Pub Date : 2026-02-02DOI: 10.1001/jamanetworkopen.2025.58573
Rebecca Halbgebauer, Fernando Gonzalez-Ortiz, Benjamin Mayer, Claudius Berger, Christian Bergmann, Helen Rinderknecht, Eberhard Barth, Lisa Wohlgemuth, Marco Mannes, Markus Otto, Hayrettin Tumani, Borna Relja, Florian Gebhard, Markus Huber-Lang, Henrik Zetterberg, Steffen Halbgebauer, Kaj Blennow
Importance: With blood-based phosphorylated tau biomarkers soon to be used for diagnosis of Alzheimer disease, analyzing tau levels in other conditions could enhance biomarker interpretability. Moreover, mechanisms of tau release into circulation remain unclear.
Objective: To evaluate concentrations of phosphorylated and nonphosphorylated tau variants in the blood of patients with multiple traumatic injuries on days 0, 1, 5, and 10 and investigate biological processes driving tau release.
Design, setting, and participants: This multiple-trauma cohort (injury severity score, ≥18) included 45 severely injured patients with (n = 27) and without (n = 18) moderate-to-severe traumatic brain injury on emergency computed tomographic imaging. Controls consisted of 24 healthy volunteers. Participants were recruited from December 1, 2013, to October 31, 2022. Blood samples were analyzed for brain-derived tau (BD-tau), total tau (t-tau), and phosphorylated tau 217 (p-tau217) and 231 (p-tau231) levels. Associations among tau concentrations, clinical data, and outcome (eg, Glasgow Coma Scale [GCS] score) were assessed. Data were analyzed from March 1, 2023, to September 30, 2024.
Exposures: Serum BD-tau, t-tau, p-tau217, and p-tau231 levels.
Results: A total of 214 serum samples were analyzed. Median age of the 45 patients was 48 (IQR, 33-60) years (35 [77.8%] male); median age of the 24 controls, 43 (IQR, 28-50) years (16 [66.7%] male). Median serum levels of tau variants were increased in patients with multiple traumatic injuries at day 0 compared with controls (t-tau: 43 [IQR, 21-95] vs 3 [IQR, 3-5] pg/mL; BD-tau: 78 [IQR, 30-343] vs 2 [IQR, 2-3] pg/mL; p-tau231: 61 [IQR, 21-79] vs 2 [IQR, 1-3] pg/mL; all, P < .001). Only median BD-tau levels remained elevated until day 10 (day 1, 25 [IQR, 14-69] pg/mL; day 5, 9 [IQR, 4-15] pg/mL; day 10, 8 [IQR, 4-18] pg/mL). Median tau levels at admission were higher in patients with lower GCS scores (BD-tau: 107 [ IQR, 59-838] vs 33 [IQR, 24-78] pg/mL [P = .01]; p-tau231: 76 [IQR, 36-114] vs 28 [IQR, 9-63] pg/mL [P = .02]). Elevated median tau levels were also observed in patients with hemorrhagic shock vs those without shock (eg, BD-tau on day 0: 113 [IQR, 78-378] vs 31 [IQR, 24-61] pg/mL; P = .002) and in nonsurvivors vs survivors with uncomplicated courses (eg, BD-tau on day 1: 92 [IQR, 22-527] vs 16 [IQR, 7-23] pg/mL; P = .009).
Conclusions and relevance: In this exploratory study among a cohort of patients with multiple traumatic injuries, levels of tau variants reflected both direct and indirect neurological injury, with BD-tau showing the most persistent elevation in the acute phase.
{"title":"Blood-Based Analysis of Different Tau Variants in Patients With Multiple Traumatic Injuries.","authors":"Rebecca Halbgebauer, Fernando Gonzalez-Ortiz, Benjamin Mayer, Claudius Berger, Christian Bergmann, Helen Rinderknecht, Eberhard Barth, Lisa Wohlgemuth, Marco Mannes, Markus Otto, Hayrettin Tumani, Borna Relja, Florian Gebhard, Markus Huber-Lang, Henrik Zetterberg, Steffen Halbgebauer, Kaj Blennow","doi":"10.1001/jamanetworkopen.2025.58573","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.58573","url":null,"abstract":"<p><strong>Importance: </strong>With blood-based phosphorylated tau biomarkers soon to be used for diagnosis of Alzheimer disease, analyzing tau levels in other conditions could enhance biomarker interpretability. Moreover, mechanisms of tau release into circulation remain unclear.</p><p><strong>Objective: </strong>To evaluate concentrations of phosphorylated and nonphosphorylated tau variants in the blood of patients with multiple traumatic injuries on days 0, 1, 5, and 10 and investigate biological processes driving tau release.</p><p><strong>Design, setting, and participants: </strong>This multiple-trauma cohort (injury severity score, ≥18) included 45 severely injured patients with (n = 27) and without (n = 18) moderate-to-severe traumatic brain injury on emergency computed tomographic imaging. Controls consisted of 24 healthy volunteers. Participants were recruited from December 1, 2013, to October 31, 2022. Blood samples were analyzed for brain-derived tau (BD-tau), total tau (t-tau), and phosphorylated tau 217 (p-tau217) and 231 (p-tau231) levels. Associations among tau concentrations, clinical data, and outcome (eg, Glasgow Coma Scale [GCS] score) were assessed. Data were analyzed from March 1, 2023, to September 30, 2024.</p><p><strong>Exposures: </strong>Serum BD-tau, t-tau, p-tau217, and p-tau231 levels.</p><p><strong>Results: </strong>A total of 214 serum samples were analyzed. Median age of the 45 patients was 48 (IQR, 33-60) years (35 [77.8%] male); median age of the 24 controls, 43 (IQR, 28-50) years (16 [66.7%] male). Median serum levels of tau variants were increased in patients with multiple traumatic injuries at day 0 compared with controls (t-tau: 43 [IQR, 21-95] vs 3 [IQR, 3-5] pg/mL; BD-tau: 78 [IQR, 30-343] vs 2 [IQR, 2-3] pg/mL; p-tau231: 61 [IQR, 21-79] vs 2 [IQR, 1-3] pg/mL; all, P < .001). Only median BD-tau levels remained elevated until day 10 (day 1, 25 [IQR, 14-69] pg/mL; day 5, 9 [IQR, 4-15] pg/mL; day 10, 8 [IQR, 4-18] pg/mL). Median tau levels at admission were higher in patients with lower GCS scores (BD-tau: 107 [ IQR, 59-838] vs 33 [IQR, 24-78] pg/mL [P = .01]; p-tau231: 76 [IQR, 36-114] vs 28 [IQR, 9-63] pg/mL [P = .02]). Elevated median tau levels were also observed in patients with hemorrhagic shock vs those without shock (eg, BD-tau on day 0: 113 [IQR, 78-378] vs 31 [IQR, 24-61] pg/mL; P = .002) and in nonsurvivors vs survivors with uncomplicated courses (eg, BD-tau on day 1: 92 [IQR, 22-527] vs 16 [IQR, 7-23] pg/mL; P = .009).</p><p><strong>Conclusions and relevance: </strong>In this exploratory study among a cohort of patients with multiple traumatic injuries, levels of tau variants reflected both direct and indirect neurological injury, with BD-tau showing the most persistent elevation in the acute phase.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 2","pages":"e2558573"},"PeriodicalIF":9.7,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146157054","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}
Pub Date : 2026-02-02DOI: 10.1001/jamanetworkopen.2025.57361
Benjamin A Howell, Junghwan Kim, Thomas A Thornhill, Jinhyung Lee, Emma T Biegacki, Lauretta E Grau, David A Fiellin, Robert Heimer, Gregg S Gonsalves
Importance: The requirement for in-person, often daily, attendance at opioid treatment programs (OTPs) makes travel times a barrier to methadone treatment. Research on methadone accessibility has primarily focused on travel via personal vehicle, and there is uncertainty about public transit travel time to methadone treatment.
Objective: To estimate travel time via personal vehicle vs public transit to methadone treatment in the state of Connecticut.
Design, setting, and participants: This cross-sectional study included geospatial analysis of median travel time to nearest OTP via personal vehicle and public transit from all census block groups (CBGs). This study took place in the state of Connecticut in 2023. Participants were all CBGs in Connecticut.
Exposures: Participants were characterized by racial and ethnic demographics; household income; car ownership; urban, suburban, or rural designations; and per-capita opioid overdose deaths.
Main outcomes and measures: The primary outcome was the median travel time to nearest OTP by via personal vehicle and public transit. Spatial error models using k-nearest neighbor spatial weight matrices were estimated to assess the associations between sociodemographic characteristics and travel times for each transportation mode (personal vehicle vs public transit) at the CBG level.
Results: From the centroids of the 2702 CBGs in Connecticut, the median (IQR) travel time to the closest OTP was 11.0 (7.5-16.3) minutes by personal vehicle and 41.7 (31.0-49.5) minutes via public transit, with 1431 CBGs (53%) lacking access to public transit or having high public transit times (>60 minutes or no trip available). Travel times via public transit increased along the urban-rural gradient and across CBGs with an increasing percentage of non-Hispanic White residents. Median (IQR) travel times to an OTP from the 489 CBGs with the highest per-capita overdose death rates were 8.2 (5.9-11.7) minutes by personal vehicle and 37.6 (27.8-48.5) minutes by public transit, with 166 (34%) lacking public transit access.
Conclusions and relevance: The findings of this cross-sectional study of barriers to access to methadone treatment suggest that areas with high overdose death rates, low car ownership, and high public transit travel times should be targets for interventions (eg, mobile services or greater use of take-home doses for patients) to lower travel-based barriers to methadone. Current federal statutes and regulations governing methadone provision are the greatest barrier, as they directly require often daily transit to opioid treatment clinics. Reducing this barrier requires policy changes.
{"title":"Travel Time to Methadone Treatment Via Personal Vehicle vs Public Transit.","authors":"Benjamin A Howell, Junghwan Kim, Thomas A Thornhill, Jinhyung Lee, Emma T Biegacki, Lauretta E Grau, David A Fiellin, Robert Heimer, Gregg S Gonsalves","doi":"10.1001/jamanetworkopen.2025.57361","DOIUrl":"10.1001/jamanetworkopen.2025.57361","url":null,"abstract":"<p><strong>Importance: </strong>The requirement for in-person, often daily, attendance at opioid treatment programs (OTPs) makes travel times a barrier to methadone treatment. Research on methadone accessibility has primarily focused on travel via personal vehicle, and there is uncertainty about public transit travel time to methadone treatment.</p><p><strong>Objective: </strong>To estimate travel time via personal vehicle vs public transit to methadone treatment in the state of Connecticut.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study included geospatial analysis of median travel time to nearest OTP via personal vehicle and public transit from all census block groups (CBGs). This study took place in the state of Connecticut in 2023. Participants were all CBGs in Connecticut.</p><p><strong>Exposures: </strong>Participants were characterized by racial and ethnic demographics; household income; car ownership; urban, suburban, or rural designations; and per-capita opioid overdose deaths.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the median travel time to nearest OTP by via personal vehicle and public transit. Spatial error models using k-nearest neighbor spatial weight matrices were estimated to assess the associations between sociodemographic characteristics and travel times for each transportation mode (personal vehicle vs public transit) at the CBG level.</p><p><strong>Results: </strong>From the centroids of the 2702 CBGs in Connecticut, the median (IQR) travel time to the closest OTP was 11.0 (7.5-16.3) minutes by personal vehicle and 41.7 (31.0-49.5) minutes via public transit, with 1431 CBGs (53%) lacking access to public transit or having high public transit times (>60 minutes or no trip available). Travel times via public transit increased along the urban-rural gradient and across CBGs with an increasing percentage of non-Hispanic White residents. Median (IQR) travel times to an OTP from the 489 CBGs with the highest per-capita overdose death rates were 8.2 (5.9-11.7) minutes by personal vehicle and 37.6 (27.8-48.5) minutes by public transit, with 166 (34%) lacking public transit access.</p><p><strong>Conclusions and relevance: </strong>The findings of this cross-sectional study of barriers to access to methadone treatment suggest that areas with high overdose death rates, low car ownership, and high public transit travel times should be targets for interventions (eg, mobile services or greater use of take-home doses for patients) to lower travel-based barriers to methadone. Current federal statutes and regulations governing methadone provision are the greatest barrier, as they directly require often daily transit to opioid treatment clinics. Reducing this barrier requires policy changes.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 2","pages":"e2557361"},"PeriodicalIF":9.7,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12869344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146113433","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}
Pub Date : 2026-02-02DOI: 10.1001/jamanetworkopen.2025.55771
Jeffrey H Silber
{"title":"Reporting Failure to Rescue Lands in Europe.","authors":"Jeffrey H Silber","doi":"10.1001/jamanetworkopen.2025.55771","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.55771","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 2","pages":"e2555771"},"PeriodicalIF":9.7,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146119043","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}
Pub Date : 2026-02-02DOI: 10.1001/jamanetworkopen.2025.59108
Jo Yi Chow, Wei Zhi Tan, Liang En Wee, Peihong Guo, Esther Li Wen Choo, Calvin Chiew, Lalitha Kurupatham, Lee Ching Ng, Po Ying Chia, David Lye, Kelvin Bryan Tan, Jue Tao Lim
{"title":"Complications, Deaths, and Disability Burden in the 2 Years Following Dengue Infection.","authors":"Jo Yi Chow, Wei Zhi Tan, Liang En Wee, Peihong Guo, Esther Li Wen Choo, Calvin Chiew, Lalitha Kurupatham, Lee Ching Ng, Po Ying Chia, David Lye, Kelvin Bryan Tan, Jue Tao Lim","doi":"10.1001/jamanetworkopen.2025.59108","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.59108","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 2","pages":"e2559108"},"PeriodicalIF":9.7,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165291","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}
Pub Date : 2026-02-02DOI: 10.1001/jamanetworkopen.2025.56570
Karen B Lasater, Matthew D McHugh, K Jane Muir
{"title":"Organizational Factors to Reattract Nurses to Hospital Employment.","authors":"Karen B Lasater, Matthew D McHugh, K Jane Muir","doi":"10.1001/jamanetworkopen.2025.56570","DOIUrl":"10.1001/jamanetworkopen.2025.56570","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 2","pages":"e2556570"},"PeriodicalIF":9.7,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12887740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146141878","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}
Pub Date : 2026-02-02DOI: 10.1001/jamanetworkopen.2025.57319
Zhe Wang, Qiuda Zheng, Phong K Thai, Coral Gartner, Jake W O'Brien, Richard Bade, Rory Verhagen, Wayne Hall, Daniel Stjepanovic, Bradley S Simpson, Emma L Keller, Kevin V Thomas, Jochen F Mueller, Ben Tscharke
Importance: Australia is leading the world in efforts to reduce tobacco use by implementing high cigarette taxes and restrictive regulations on nicotine vaping products. However, concerns have emerged that these policies may unintentionally drive the expansion of illicit tobacco and vaping markets, potentially undermining public health gains.
Objectives: To assess spatial and temporal changes in total nicotine, tobacco-derived nicotine, and illicit tobacco use across Australian regions of different remoteness from 2017 to 2023.
Design, setting, and participants: This longitudinal, cross-sectional wastewater study was performed from April 2017 to April 2023. Wastewater samples were collected from as many as 55 wastewater treatment plants (WWTPs) in Australia, including 3 remoteness levels: major cities, inner regional, and outer regional to remote areas. The selected WWTPs serve more than 50% of the Australian population.
Main outcomes and measures: Nicotine metabolites (cotinine and hydroxycotinine) and the tobacco-specific alkaloid (anabasine) were analyzed in wastewater samples using a validated liquid-chromatography tandem mass spectrometry method. Total nicotine and tobacco-derived nicotine consumption were back-estimated. Illicit tobacco use was identified in combination with the tobacco sales data.
Results: Wastewater samples collected across Australia, representing 14 million people, were analyzed for back-estimation. Total nicotine consumption declined fastest in outer regional to remote areas (-2.2% annually; 95% CI, -3.2% to -1.1%), followed by inner regional areas (-1.4% annually; 95% CI, -2.1% to -0.8%), and remained stable in major cities. By comparison, tobacco-derived nicotine consumption decreased faster in major cities (-5.0% annually; 95% CI, -8.3% to -1.9%) and inner regional areas (-9.8% annually; 95% CI, -12.5% to -7.3%) than in the outer regional to remote areas (-2.3% annually; 95% CI, -6.0% to 1.8%). Illicit tobacco use was estimated to have increased from 1350 to 3400 tons from 2017 to 2023.
Conclusions and relevance: In this cross-sectional study of wastewater surveillance in Australia, different trends of tobacco use were observed across regions, accompanied by increasing use of illicit tobacco and vaping products. These findings provide evidence for future tobacco and vaping control policies. Ongoing wastewater monitoring is essential for evaluating new tobacco and vaping product control measures implemented in 2024.
{"title":"National Wastewater Surveillance of Illicit Tobacco and Vaping Use Trends in Australia.","authors":"Zhe Wang, Qiuda Zheng, Phong K Thai, Coral Gartner, Jake W O'Brien, Richard Bade, Rory Verhagen, Wayne Hall, Daniel Stjepanovic, Bradley S Simpson, Emma L Keller, Kevin V Thomas, Jochen F Mueller, Ben Tscharke","doi":"10.1001/jamanetworkopen.2025.57319","DOIUrl":"10.1001/jamanetworkopen.2025.57319","url":null,"abstract":"<p><strong>Importance: </strong>Australia is leading the world in efforts to reduce tobacco use by implementing high cigarette taxes and restrictive regulations on nicotine vaping products. However, concerns have emerged that these policies may unintentionally drive the expansion of illicit tobacco and vaping markets, potentially undermining public health gains.</p><p><strong>Objectives: </strong>To assess spatial and temporal changes in total nicotine, tobacco-derived nicotine, and illicit tobacco use across Australian regions of different remoteness from 2017 to 2023.</p><p><strong>Design, setting, and participants: </strong>This longitudinal, cross-sectional wastewater study was performed from April 2017 to April 2023. Wastewater samples were collected from as many as 55 wastewater treatment plants (WWTPs) in Australia, including 3 remoteness levels: major cities, inner regional, and outer regional to remote areas. The selected WWTPs serve more than 50% of the Australian population.</p><p><strong>Main outcomes and measures: </strong>Nicotine metabolites (cotinine and hydroxycotinine) and the tobacco-specific alkaloid (anabasine) were analyzed in wastewater samples using a validated liquid-chromatography tandem mass spectrometry method. Total nicotine and tobacco-derived nicotine consumption were back-estimated. Illicit tobacco use was identified in combination with the tobacco sales data.</p><p><strong>Results: </strong>Wastewater samples collected across Australia, representing 14 million people, were analyzed for back-estimation. Total nicotine consumption declined fastest in outer regional to remote areas (-2.2% annually; 95% CI, -3.2% to -1.1%), followed by inner regional areas (-1.4% annually; 95% CI, -2.1% to -0.8%), and remained stable in major cities. By comparison, tobacco-derived nicotine consumption decreased faster in major cities (-5.0% annually; 95% CI, -8.3% to -1.9%) and inner regional areas (-9.8% annually; 95% CI, -12.5% to -7.3%) than in the outer regional to remote areas (-2.3% annually; 95% CI, -6.0% to 1.8%). Illicit tobacco use was estimated to have increased from 1350 to 3400 tons from 2017 to 2023.</p><p><strong>Conclusions and relevance: </strong>In this cross-sectional study of wastewater surveillance in Australia, different trends of tobacco use were observed across regions, accompanied by increasing use of illicit tobacco and vaping products. These findings provide evidence for future tobacco and vaping control policies. Ongoing wastewater monitoring is essential for evaluating new tobacco and vaping product control measures implemented in 2024.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 2","pages":"e2557319"},"PeriodicalIF":9.7,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12887742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146141906","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}
Pub Date : 2026-02-02DOI: 10.1001/jamanetworkopen.2025.57189
Minerva Rivas Velarde, Laura Catalina Izquierdo Martinez, Jyoti Dalal, Angela Martinez-R, Karen Libey Guevara Rojas, Nicolas Alfonso Parra Valero, Danna Lesley Cruz Reyes, Jess Cuculick, Alexie Vallejo-Silva, Jonathan Irreño-Sotomonte, Nora Groce
Importance: Current interpretation services for Deaf patients who use sign language are often ineffective or unacceptable. In-person interpretation is frequently unavailable, and while video remote interpreting (VRI) remains underused, its scalability may be a solution given interpreter shortages and cost barriers. Existing research focuses on user and interpreter preferences, leaving a critical gap in understanding how interpretation formats affect communication quality.
Objective: To evaluate the effectiveness of VRI in improving communication outcomes between Deaf patients and physicians compared with usual communication tools, such as self-arranging interpretation, lip-reading, note-taking, and the use of images.
Design, setting, and participants: This randomized clinical trial was conducted in Colombia at a public hospital from August 2023 to October 2024, involving Deaf adults who use Colombian Sign Language as their primary language. Participants were randomly assigned to either the control or intervention group. The data were analyzed between January and May 2025.
Interventions: Patients were divided into 2 groups: an intervention group that received a medical appointment via VRI and a control group that received one via the current standard of communication. Both the Deaf participants and the health care professionals were blinded to the allocation.
Main outcomes and measures: An assessment of communication using the Doctor-Patient Communication scale.
Results: Data were collected from 210 Deaf participants, including 123 (58.6%) women and 87 (41.4%) men, with a mean (SD) age of 42 (13) years (range, 18-84 years). Overall, 108 participants (51.4%) reported using VRI. The intervention revealed that having VRI did not always result in improved communication between Deaf individuals and physicians. While those using VRI were more likely to report positive outcomes in certain areas, such as being encouraged to express themselves (odds ratio, 1.90; 95% CI, 1.13-3.18; P = .02), there was no difference in other areas, such as understanding the doctor (OR, 1.33; 95% CI, 0.79-2.23; P = .28).
Conclusions and relevance: In this randomized clinical trial of VRI in the health care context, some aspects of clinical communication were improved, but others were not. This suggests that critical preconditions have to be met for this technology to achieve its intended impact.
重要性:目前为使用手语的聋人提供的口译服务通常是无效的或不可接受的。现场口译通常不可用,而视频远程口译(VRI)仍未得到充分利用,但鉴于口译员短缺和成本障碍,其可扩展性可能是一种解决方案。现有的研究主要集中在用户和口译员的偏好上,在理解口译格式如何影响沟通质量方面留下了关键的空白。目的:评价VRI在改善耳聋患者与医生之间沟通效果方面的效果,并与常用的沟通工具(如自安排传译、唇读、笔记和图像使用)进行比较。设计、环境和参与者:这项随机临床试验于2023年8月至2024年10月在哥伦比亚的一家公立医院进行,涉及以哥伦比亚手语为主要语言的聋人成年人。参与者被随机分配到对照组或干预组。这些数据是在2025年1月至5月期间分析的。干预:患者被分为两组:干预组通过VRI接受医疗预约,对照组通过当前通信标准接受医疗预约。聋人参与者和卫生保健专业人员都对分配不知情。主要结果和措施:使用医患沟通量表评估沟通。结果:收集了210名聋人参与者的数据,其中女性123名(58.6%),男性87名(41.4%),平均(SD)年龄42(13)岁(范围18-84岁)。总体而言,108名参与者(51.4%)报告使用VRI。干预显示,VRI并不总是导致聋人与医生之间沟通的改善。而那些使用VRI的人更有可能在某些领域报告积极的结果,比如被鼓励表达自己(优势比,1.90;95% CI, 1.13-3.18; P =。02),其他方面无差异,如理解医生(OR, 1.33; 95% CI, 0.79-2.23; P = 0.28)。结论和相关性:在这个卫生保健背景下的VRI随机临床试验中,临床沟通的某些方面得到了改善,但其他方面则没有。这表明,这项技术要实现其预期的影响,必须满足关键的先决条件。试验注册:ClinicalTrials.gov标识符:NCT05966623。
{"title":"Video Remote Sign Language Interpreting and Health Communication for Deaf Patients: A Randomized Clinical Trial.","authors":"Minerva Rivas Velarde, Laura Catalina Izquierdo Martinez, Jyoti Dalal, Angela Martinez-R, Karen Libey Guevara Rojas, Nicolas Alfonso Parra Valero, Danna Lesley Cruz Reyes, Jess Cuculick, Alexie Vallejo-Silva, Jonathan Irreño-Sotomonte, Nora Groce","doi":"10.1001/jamanetworkopen.2025.57189","DOIUrl":"10.1001/jamanetworkopen.2025.57189","url":null,"abstract":"<p><strong>Importance: </strong>Current interpretation services for Deaf patients who use sign language are often ineffective or unacceptable. In-person interpretation is frequently unavailable, and while video remote interpreting (VRI) remains underused, its scalability may be a solution given interpreter shortages and cost barriers. Existing research focuses on user and interpreter preferences, leaving a critical gap in understanding how interpretation formats affect communication quality.</p><p><strong>Objective: </strong>To evaluate the effectiveness of VRI in improving communication outcomes between Deaf patients and physicians compared with usual communication tools, such as self-arranging interpretation, lip-reading, note-taking, and the use of images.</p><p><strong>Design, setting, and participants: </strong>This randomized clinical trial was conducted in Colombia at a public hospital from August 2023 to October 2024, involving Deaf adults who use Colombian Sign Language as their primary language. Participants were randomly assigned to either the control or intervention group. The data were analyzed between January and May 2025.</p><p><strong>Interventions: </strong>Patients were divided into 2 groups: an intervention group that received a medical appointment via VRI and a control group that received one via the current standard of communication. Both the Deaf participants and the health care professionals were blinded to the allocation.</p><p><strong>Main outcomes and measures: </strong>An assessment of communication using the Doctor-Patient Communication scale.</p><p><strong>Results: </strong>Data were collected from 210 Deaf participants, including 123 (58.6%) women and 87 (41.4%) men, with a mean (SD) age of 42 (13) years (range, 18-84 years). Overall, 108 participants (51.4%) reported using VRI. The intervention revealed that having VRI did not always result in improved communication between Deaf individuals and physicians. While those using VRI were more likely to report positive outcomes in certain areas, such as being encouraged to express themselves (odds ratio, 1.90; 95% CI, 1.13-3.18; P = .02), there was no difference in other areas, such as understanding the doctor (OR, 1.33; 95% CI, 0.79-2.23; P = .28).</p><p><strong>Conclusions and relevance: </strong>In this randomized clinical trial of VRI in the health care context, some aspects of clinical communication were improved, but others were not. This suggests that critical preconditions have to be met for this technology to achieve its intended impact.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT05966623.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 2","pages":"e2557189"},"PeriodicalIF":9.7,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12873765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146118982","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}
Pub Date : 2026-02-02DOI: 10.1001/jamanetworkopen.2025.58197
Brian C King, Nisha Dalvie, Susanne Hay, Erik A Jensen, John A F Zupancic
Importance: Predischarge car seat tolerance screening (CSTS) has been recommended by the American Academy of Pediatrics since 1991 for preterm and at-risk full-term-born infants. However, it remains unclear whether routine CSTS prevents adverse outcomes after discharge.
Objective: To estimate the frequency of failed CSTS and its association with adverse postdischarge outcomes.
Data sources: PubMed, Embase, and Web of Science were searched for English-language studies published before June 2025.
Study selection: Randomized trials, nonrandomized intervention studies (utilizing a comparison group discharged without CSTS), and single-group observational studies were eligible.
Data extraction and synthesis: Data were extracted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline by 2 reviewers. Study quality was assessed using the Risk of Bias in Nonrandomized Studies tool.
Main outcomes and measures: Outcomes were 30-day readmission, mortality, and predischarge length of stay for intervention studies, and first and subsequent CSTS failure rates for single-group studies. Random-effects models were used to pool data, and generalized linear mixed models were used to estimate pooled treatment effects from 2-group studies and CSTS failure event rates from all included studies.
Results: A total of 21 studies were included. No randomized trials were identified. Three nonrandomized intervention studies (54 358 participants; 27 786 participants without CSTS) reported postdischarge outcomes. There was no difference in 30-day mortality (2 studies; not pooled due to 0 events), 30-day readmissions (odds ratio, 1.05; 95% CI, 0.86-1.28; 3 studies; 54 559 participants), or combined 30-day mortality or readmission (odds ratio, 1.17; 95% CI, 0.95-1.43; 2 studies; 49 420 participants) among infants receiving predischarge CSTS compared with those that did not. Pooled analysis estimated 8.62 (95% CI, 6.42-11.47) first-test failures per 100 patients (21 studies; 39 052 participants) and 24.40 (95% CI, 6.44-34.64) repeat-test failures per 100 patients (11 studies; 912 participants).
Conclusions and relevance: In this systematic review and meta-analysis of predischarge CSTS for preterm and at-risk full-term-born infants, CSTS was not associated with a reduction in postdischarge readmission or mortality. These findings call into question whether routine CSTS before discharge improves outcomes in preterm or at-risk full-term infants.
{"title":"Predischarge Car Seat Tolerance Screening in Preterm and At-Risk Full-Term Infants: A Systematic Review and Meta-Analysis.","authors":"Brian C King, Nisha Dalvie, Susanne Hay, Erik A Jensen, John A F Zupancic","doi":"10.1001/jamanetworkopen.2025.58197","DOIUrl":"10.1001/jamanetworkopen.2025.58197","url":null,"abstract":"<p><strong>Importance: </strong>Predischarge car seat tolerance screening (CSTS) has been recommended by the American Academy of Pediatrics since 1991 for preterm and at-risk full-term-born infants. However, it remains unclear whether routine CSTS prevents adverse outcomes after discharge.</p><p><strong>Objective: </strong>To estimate the frequency of failed CSTS and its association with adverse postdischarge outcomes.</p><p><strong>Data sources: </strong>PubMed, Embase, and Web of Science were searched for English-language studies published before June 2025.</p><p><strong>Study selection: </strong>Randomized trials, nonrandomized intervention studies (utilizing a comparison group discharged without CSTS), and single-group observational studies were eligible.</p><p><strong>Data extraction and synthesis: </strong>Data were extracted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline by 2 reviewers. Study quality was assessed using the Risk of Bias in Nonrandomized Studies tool.</p><p><strong>Main outcomes and measures: </strong>Outcomes were 30-day readmission, mortality, and predischarge length of stay for intervention studies, and first and subsequent CSTS failure rates for single-group studies. Random-effects models were used to pool data, and generalized linear mixed models were used to estimate pooled treatment effects from 2-group studies and CSTS failure event rates from all included studies.</p><p><strong>Results: </strong>A total of 21 studies were included. No randomized trials were identified. Three nonrandomized intervention studies (54 358 participants; 27 786 participants without CSTS) reported postdischarge outcomes. There was no difference in 30-day mortality (2 studies; not pooled due to 0 events), 30-day readmissions (odds ratio, 1.05; 95% CI, 0.86-1.28; 3 studies; 54 559 participants), or combined 30-day mortality or readmission (odds ratio, 1.17; 95% CI, 0.95-1.43; 2 studies; 49 420 participants) among infants receiving predischarge CSTS compared with those that did not. Pooled analysis estimated 8.62 (95% CI, 6.42-11.47) first-test failures per 100 patients (21 studies; 39 052 participants) and 24.40 (95% CI, 6.44-34.64) repeat-test failures per 100 patients (11 studies; 912 participants).</p><p><strong>Conclusions and relevance: </strong>In this systematic review and meta-analysis of predischarge CSTS for preterm and at-risk full-term-born infants, CSTS was not associated with a reduction in postdischarge readmission or mortality. These findings call into question whether routine CSTS before discharge improves outcomes in preterm or at-risk full-term infants.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 2","pages":"e2558197"},"PeriodicalIF":9.7,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12887743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146142249","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}
Pub Date : 2026-02-02DOI: 10.1001/jamanetworkopen.2025.57241
Jennifer Wild, Gabriella Tyson, Graham Thew, Abbie Wilkins, Esther Beierl, Shama El-Salahi, Hjördis Lorenz, Ceri Storch, Haddi Browne, Daniel Morris, Ed Watkins, Anke Ehlers
Importance: Rates of posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) are high among paramedics.
Objective: To evaluate the efficacy of a cognitive resilience training program for reducing the development of PTSD and MDD among early career paramedics compared with psychoeducation and standard practice.
Design, setting, and participants: This randomized clinical trial of paramedics training at 15 universities across England was conducted between October 2017 to October 2022 with 12-month follow-up. Data were analyzed from December 2023 to July 2025.
Intervention: Participants were randomized to receive internet-delivered cognitive training in resilience (iCT-R), psychoeducation, or standard practice. iCT-R, a guided online intervention that utilizes cognitive therapy tools to target predictors of PTSD and MDD identified in prospective research with paramedics, consisted of 6 modules delivered over 6 weeks with 6-monthly top-up sessions delivered by email. Internet-delivered psychoeducation, a supported online psychoeducation intervention, consisted of 6 topics (1 topic per week) with 6-monthly top-up sessions delivered by email. Standard practice was training as usual.
Main outcomes and measures: The primary outcome was rate of PTSD and MDD at 1-year follow-up, assessed by independent assessors blinded to intervention using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Secondary outcomes included measures of PTSD and depression symptom severity, resilience, rumination, anxiety, psychological distress, and well-being. Intent-to-treat analyses were conducted, with the primary outcome analyzed using mixed-effects logistic regression.
Results: Of 570 student paramedics enrolled (372 female [65.3%]; mean [SD] age, 23.67 [6.88] years), 195 were randomized to iCT-R, 197 to psychoeducation, and 178 to standard practice. For participants randomized to iCT-R, the odds of meeting criteria for PTSD or MDD at 12 months were significantly lower compared with psychoeducation (odds ratio [OR], 0.20; 95% CI, 0.05-0.73) and standard practice (OR, 0.25; 95% CI, 0.07-0.97). Providing iCT-R training to 18 to 24 paramedic trainees (number needed to treat) would prevent 1 case of PTSD or MDD.
Conclusions and relevance: In this randomized clinical trial, participants receiving iCT-R were approximately 5 times less likely to develop PTSD or MDD at 1-year follow-up compared with psychoeducation and 4 times less likely when compared with standard practice. These findings suggest that iCT-R appears to decrease the likelihood of developing PTSD and MDD in early career paramedics.
{"title":"Cognitive Resilience Training to Prevent PTSD and Major Depressive Disorder in Paramedic Recruits: A Randomized Clinical Trial.","authors":"Jennifer Wild, Gabriella Tyson, Graham Thew, Abbie Wilkins, Esther Beierl, Shama El-Salahi, Hjördis Lorenz, Ceri Storch, Haddi Browne, Daniel Morris, Ed Watkins, Anke Ehlers","doi":"10.1001/jamanetworkopen.2025.57241","DOIUrl":"10.1001/jamanetworkopen.2025.57241","url":null,"abstract":"<p><strong>Importance: </strong>Rates of posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) are high among paramedics.</p><p><strong>Objective: </strong>To evaluate the efficacy of a cognitive resilience training program for reducing the development of PTSD and MDD among early career paramedics compared with psychoeducation and standard practice.</p><p><strong>Design, setting, and participants: </strong>This randomized clinical trial of paramedics training at 15 universities across England was conducted between October 2017 to October 2022 with 12-month follow-up. Data were analyzed from December 2023 to July 2025.</p><p><strong>Intervention: </strong>Participants were randomized to receive internet-delivered cognitive training in resilience (iCT-R), psychoeducation, or standard practice. iCT-R, a guided online intervention that utilizes cognitive therapy tools to target predictors of PTSD and MDD identified in prospective research with paramedics, consisted of 6 modules delivered over 6 weeks with 6-monthly top-up sessions delivered by email. Internet-delivered psychoeducation, a supported online psychoeducation intervention, consisted of 6 topics (1 topic per week) with 6-monthly top-up sessions delivered by email. Standard practice was training as usual.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was rate of PTSD and MDD at 1-year follow-up, assessed by independent assessors blinded to intervention using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Secondary outcomes included measures of PTSD and depression symptom severity, resilience, rumination, anxiety, psychological distress, and well-being. Intent-to-treat analyses were conducted, with the primary outcome analyzed using mixed-effects logistic regression.</p><p><strong>Results: </strong>Of 570 student paramedics enrolled (372 female [65.3%]; mean [SD] age, 23.67 [6.88] years), 195 were randomized to iCT-R, 197 to psychoeducation, and 178 to standard practice. For participants randomized to iCT-R, the odds of meeting criteria for PTSD or MDD at 12 months were significantly lower compared with psychoeducation (odds ratio [OR], 0.20; 95% CI, 0.05-0.73) and standard practice (OR, 0.25; 95% CI, 0.07-0.97). Providing iCT-R training to 18 to 24 paramedic trainees (number needed to treat) would prevent 1 case of PTSD or MDD.</p><p><strong>Conclusions and relevance: </strong>In this randomized clinical trial, participants receiving iCT-R were approximately 5 times less likely to develop PTSD or MDD at 1-year follow-up compared with psychoeducation and 4 times less likely when compared with standard practice. These findings suggest that iCT-R appears to decrease the likelihood of developing PTSD and MDD in early career paramedics.</p><p><strong>Trial registration: </strong>isrctn.org Identifier: ISRCTN16493616.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 2","pages":"e2557241"},"PeriodicalIF":9.7,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12887744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146142635","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}