JAMA Network Open最新文献_第5页

Costs and Outcomes in Telemedicine-Can "House Calls" Make Sense and Cents? 远程医疗的成本和结果——“上门服务”有意义吗？

IF 9.7 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

JAMA Network Open

Pub Date : 2026-02-02 DOI: 10.1001/jamanetworkopen.2025.56111

John L Havlik, Keith Humphreys

引用次数: 0

Self-Acupressure for Fatigue in Patients Surviving Ovarian Cancer: A Randomized Clinical Trial. 自我穴位按压治疗卵巢癌患者的疲劳：一项随机临床试验。

IF 9.7 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

JAMA Network Open

Pub Date : 2026-02-02 DOI: 10.1001/jamanetworkopen.2025.56357

Suzanna M Zick, Dongru Chen, Richard E Harris, Grant Kruger, Amy Runyon, Ananda Sen, Sara Snyder, Celeste Leigh Pearce

Importance: 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.Objective: 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.Design, setting, and participants: 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.Intervention: Randomization (1:1:1) to 6 weeks of TSA or SSA, taught via mobile app, or UC.Main outcomes and measures: 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.Results: 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.Conclusions and relevance: 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

重要性：疲劳是卵巢癌的一个负担，与睡眠和生活质量差有关。自指压是临床指南中推荐的，但在实施方面存在实质性障碍。使用移动应用程序可以解决这些障碍。目的：探讨与假自我穴位按压（SSA）和常规护理（UC）相比，通过移动应用程序学习6周的真自我穴位按压（TSA）是否能改善卵巢癌女性的癌症疲劳、睡眠和生活质量，以及在18周的洗脱期是否能持续改变。设计、环境和参与者：该3期单盲随机临床试验于2019年10月至2023年12月进行。数据收集于2024年11月结束。参与者包括疲劳的卵巢癌幸存者（基于简短疲劳量表[BFI]评分≥4），并从肿瘤登记处和社交媒体中招募。干预：随机（1:1:1）至6周的TSA或SSA，通过移动应用程序或UC进行教学。主要结局和测量：主要结局是BFI从基线到第6周的变化。次要分析是第24周的BFI评分，以及基线和第6周、第12周和第24周的睡眠障碍（基于匹兹堡睡眠质量指数）和生活质量（基于卵巢癌治疗功能评估）。结果：在360名被筛查的参与者中，171名女性被随机分配（平均[SD]年龄为56岁）。在160名被分配到两组的参与者中，53名（33.1%）接受TSA， 56名（35.0%）接受SSA， 51名（31.9%）接受UC。其中，TSA组在治疗结束时达到临床正常疲劳水平的比例为58.5%，SSA组为51.1%，UC组为17.6%。6周时，与仅UC组相比，TSA组的BFI变化评分明显更好，而SSA组则没有（TSA vs UC：调整平均差值，-1.23 [95% CI, -2.17至-0.29]，SSA vs UC：调整平均差值，-0.91 [95% CI, -1.83至0.02]）。TSA和SSA的变化分数彼此之间没有显著差异。与UC相比，自指压对疲劳的相对益处持续到24周（TSA与UC：平均差异，-1.38 [95% CI, -2.36至-0.41]，SSA与UC：平均差异，-0.97 [95% CI, -1.93至-0.02]）。在睡眠质量方面，TSA和SSA与UC或彼此之间均无显著差异。与UC相比，只有TSA显著改善了生活质量（优势比为2.85 [95% CI， 1.20至6.80]）。真实或虚假的自我穴位按压均未导致任何不良事件。结论和相关性：在这项随机临床试验中，与UC相比，TSA和SSA显著减轻了疲劳，并且这些变化具有临床意义和持续性。没有观察到对睡眠质量的影响。通过移动应用程序教授的自我穴位按摩，为治疗癌症疲劳提供了一种安全、低成本的选择。试验注册：ClinicalTrials.gov标识符：NCT03763838。

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引用次数: 0

Feasibility of an Indigenous Food Is Medicine Program for Patients With Heart Failure in Rural Navajo Nation: The MUTTON-HF Nonrandomized Clinical Trial. 纳瓦霍乡村心力衰竭患者土著食物即药物项目的可行性：羊肉- hf非随机临床试验。

IF 9.7 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

JAMA Network Open

Pub Date : 2026-02-02 DOI: 10.1001/jamanetworkopen.2025.56117

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

Importance: 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.Objective: 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.Design, setting, and participants: 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.Intervention: Patients received 14 culturally and medically tailored meals weekly (2 meals daily) for 4 weeks.Main outcomes and measures: 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).Results: 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

重要性：移民殖民主义的持续后果产生了不利的结构性驱动因素，特别是营养不安全，导致土著人口之间心血管健康的差异。土著社区越来越重视回收传统的接触前食品以改善健康。因此，开发了一种本地采购的、土著的、医学定制的膳食供应计划——mutton - hf（医学上利用定制的传统食品来优化心力衰竭患者的营养），以改善健康状况。目的：确定实施结果，包括可行性和可接受性，并探讨针对纳瓦霍族农村心力衰竭患者的医学定制膳食计划的干预前和干预后健康措施，该计划包括传统食物和食谱。设计、环境和参与者：从2024年10月7日至2025年2月3日进行了单臂非随机临床试验，以评估MUTTON-HF项目的实施和健康结果。参与者包括被诊断为心力衰竭的成年人（≥18岁），他们在纳瓦霍族农村的2个印第安人卫生服务点之一接受治疗。干预：患者每周接受14次文化和医学定制餐（每天2餐），持续4周。主要结果和措施：主要结果是干预的可行性和可接受性，通过调查、定性访谈和30天的规划数据进行评估。通过评估每位患者成功接收餐盒的数量和百分比来确定干预的可行性。采用干预措施可接受性（AIM）（评分范围，4-20）、患者方案评分（范围，1-10）和净推荐评分来评估可接受性。次要结果通过调查和医疗记录审查进行评估，包括干预措施的采用和保真度，社区合作伙伴（包括农民和牧场主，使用干预措施的可行性[得分范围，4-20]）的可行性，以及干预前与干预后的健康措施（如临床生物标志物，粮食不安全[基于美国农业部6项简短形式粮食安全调查模块]）。12项堪萨斯城心肌病问卷[KCCQ]评分和文化联系量表[CCS]评分)。结果：本研究纳入了20例居住在亚利桑那州和新墨西哥州半径超过136 km的社区的美洲印第安人患者（平均[SD]年龄58.2[11.7]岁，男性13例[65.0%]）。患者的平均左室射血分数（SD）为40.0%（16.0%）。80份每周餐盒中，72份（90.0%）被患者成功接收。平均（SD） AIM评分为16.9(3.1)，平均（SD）患者计划评分为8.6(1.6)，净推荐评分为45.0%。大多数患者（17例[85.0%]）报告说，他们可能会改变饮食习惯，使其更加健康。社区农民和牧场主的干预措施可行性平均（SD）得分为19.8(0.5)，社区合作伙伴的干预措施可行性平均（SD）得分为20(0)。在食物安全（食物安全的患者人数从8人[40.0%]增加到17人[85.0%]）、KCCQ身体限制（平均[SD]，从59.6[31.3]增加到82.7[21.9]）和社会限制（平均[SD]，从74.6[24.1]增加到83.8[25.0]）评分、CCS传统亚评分（平均[SD]，从7.2[2.9]增加到7.9[3.0]）以及肥胖患者体重变化（平均[SD]， -2.3 [3.3] kg）方面，干预前和干预后均有显著改善。结论和相关性：在这项非随机临床试验中，结合土著食谱和当地食物的MUTTON-HF干预对纳瓦霍农村心力衰竭患者是可行和可接受的。这些发现将为未来的随机临床试验提供信息，以评估这种干预措施对促进土著心血管健康和食物主权的有效性。试验注册：ClinicalTrials.gov标识符：NCT06675331。

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引用次数: 0

Generative Artificial Intelligence Applications Use Among US Youth. 生成式人工智能在美国年轻人中的应用。

IF 9.7 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

JAMA Network Open

Pub Date : 2026-02-02 DOI: 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.

重要性：随着生成式人工智能（GenAI）工具越来越多地融入年轻人的日常生活，研究它们的使用模式及其对心理健康的潜在影响至关重要。虽然有证据表明成年人中使用GenAI的速度很快，但青少年中使用GenAI的比率基本上没有记录。目的：描述GenAI应用程序（app）在美国年轻人中的使用情况，包括采用率和使用时间。设计、设置和参与者：本横断面研究记录了从家长监控应用程序中提取的美国青少年的数字行为。参与者年龄在4至17岁之间，并且是在美国使用市售Aura应用程序的家庭。除了出生年份外，没有收集到关于孩子的识别信息。在2024年9月至2025年4月期间，采用被动传感方法从自然智能设备的使用中收集数据。数据分析是在2025年5月和6月进行的。主要结果和衡量标准：按年龄和时间段衡量的采用率（即在其设备上访问GenAI应用的年轻人数量）和使用GenAI的时间（即访问GenAI应用的平均时间）。结果：在6488名参与者中，近2072名年轻人（31.9%）在他们的设备上使用GenAI应用程序。GenAI的使用在青少年中最高（13 - 14岁，2139人中有899人[42.0%]；15 - 17岁，1246人中有628人[50.4%]），尽管在青少年前（10 - 12岁，2366人中有484人[20.5%]）和学龄儿童（8 - 9岁，522人中有49人[9.4%]）中采用GenAI的情况也不是微不足道的。GenAI在放学后的使用率高于夜间或在校期间。总体而言，用户每天使用GenAI的平均（SD）为2.37（10.55）分钟，中位数（IQR）为0.18（0.04-0.84）分钟，但较大的方差和倾斜分布表明，一小部分年轻人广泛使用GenAI，最严重的用户每天使用GenAI的时间超过40分钟。结论和相关性：在这项横断面研究中，参与者使用AI应用程序的情况差异很大，多达一半的青少年使用一些应用程序，一小部分人使用大量应用程序。未来的研究必须解决基因使用的个体差异，以确定对发展的影响。

{"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":"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.","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}

引用次数: 0

Anxiety or Depression Trends by Disability Status and Demographic Intersections in US Adults, 2019-2023. 2019-2023年美国成年人残疾状况和人口交叉点的焦虑或抑郁趋势

IF 9.7 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

JAMA Network Open

Pub Date : 2026-02-02 DOI: 10.1001/jamanetworkopen.2025.57332

David Adzrago, Kayo Fujimoto, J Michael Wilkerson, Typhanye V Dyer, Faustine Williams

Importance: 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.Objective: To examine trends in anxiety and depression prevalence among US adults from 2019 to 2023 by disability status and demographic characteristics.Design, setting, and participants: 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.Exposures: Disability status (measured using Washington Group on Disability Statistics Short Set on Functioning), race and ethnicity, sex, and nativity.Main outcomes and measures: 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.Results: 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).<st

重要性：心理健康问题，特别是焦虑和抑郁，仍然是美国疾病负担的主要原因之一。然而，在残疾状况和人口统计中，焦虑和抑郁的趋势仍未得到充分研究。目的：根据残疾状况和人口统计学特征，研究2019年至2023年美国成年人焦虑和抑郁患病率的趋势。设计、环境和参与者：这项横断面研究使用了2019年至2023年全国健康访谈调查中基于全国人口的数据。数据收集自18岁以上非收容美国平民成人的家庭概率样本。数据分析时间为2024年12月6日至2025年11月19日。暴露：残疾状况（使用华盛顿残疾统计小组功能短集测量），种族和民族，性别和出生。主要结果和测量：主要结果是自我报告的焦虑或抑郁症状，使用华盛顿残疾统计小组功能扩展集进行评估。结合点回归用于估计年龄标准化流行趋势和平均年百分比变化（AAPC）跨越残疾状况、种族和民族、性别和出生。结果：共检测150 220例成人（女性81 525例[51.3%]，45-64岁48 814例[32.3%]，美国出生126 051例[81.1%]），其中黑人16 172例（11.9%），西班牙裔或拉丁裔20 427例（17.7%），其他种族或民族12 221例（8.9%），白人101 400例（61.4%）。一般残疾15 519人（8.2%），焦虑或抑郁60 248人（42.3%）。从2019年到2023年，无残疾个体的焦虑或抑郁患病率显著增加（AAPC, 3.93; 95% CI, 2.15-5.75）。在没有残疾的所有种族和族裔群体中，患病率都有所增加，其中黑人受访者（AAPC, 4.77; 95% CI, 0.61-9.10）和其他种族或族裔受访者（AAPC, 6.95; 95% CI, 2.56-11.53）的增幅最高。患病率仅在没有残疾的女性中增加（AAPC, 3.50; 95% CI, 2.14-4.87），而在有残疾（AAPC, 3.25; 95% CI, 0.41-6.17）和没有残疾（AAPC, 4.62; 95% CI, 1.70-7.63）的男性中增加。在美国以外出生的无残疾个体（AAPC, 5.57, 95% CI, 3.10-8.11）比残疾个体（AAPC, 3.46, 95% CI, 0.06-6.98）和在美国出生的无残疾个体（AAPC, 3.75, 95% CI, 2.14-5.40）有更高的增长。在种族和民族、性别和出生的交叉路口，非美国出生的无残疾黑人女性个体的增长最高（AAPC, 14.89; 95% CI, 0.48-31.36）。结论和相关性：这项横断面研究发现，焦虑或抑郁的患病率呈上升趋势，特别是在无残疾的个体、在美国以外出生的个体、黑人个体和不认为自己是黑人、西班牙裔或白人的个体、以及男性和在美国以外出生的残疾个体中。这些发现强调需要有针对性的心理健康干预措施，以解决残疾状况和人口交叉点之间的差异。

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引用次数: 0

Early Intervention Developmental Programming and Childhood Academic Outcomes. 早期干预、发展规划和儿童学业成果。

IF 9.7 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

JAMA Network Open

Pub Date : 2026-02-02 DOI: 10.1001/jamanetworkopen.2025.55890

Jeanette A Stingone, Katharine H McVeigh, Lidiya Lednyak

Importance: National monitoring surveys indicate that developmental disabilities among US children constitute a substantial public health issue. While scientific literature documents the benefits of targeted, developmental interventions, there has been less study of formal early intervention (EI) services provided through Part C of the Individuals With Disabilities Education Act.

Objective: To assess the population-level utilization of the New York City EI program and estimate the association between receipt of EI services before 3 years of age and academic achievement later in childhood.

Design, setting, and participants: This retrospective cohort study was performed within an administrative data linkage of public health and educational data systems in New York City, with records from January 1, 1994, to December 31, 2007. Participants included children born in New York City between January 1, 1994, and December 31, 1998, who attended public elementary school for third grade. Analyses were conducted from January 1, 2023, to December 31, 2024.

Exposure: Any use of EI services from birth through 3 years of age.

Main outcomes and measures: The primary outcomes were standardized test scores in math and English language arts (ELA) in third grade. After propensity score matching, linear and log-binomial regression were used to estimate differences in standardized test scores and incidence ratios of meeting test-based standards, comparing individuals who did and did not receive EI services.

Results: The study population consisted of 214 370 children with records through third grade. Of the 13 022 children who had received EI services (6.1%) before 3 years of age, 8516 (65.4%) were male (mean [SD] gestational age, 37.5 [3.8] weeks). When examining third grade standardized test scores, higher absolute test scores were observed among children who received EI in ELA (estimate, 0.045; 95% CI, 0.021-0.069) and greater incidence of meeting test-based standards in both math (incidence ratio, 1.08; 95% CI, 1.06-1.10) and ELA (incidence ratio, 1.09; 95% CI, 1.07-1.12) when comparing propensity score-matched samples. Evidence of heterogeneity was observed, as individuals who required special education, those from households with lower socioeconomic status, and those born to immigrant mothers had greater test score benefits associated with EI.

Conclusions and relevance: The findings of this cohort study suggest that EI services for children younger than 3 years with moderate to severe developmental delays or disabilities had tangible academic benefits later in childhood. Future research should investigate the implementation of EI services among individuals with different diagnoses and developmental delays to determine the most beneficial service plans for children with differing needs.

重要性：国家监测调查表明，美国儿童的发育障碍构成了一个重大的公共卫生问题。虽然科学文献记录了有针对性的发展干预的好处，但通过《残疾人教育法》C部分提供的正式早期干预（EI）服务的研究较少。目的：评估纽约市EI计划的人口水平利用率，并估计3岁前接受EI服务与儿童后期学业成绩之间的关系。设计、环境和参与者：本回顾性队列研究在纽约市公共卫生和教育数据系统的行政数据链中进行，记录时间为1994年1月1日至2007年12月31日。研究对象包括1994年1月1日至1998年12月31日期间出生在纽约市的三年级公立小学学生。分析时间为2023年1月1日至2024年12月31日。暴露：从出生到3岁的任何EI服务的使用。主要结果和测量：主要结果是三年级数学和英语语言艺术（ELA）的标准化考试成绩。在倾向得分匹配后，使用线性和对数二项回归来估计标准化测试分数和符合测试标准的发生率的差异，比较接受和未接受EI服务的个体。结果：研究人群包括214 370名有记录的三年级儿童。在13 022名3岁前接受过EI服务的儿童（6.1%）中，8516名（65.4%）为男性（平均胎龄37.5[3.8]周）。当检查三年级标准化测试成绩时，在ELA中接受EI的儿童中观察到更高的绝对测试成绩（估计值，0.045;95% CI, 0.021-0.069），并且在比较倾向分数匹配的样本时，在数学（发生率比，1.08;95% CI, 1.06-1.10）和ELA（发生率比，1.09;95% CI, 1.07-1.12）中达到基于测试的标准的发生率更高。异质性的证据被观察到，需要特殊教育的个体，来自社会经济地位较低的家庭的个体，以及移民母亲所生的个体，与EI相关的测试成绩收益更大。结论和相关性：这项队列研究的结果表明，对于3岁以下中度至重度发育迟缓或残疾的儿童，EI服务在儿童后期具有明显的学习效益。未来的研究应该调查不同诊断和发育迟缓的个体对EI服务的实施情况，以确定对有不同需求的儿童最有益的服务计划。

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引用次数: 0

Historically Black College or University Attendance and Cognition in US Black Adults. 美国黑人成人的历史黑人学院或大学出勤率和认知。

IF 9.7 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

JAMA Network Open

Pub Date : 2026-02-02 DOI: 10.1001/jamanetworkopen.2025.58329

Marilyn D Thomas, Carol Wei, Min Hee Kim, Jennifer Manly, Suzanne E Judd, Justin S White, Virginia J Howard, Christina Mangurian, Rita Hamad, M Maria Glymour

Importance: Black adults may derive long-term cognitive benefits from attendance at a historically Black college or university (HBCU) compared with a predominantly White institution (PWI). This association has not been evaluated in a nationwide sample.

Objective: To estimate the association between HBCU vs PWI attendance and cognitive health among later-life Black adults.

Design, setting, and participants: This cohort study used data from the Reasons for Geographic and Racial Differences in Stroke study, a prospective cohort study that recruited Black and White US adults aged 45 years and older during 2003 to 2007. The national cohort oversampled Black individuals and residents from the Stroke Belt (56%), a group of 8 Southern states defined by excess stroke mortality. The analytic sample included Black participants who attended high school in a state with an HBCU and attended college. Analysis was conducted from February to September 2025.

Exposure: Participants self-reported each college ever attended, classified as a PWI (reference) or HBCU.

Main outcomes and measures: Assessments of memory, language, and global cognition were conducted during follow-up every 6 months (2006-2021). Cognitive measures were standardized (ie, z-transformed). Linear regression was used to estimate the average treatment effect (ATE) using inverse of probability of treatment weighting. Additional analyses evaluated potential modification by being college-aged before 1955 (during legal racial segregation), 1955 to 1964 (during sanctioned racial discrimination), or after 1964.

Results: Among 1978 Black college-goers (mean [SD] age at first assessment, 61.8 [8.2] years; 1333 [67.4%] female), 699 (35.3%) attended an HBCU, 1952 (98.7%) completed a memory assessment, 1970 (99.6%) completed a language assessment, and 530 (26.8%) completed both assessments during the same follow-up visit. Compared with PWI attendance, HBCU attendance was associated with better z-scored memory (ATE, 0.13; 95% CI, 0.05-0.21), language (ATE, 0.19; 95% CI, 0.08-0.29), and global cognition (ATE, 0.22; 95% CI, 0.09-0.34). Estimates were consistent for individuals who were college-aged after 1955 but were not statistically significant among respondents who were college-aged prior to 1955.

Conclusions and relevance: In this cohort study using a national dataset, HBCU attendance was associated with better cognition compared with PWI attendance for aging Black adults, which held for those attending college before and after legal racial segregation and sanctioned racial discrimination in education.

重要性：与白人占主导地位的大学（PWI）相比，黑人成年人可能从进入传统黑人学院或大学（HBCU）获得长期的认知益处。这种联系尚未在全国范围内的样本中进行评估。目的：评估黑人成年后HBCU与PWI出席率与认知健康之间的关系。设计、环境和参与者：该队列研究使用了卒中地理和种族差异研究的数据，这是一项前瞻性队列研究，在2003年至2007年期间招募了45岁及以上的美国黑人和白人。国家队列从中风带（56%）的黑人和居民中进行了抽样调查，中风带是由南方8个州组成的一组，中风死亡率过高。分析样本包括在有HBCU的州上高中和上大学的黑人参与者。分析时间为2025年2月至9月。接触：参与者自我报告所上过的大学，分类为PWI（参考）或HBCU。主要结果和测量方法：在每6个月的随访期间（2006-2021年）对记忆、语言和整体认知进行评估。认知测量是标准化的（即z转换）。采用线性回归，利用处理权重的概率逆估计平均处理效果（ATE）。另外的分析通过1955年之前（合法的种族隔离时期）、1955年到1964年（合法的种族歧视时期）或1964年之后的大学生年龄来评估潜在的改变。结果：在1978名黑人大学生中（首次评估时的平均[SD]年龄为61.8[8.2]岁；1333名[67.4%]名女性），699名（35.3%）参加了HBCU， 1952名（98.7%）完成了记忆评估，1970名（99.6%）完成了语言评估，530名（26.8%）在同一次随访期间完成了两项评估。与PWI出勤率相比，HBCU出勤率与更好的z评分记忆（ATE, 0.13; 95% CI, 0.05-0.21）、语言（ATE, 0.19; 95% CI, 0.08-0.29）和整体认知（ATE, 0.22; 95% CI, 0.09-0.34）相关。对于1955年之后上大学的人来说，估计是一致的，但对于1955年之前上大学的人来说，统计上不显着。结论和相关性：在这项使用国家数据集的队列研究中，与老年黑人的PWI出勤率相比，HBCU出勤率与更好的认知有关，这对于在法律种族隔离和教育中认可的种族歧视之前和之后上大学的人来说都是如此。

{"title":"Historically Black College or University Attendance and Cognition in US Black Adults.","authors":"Marilyn D Thomas, Carol Wei, Min Hee Kim, Jennifer Manly, Suzanne E Judd, Justin S White, Virginia J Howard, Christina Mangurian, Rita Hamad, M Maria Glymour","doi":"10.1001/jamanetworkopen.2025.58329","DOIUrl":"10.1001/jamanetworkopen.2025.58329","url":null,"abstract":"Importance: Black adults may derive long-term cognitive benefits from attendance at a historically Black college or university (HBCU) compared with a predominantly White institution (PWI). This association has not been evaluated in a nationwide sample.Objective: To estimate the association between HBCU vs PWI attendance and cognitive health among later-life Black adults.Design, setting, and participants: This cohort study used data from the Reasons for Geographic and Racial Differences in Stroke study, a prospective cohort study that recruited Black and White US adults aged 45 years and older during 2003 to 2007. The national cohort oversampled Black individuals and residents from the Stroke Belt (56%), a group of 8 Southern states defined by excess stroke mortality. The analytic sample included Black participants who attended high school in a state with an HBCU and attended college. Analysis was conducted from February to September 2025.Exposure: Participants self-reported each college ever attended, classified as a PWI (reference) or HBCU.Main outcomes and measures: Assessments of memory, language, and global cognition were conducted during follow-up every 6 months (2006-2021). Cognitive measures were standardized (ie, z-transformed). Linear regression was used to estimate the average treatment effect (ATE) using inverse of probability of treatment weighting. Additional analyses evaluated potential modification by being college-aged before 1955 (during legal racial segregation), 1955 to 1964 (during sanctioned racial discrimination), or after 1964.Results: Among 1978 Black college-goers (mean [SD] age at first assessment, 61.8 [8.2] years; 1333 [67.4%] female), 699 (35.3%) attended an HBCU, 1952 (98.7%) completed a memory assessment, 1970 (99.6%) completed a language assessment, and 530 (26.8%) completed both assessments during the same follow-up visit. Compared with PWI attendance, HBCU attendance was associated with better z-scored memory (ATE, 0.13; 95% CI, 0.05-0.21), language (ATE, 0.19; 95% CI, 0.08-0.29), and global cognition (ATE, 0.22; 95% CI, 0.09-0.34). Estimates were consistent for individuals who were college-aged after 1955 but were not statistically significant among respondents who were college-aged prior to 1955.Conclusions and relevance: In this cohort study using a national dataset, HBCU attendance was associated with better cognition compared with PWI attendance for aging Black adults, which held for those attending college before and after legal racial segregation and sanctioned racial discrimination in education.","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 2","pages":"e2558329"},"PeriodicalIF":9.7,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12895292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146157057","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}

引用次数: 0

Institutional Factors and Shared Decision-Making for Atrial Fibrillation. 房颤的制度因素和共同决策。

IF 9.7 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

JAMA Network Open

Pub Date : 2026-02-02 DOI: 10.1001/jamanetworkopen.2025.56867

Haya Kaliounji, Benjamin A Steinberg

引用次数: 0

Error in Byline. 署名错误。

IF 9.7 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

JAMA Network Open

Pub Date : 2026-02-02 DOI: 10.1001/jamanetworkopen.2026.2242

引用次数: 0

Enhanced Prenatal Care Models and Postpartum Depression: The EMBRACE Randomized Clinical Trial. 强化产前护理模式与产后抑郁：EMBRACE随机临床试验

IF 9.7 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

JAMA Network Open

Pub Date : 2026-02-02 DOI: 10.1001/jamanetworkopen.2025.59883

Jennifer N Felder, Daisy León-Martínez, Deborah Karasek, Venise Curry, Kristin Carraway, Patience A Afulani, Bridgette Blebu, Brittany Chambers-Butcher, Kimberly Coleman-Phox, Bethany J Simard, Cinthia Blat, Mary A Garza, Charles E McCulloch, Miriam Kuppermann

Importance: Racial, ethnic, and income disparities in perinatal depression prevalence and treatment are partially driven by social determinants of health. Effective treatments addressing these determinants are needed.Objective: To determine whether enhanced group prenatal care (eGPC) outperforms enhanced individual prenatal care (eIPC) for reducing perinatal depressive symptoms.Design, setting, and participants: This randomized clinical trial was conduced in 10 Medicaid-serving clinics in California's San Joaquin Valley, enrolling English- or Spanish-speaking Medicaid-eligible pregnant individuals at less than 25 weeks' gestation, from November 2019 to January 2024, with 2 follow-up surveys through 12 weeks postpartum. Analyses were conducted as intention-to-treat. Data were analyzed from December 2024 to December 2025.Interventions: Participants were randomized to eIPC or eGPC. eIPC enhancements included assessments tailored to individual psychosocial, clinical, oral health, and substance use needs. eGPC enhancements included childcare, perinatal mental health screening and referral, transportation stipends, free groceries, and information on community resources.Main outcomes and measures: The primary outcome was depression, operationalized as change in Patient Health Questionnaire-9 scores from baseline to 3 months postpartum. Outcomes were assessed by masked assessors.Results: Of 1663 individuals assessed, 678 were enrolled and randomized; 4 withdrew consent, yielding an analyzed sample of 674 participants (mean [SD] age, 27.0 [5.8] years), including 50 African American or Black participants (7.4%); 37 biracial, multiracial, or multiethnic participants (5.5%); 485 Latine participants (72.0%); 77 White participants (11.4%); and 24 participants who identified as another race or ethnicity (3.6%). After randomization, there were 294 participants in the eGPC group and 380 participants in the eIPC group. No difference in reductions in depressive symptom severity from baseline to 3 months postpartum by randomization group was observed (Cohen d for between-group change, 0.1; 95% CI, -0.1 to 0.3; P = .45), adjusting for baseline depressive symptom severity, self-reported history of a mental health condition, language, and calendar time at enrollment. Instead, participants in both groups experienced small to moderate reductions in depression symptoms from baseline to 3 months postpartum (eGPC: mean [SD] difference, -2.2 [5.3]; Cohen d = -0.4; 95% CI, -0.6 to -0.3; P < .001; eIPC: mean [SD] difference, -1.6 [4.5]; Cohen d = -0.5; 95% CI, -0.6 to -0.4; P < .001).Conclusions and relevance: In this randomized clinical trial of pregnant, low-income, primarily Latine individuals, statistically significant improvements were observed in depressive symptom severity from baseline to postpartum, regardl

重要性：围产期抑郁症患病率和治疗方面的种族、民族和收入差异部分是由健康的社会决定因素驱动的。需要针对这些决定因素的有效治疗。目的：确定加强群体产前护理（eGPC）是否优于加强个人产前护理（eIPC）减轻围产期抑郁症状。设计、环境和参与者：这项随机临床试验在加利福尼亚州圣华金谷的10家医疗补助服务诊所进行，从2019年11月到2024年1月，招募了怀孕不到25周的符合医疗补助条件的英语或西班牙语孕妇，并进行了两次随访调查，直到产后12周。分析作为意向治疗进行。数据分析时间为2024年12月至2025年12月。干预措施：参与者随机分为eIPC组和eGPC组。eIPC的改进包括针对个人心理社会、临床、口腔健康和药物使用需求量身定制的评估。增强的eGPC包括儿童保育、围产期心理健康筛查和转诊、交通补贴、免费食品杂货以及社区资源信息。主要结局和测量：主要结局是抑郁，通过患者健康问卷-9评分从基线到产后3个月的变化来实现。结果由匿名评估者评估。结果：在1663名被评估的个体中，678名被纳入并随机化；4人撤回同意，共分析了674名参与者（平均[SD]年龄27.0[5.8]岁），其中包括50名非裔美国人或黑人参与者（7.4%）；37名混血、多种族或多民族参与者（5.5%）；拉丁裔参与者485人（72.0%）；白人77人（11.4%）；24名参与者认为自己是另一个种族或民族（3.6%）。随机分组后，eGPC组有294人，eIPC组有380人。从基线到产后3个月，随机分组在抑郁症状严重程度的减轻方面没有观察到差异(Cohen d组间变化，0.1;95% CI, -0.1 ~ 0.3; P =。45)，调整基线抑郁症状严重程度、自我报告的精神健康状况史、语言和入组时的日历时间。相反，从基线到产后3个月，两组参与者的抑郁症状都有小到中度的减轻（eGPC：平均[SD]差异，-2.2 [5.3];Cohen d = -0.4; 95% CI, -0.6至-0.3；P）结论和相关性：在这项针对孕妇、低收入、主要是拉丁裔个体的随机临床试验中，无论产前护理类型如何，从基线到产后，抑郁症状严重程度均有统计学意义的改善。没有证据表明加强产前护理对改善抑郁症状有什么不同。试验注册：ClinicalTrials.gov标识符：NCT04154423。

{"title":"Enhanced Prenatal Care Models and Postpartum Depression: The EMBRACE Randomized Clinical Trial.","authors":"Jennifer N Felder, Daisy León-Martínez, Deborah Karasek, Venise Curry, Kristin Carraway, Patience A Afulani, Bridgette Blebu, Brittany Chambers-Butcher, Kimberly Coleman-Phox, Bethany J Simard, Cinthia Blat, Mary A Garza, Charles E McCulloch, Miriam Kuppermann","doi":"10.1001/jamanetworkopen.2025.59883","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.59883","url":null,"abstract":"Importance: Racial, ethnic, and income disparities in perinatal depression prevalence and treatment are partially driven by social determinants of health. Effective treatments addressing these determinants are needed.Objective: To determine whether enhanced group prenatal care (eGPC) outperforms enhanced individual prenatal care (eIPC) for reducing perinatal depressive symptoms.Design, setting, and participants: This randomized clinical trial was conduced in 10 Medicaid-serving clinics in California's San Joaquin Valley, enrolling English- or Spanish-speaking Medicaid-eligible pregnant individuals at less than 25 weeks' gestation, from November 2019 to January 2024, with 2 follow-up surveys through 12 weeks postpartum. Analyses were conducted as intention-to-treat. Data were analyzed from December 2024 to December 2025.Interventions: Participants were randomized to eIPC or eGPC. eIPC enhancements included assessments tailored to individual psychosocial, clinical, oral health, and substance use needs. eGPC enhancements included childcare, perinatal mental health screening and referral, transportation stipends, free groceries, and information on community resources.Main outcomes and measures: The primary outcome was depression, operationalized as change in Patient Health Questionnaire-9 scores from baseline to 3 months postpartum. Outcomes were assessed by masked assessors.Results: Of 1663 individuals assessed, 678 were enrolled and randomized; 4 withdrew consent, yielding an analyzed sample of 674 participants (mean [SD] age, 27.0 [5.8] years), including 50 African American or Black participants (7.4%); 37 biracial, multiracial, or multiethnic participants (5.5%); 485 Latine participants (72.0%); 77 White participants (11.4%); and 24 participants who identified as another race or ethnicity (3.6%). After randomization, there were 294 participants in the eGPC group and 380 participants in the eIPC group. No difference in reductions in depressive symptom severity from baseline to 3 months postpartum by randomization group was observed (Cohen d for between-group change, 0.1; 95% CI, -0.1 to 0.3; P = .45), adjusting for baseline depressive symptom severity, self-reported history of a mental health condition, language, and calendar time at enrollment. Instead, participants in both groups experienced small to moderate reductions in depression symptoms from baseline to 3 months postpartum (eGPC: mean [SD] difference, -2.2 [5.3]; Cohen d = -0.4; 95% CI, -0.6 to -0.3; P < .001; eIPC: mean [SD] difference, -1.6 [4.5]; Cohen d = -0.5; 95% CI, -0.6 to -0.4; P < .001).Conclusions and relevance: In this randomized clinical trial of pregnant, low-income, primarily Latine individuals, statistically significant improvements were observed in depressive symptom severity from baseline to postpartum, regardl","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"9 2","pages":"e2559883"},"PeriodicalIF":9.7,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146201655","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}

引用次数: 0