.0%] of the total effects for Tele-BA and Tele-MF, respectively).Conclusions and relevance: In this randomized clinical trial, brief telephone-delivered behavioral activation and mindfulness interventions by lay counselors sustainably reduced loneliness and enhanced well-being during 12 months i

重要性：晚年孤独是一个严重的公共卫生问题，但缓解它的干预措施的长期疗效和机制仍未得到充分探讨。目的：评估非专业咨询师提供的、基于电话的行为激活和正念干预在减少孤独感和提高高危老年人幸福感方面的12个月有效性，并研究社会隔离是否介导了这些效果。设计、环境和参与者：帮助缓解香港老年人孤独感（heala - hoa）是一项三组、评估者盲法随机临床试验，于2021年4月1日至2024年4月28日进行。符合条件的65岁或以上独居、数字排斥、孤独和经历经济困难的参与者是从公共住房、社区中心、老年人学院和口口相传中招募的。参与者以1:1:1的比例随机分配，接受电话传递的行为激活（Tele-BA）、电话传递的正念（Tele-MF）或电话传递的友谊（Tele-BF[注意力控制]）。干预措施：参与者接受8次30分钟的会议，由训练有素的非专业咨询师通过电话提供，为期4周。主要结局和测量：主要结局是孤独感，使用UCLA孤独量表（UCLA- ls）和De Jong Gierveld孤独量表（DJGL）测量。次要结局包括感知压力、社会支持、睡眠质量、生活满意度、焦虑、抑郁症状和心理健康。社会孤立是一种中介。在基线和随访1、3、6和12个月时评估结果。结果：在筛选的4152名个体中，随机抽取1151名参与者（平均[SD]年龄76.6[7.8]岁，843名[73.2%]名女性，965名[83.8%]名患有≥1种慢性疾病）（Tele-BA， 335名[29.1%],Tele-MF， 460名[40.0%],Tele-BF， 356名[30.9%]）。使用线性混合效应模型的意向治疗分析显示，Tele-BA组间孤独感在12个月时发生显著变化（UCLA-LS：平均差异[MD]， -0.73; 95% CI, -1.29至-0.16;P = 0.01; DJGL: MD, -0.13; 95% CI, -0.23至-0.03;P = 0.01）。01)和Tele-MF (UCLA-LS:医学博士,-0.72;95%置信区间,-1.24至-0.20;P =。003)与Tele-BF相比。次要结果，包括睡眠质量、心理健康和生活满意度也显著改善。6个月时的社会隔离部分介导了12个月时两种干预对孤独感（UCLA-LS）的影响（分别占远程ba和远程mf总影响的0.13[13.5%]和0.18[18.0%]）。结论和相关性：在这项随机临床试验中，由非专业咨询师进行的简短的电话行为激活和正念干预在12个月内持续减少了有风险的老年人的孤独感和幸福感，社会隔离是部分中介。这些可扩展的干预措施为对抗晚年孤独提供了有效的解决方案。未来的研究应探讨这些干预措施在香港以外的适用性及其成本效益。试验注册：标识符：ChiCTR2300072909。

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引用次数: 0

Equity, Diversity, and Inclusion Programs in Health Care Institutions: A Systematic Review and Meta-Analysis. 卫生保健机构的公平、多样性和包容计划：系统回顾和荟萃分析。

IF 9.7 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

JAMA Network Open

Pub Date : 2026-02-02 DOI: 10.1001/jamanetworkopen.2025.55896

Deena Fremont, Amos Buh, Claire Hoar-Stephens, Nandini Biyani, Shaafi Mahbub, Ria Singla, Muhammad Zameer, Phalone Mei Nsen, Rachel Kang, Rohan Kiska, Stephen G Fung, Marco Solmi, Maya Gibb, Mekaylah Scott, Maria Salman, Kathryn Lee, Benjamin Milone, Gamal Wafy, Sarah Syed, Shan Dhaliwal, Ayub Akbari, Pierre A Brown, Gregory L Hundemer, Manish M Sood

Importance: Equity, diversity, and inclusion (EDI) initiatives are politically polarizing and increasingly adopted in the health care setting. Their broader impact across different health care career types, career stages, and various levels of education remains largely unknown.

Objective: To assess EDI programs and their associated outcomes within health care institutions.

Data sources: A Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020-compliant systematic review searching PubMed, Scopus, Web of Science, CINAHL, and PsychINFO databases from January 2010 to December 2023.

Study selection: Two independent reviewers screened studies that assessed EDI programs or policies in health care institutions.

Data extraction and synthesis: Programs were categorized based on reported outcomes, including participant satisfaction, increased awareness of EDI-related topics, increases in the proportion of underrepresented minority individuals within medical education or the health care workforce, and overall program impact. Odds ratios (ORs) were pooled using a random-effects model. Analyses followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. Analysis was conducted June 2025.

Main outcomes and measures: Outcome measures included the proportion of diversity among the workforce, employee and patient satisfaction, and the proportion of employees recruited and retained after program implementation.

Results: In total, 43 studies incorporating more than 15 000 individuals involved in EDI programs were included. Interventions were multifaceted, including 14 career advancement and training programs, 16 diversity representation programs, 11 academia and research support initiatives, and the growth of 2 pipeline programs. Furthermore, interventions demonstrated consistent improvement in EDI initiatives, with perceived benefit in promoting underrepresented minority populations. Findings from the meta-analysis of 2 studies showed that minority representation in competitive medical residencies increased after implementation of 2 EDI interventions (OR, 1.73; 95% CI, 1.21-2.47). Among the 43 studies included in the Joanna Briggs Institute assessment of methodological quality, 7 (16.3%) were rated as high quality, 20 (46.5%) as moderate quality, and 16 (37.2%) as low quality.

Conclusions and relevance: In this systematic review and meta-analysis of EDI initiatives in health care institutions, programs were associated with an increased workforce diversity. These findings support the continued use of EDI initiatives to promote a more inclusive and equitable health care culture.

重要性：公平、多样性和包容（EDI）倡议在政治上两极分化，越来越多地在卫生保健环境中被采用。它们对不同医疗保健职业类型、职业阶段和不同教育水平的更广泛影响在很大程度上仍然未知。目的：评估卫生保健机构的电子数据交换项目及其相关结果。数据来源：2010年1月至2023年12月，检索PubMed， Scopus, Web of Science， CINAHL和PsychINFO数据库，符合系统评价和荟萃分析（PRISMA） 2020标准的首选报告项目。研究选择：两名独立审稿人筛选了评估医疗机构EDI项目或政策的研究。数据提取和综合：根据报告的结果对项目进行分类，包括参与者满意度、对电子数据管理相关主题的认识提高、医学教育或卫生保健工作人员中未被充分代表的少数群体比例的增加以及总体项目影响。使用随机效应模型汇总优势比（ORs）。分析遵循系统评价和元分析报告指南的首选报告项目。分析于2025年6月进行。主要结果和测量方法：结果测量方法包括劳动力多样性比例、员工和患者满意度、项目实施后招聘和保留员工的比例。结果：共纳入43项研究，涉及超过15,000 000人参与EDI计划。干预措施是多方面的，包括14个职业发展和培训项目，16个多元化代表项目，11个学术和研究支持项目，以及2个管道项目的增长。此外，干预措施显示了EDI倡议的持续改善，在促进未被充分代表的少数民族人口方面有明显的好处。2项研究的荟萃分析结果显示，实施2项EDI干预后，少数族裔在竞争性住院医师中的代表性增加（OR, 1.73; 95% CI, 1.21-2.47）。在乔安娜布里格斯研究所方法学质量评估纳入的43项研究中，7项（16.3%）为高质量，20项（46.5%）为中等质量，16项（37.2%）为低质量。结论和相关性：在对医疗机构EDI计划的系统回顾和荟萃分析中，计划与增加的劳动力多样性有关。这些发现支持继续使用电子数据交换倡议，以促进更加包容和公平的卫生保健文化。

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引用次数: 0

Serous Ovarian Cancer Following Opportunistic Bilateral Salpingectomy. 机会性双侧输卵管切除术后浆液性卵巢癌。

IF 9.7 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

JAMA Network Open

Pub Date : 2026-02-02 DOI: 10.1001/jamanetworkopen.2025.57267

Ramlogan Sowamber, Alice J Mei, Paramdeep Kaur, Julianne McLeod, Emily McKay, Alex Lukey, Jamie Bakkum-Gamez, Natalia Buza, Paul A Cohen, Kyle Devins, Rhonda Farrell, Christine Garcia, Blake Gilks, Ellen Goode, Anjelica Hodgson, Brooke Howitt, Pei Hui, Jutta Huvila, Anthony Karnezis, Kianoosh Keyhanian, Mary Kinloch, Martin Köbel, Felix K F Kommoss, Lawrence Kushi, Janice S Kwon, Kara Long-Roche, Anais Malpica, Jessica N McAlpine, Dianne Miller, Esther Oliva, Andrea Palicelli, Aleksandra Paliga, Carlos Parra-Herran, Celeste Leigh Pearce, Sharnel Perera, Jurgen M Piek, Haiyan Qiu, Joseph Rabban, Robert Rome, Miranda Steenbeek, Rebecca Stone, Aline Talhouk, Kristin M Tischer, Britton Trabert, Penelope M Webb, John R Zalcberg, David G Huntsman, Gillian E Hanley

引用次数: 0

Blended Delivery of a Primary Care Parenting Program for Child Development: A Randomized Clinical Trial. 一项儿童发展的初级保健育儿计划的混合交付：一项随机临床试验。

IF 9.7 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

JAMA Network Open

Pub Date : 2026-02-02 DOI: 10.1001/jamanetworkopen.2025.56024

Susan M Chang, Joanne A Smith, Amika S Wright, Julia Rowe-Porter, Kemisha Shaw-Kelly, Florencia Lopez-Boo, Susan P Walker

Importance: There is substantial evidence that programs that build parents' abilities to support early learning benefit children's development. Evidence is needed on how to integrate and scale these programs within government services.Objective: To determine whether a parenting program implemented by government primary health care services and combining in-person and remote delivery benefits children's development and parenting attitudes and behaviors.Design, setting, and participants: In this single-blind randomized clinical trial, enrollment began in July 2022 in primary health care centers in Jamaica. The intervention was phased in from September 2022 to August 2023 and lasted 8 months. Data collection ended in April 2024. Families with children aged 3 to 28 months from communities served by the centers were identified by health staff. Following eligibility checks and informed consent, families were randomly assigned to intervention or waiting list control.Intervention: The intervention aimed to strengthen parents' skills in helping their child learn through play and responsive interactions. Community health workers used a curriculum with age-appropriate play and language activities and made fortnightly contacts with families, alternating between home visits and telephone calls.Main outcomes and measures: Child development was measured with the Griffiths Mental Development Scales and parenting behaviors (involvement, responsivity, acceptance, and learning materials) with the Home Observation for Measurement of the Environment (HOME). Effect size (ES) was calculated by dividing the regression coefficient by the pooled-sample SD.Results: A total of 627 children were enrolled (311 intervention and 316 control; 322 [51.4%] male). At follow-up, 491 children (78.3%) were assessed, 237 (76.2%) of those in the intervention group and 254 (80.4%) in the control group. Children's mean (SD) age at follow-up was 27.0 (5.8) months in the control and 27.0 (6.1) months in the intervention group. A total of 393 mothers (62.7%) had completed secondary school. There were no significant differences in follow-up rate or characteristics between groups. Intention-to-treat multivariate regression analyses with inverse probability weights showed benefits for children's overall developmental quotient (ES, 0.17 SD; 95% CI, 0.01-0.33 SD), fine motor ability score (ES, 0.19 SD; 95% CI, 0.03-0.36 SD), and parent behaviors (HOME score ES, 0.25 SD; 95% CI, 0.08-0.41 SD).Conclusions and relevance: In this randomized clinical trial of a parenting program delivered through primary health care, the intervention benefited child development and parenting. Findings suggest combining in-person and remote methods may be a useful strategy for scaling.Trial registration: ISRCTN Registry Identifier: IS

重要性：有大量证据表明，培养父母支持早期学习能力的项目有利于儿童的发展。需要证据来证明如何在政府服务中整合和扩大这些项目。目的：探讨由政府初级卫生保健服务机构实施的亲临和远程分娩相结合的育儿方案是否有利于儿童的发育和育儿态度与行为。设计、环境和参与者：在这项单盲随机临床试验中，于2022年7月在牙买加的初级卫生保健中心开始招募。干预从2022年9月到2023年8月分阶段进行，持续了8个月。数据收集于2024年4月结束。来自中心服务社区的有3至28个月儿童的家庭由卫生工作人员确定。在资格检查和知情同意之后，家庭被随机分配到干预组或等候组。干预：干预旨在加强家长帮助孩子通过游戏和反应性互动学习的技能。社区卫生工作者使用一套包含适龄游戏和语言活动的课程，每两周与家庭接触一次，轮流进行家访和电话访问。主要结果和测量方法：采用格里菲斯心理发展量表（Griffiths Mental development scale）测量儿童发展，采用家庭环境测量观察量表（Home）测量父母行为（参与、反应性、接受性和学习材料）。效应量（ES）由回归系数除以混合样本SD计算。结果：共纳入627例儿童（干预311例，对照组316例；男性322例，占51.4%）。随访491例（78.3%），干预组237例（76.2%），对照组254例（80.4%）。对照组患儿随访时平均（SD）年龄为27.0（5.8）个月，干预组患儿随访时平均（SD）年龄为27.0（6.1）个月。共有393名母亲（62.7%）完成了中学教育。两组间随访率和随访特征无显著差异。意向-治疗多因素反向概率加权回归分析显示，儿童整体发展商（ES, 0.17 SD; 95% CI, 0.01-0.33 SD）、精细运动能力评分（ES, 0.19 SD; 95% CI, 0.03-0.36 SD）和父母行为（HOME评分ES， 0.25 SD; 95% CI, 0.08-0.41 SD）均有益处。结论和相关性：在这项通过初级卫生保健提供的育儿计划的随机临床试验中，干预有利于儿童的发育和育儿。研究结果表明，将面对面和远程方法相结合可能是扩展的有用策略。试验注册：ISRCTN注册中心标识：ISRCTN11059214。

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引用次数: 0

Growth Trajectories in Infants From Families With Plant-Based or Omnivorous Dietary Patterns. 植物性或杂食性饮食模式家庭婴儿的生长轨迹。

IF 9.7 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

JAMA Network Open

Pub Date : 2026-02-02 DOI: 10.1001/jamanetworkopen.2025.57798

Kerem Avital, Naomi Fliss-Isakov, Danit R Shahar, Moran Blaychfeld-Magnazi, Sivan Ben-Avraham, Sigal Tepper, Uri Hamiel

Importance: The safety of plant-based family diets, particularly vegan diets, during pregnancy and infancy is debated. Large population data on infant growth are scarce.Objective: To examine whether family dietary patterns (vegan, vegetarian, and omnivorous) are associated with growth trajectories, weight, and length among infants.Design, setting, and participants: This retrospective cohort study used data collected from January 1, 2014, through December 31, 2023, from a national network of public family care centers in Israel providing health and developmental surveillance for infants. Singleton births of infants gestational age 32 weeks or later without congenital malformations or birth weight less than 1500 g were followed up for 24 months. The data were analyzed between November 17, 2024, and December 6, 2025.Exposure: The family diet as recorded at least 6 months after delivery.Main outcomes and measures: The primary outcome was infant length. Secondary outcomes included weight, head circumference, stunting (length-for-age z score less than -2), underweight (weight-for-length z score less than -2), and overweight (weight-for-length z score >2). Growth trajectories were analyzed using linear mixed-effects models, and nutritional status at birth, early infancy (ie, first 60 days of life), and 24 months were analyzed using logistic regression.Results: Among 1 198 818 infants (mean [SD] gestational age, 39.2 [1.5] weeks; 53.2% male), 98.5% were from omnivorous households; 0.3% from vegan households, and 1.2% from vegetarian households. Differences in early-infancy length and length-for-age z scores among dietary groups were small (World Health Organization z score ≤0.3), and stunting prevalence was similar across groups (from 7.0% in the vegan and vegetarian groups to 7.1% in the omnivorous group), while underweight was more common in infants in the vegan vs omnivorous groups (adjusted odds ratio, 1.37 [95% CI, 1.15-1.63]). By age 24 months, stunting prevalence declined to 3.1%, 3.4%, and 3.9% in omnivore, vegetarian, and vegan groups, respectively, with no significant differences among the groups. Underweight and overweight were also low, with no differences by dietary group at age 24 months. Mean differences for weight, length, and head circumference were clinically minor (World Health Organization z score <0.2) and diminished further in adjusted longitudinal models.Conclusions and relevance: In this cohort study, infants from vegan households had growth patterns similar to those from omnivorous households, with a higher odds of early underweight that decreased by age 24 months. In the context of developed countries, these findings seem reassuring. Further research should examine vegan diet quality and the impact of nutritional counseling during pregnancy and infancy in supporting o

重要性：以植物为基础的家庭饮食，特别是纯素饮食，在怀孕和婴儿期间的安全性是有争议的。关于婴儿生长的大量人口数据很少。目的：研究家庭饮食模式（纯素、素食和杂食性）是否与婴儿的生长轨迹、体重和身高有关。设计、环境和参与者：这项回顾性队列研究使用了从2014年1月1日至2023年12月31日收集的数据，这些数据来自以色列公共家庭护理中心的国家网络，为婴儿提供健康和发育监测。对胎龄32周及以后无先天性畸形或出生体重小于1500 g的单胎婴儿进行24个月的随访。这些数据是在2024年11月17日至2025年12月6日之间进行分析的。暴露：分娩后至少6个月的家庭饮食记录。主要观察指标：主要观察指标为婴儿体长。次要结局包括体重、头围、发育迟缓（身高与年龄比值z得分小于-2）、体重不足（身高与体重比值z得分小于-2）和超重（身高与体重比值z得分为>.2）。使用线性混合效应模型分析生长轨迹，并使用逻辑回归分析出生时、婴儿期早期（即生命的前60天）和24个月时的营养状况。结果：1 198 818例婴儿（平均[SD]胎龄39.2[1.5]周，男性53.2%）中，98.5%来自杂食性家庭；0.3%来自纯素食家庭，1.2%来自素食家庭。不同饮食组之间的婴儿早期身高和年龄长度z评分差异很小（世界卫生组织z评分≤0.3），各组发育迟缓患病率相似（纯素食组为7.0%，杂食性组为7.1%），而纯素食组和杂食性组的婴儿体重不足更为常见（调整优势比为1.37 [95% CI, 1.15-1.63]）。到24个月大时，杂食、素食和纯素食组的发育迟缓患病率分别降至3.1%、3.4%和3.9%，各组间无显著差异。体重过轻和超重的比例也很低，在24个月大时，不同饮食组之间没有差异。结论和相关性：在这项队列研究中，来自纯素食家庭的婴儿的生长模式与来自杂食性家庭的婴儿相似，早期体重不足的几率更高，到24个月时体重不足的几率降低。在发达国家的背景下，这些发现似乎令人放心。进一步的研究应该检查纯素饮食的质量以及孕期和婴儿期营养咨询对支持婴儿最佳发育的影响。

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引用次数: 0