JAMA Network Open最新文献

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.

Importance: As telehealth (ie, telephone and video) becomes a larger component of primary care, understanding its impact on care quality is critical.

Objective: To evaluate whether the proportion of primary care received via telehealth is associated with differences in quality-of-care outcomes among veterans who frequently use primary care.

Design, setting, and participants: This is a retrospective cohort study of veterans empaneled to Veterans Health Administration (VHA) primary care in fiscal years 2022 and 2023 (October 1, 2021, to September 30, 2023) with 3 or more primary care visits. Telehealth proportion categories were none (0.0% primary care visits telehealth), low (>0.0% to <28.6%), intermediate (28.6% to <50.0%), or high (≥50.0%).

Exposure: Proportion of primary care delivered via telehealth.

Main outcomes and measures: The primary outcomes were influenza vaccination, hypertension control, statin therapy and adherence, and screenings and/or counseling for depression, tobacco, and alcohol use. Multivariable logistic regression was used to estimate adjusted average marginal effects (AMEs), controlling for sociodemographic, geographic, and clinical characteristics.

Results: This study included 744 599 veterans (mean [SD] age, 65 [15] years; 638 289 male [86%]). Compared with veterans receiving in-person care only, those who received a low proportion of care via telehealth had similar quality of outcomes for all cardiovascular and behavioral health measures. Influenza vaccination rates were modestly lower in the low-telehealth group vs the in-person only group (age ≥66 years, AME, -1.93% [95% CI, -2.58% to -1.29%]; age 19-65 years, AME, -1.57% [95% CI, -2.28% to -0.86%]). High telehealth users (≥50% telehealth) had the lowest adjusted likelihoods for most quality outcomes, including influenza vaccination (age ≥66 years, AME, -8.96% [95% CI, -9.84% to -8.07%]; age 19-65 years, AME, -9.72% [95% CI, -10.84% to -8.60%]) statin adherence (AME, -2.03% [95% CI -2.93% to -1.14%]) and depression screening (AME, -2.14% [95% CI, -3.20% to -1.08%]).

Conclusions and relevance: In this cohort study of veterans with 3 or more primary care visits, primary care quality was similar for individuals who received all in-person care and those receiving low or intermediate proportions of telehealth. However, high telehealth use was associated with lower quality for several services, especially those requiring in-person interaction. Findings demonstrate the viability of hybrid telehealth and in-person models. Additional resources might be needed to ensure high-quality primary care for high proportion telehealth users.

Importance: Early parental recognition of severe illness in children and adolescents is crucial for timely management and improved outcomes in pediatric emergency care.

Objective: To assess how accurately parents can identify severe illness in their children using a questionnaire completed shortly after arrival at the emergency department (ED).

Design, setting, and participants: This diagnostic study was conducted in a tertiary pediatric ED in northern Finland. Data were collected in 2019 to 2021, and this analysis was conducted in May 2024 to May 2025. Children and adolescents whose parents completed the questionnaire before physician assessment were included.

Exposures: A structured, 36-item parental questionnaire assessing symptoms and the child or adolescent's overall condition.

Main outcomes and measures: Severe illness was defined as 1 or more of the following: admission to the pediatric intensive care unit, hospital treatment of more than 24 hours, need for intravenous or nasogastric fluids, need for intravenous antibiotics for more than 24 hours, oxygen saturation less than 93% or the need for inhaled medications, anaphylactic shock, intoxication requiring hospital admission, or surgical intervention. Sensitivity and specificity were calculated for each question. To identify parental triage questions with the strongest diagnostic value, a machine learning analysis was conducted.

Results: Among 2375 included children and adolescents (mean [SD] age, 5.4 [4.6] years; 1140 female [48.0%]), 567 individuals (23.9%) met criteria for severe illness. Moderate to high parental worry showed the highest sensitivity (91.0% [95% CI, 88.3%-93.2%]) but the lowest specificity (17.5% [95% CI, 15.8%-19.4%]). Other specific pediatric questions demonstrated modest diagnostic accuracy with limited additional value. The machine learning model (area under the receiver operating characteristic curve, 0.71; 95% CI, 0.65-0.77) identified parental worry (feature importance score, 0.047), parent assessments of child or adolescent's general condition (feature importance score, 0.046), and need for treatment (feature importance score, 0.141) as the strongest predictors of hospital admission.

Conclusions and relevance: In this study, parental worry identified most cases of severe illness but had low specificity. These findings suggest that while parental concern may serve as an initial screening indicator, it should be complemented by clinical evaluation and objective measures to avoid unnecessary escalation of care.

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.