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Journal of the American Medical Association最新文献

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Pharmacy Closures and Anticonvulsant Medication Prescription Fills. 药房关闭与抗惊厥药物处方的填写。
Q1 Medicine Pub Date : 2024-11-04 DOI: 10.1001/jama.2024.19993
Kelly E Anderson, Maitreyi Sahu, Michael J DiStefano, Carl V Asche, T Joseph Mattingly
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引用次数: 0
The Accidental Teacher-Direct-Care Physicians Increasingly Placed in Teaching Roles. 意外的教师--越来越多的直接护理医生被赋予教学角色。
Q1 Medicine Pub Date : 2024-11-04 DOI: 10.1001/jama.2024.17626
Joseph R Sweigart, Rebecca Watson, Alfred Burger
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引用次数: 0
US Elections Will Determine the Fate of Extended ACA Subsidies. 美国大选将决定 ACA 津贴延期的命运。
Q1 Medicine Pub Date : 2024-11-04 DOI: 10.1001/jama.2024.22992
Patrick N O'Mahen, Laura A Petersen
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引用次数: 0
Incorrect Wording. 用词不当。
Q1 Medicine Pub Date : 2024-11-03 DOI: 10.1001/jama.2024.23634
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引用次数: 0
A Digital Health Behavior Intervention to Prevent Childhood Obesity: The Greenlight Plus Randomized Clinical Trial. 预防儿童肥胖的数字健康行为干预:Greenlight Plus 随机临床试验。
Q1 Medicine Pub Date : 2024-11-03 DOI: 10.1001/jama.2024.22362
William J Heerman, Russell L Rothman, Lee M Sanders, Jonathan S Schildcrout, Kori B Flower, Alan M Delamater, Melissa C Kay, Charles T Wood, Rachel S Gross, Aihua Bian, Laura E Adams, Evan C Sommer, H Shonna Yin, Eliana M Perrin, Belen de la Barrera, Malakha Bility, Michelle Cruz Jimenez Smith, Evelyn F Cruzatte, Gabriela Guevara, Janna B Howard, Jacarra Lampkin, Colin J Orr, Jennifer Pilotos McBride, Lourdes Quintana Forster, Kimberly S Ramirez, Javier Rodriguez, Samantha Schilling, W Elizabeth Shepard, Altagracia Soto, Jessica J Velazquez, Shelby Wallace
<p><strong>Importance: </strong>Infant growth predicts long-term obesity and cardiovascular disease. Previous interventions designed to prevent obesity in the first 2 years of life have been largely unsuccessful. Obesity prevalence is high among traditional racial and ethnic minority groups.</p><p><strong>Objective: </strong>To compare the effectiveness of adding a digital childhood obesity prevention intervention to health behavior counseling delivered by pediatric primary care clinicians.</p><p><strong>Design, setting, and participants: </strong>Individually randomized, parallel-group trial conducted at 6 US medical centers and enrolling patients shortly after birth. To be eligible, parents spoke English or Spanish, and children were born after 34 weeks' gestational age. Study enrollment occurred between October 2019 and January 2022, with follow-up through January 2024.</p><p><strong>Interventions: </strong>In the clinic-based health behavior counseling (clinic-only) group, pediatric clinicians used health literacy-informed booklets at well-child visits to promote healthy behaviors (n = 451). In the clinic + digital intervention group, families also received health literacy-informed, individually tailored, responsive text messages to support health behavior goals and a web-based dashboard (n = 449).</p><p><strong>Main outcomes and measures: </strong>The primary outcome was child weight-for-length trajectory over 24 months. Secondary outcomes included weight-for-length z score, body mass index (BMI) z score, and the percentage of children with overweight or obesity.</p><p><strong>Results: </strong>Of 900 randomized children, 86.3% had primary outcome data at the 24-month follow-up time point; 143 (15.9%) were Black, non-Hispanic; 405 (45.0%) were Hispanic; 185 (20.6%) were White, non-Hispanic; and 165 (18.3%) identified as other or multiple races and ethnicities. Children in the clinic + digital intervention group had a lower mean weight-for-length trajectory, with an estimated reduction of 0.33 kg/m (95% CI, 0.09 to 0.57) at 24 months. There was also an adjusted mean difference of -0.19 (95% CI, -0.37 to -0.02) for weight-for-length z score and -0.19 (95% CI, -0.36 to -0.01) for BMI z score. At age 24 months, 23.2% of the clinic + digital intervention group compared with 24.5% of the clinic-only group had overweight or obesity (adjusted risk ratio, 0.91 [95% CI, 0.70 to 1.17]) based on the Centers for Disease Control and Prevention criteria of BMI 85th percentile or greater. At that age, 7.4% of the clinic + digital intervention group compared with 12.7% of the clinic-only group had obesity (adjusted risk ratio, 0.56 [95% CI, 0.36 to 0.88]).</p><p><strong>Conclusions and relevance: </strong>A health literacy-informed digital intervention improved child weight-for-length trajectory across the first 24 months of life and reduced childhood obesity at 24 months. The intervention was effective in a racially and ethnically diverse population that in
重要性:婴儿生长可预测长期肥胖和心血管疾病。以往旨在预防婴儿出生后头两年肥胖的干预措施大多不成功。肥胖症在传统的少数种族群体中发病率很高:目的:比较在儿科初级保健临床医生提供的健康行为咨询基础上增加数字儿童肥胖预防干预的效果:在美国 6 家医疗中心进行的个人随机平行分组试验,招募出生后不久的患者。符合条件的父母必须会讲英语或西班牙语,且孩子在胎龄 34 周后出生。研究注册时间为 2019 年 10 月至 2022 年 1 月,随访至 2024 年 1 月:在诊所健康行为咨询(纯诊所)组中,儿科临床医生在儿童健康访视时使用健康知识小册子来促进健康行为(n = 451)。在门诊+数字干预组中,家庭还收到了以健康知识为基础的、为个人量身定制的响应性短信,以支持健康行为目标和基于网络的仪表板(n = 449):主要结果和测量指标:主要结果是24个月内儿童体重身长轨迹。次要结果包括体重身长 Z 值、体重指数 (BMI) Z 值以及超重或肥胖儿童的百分比:在随机抽取的 900 名儿童中,86.3% 的儿童在 24 个月的随访时间点有主要结果数据;143 人(15.9%)为非西班牙裔黑人;405 人(45.0%)为西班牙裔;185 人(20.6%)为非西班牙裔白人;165 人(18.3%)被认定为其他或多个种族和民族。诊所+数字干预组儿童的平均体重-身长曲线较低,24 个月时估计降低了 0.33 kg/m(95% CI,0.09 至 0.57)。此外,体重身长Z值调整后的平均差异为-0.19(95% CI,-0.37至-0.02),BMI z值调整后的平均差异为-0.19(95% CI,-0.36至-0.01)。在 24 个月大时,根据美国疾病控制和预防中心的 BMI 85th 百分位数或更高的标准,诊所+数字干预组中有 23.2% 的人超重或肥胖,而仅有诊所干预组中有 24.5% 的人超重或肥胖(调整后风险比为 0.91 [95% CI, 0.70 至 1.17])。在该年龄段,诊所+数字干预组中有 7.4% 的人患有肥胖症,而仅有诊所干预组中有 12.7% 的人患有肥胖症(调整后风险比为 0.56 [95% CI, 0.36 至 0.88]):以健康知识为导向的数字化干预改善了儿童出生后24个月内的体重身长轨迹,并在24个月时减少了儿童肥胖。该干预措施对种族和民族多元化人群有效,其中包括儿童肥胖风险较高的群体:试验注册:ClinicalTrials.gov Identifier:试验注册:ClinicalTrials.gov Identifier:NCT04042467。
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引用次数: 0
Breast Cancer Incidence Still Rising Despite Decline in Death Rates. 尽管死亡率有所下降,但乳腺癌发病率仍在上升。
Q1 Medicine Pub Date : 2024-11-01 DOI: 10.1001/jama.2024.22056
Avery Orrall
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引用次数: 0
CDC Reports 13 Dairy Farm Workers Infected With Bird Flu in California. 疾病预防控制中心报告加利福尼亚州 13 名奶牛场工人感染禽流感。
Q1 Medicine Pub Date : 2024-11-01 DOI: 10.1001/jama.2024.22055
Avery Orrall
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引用次数: 0
Incorrect Arm Positions Increase Blood Pressure Readings. 不正确的手臂姿势会增加血压读数。
Q1 Medicine Pub Date : 2024-11-01 DOI: 10.1001/jama.2024.22061
Avery Orrall
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引用次数: 0
Large Marburg Virus Disease Outbreak in the Republic of Rwanda. 卢旺达共和国大规模爆发马尔堡病毒病。
Q1 Medicine Pub Date : 2024-11-01 DOI: 10.1001/jama.2024.22057
Avery Orrall
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引用次数: 0
More People in Their 40s Being Screened for Colorectal Cancer Under New Recommendation. 根据新建议,更多 40 多岁的人接受结直肠癌筛查。
Q1 Medicine Pub Date : 2024-11-01 DOI: 10.1001/jama.2024.22058
Avery Orrall
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引用次数: 0
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