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.2025.56865
Britton Scheuermann
{"title":"Targeting Disparities in Cardiovascular Disease Risk Prediction in Asian and Pacific Islander Populations.","authors":"Britton Scheuermann","doi":"10.1001/jamanetworkopen.2025.56865","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.56865","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 2","pages":"e2556865"},"PeriodicalIF":9.7,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165385","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.2025.58954
Bertrand Drugeon, Gabor Mihala, Jessica Schults, Benjamin Bigaud, Jérémy Guenezan, Guillaume Batiot, Natalie Barker, Nicolas Marjanovic, Niccolò Buetti, Olivier Mimoz
Importance: Intravascular catheters are essential in health care but remain a major source of health care-associated infections. Optimal skin antisepsis before insertion is key, yet the most effective antiseptic agent, concentration, and formulation remain uncertain.
Objective: To determine the concentration and formulation of chlorhexidine gluconate (CHG) or povidone-iodine (PVI) associated with the lowest incidence of catheter-related infections (CRIs).
Data sources: PubMed, EMBASE, Cochrane Central, Scopus, Web of Science, and CINAHL were searched through January 7, 2025, without restrictions. Trial registries and reference lists of relevant studies and guidelines were reviewed.
Study selection: Randomized clinical trials (RCTs) comparing CHG- or PVI-based skin antisepsis before insertion of intravascular catheters were eligible if they reported at least 1 CRI outcome (catheter-related bloodstream infection [CRBSI], catheter tip colonization, or local infection). Two independent reviewers screened titles, abstracts, and full texts.
Data extraction and synthesis: Data were extracted independently by 2 reviewers following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk of bias was assessed with the Cochrane risk of bias 2 tool. A random-effects network meta-analysis (NMA) was performed to estimate relative risks (RRs) with 95% CIs.
Main outcomes and measures: The primary outcomes were incidence of CRBSIs, catheter tip colonization, and local infections associated with CHG or PVI formulations.
Results: Sixteen RCTs (7803 patients; 11 985 catheters) met inclusion criteria. When compared with aqueous formulations, alcohol-based formulations were consistently associated with lower infections rates, with isopropyl alcohol being superior to ethanol. Compared with alcoholic PVI, alcoholic CHG was associated with lower CRBSIs (RR, 0.70 [95% CI, 0.45 to 1.08]), catheter tip colonizations (RR, 0.42 [95% CI, 0.37 to 0.48]), and local infections (RR, 0.40 [95% CI, 0.23 to 0.70]). High concentration CHG (1% or higher) further lowered CRBSIs (RR, 0.31 [95% CI, 0.19 to 0.52]) and colonization (RR, 0.36 [95% CI, 0.30 to 0.42]) compared with lower concentrations. Local adverse events were uncommon, slightly more frequent with alcohol-based formulations, and similar between CHG and PVI.
Conclusions and relevance: In this NMA of RCTs, high concentration CHG in isopropyl alcohol was associated with the lowest incidence of CRIs. These results suggest that alcoholic PVI and aqueous formulations should be reserved for situations in which CHG or alcohol cannot be used.
{"title":"Chlorhexidine vs Povidone-Iodine and Incidence of Catheter-Related Infections: A Systematic Review and Meta-Analysis.","authors":"Bertrand Drugeon, Gabor Mihala, Jessica Schults, Benjamin Bigaud, Jérémy Guenezan, Guillaume Batiot, Natalie Barker, Nicolas Marjanovic, Niccolò Buetti, Olivier Mimoz","doi":"10.1001/jamanetworkopen.2025.58954","DOIUrl":"10.1001/jamanetworkopen.2025.58954","url":null,"abstract":"<p><strong>Importance: </strong>Intravascular catheters are essential in health care but remain a major source of health care-associated infections. Optimal skin antisepsis before insertion is key, yet the most effective antiseptic agent, concentration, and formulation remain uncertain.</p><p><strong>Objective: </strong>To determine the concentration and formulation of chlorhexidine gluconate (CHG) or povidone-iodine (PVI) associated with the lowest incidence of catheter-related infections (CRIs).</p><p><strong>Data sources: </strong>PubMed, EMBASE, Cochrane Central, Scopus, Web of Science, and CINAHL were searched through January 7, 2025, without restrictions. Trial registries and reference lists of relevant studies and guidelines were reviewed.</p><p><strong>Study selection: </strong>Randomized clinical trials (RCTs) comparing CHG- or PVI-based skin antisepsis before insertion of intravascular catheters were eligible if they reported at least 1 CRI outcome (catheter-related bloodstream infection [CRBSI], catheter tip colonization, or local infection). Two independent reviewers screened titles, abstracts, and full texts.</p><p><strong>Data extraction and synthesis: </strong>Data were extracted independently by 2 reviewers following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk of bias was assessed with the Cochrane risk of bias 2 tool. A random-effects network meta-analysis (NMA) was performed to estimate relative risks (RRs) with 95% CIs.</p><p><strong>Main outcomes and measures: </strong>The primary outcomes were incidence of CRBSIs, catheter tip colonization, and local infections associated with CHG or PVI formulations.</p><p><strong>Results: </strong>Sixteen RCTs (7803 patients; 11 985 catheters) met inclusion criteria. When compared with aqueous formulations, alcohol-based formulations were consistently associated with lower infections rates, with isopropyl alcohol being superior to ethanol. Compared with alcoholic PVI, alcoholic CHG was associated with lower CRBSIs (RR, 0.70 [95% CI, 0.45 to 1.08]), catheter tip colonizations (RR, 0.42 [95% CI, 0.37 to 0.48]), and local infections (RR, 0.40 [95% CI, 0.23 to 0.70]). High concentration CHG (1% or higher) further lowered CRBSIs (RR, 0.31 [95% CI, 0.19 to 0.52]) and colonization (RR, 0.36 [95% CI, 0.30 to 0.42]) compared with lower concentrations. Local adverse events were uncommon, slightly more frequent with alcohol-based formulations, and similar between CHG and PVI.</p><p><strong>Conclusions and relevance: </strong>In this NMA of RCTs, high concentration CHG in isopropyl alcohol was associated with the lowest incidence of CRIs. These results suggest that alcoholic PVI and aqueous formulations should be reserved for situations in which CHG or alcohol cannot be used.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 2","pages":"e2558954"},"PeriodicalIF":9.7,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165299","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.2025.59227
Han Zhang, Jun Soo Lee, Sein Kim, Ashutosh Kumar, Yu Wang, Omoye Imoisili, Feijun Luo, Utibe R Essien
<p><strong>Importance: </strong>Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a major factor underlying US health care costs. While its clinical burden is well documented, the full economic impact of AF-particularly among working-age adults with productivity losses-remains underexplored.</p><p><strong>Objective: </strong>To estimate medical costs and productivity losses associated with AF among privately insured US employees and assess whether this burden varies by sex and rurality.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study used 2021 Merative MarketScan Commercial Claims and Health and Productivity Management Databases. The sample included adults aged 18 to 64 years with continuous enrollment in noncapitated, employer-sponsored insurance and no pregnancy-related diagnoses. Analyses were conducted during January to July 2025.</p><p><strong>Exposures: </strong>Diagnosis of AF, defined by 1 or more inpatient or emergency department claims or 2 or more outpatient claims with International Classification of Disease, Tenth Revision, Clinical Modification code I48.</p><p><strong>Main outcomes and measures: </strong>Primary outcomes were total all-cause annual medical costs and productivity losses. Medical costs were disaggregated into emergency department, inpatient, outpatient, and prescription costs. Productivity losses included sick leave, short-term disability, and long-term disability; days were observed directly, and dollar-valued costs were estimated by applying national average wages. All outcomes were prespecified. Propensity score overlap weighting was applied to balance covariates.</p><p><strong>Results: </strong>Among 1 612 398 individuals (mean [SD] age, 44.00 [11.11] years; 623 335 female [38.66%]; 1 489 709 [92.39%] living in an urban area), 10 190 (0.63%) were diagnosed with AF. AF was associated with $11 392.55 (95% CI, $10 649.70-$12 135.38) in incremental annual medical costs, primarily from outpatient care ($7058.81 [95% CI, $6563.89-$7553.72] for services and $1874.58 [95% CI, $1600.61-$2148.56] for prescriptions). Compared with those without AF, those with AF had 0.97 (95% CI, 0.02-1.93) excess sick leave days and 2.93 (95% CI, 2.14-3.72) excess short-term disability days, translating to productivity-related costs of $269.81 (95% CI, $144.65-$397.77) for sick leave and $570.51 (95% CI, $471.21-$669.81) for short-term disability. Long-term disability outcomes did not differ significantly. Females incurred higher AF-related emergency (mean difference, $422.61; 95% CI, $178.32-$666.89) and inpatient care costs (mean difference, $1588.67; 95% CI, $466.23-$2711.12) than males.</p><p><strong>Conclusions and relevance: </strong>In this cross-sectional study of privately insured employees, AF was associated with $11 393 in higher medical costs per person, with outpatient care accounting for the largest share, and $840 in higher productivity losses per person. These f
{"title":"Medical Costs and Productivity Losses of Atrial Fibrillation Among US Privately Insured Employees.","authors":"Han Zhang, Jun Soo Lee, Sein Kim, Ashutosh Kumar, Yu Wang, Omoye Imoisili, Feijun Luo, Utibe R Essien","doi":"10.1001/jamanetworkopen.2025.59227","DOIUrl":"10.1001/jamanetworkopen.2025.59227","url":null,"abstract":"<p><strong>Importance: </strong>Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a major factor underlying US health care costs. While its clinical burden is well documented, the full economic impact of AF-particularly among working-age adults with productivity losses-remains underexplored.</p><p><strong>Objective: </strong>To estimate medical costs and productivity losses associated with AF among privately insured US employees and assess whether this burden varies by sex and rurality.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study used 2021 Merative MarketScan Commercial Claims and Health and Productivity Management Databases. The sample included adults aged 18 to 64 years with continuous enrollment in noncapitated, employer-sponsored insurance and no pregnancy-related diagnoses. Analyses were conducted during January to July 2025.</p><p><strong>Exposures: </strong>Diagnosis of AF, defined by 1 or more inpatient or emergency department claims or 2 or more outpatient claims with International Classification of Disease, Tenth Revision, Clinical Modification code I48.</p><p><strong>Main outcomes and measures: </strong>Primary outcomes were total all-cause annual medical costs and productivity losses. Medical costs were disaggregated into emergency department, inpatient, outpatient, and prescription costs. Productivity losses included sick leave, short-term disability, and long-term disability; days were observed directly, and dollar-valued costs were estimated by applying national average wages. All outcomes were prespecified. Propensity score overlap weighting was applied to balance covariates.</p><p><strong>Results: </strong>Among 1 612 398 individuals (mean [SD] age, 44.00 [11.11] years; 623 335 female [38.66%]; 1 489 709 [92.39%] living in an urban area), 10 190 (0.63%) were diagnosed with AF. AF was associated with $11 392.55 (95% CI, $10 649.70-$12 135.38) in incremental annual medical costs, primarily from outpatient care ($7058.81 [95% CI, $6563.89-$7553.72] for services and $1874.58 [95% CI, $1600.61-$2148.56] for prescriptions). Compared with those without AF, those with AF had 0.97 (95% CI, 0.02-1.93) excess sick leave days and 2.93 (95% CI, 2.14-3.72) excess short-term disability days, translating to productivity-related costs of $269.81 (95% CI, $144.65-$397.77) for sick leave and $570.51 (95% CI, $471.21-$669.81) for short-term disability. Long-term disability outcomes did not differ significantly. Females incurred higher AF-related emergency (mean difference, $422.61; 95% CI, $178.32-$666.89) and inpatient care costs (mean difference, $1588.67; 95% CI, $466.23-$2711.12) than males.</p><p><strong>Conclusions and relevance: </strong>In this cross-sectional study of privately insured employees, AF was associated with $11 393 in higher medical costs per person, with outpatient care accounting for the largest share, and $840 in higher productivity losses per person. These f","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 2","pages":"e2559227"},"PeriodicalIF":9.7,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165434","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.2025.57180
Xiaofan Guo, Shiyu Zhou, Jianjun Mu, Chunxia Zhao, Guozhe Sun, Ying Zhou, Yao Yu, Xiangyu Tan, Yangzhi Yin, Ziyi Xie, Wei Miao, Wenhang Li, Caiyu Zhang, Chenhua He, Jie Chen, Xiaoxuan Tian, Tianhao Li, Yifei Chen, Xiaobing Zhou, Mengling Lu, Qiyu Li, Ning Ye, Guangxiao Li, Yingxian Sun
<p><strong>Importance: </strong>Cardiovascular-kidney-metabolic (CKM) syndrome represents a syndromic continuum encompassing overlapping cardiovascular, kidney, and metabolic dysfunction. Hypertension is a central driver in the pathogenesis of CKM syndrome, promoting both kidney and metabolic deterioration, but little is known about the benefits of intensive blood pressure (BP) control across CKM syndrome stages.</p><p><strong>Objective: </strong>To evaluate CKM syndrome stage-specific outcomes, safety, and net clinical benefits associated with a comprehensive intensive BP intervention.</p><p><strong>Design, setting, and participants: </strong>This is a post hoc, secondary analysis of a cluster randomized clinical trial, the China Rural Hypertension Control Project (CRHCP), which was conducted between May 2018 and March 2023. Participants were adults aged 40 years or older with hypertension and CKM syndrome stages 2 to 4, which were defined using standard criteria. Stage 2 indicates that the patient has a metabolic risk factor; stage 3, subclinical cardiovascular disease or predicted 10-year risk of 20% or greater; and stage 4, clinical cardiovascular disease. In this analysis, participants had a median (IQR) follow-up of 3.02 (2.97-3.06) years. Data analysis was conducted from November 2024 to June 2025.</p><p><strong>Intervention: </strong>The comprehensive BP control strategy targeted a systolic BP less than 130 mm Hg and a diastolic BP less than 80 mm Hg. The intervention was delivered by trained nonphysician practitioners.</p><p><strong>Main outcomes and measures: </strong>The primary clinical outcome was a composite of major adverse cardiovascular events (stroke, myocardial infarction, heart failure, or cardiovascular death). Safety outcomes included hypotension, syncope, injurious falls, and kidney adverse events. A quantitative benefit-harm analysis was conducted to estimate net benefit associated with the intervention.</p><p><strong>Results: </strong>Among 33 736 participants (mean [SD] age, 63.0 [9.2] years; 20 677 [61.3%] women), 18 662 (55.3%) had stage 2 CKM syndrome (of whom 9526 [51.0%] received the intervention), 7984 (23.7%) had stage 3 (of whom 4032 [50.5%] received the intervention), and 7090 (21.0%) had stage 4 (of whom 3713 [52.4%] received the intervention). Treatment outcomes were generally consistent across CKM syndrome stages. Intensive BP control was associated with reduced cardiovascular events across all stages: in stage 2, the hazard ratio (HR) was 0.61 (95% CI, 0.50-0.73); in stage 3, the HR was 0.71 (95% CI, 0.58-0.84); and in stage 4, the HR was 0.67 (95% CI, 0.58-0.76). The risk of all-cause mortality was also lower in stage 2 (HR, 0.73; 95% CI, 0.57-0.90) and stage 3 (HR, 0.82; 95% CI, 0.68-0.96) but not in stage 4 (HR, 1.02; 95% CI, 0.84-1.20). Risk of hypotension increased across all stages (relative risk range, 1.79-2.34), while other adverse events, including kidney events, were similar between groups, despit
{"title":"Intensive Blood Pressure Control and Cardiovascular Outcomes Across Cardiovascular-Kidney-Metabolic Syndrome Stages: A Post Hoc Analysis of the China Rural Hypertension Control Project.","authors":"Xiaofan Guo, Shiyu Zhou, Jianjun Mu, Chunxia Zhao, Guozhe Sun, Ying Zhou, Yao Yu, Xiangyu Tan, Yangzhi Yin, Ziyi Xie, Wei Miao, Wenhang Li, Caiyu Zhang, Chenhua He, Jie Chen, Xiaoxuan Tian, Tianhao Li, Yifei Chen, Xiaobing Zhou, Mengling Lu, Qiyu Li, Ning Ye, Guangxiao Li, Yingxian Sun","doi":"10.1001/jamanetworkopen.2025.57180","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.57180","url":null,"abstract":"<p><strong>Importance: </strong>Cardiovascular-kidney-metabolic (CKM) syndrome represents a syndromic continuum encompassing overlapping cardiovascular, kidney, and metabolic dysfunction. Hypertension is a central driver in the pathogenesis of CKM syndrome, promoting both kidney and metabolic deterioration, but little is known about the benefits of intensive blood pressure (BP) control across CKM syndrome stages.</p><p><strong>Objective: </strong>To evaluate CKM syndrome stage-specific outcomes, safety, and net clinical benefits associated with a comprehensive intensive BP intervention.</p><p><strong>Design, setting, and participants: </strong>This is a post hoc, secondary analysis of a cluster randomized clinical trial, the China Rural Hypertension Control Project (CRHCP), which was conducted between May 2018 and March 2023. Participants were adults aged 40 years or older with hypertension and CKM syndrome stages 2 to 4, which were defined using standard criteria. Stage 2 indicates that the patient has a metabolic risk factor; stage 3, subclinical cardiovascular disease or predicted 10-year risk of 20% or greater; and stage 4, clinical cardiovascular disease. In this analysis, participants had a median (IQR) follow-up of 3.02 (2.97-3.06) years. Data analysis was conducted from November 2024 to June 2025.</p><p><strong>Intervention: </strong>The comprehensive BP control strategy targeted a systolic BP less than 130 mm Hg and a diastolic BP less than 80 mm Hg. The intervention was delivered by trained nonphysician practitioners.</p><p><strong>Main outcomes and measures: </strong>The primary clinical outcome was a composite of major adverse cardiovascular events (stroke, myocardial infarction, heart failure, or cardiovascular death). Safety outcomes included hypotension, syncope, injurious falls, and kidney adverse events. A quantitative benefit-harm analysis was conducted to estimate net benefit associated with the intervention.</p><p><strong>Results: </strong>Among 33 736 participants (mean [SD] age, 63.0 [9.2] years; 20 677 [61.3%] women), 18 662 (55.3%) had stage 2 CKM syndrome (of whom 9526 [51.0%] received the intervention), 7984 (23.7%) had stage 3 (of whom 4032 [50.5%] received the intervention), and 7090 (21.0%) had stage 4 (of whom 3713 [52.4%] received the intervention). Treatment outcomes were generally consistent across CKM syndrome stages. Intensive BP control was associated with reduced cardiovascular events across all stages: in stage 2, the hazard ratio (HR) was 0.61 (95% CI, 0.50-0.73); in stage 3, the HR was 0.71 (95% CI, 0.58-0.84); and in stage 4, the HR was 0.67 (95% CI, 0.58-0.76). The risk of all-cause mortality was also lower in stage 2 (HR, 0.73; 95% CI, 0.57-0.90) and stage 3 (HR, 0.82; 95% CI, 0.68-0.96) but not in stage 4 (HR, 1.02; 95% CI, 0.84-1.20). Risk of hypotension increased across all stages (relative risk range, 1.79-2.34), while other adverse events, including kidney events, were similar between groups, despit","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 2","pages":"e2557180"},"PeriodicalIF":9.7,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146180057","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.2025.56111
John L Havlik, Keith Humphreys
{"title":"Costs and Outcomes in Telemedicine-Can \"House Calls\" Make Sense and Cents?","authors":"John L Havlik, Keith Humphreys","doi":"10.1001/jamanetworkopen.2025.56111","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.56111","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 2","pages":"e2556111"},"PeriodicalIF":9.7,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146142666","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.2025.56357
Suzanna M Zick, Dongru Chen, Richard E Harris, Grant Kruger, Amy Runyon, Ananda Sen, Sara Snyder, Celeste Leigh Pearce
<p><strong>Importance: </strong>Fatigue is a burdensome effect of ovarian cancer that is associated with poor sleep and quality of life. Self-acupressure is recommended in clinical guidelines but has substantial barriers to implementation. Use of a mobile app may address these barriers.</p><p><strong>Objective: </strong>To investigate whether 6 weeks of true self-acupressure (TSA), learned via a mobile app, improves cancer fatigue, sleep, and quality of life in women with ovarian cancer compared with sham self-acupressure (SSA) and usual care (UC) and whether changes are sustained during an 18-week washout period.</p><p><strong>Design, setting, and participants: </strong>This phase 3 single-blind randomized clinical trial was conducted from October 2019 to December 2023. Data collection ended in November 2024. Participants included ovarian cancer survivors who were fatigued (based on a Brief Fatigue Inventory [BFI] score ≥4) and who were recruited from tumor registries and social media.</p><p><strong>Intervention: </strong>Randomization (1:1:1) to 6 weeks of TSA or SSA, taught via mobile app, or UC.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the change in the BFI from baseline to week 6. Secondary analyses were the BFI score at week 24 and sleep disturbance (based on the Pittsburgh Sleep Quality Index) and quality of life (based on the Functional Assessment of Cancer Therapy-Ovarian) administered at baseline and at weeks 6, 12, and 24.</p><p><strong>Results: </strong>Among the 360 participants who were screened, 171 women were randomized (mean [SD] age, 56 [12] years). Of the 160 participants who were allocated to the arms, 53 (33.1%) received TSA, 56 (35.0%) received SSA, and 51 (31.9%) received UC. Of these, the proportion achieving a clinically normal fatigue level at the end of treatment was 58.5% for the TSA arm, 51.1% for the SSA arm, and 17.6% for the UC arm. At 6 weeks, the BFI change scores were significantly better in the TSA arm but not in the SSA arm when they were compared with the UC-only arm (TSA vs UC: adjusted mean difference, -1.23 [95% CI, -2.17 to -0.29] and SSA vs UC: adjusted mean difference, -0.91 [95% CI, -1.83 to 0.02]). TSA and SSA change scores did not differ significantly from one another. The relative benefit of self-acupressure compared with UC on fatigue persisted at 24 weeks (TSA vs UC: mean difference, -1.38 [95% CI, -2.36 to -0.41] and SSA vs UC: mean difference, -0.97 [95% CI, -1.93 to -0.02]). Neither TSA nor SSA was significantly different than UC or each other for sleep quality. Only TSA significantly improved quality of life vs UC (odds ratio, 2.85 [95% CI, 1.20 to 6.80]). Neither true nor sham self-acupressure led to any adverse events.</p><p><strong>Conclusions and relevance: </strong>In this randomized clinical trial, TSA and SSA significantly reduced fatigue compared with UC, and these changes were both clinically meaningful and sustained. No impact was observed on sleep q
{"title":"Self-Acupressure for Fatigue in Patients Surviving Ovarian Cancer: A Randomized Clinical Trial.","authors":"Suzanna M Zick, Dongru Chen, Richard E Harris, Grant Kruger, Amy Runyon, Ananda Sen, Sara Snyder, Celeste Leigh Pearce","doi":"10.1001/jamanetworkopen.2025.56357","DOIUrl":"10.1001/jamanetworkopen.2025.56357","url":null,"abstract":"<p><strong>Importance: </strong>Fatigue is a burdensome effect of ovarian cancer that is associated with poor sleep and quality of life. Self-acupressure is recommended in clinical guidelines but has substantial barriers to implementation. Use of a mobile app may address these barriers.</p><p><strong>Objective: </strong>To investigate whether 6 weeks of true self-acupressure (TSA), learned via a mobile app, improves cancer fatigue, sleep, and quality of life in women with ovarian cancer compared with sham self-acupressure (SSA) and usual care (UC) and whether changes are sustained during an 18-week washout period.</p><p><strong>Design, setting, and participants: </strong>This phase 3 single-blind randomized clinical trial was conducted from October 2019 to December 2023. Data collection ended in November 2024. Participants included ovarian cancer survivors who were fatigued (based on a Brief Fatigue Inventory [BFI] score ≥4) and who were recruited from tumor registries and social media.</p><p><strong>Intervention: </strong>Randomization (1:1:1) to 6 weeks of TSA or SSA, taught via mobile app, or UC.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the change in the BFI from baseline to week 6. Secondary analyses were the BFI score at week 24 and sleep disturbance (based on the Pittsburgh Sleep Quality Index) and quality of life (based on the Functional Assessment of Cancer Therapy-Ovarian) administered at baseline and at weeks 6, 12, and 24.</p><p><strong>Results: </strong>Among the 360 participants who were screened, 171 women were randomized (mean [SD] age, 56 [12] years). Of the 160 participants who were allocated to the arms, 53 (33.1%) received TSA, 56 (35.0%) received SSA, and 51 (31.9%) received UC. Of these, the proportion achieving a clinically normal fatigue level at the end of treatment was 58.5% for the TSA arm, 51.1% for the SSA arm, and 17.6% for the UC arm. At 6 weeks, the BFI change scores were significantly better in the TSA arm but not in the SSA arm when they were compared with the UC-only arm (TSA vs UC: adjusted mean difference, -1.23 [95% CI, -2.17 to -0.29] and SSA vs UC: adjusted mean difference, -0.91 [95% CI, -1.83 to 0.02]). TSA and SSA change scores did not differ significantly from one another. The relative benefit of self-acupressure compared with UC on fatigue persisted at 24 weeks (TSA vs UC: mean difference, -1.38 [95% CI, -2.36 to -0.41] and SSA vs UC: mean difference, -0.97 [95% CI, -1.93 to -0.02]). Neither TSA nor SSA was significantly different than UC or each other for sleep quality. Only TSA significantly improved quality of life vs UC (odds ratio, 2.85 [95% CI, 1.20 to 6.80]). Neither true nor sham self-acupressure led to any adverse events.</p><p><strong>Conclusions and relevance: </strong>In this randomized clinical trial, TSA and SSA significantly reduced fatigue compared with UC, and these changes were both clinically meaningful and sustained. No impact was observed on sleep q","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 2","pages":"e2556357"},"PeriodicalIF":9.7,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12878437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146124731","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.2025.56117
Lauren A Eberly, Carmen George, Sharon Sandman, Denee Bex, Matt Chandra, Kaitlyn Shultz, Ada Tennison, Rebecca Wickre, Bennett Wickre, Larissa Morgan, Leah Gray, Mackenzie Bolas, Benjamin Feliciano, DezBaa Damon-Mallette, Erica Lindsey, Jacob Manche, Pamela Detsoi-Smiley, Paula Mora, Maricruz Merino, Sonya S Shin
<p><strong>Importance: </strong>The ongoing consequences of settler colonialism produce adverse structural drivers, particularly nutrition insecurity, that contribute to cardiovascular health disparities among Indigenous populations. There is increased focus in Native communities to reclaim traditional precontact foods to improve health. Therefore, a locally sourced, Indigenous, medically tailored meal delivery program-MUTTON-HF (Medically Utilized Tailored Traditional Foods to Optimize Nutrition in Heart Failure)-was developed to improve health outcomes.</p><p><strong>Objective: </strong>To determine implementation outcomes, including feasibility and acceptability, as well as to explore preintervention vs postintervention health measures of a medically tailored meal program incorporating traditional foods and recipes for patients with heart failure in rural Navajo Nation.</p><p><strong>Design, setting, and participants: </strong>The single-arm pilot nonrandomized clinical trial was conducted from October 7, 2024, to February 3, 2025, to evaluate implementation and health outcomes of the MUTTON-HF program. Participants included adults (≥18 years) with a diagnosis of heart failure who were receiving care at one of 2 Indian Health Service sites in rural Navajo Nation.</p><p><strong>Intervention: </strong>Patients received 14 culturally and medically tailored meals weekly (2 meals daily) for 4 weeks.</p><p><strong>Main outcomes and measures: </strong>The primary outcomes were intervention feasibility and acceptability, assessed with surveys, qualitative interviews, and programmatic data at 30 days. Intervention feasibility was determined by evaluating the number and percentage of meal boxes successfully received by each patient. Acceptability was assessed using the Acceptability of Intervention Measure (AIM) (score range, 4-20), patient program ratings (range, 1-10), and the Net Promoter Score. Secondary outcomes, which were assessed via surveys and medical record review, included intervention adoption and fidelity, feasibility for community partners (including farmers and ranchers, using the Feasibility of Intervention Measure [score range, 4-20]), and preintervention vs postintervention health measures (eg, clinical biomarkers, food insecurity [based on the US Department of Agriculture 6-item Short-Form Food Security Survey Module], 12-item Kansas City Cardiomyopathy Questionnaire [KCCQ] scores, and Cultural Connectedness Scale [CCS] scores).</p><p><strong>Results: </strong>This study enrolled 20 American Indian patients (mean [SD] age, 58.2 [11.7] years; 13 were male [65.0%]) residing in communities exceeding a 136-km radius in Arizona and New Mexico. Patients had a mean (SD) left ventricular ejection fraction of 40.0% (16.0%). Of the 80 weekly meal boxes, 72 (90.0%) were successfully received by patients. The mean (SD) AIM score was 16.9 (3.1), the mean (SD) patient program rating was 8.6 (1.6), and the Net Promoter Score was 45.0%. Most patient
{"title":"Feasibility of an Indigenous Food Is Medicine Program for Patients With Heart Failure in Rural Navajo Nation: The MUTTON-HF Nonrandomized Clinical Trial.","authors":"Lauren A Eberly, Carmen George, Sharon Sandman, Denee Bex, Matt Chandra, Kaitlyn Shultz, Ada Tennison, Rebecca Wickre, Bennett Wickre, Larissa Morgan, Leah Gray, Mackenzie Bolas, Benjamin Feliciano, DezBaa Damon-Mallette, Erica Lindsey, Jacob Manche, Pamela Detsoi-Smiley, Paula Mora, Maricruz Merino, Sonya S Shin","doi":"10.1001/jamanetworkopen.2025.56117","DOIUrl":"10.1001/jamanetworkopen.2025.56117","url":null,"abstract":"<p><strong>Importance: </strong>The ongoing consequences of settler colonialism produce adverse structural drivers, particularly nutrition insecurity, that contribute to cardiovascular health disparities among Indigenous populations. There is increased focus in Native communities to reclaim traditional precontact foods to improve health. Therefore, a locally sourced, Indigenous, medically tailored meal delivery program-MUTTON-HF (Medically Utilized Tailored Traditional Foods to Optimize Nutrition in Heart Failure)-was developed to improve health outcomes.</p><p><strong>Objective: </strong>To determine implementation outcomes, including feasibility and acceptability, as well as to explore preintervention vs postintervention health measures of a medically tailored meal program incorporating traditional foods and recipes for patients with heart failure in rural Navajo Nation.</p><p><strong>Design, setting, and participants: </strong>The single-arm pilot nonrandomized clinical trial was conducted from October 7, 2024, to February 3, 2025, to evaluate implementation and health outcomes of the MUTTON-HF program. Participants included adults (≥18 years) with a diagnosis of heart failure who were receiving care at one of 2 Indian Health Service sites in rural Navajo Nation.</p><p><strong>Intervention: </strong>Patients received 14 culturally and medically tailored meals weekly (2 meals daily) for 4 weeks.</p><p><strong>Main outcomes and measures: </strong>The primary outcomes were intervention feasibility and acceptability, assessed with surveys, qualitative interviews, and programmatic data at 30 days. Intervention feasibility was determined by evaluating the number and percentage of meal boxes successfully received by each patient. Acceptability was assessed using the Acceptability of Intervention Measure (AIM) (score range, 4-20), patient program ratings (range, 1-10), and the Net Promoter Score. Secondary outcomes, which were assessed via surveys and medical record review, included intervention adoption and fidelity, feasibility for community partners (including farmers and ranchers, using the Feasibility of Intervention Measure [score range, 4-20]), and preintervention vs postintervention health measures (eg, clinical biomarkers, food insecurity [based on the US Department of Agriculture 6-item Short-Form Food Security Survey Module], 12-item Kansas City Cardiomyopathy Questionnaire [KCCQ] scores, and Cultural Connectedness Scale [CCS] scores).</p><p><strong>Results: </strong>This study enrolled 20 American Indian patients (mean [SD] age, 58.2 [11.7] years; 13 were male [65.0%]) residing in communities exceeding a 136-km radius in Arizona and New Mexico. Patients had a mean (SD) left ventricular ejection fraction of 40.0% (16.0%). Of the 80 weekly meal boxes, 72 (90.0%) were successfully received by patients. The mean (SD) AIM score was 16.9 (3.1), the mean (SD) patient program rating was 8.6 (1.6), and the Net Promoter Score was 45.0%. Most patient","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 2","pages":"e2556117"},"PeriodicalIF":9.7,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12881988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146131753","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.2025.56631
Anne J Maheux, Samir Akre-Bhide, Debra Boeldt, Jessica E Flannery, Zachary Richardson, Kaitlyn Burnell, Eva H Telzer, Scott H Kollins
Importance: As generative artificial intelligence (GenAI) tools become increasingly integrated into the daily lives of youth, it is critical to study their usage patterns and potential implications for mental health. While there is evidence of a rapid pace of adoption among adults, rates of GenAI use among youth remains largely undocumented.
Objective: To characterize GenAI application (app) usage among US youth, including adoption rates and time spent.
Design, setting, and participants: This cross-sectional study documented digital behavior of US youth extracted from a parental monitoring app. Participants were ages 4 to 17 years and were in families using a commercially available Aura app in the US. No identifying information was collected about the child except year of birth. Data were collected using passive sensing methods from naturalistic smart device use between September 2024 and April 2025. Data were analyzed in May and June 2025.
Main outcome and measures: Adoption rates (ie, number of youth ever accessing GenAI apps on their device) and time spent using GenAI (ie, average minutes accessing GenAI apps), measured by age and time period.
Results: In a cohort of 6488 participants, nearly 2072 youths (31.9%) used GenAI apps on their device. GenAI use was highest among teens (age 13 to 14 years, 899 of 2139 [42.0%]; age 15 to 17 years, 628 of 1246 [50.4%]), although adoption among preteens (age 10 to 12 years, 484 of 2366 [20.5%]) and school-aged children (age 8 to 9 years, 49 of 522 [9.4%]) was not trivial. GenAI usage was higher after school than at nighttime or during school. Overall, users spent a mean (SD) 2.37 (10.55) and a median (IQR) 0.18 (0.04-0.84) minutes a day using GenAI, yet large variances and skewed distributions suggest that a small subset of youth use GenAI extensively, with the heaviest users accessing GenAI for over 40 minutes a day.
Conclusions and relevance: In this cross-sectional study, Gen AI app use varied widely among participants, with up to half of adolescents having some use and a small subset engaging in heavy use. Future research must address individual differences in GenAI use to determine impacts on development.
{"title":"Generative Artificial Intelligence Applications Use Among US Youth.","authors":"Anne J Maheux, Samir Akre-Bhide, Debra Boeldt, Jessica E Flannery, Zachary Richardson, Kaitlyn Burnell, Eva H Telzer, Scott H Kollins","doi":"10.1001/jamanetworkopen.2025.56631","DOIUrl":"10.1001/jamanetworkopen.2025.56631","url":null,"abstract":"<p><strong>Importance: </strong>As generative artificial intelligence (GenAI) tools become increasingly integrated into the daily lives of youth, it is critical to study their usage patterns and potential implications for mental health. While there is evidence of a rapid pace of adoption among adults, rates of GenAI use among youth remains largely undocumented.</p><p><strong>Objective: </strong>To characterize GenAI application (app) usage among US youth, including adoption rates and time spent.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study documented digital behavior of US youth extracted from a parental monitoring app. Participants were ages 4 to 17 years and were in families using a commercially available Aura app in the US. No identifying information was collected about the child except year of birth. Data were collected using passive sensing methods from naturalistic smart device use between September 2024 and April 2025. Data were analyzed in May and June 2025.</p><p><strong>Main outcome and measures: </strong>Adoption rates (ie, number of youth ever accessing GenAI apps on their device) and time spent using GenAI (ie, average minutes accessing GenAI apps), measured by age and time period.</p><p><strong>Results: </strong>In a cohort of 6488 participants, nearly 2072 youths (31.9%) used GenAI apps on their device. GenAI use was highest among teens (age 13 to 14 years, 899 of 2139 [42.0%]; age 15 to 17 years, 628 of 1246 [50.4%]), although adoption among preteens (age 10 to 12 years, 484 of 2366 [20.5%]) and school-aged children (age 8 to 9 years, 49 of 522 [9.4%]) was not trivial. GenAI usage was higher after school than at nighttime or during school. Overall, users spent a mean (SD) 2.37 (10.55) and a median (IQR) 0.18 (0.04-0.84) minutes a day using GenAI, yet large variances and skewed distributions suggest that a small subset of youth use GenAI extensively, with the heaviest users accessing GenAI for over 40 minutes a day.</p><p><strong>Conclusions and relevance: </strong>In this cross-sectional study, Gen AI app use varied widely among participants, with up to half of adolescents having some use and a small subset engaging in heavy use. Future research must address individual differences in GenAI use to determine impacts on development.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 2","pages":"e2556631"},"PeriodicalIF":9.7,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12865656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146104792","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.2025.57332
David Adzrago, Kayo Fujimoto, J Michael Wilkerson, Typhanye V Dyer, Faustine Williams
<p><strong>Importance: </strong>Mental health problems, particularly anxiety and depression, remain among the leading causes of disease burden in the US. However, trends in anxiety and depression across disability status and demographics remain understudied.</p><p><strong>Objective: </strong>To examine trends in anxiety and depression prevalence among US adults from 2019 to 2023 by disability status and demographic characteristics.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study used national population-based data from the National Health Interview Surveys from 2019 to 2023. Data were collected from household probability samples of noninstitutionalized US civilian adults aged at least 18 years. Data analyses were performed from December 6, 2024, to November 19, 2025.</p><p><strong>Exposures: </strong>Disability status (measured using Washington Group on Disability Statistics Short Set on Functioning), race and ethnicity, sex, and nativity.</p><p><strong>Main outcomes and measures: </strong>The primary outcomes were self-reported anxiety or depression symptoms, assessed using the Washington Group on Disability Statistics Extended Set on Functioning. Joinpoint regression was used to estimate age-standardized prevalence trends and average annual percentage change (AAPC) across disability status, race and ethnicity, sex, and nativity.</p><p><strong>Results: </strong>A total of 150 220 adults were examined (81 525 [51.3%] female; 48 814 individuals [32.3%] aged 45-64 years; 126 051 individuals [81.1%] born in the US), including 16 172 Black individuals (11.9%), 20 427 Hispanic or Latino individuals (17.7%), 12 221 individuals (8.9%) who identified as another race or ethnicity, and 101 400 White individuals (61.4%). There were 15 519 respondents (8.2%) with general disability status and 60 248 respondents (42.3%) with anxiety or depression. From 2019 to 2023, anxiety or depression prevalence increased significantly among individuals without disabilities (AAPC, 3.93; 95% CI, 2.15-5.75). Prevalence increased across all racial and ethnic groups without disabilities, with the highest increases among Black respondents (AAPC, 4.77; 95% CI, 0.61-9.10) and respondents who identified as another race or ethnicity (AAPC, 6.95; 95% CI, 2.56-11.53). Prevalence increased only among females without disabilities (AAPC, 3.50; 95% CI, 2.14-4.87), while increases were observed among males with (AAPC, 3.25; 95% CI, 0.41-6.17) and without (AAPC, 4.62; 95% CI, 1.70-7.63) disabilities. Individuals born outside the US without disabilities experienced higher increases (AAPC, 5.57; 95% CI, 3.10-8.11) than those with disabilities (AAPC, 3.46; 95% CI, 0.06-6.98) and individuals born in the US without disabilities (AAPC, 3.75; 95% CI, 2.14-5.40). Across race and ethnicity, sex, and nativity intersections, Black female individuals born outside the US without disabilities exhibited the highest increase (AAPC, 14.89; 95% CI, 0.48-31.36).</p><p><st
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