JAMA Network Open最新文献

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.

Importance: Kidney transplantation improves survival and quality of life for individuals with end-stage kidney disease (ESKD). However, its effect on objective economic outcomes, such as employment income, remains insufficiently studied.

Objective: To quantify changes in employment income before and after kidney transplantation in Canada using linked administrative health and tax data.

Design, setting, and participants: This population-based cohort study included nationwide data from Canadian adults receiving a kidney transplant between 2007 and 2016. Data were from the Canadian Hospitalization and Taxation Database (C-HAT), which includes hospital discharge records and income tax data. Eligible adults were aged 30 to 62 years; exclusions included repeat or multiorgan transplants, residents of Quebec or territories, and individuals with incomplete tax data or those in the top or bottom 1% of income earners. Data analyses were conducted between June 2024 to October 2025.

Exposure: Kidney transplant.

Main outcome and measures: The primary outcome was annual employment income, derived from tax records for 3 years before and after transplant. Employment income was defined as the combined total of employment income, self-employment income, and other employment income, and adjusted to 2023 Canadian dollars using the Bank of Canada Consumer Price Index. A linear mixed-effects model was used to evaluate changes in income over time.

Results: The final cohort included 3230 individuals (mean [SD] age, 47 [8.4] years), of whom 1120 (34.7%) were female and 2630 (81.4%) were aged 30 to 55 years. Pretransplant, income declined by $4293 per year (95% CI, -$4726 to -$3861 per year; P < .001); posttransplant, income increased by $1006 per year (95% CI, $406 to $1605; P = .001).

Conclusions and relevance: In this cohort study of 3230 kidney transplant recipients, kidney transplant was associated with a reversal of declining employment income, indicating meaningful economic recovery. These findings highlight the broader socioeconomic value of transplantation and may inform policies that support patients during pretransplant vulnerability and facilitate successful return to work.

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.