JAMA Health Forum最新文献

Importance: Physician emigration from low- and middle-income countries to high-income countries is a major driver of inequitable distribution of health care and health outcomes across the world. World Health Organization (WHO) signatory countries unanimously signed the voluntary Global Code of Practice on the International Recruitment of Health Personnel (WHO Code) in 2010. The goal was to reduce health care workforce emigration by discouraging active recruitment of physicians from WHO-designated shortage countries and by promoting investment in the physician workforce in those countries. This study adds to the literature by providing evidence about whether the goal has been achieved 10 years after worldwide implementation of the WHO Code.

Objective: To evaluate whether the WHO Code was associated with changes in physician emigration and physician density in WHO-designated shortage countries after 2010.

Design, setting, and participants: A difference-in-differences design was used to examine trends in physician supply before and after 2010. The data (from 2000 through 2021) were collected by the Organization for Economic Co-operation and Development (OECD) and were used to examine physician outflow from 56 WHO-designated shortage countries vs 116 nonshortage countries. The data analysis took place October 2024 to September 2025.

Exposures: Worldwide adoption of the 2010 WHO Code.

Main outcomes and measures: The primary outcome was annual physician migration to OECD countries and the secondary outcome was physician density by country and year (per 1000 population using World Bank data) in the origin countries.

Results: A total of 135 888 physicians emigrated from WHO-designated shortage countries during 2000 to 2021 and 516 030 physicians emigrated from nonshortage countries. Compared with nonshortage countries, there was a decrease in physician outflow by 47.03 physicians (95% CI, -92.29 to -1.76 physicians) per country per year after 2010 in WHO-designated shortage countries and the WHO Code was associated with a reduction of nearly 30% in the average annual outflow of physicians from these countries. However, there was a slight decrease in physician density in the WHO-designated shortage countries after 2010 (-0.22 [95% CI, -0.33 to -0.11] physicians per 1000 population) compared with the nonshortage countries.

Conclusions and relevance: This study found that voluntary implementation of the WHO Code was associated with lower physician outflow from WHO-designated shortage countries without improvement in physician density in those countries.

Importance: Enrollment in public benefits is associated with improved health outcomes, yet many eligible individuals do not claim them. Public benefit programs are important policy tools to address health-related social needs. Health systems have developed new partnerships with community organizations to assist patients with enrollment in benefits.

Objective: To determine whether text messages were more effective than paper referrals in prompting patients to contact benefits navigators following discharge from the emergency department.

Design, setting, and participants: This 2-arm, nonblinded, randomized clinical trial was conducted from November 2023 to April 2024 at 2 academic hospital emergency departments in Philadelphia, Pennsylvania, and included adult individuals in stable condition with Medicaid or Medicare insurance who were discharged from the emergency department and eligible for at least 1 of 10 public benefit programs. Individuals were excluded if they were unable to read English or did not have access to a mobile phone. Data were analyzed from May 2024 to November 2024.

Interventions: Eligible participants were randomized in a 1:1 ratio. Participants allocated to the intervention received a series of 4 automated text messages over 14 days that prompted them to contact a benefits navigator telephone line operated by a community partner; those allocated to the control group received a paper flyer.

Main outcomes and measures: The primary outcome was whether study participants called benefits navigators within 14 days. Secondary outcomes included whether study participants submitted any benefits application within 14 days.

Results: Of 1778 patients screened, there were 160 participants enrolled. Participants' mean (SD) age was 44 (17) years; 94 (59%) were women, 145 (91%) were non-Hispanic Black, and 11 (7%) were non-Hispanic White. In the intervention group, 20 participants (25%) contacted benefits navigators vs 0 in the control group (difference, 25 percentage points; 95% CI, 16%-35%). In the intervention group, 11 participants (14%) submitted at least 1 application for public benefits compared with 0 in the control group (difference, 14 percentage points; 95% CI, 6-22).

Conclusions and relevance: The trial results suggest that text messages were more effective than paper referrals to help eligible emergency department patients seek assistance with public benefits applications. Text messages may offer a tool to allow health systems, in collaboration with community partners, to address health-related social needs.

Trial registration: ClinicalTrials.gov Identifier: NCT05654220.

Importance: Cervical cancer remains a major public health challenge in China, and human papillomavirus (HPV) vaccine uptake remains far below the global average. Understanding public responses to national policy interventions is critical for promoting equitable vaccine access and uptake.

Objective: To assess the association between 2 national HPV vaccination policies (August 2022 age expansion approval for HPV vaccination [policy 1] and January 2023 National Action Plan for Accelerating the Elimination of Cervical Cancer [policy 2]) in China and public discourse and engagement on social media.

Design, setting, and participants: Cross-sectional study using interrupted time-series analysis of publicly available posts by individual users containing HPV-related and vaccine-related keywords from China's largest text-based social media platform collected between December 2021 and December 2024. Latent Dirichlet allocation topic modeling was used to identify 16 topics grouped into 5 thematic domains.

Main outcomes and measures: Changes in the daily trends of public discussions across 5 thematic domains and 16 topics before and after policy implementation using interrupted time-series analysis.

Results: This study analyzed 353 530 HPV-related posts on the social media platform from December 2021 to December 2024. Vaccine accessibility discussions initially increased following the age expansion policy (regression coefficient, 0.08; 95% CI, 0.05-0.12; P < .001). After the launch of the National Action Plan, discussions on the theme of vaccine accessibility decreased by 0.11 percentage points per day (95% CI, -0.14 to -0.08; P < .001). Conversely, discussions on awareness and knowledge increased by 0.04 percentage points per day (95% CI, 0.03-0.06; P < .001), as well as gender and sociocultural factors, which increased by 0.04 percentage points per day (95% CI, 0.02-0.06; P < .001).

Conclusions and relevance: These findings suggest that national HPV vaccination policies in China were associated with shifts in public discourse, including alleviated access concerns and increased health awareness and gender equity discussions. Social media data can provide timely insights into public responses to health interventions and inform strategies to promote equitable HPV vaccine uptake and cervical cancer elimination.

Importance: Manufacturers of drug-device combinations, such as inhalers and injectable medications, often obtain patents not just on the active pharmaceutical ingredients of these products (primary patents) but also on other features, such as their formulations and methods of use (secondary patents) and delivery devices (tertiary patents). Courts, policymakers, and regulators have recently begun scrutinizing whether manufacturers may be improperly listing tertiary patents with the Food and Drug Administration (FDA) that lack claims on active pharmaceutical ingredients and whether such patents may be delaying generic competition. However, the full scope of patenting practices on drug-device combinations remains unknown.

Objective: To analyze patent protection on small-molecule drugs approved by the FDA from 1986 to 2023 with 1 or more tertiary patents.

Design, setting, and participants: In this retrospective cohort study of patenting practices on drug-device combinations, all patents listed in the FDA's Approved Drug Products With Therapeutic Equivalence Evaluations (Orange Book) were categorized (primary, secondary, or tertiary), and products with at least 1 tertiary patent were included. Analyses were performed between May 2024 and October 2025.

Main outcomes and measures: The primary outcome of the study was the duration of expected patent protection on each product, measured from the time of approval until expiration of the last-to-expire patent. Added protection from tertiary patents that went beyond protection afforded by primary or secondary patents was also analyzed.

Results: The FDA approved 331 products from 1986 to 2023 with 1 or more tertiary patents; 137 of 3241 patents (4.2%) listed on these products were primary patents, 1353 of 3241 were secondary patents (41.7%), and 1751 of 3241 were tertiary patents (54.0%). Among tertiary patents, 1047 of 1751 (59.8%) lacked claims making any mention of active pharmaceutical ingredients. The median (IQR) duration of expected patent protection among products in the cohort was 17.6 (14.4-21.2) years. There were 180 products (54.4%) that had tertiary patents extending periods of expected protection beyond other patents, and the median (IQR) duration of added protection was 7.5 (2.8-13.9) years.

Conclusions and relevance: The findings of this cohort study suggest that policymakers and regulators should take steps to ensure that tertiary patents are not improperly listed in the Orange Book and that generic competition occurs in a timely fashion.

Importance: Homelessness is associated with negative health outcomes and increased health care costs. The United States Department of Veterans Affairs (VA) Supportive Services for Veteran Families (SSVF) program provides housing-related financial assistance and other supports to veterans experiencing housing instability; however, little is known regarding short-term assistance interventions with a prevention focus.

Objective: To estimate potential impacts of the SSVF program in mortality and health care cost outcomes over 3 years following program entry.

Design, setting, and participants: Using observational data, outcomes were compared between veterans who enrolled in SSVF with those who did not for each month from October 2015 to December 2018. A propensity score for SSVF enrollment was calculated using observable characteristics including demographics, housing history, health care cost history, comorbidities, and geography. Using inverse probability of treatment weighting-a propensity score-based method that creates a pseudopopulation in which treatment groups are balanced on observed covariates-the potential impacts of SSVF enrollment in mortality were estimated using a Cox proportional hazards regression and health care costs with a generalized linear model over the 3 years following the trial index date. Data were from the VA electronic health record for a cohort of veterans receiving care in the VA system. Each trial drew on veterans with evidence of homelessness in structured and unstructured medical records during the previous month. Data were analyzed from November 1, 2023, to September 9, 2025.

Exposure: The exposure was enrollment in the SSVF program, from the Homeless Management Information System data.

Main outcome: The main outcomes were all-cause mortality and VA health care costs.

Results: The cohort consisted of 693 383 patient-trials with 26 649 (3.8%) enrolling in SSVF (mean [SD] age, 52.7 [12.6] years; 89.6% male) and 666 734 (96.5%) in the no SSVF group (mean [SD] age, 53.8 [13.0] years; 90.8% male). Enrollment in SSVF was associated with a decrease in the risk of mortality (hazard ratio, 0.87; 95% CI, 0.82-0.92). In addition, enrollment in SSVF was associated with an increase in outpatient costs ($7534; 95% CI, $6767-$8302) and a decrease in inpatient costs (-$10 020; 95% CI, -$13 644 to -$6396).

Conclusions and relevance: In this study, federal prevention solutions to homelessness were associated with improved health outcomes and lower inpatient costs, which should inform national policy debates within and beyond the VA.

Importance: Firearm suicides constitute a crisis in the US, accounting for more than half (55.4%) of all suicide deaths in 2023. Extreme Risk Protection Orders (ERPOs; ie, red flag laws) authorize temporary firearm removal from individuals deemed at high risk of harming themselves or others. While ERPOs are designed to reduce firearm-related suicides, whether they result in a net reduction in suicide deaths or shift firearm suicides to suicides by other methods remains an important but unresolved issue in determining their effectiveness.

Objective: To determine the association of ERPOs with firearm suicides and nonfirearm suicides in states with sufficient postpolicy data and no confounding firearm legislation that may bias findings on ERPO outcomes.

Design, setting, and participants: In this cohort study, 2-way difference-in-differences event study analyses were conducted using county-level data from 2012 to 2022. All states that passed ERPO laws alone, with no other new firearm laws, from 2018 to 2020, and had at least 1 year post-ERPO laws during which no new firearm laws were passed were investigated. All states that had no existing ERPO laws and passed no new firearm legislation from 2016 to 2022 were used for comparison. The model accounted for staggered treatment timing, treatment heterogeneity, and key methodological assumptions. Data were analyzed between February 6 and October 9, 2025.

Exposure: State-level ERPO law passage.

Main outcomes and measures: County-level annual firearm suicides and nonfirearm suicides per 100 000 population, derived from Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research.

Results: This study examined county-level data from 4 states passing ERPO laws alone (Massachusetts, New Jersey, New Mexico, and Rhode Island) compared with 8 that did not (Alabama, Alaska, Michigan, Minnesota, Nebraska, North Carolina, Pennsylvania, and South Carolina). ERPO passage was associated with a mean reduction of 3.79 firearm suicides per 100 000 population after 1 year (95% CI, -6.74 to -0.83; P = .01), equivalent to an estimated 675 suicides. With regard to nonfirearm suicides, no association was found in the year ERPO laws were passed (0.41; 95% CI, -1.21 to 1.94; P = .60) or in the next year (-2.45; 95% CI, -6.84 to 1.93; P = .27).

Conclusions and relevance: In this cohort study, ERPO laws in Massachusetts, New Jersey, New Mexico, and Rhode Island were associated with substantial reductions in firearm suicides, with no evidence of substitution with nonfirearm methods. These findings support ERPOs as targeted public health interventions to reduce firearm suicides without increasing suicides by other methods.