Posttraumatic Stress Disorder and Type 2 Diabetes Outcomes in Veterans

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. ET, TUESDAY, AUGUST 13, 2024

Media advisory: The full study is linked to this news release.

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About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication. 

 

About The Study: The findings of this cohort study of patients with comorbid posttraumatic stress disorder (PTSD) and type 2 diabetes suggest that PTSD is a modifiable risk factor associated with a modest reduction in microvascular complications. Further research is needed to determine whether findings are similar in non-Veterans Health Administration health care settings. 

Corresponding Author: To contact the corresponding author, Jeffrey F. Scherrer, PhD, email jeffrey.scherrer@health.slu.edu.

 

(doi:10.1001/jamanetworkopen.2024.27569)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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Plant and Animal Fat Intake and Overall and Cardiovascular Disease Mortality

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GLP-1RA vs DPP-4i Use and Rates of Hyperkalemia and RAS Blockade Discontinuation in Type 2 Diabetes

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Infant Feeding and Weight Trajectories in the Eat, Sleep, Console Trial

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Hospitalizations for Multisystem Inflammatory Syndrome in Children (MIS-C) in US Children’s Hospitals in 2023 vs 2021

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Early-Childhood Tablet Use and Outbursts of Anger

JAMA Pediatrics

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, AUGUST 12, 2024

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About The Study: Child tablet use at age 3.5 years was associated with more expressions of anger and frustration by the age of 4.5 years in this study. Child proneness to anger/frustration at age 4.5 years was then associated with more use of tablets by age 5.5 years. These results suggest that early-childhood tablet use may contribute to a cycle that is deleterious for emotional regulation.

Corresponding Author: To contact the corresponding author, Caroline Fitzpatrick, PhD, email caroline.fitzpatrick@usherbrooke.ca.

 

(doi:10.1001/jamapediatrics.2024.2511)

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Alcohol Consumption Patterns and Mortality Among Older Adults With Health-Related or Socioeconomic Risk Factors

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. ET, MONDAY, AUGUST 12, 2024

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About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication. 

 

About The Study: In this cohort study of older drinkers from the UK, even low-risk drinking was associated with higher mortality among older adults with health-related or socioeconomic risk factors. The attenuation of mortality observed for wine preference and drinking only during meals requires further investigation, as it may mostly reflect the effect of healthier lifestyles, slower alcohol absorption, or nonalcoholic components of beverages. 

Corresponding Author: To contact the corresponding author, Rosario Ortolá, MD, PhD, email rosario.ortola@uam.es.

 

(doi:10.1001/jamanetworkopen.2024.24495)

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Comparative Safety of In Utero Exposure to Buprenorphine Combined With Naloxone vs Buprenorphine Alone

JAMA

EMBARGOED FOR RELEASE: 11 A.M. ET, MONDAY, AUGUST 12, 2024

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About The Study: There were similar and, in some instances, more favorable neonatal and maternal outcomes for pregnancies exposed to buprenorphine combined with naloxone compared with buprenorphine alone. For the outcomes assessed, compared with buprenorphine alone, buprenorphine with naloxone during pregnancy appears to be a safe treatment option. This supports the view that both formulations are reasonable options for the treatment of opioid use disorder in pregnancy, affirming flexibility in collaborative treatment decision-making.

Corresponding Author: To contact the corresponding author, Loreen Straub, MD, MS, email lstraub@bwh.harvard.edu.

 

(doi:10.1001/jama.2024.11501)

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Universal Free School Meals and School and Student Outcomes

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. ET, FRIDAY, AUGUST 9, 2024

Media advisory: The full study is linked to this news release.

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About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication. 

 

About The Study: In this systematic review, universal free school meals were associated with increased meal participation, no or slight improvements in attendance, and decreased obesity prevalence and suspension rates; certainty of evidence was moderate for lunch participation and low or very low for other outcomes. Studies did not report several important outcomes, such as diet quality and food security, suggesting the need for more high-quality research encompassing policy-relevant indicators. 

Corresponding Author: To contact the corresponding author, Amanda MacFarlane, PhD, email amanda.macfarlane@ag.tamu.edu.

 

(doi:10.1001/jamanetworkopen.2024.24082)

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Extent of Drug Patents With Terminal Disclaimers and Obviousness-Type Double Patenting Rejections

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Neighborhood-Level Social Determinants of Health and Presenting Characteristics for Rhegmatogenous Retinal Detachments

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Leading Causes of Death in the US, 2019-2023

JAMA

EMBARGOED FOR RELEASE: 1 P.M. ET, THURSDAY, AUGUST 8, 2024

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About The Article: This Viewpoint from the National Center for Health Statistics reports the leading causes of death in the U.S. from 2019 to 2023, including the emergence of COVID-19 and shifts in other top causes as pandemic deaths decreased.

Corresponding Author: To contact the corresponding author, Farida Bhuiya Ahmad, MPH, email hhi0@cdc.gov.

 

(doi:10.1001/jama.2024.15563)

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Oral Antibiotics and Risk of Serious Cutaneous Adverse Drug Reactions

JAMA

EMBARGOED FOR RELEASE: 11 A.M. ET, THURSDAY, AUGUST 8, 2024

Media advisory: The full study is linked to this news release.

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About The Study: Commonly prescribed oral antibiotics are associated with an increased risk of serious cutaneous adverse drug reactions compared with macrolides, with sulfonamides and cephalosporins carrying the highest risk. Prescribers should preferentially use lower-risk antibiotics when clinically appropriate.

Corresponding Author: To contact the corresponding author, David N. Juurlink, M.D., Ph.D., email david.juurlink@ices.on.ca.

 

(doi:10.1001/jama.2024.11437)

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Childhood and Adolescent Depression Symptoms and Young Adult Mental Health and Psychosocial Outcomes

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. ET, THURSDAY, AUGUST 8, 2024

Media advisory: The full study and commentary are linked to this news release.

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About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication. 

 

About The Study: In this cohort study of Canadian children and adolescents, childhood and adolescent depression symptoms were associated with impaired adult psychosocial functioning. Interventions should aim to screen and monitor children and adolescents for depression to inform policymaking regarding young adult mental health and psychosocial outcomes. 

Corresponding Author: To contact the corresponding author, Marilyn N. Ahun, PhD, email marilyn.ahun@mcgill.ca.

 

(doi:10.1001/jamanetworkopen.2024.25987)

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Cannabis Use and Head and Neck Cancer

JAMA Otolaryngology–Head & Neck Surgery

EMBARGOED FOR RELEASE: 11 A.M. (ET), THURSDAY, AUGUST 8, 2024

Media advisory: The full study and commentary are linked to this news release.

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About The Study: This cohort study highlights an association between cannabis-related disorder and the development of head and neck cancer in adult patients. Given the limitations of the database, future research should examine the mechanism of this association and analyze dose response with strong controls to further support evidence of cannabis use as a risk factor for head and neck cancers. 

Corresponding Author: To contact the corresponding author, Niels C. Kokot, MD, email niels.kokot@med.usc.edu.

 

(doi:10.1001/jamaoto.2024.2419)

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Neighborhood Socioeconomic Disadvantage Across the Life Course and Premature Mortality

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. ET, WEDNESDAY, AUGUST 7, 2024

Media advisory: The full study is linked to this news release.

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About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication. 

 

About The Study: Low neighborhood socioeconomic status was associated with premature mortality in this study. The risk of premature mortality was greatest among individuals experiencing persistently low neighborhood socioeconomic status from young to middle adulthood. Place-based interventions that target neighborhood social determinants of health should be designed from a life course perspective that accounts for early-life socioeconomic inequality. 

Corresponding Author: To contact the corresponding author, Wayne R. Lawrence, DrPH, email wayne.lawrence@nih.gov.

 

(doi:10.1001/jamanetworkopen.2024.26243)

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Rates of Sudden Death After Myocardial Infarction— Insights From the VALIANT and PARADISE-MI Trials

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Primary Care Use and 90-Day Mortality Among Older Adults Undergoing Cancer Surgery

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Controversial FDA Decision Authorizes Menthol-Flavored E-Cigarettes Despite Risks to Youth

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Variability in Constituents of E-Cigarette Products Containing Nicotine Analogues

JAMA

EMBARGOED FOR RELEASE: 11 A.M. ET, WEDNESDAY, AUGUST 7, 2024

Media advisory: The full study is linked to this news release.

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About The Study: Discrepancies were observed between labeled and measured concentrations of nicotine analogues in e-cigarettes and e-cigarette liquids marketed as nicotine replacements and exempt from FDA’s regulatory purview. Such discrepancies may lead to uncertainty about user exposure. When coupled with the largely unknown acute and chronic inhalation hazards and addictive potential of nicotine analogues, assessing product risk based on exposure becomes challenging from a clinical and regulatory standpoint. With e-cigarettes increasingly considered for smoking cessation, the advent of nicotine analogue–containing products with unknown health risks raises concern.

Corresponding Author: To contact the corresponding author, Sven E. Jordt, PhD, email sven.jordt@duke.edu.

 

(doi:10.1001/jama.2024.12408)

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A Vaping Cessation Text Message Program for Adolescent E-Cigarette Users

JAMA

EMBARGOED FOR RELEASE: 11 A.M. ET, WEDNESDAY, AUGUST 7, 2024

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About The Study: A tailored, interactive text message intervention increased self-reported vaping cessation rates among adolescents recruited via social media channels.

Quote from corresponding author Amanda L. Graham, PhD:

“Health care providers, teachers, and parents have been asking how to help teens quit vaping. This study is a critical breakthrough that demonstrates the power of a behavioral intervention for vaping cessation. Text messages serve as powerful reminders of an initial commitment to quit and can deliver proven behavior change support right to a young person’s phone.

“We also did not see evidence that teens who quit vaping transitioned to smoking. The intervention was effective in reducing dual use (smoking and vaping) and keeping teens in this study from starting to smoke.”

 

Contact information for Amanda L. Graham, PhD: email Megan Kelley (mkelley@truthinitiative.org).

 

(doi:10.1001/jama.2024.11057)

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Demographic Representation of Generative AI Images of Physicians

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. ET, TUESDAY, AUGUST 6, 2024

Media advisory: The full study and commentary are linked to this news release.

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About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication. 

 

About The Study: This study identifies demographic biases in artificial intelligence (AI)-generated images of physicians with disproportionate representation of white and male physicians and concerning underrepresentation of other races and ethnicities (Asian and Latino) and female physicians in some platforms. This bias has the potential to reinforce stereotypes and undermine diversity, equity, and inclusion initiatives within health care. 

Corresponding Author: To contact the corresponding author, Sang Won Lee, MSc, email sangwon_lee@hms.harvard.edu.

 

(doi:10.1001/jamanetworkopen.2024.25993)

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AI for Early Detection of Pediatric Eye Diseases Using Mobile Photos

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. ET, TUESDAY, AUGUST 6, 2024

Media advisory: The full study is linked to this news release.

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About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication. 

 

About The Study: In this cross-sectional study, the artificial intelligence (AI) model demonstrated strong performance in accurately identifying myopia, strabismus, and ptosis using only smartphone images. These results suggest that such a model could facilitate the early detection of pediatric eye diseases in a convenient manner at home.

Corresponding Authors: To contact the corresponding authors, email Lin Li, MD, PhD (jannetlee130@gmail.com), and Jie Xu, DHM (xujie@pjlab.org.cn).

 

(doi:10.1001/jamanetworkopen.2024.25124)

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Type 2 Diabetes and Fracture Risk in Older Women

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. ET, TUESDAY, AUGUST 6, 2024

Media advisory: The full study is linked to this news release.

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About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication. 

 

About The Study: The results from this study suggest that the higher fracture risk among older women with type 2 diabetes may be due to impaired physical function and not skeletal characteristics. 

Corresponding Author: To contact the corresponding author, Mattias Lorentzon, MD, PhD, email mattias.lorentzon@medic.gu.se.

 

(doi:10.1001/jamanetworkopen.2024.25106)

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Estimated Exposure to 6 Potentially Hepatotoxic Botanicals in US Adults

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. ET, MONDAY, AUGUST 5, 2024

Media advisory: The full study is linked to this news release.

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About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication. 

 

About The Study: In this survey study, an estimated 15.6 million U.S. adults consumed at least one botanical product with liver liability within the past 30 days, comparable with the number of people who consumed nonsteroidal anti-inflammatory drugs and a commonly prescribed hypolipidemic drug. Turmeric was most frequently reported, followed in order by green tea, ashwagandha, Garcinia cambogia, red yeast rice, and black cohosh products.  Given a lack of regulatory oversight on the manufacturing and testing of botanical products, clinicians should be aware of possible adverse events from consumption of these largely unregulated products. 

Corresponding Author: To contact the corresponding author, Alisa Likhitsup, MD, MPH, email allikhit@med.umich.edu.

 

(doi:10.1001/jamanetworkopen.2024.25822)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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COVID-19 Pandemic School Disruptions and Acute Mental Health in Children and Adolescents

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. ET, MONDAY, AUGUST 5, 2024

Media advisory: The full study is linked to this news release.

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About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication. 

 

About The Study: In this cross-sectional study of 13,000 pediatric emergency department visits at nine university hospitals in Italy, school opening following a COVID-19 pandemic–related school disruption was associated with an increase in acute psychiatric emergencies. The findings of this study suggest that school may be a major source of stress for youths; factors mediating school-associated mental health disturbances in youth should be investigated. 

Corresponding Author: To contact the corresponding author, Benedetto Vitiello, MD, email benedetto.vitiello@unito.it.

 

(doi:10.1001/jamanetworkopen.2024.25829)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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Health, Access to Care, and Financial Barriers to Care Among People Incarcerated in US Prisons

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Pain Phenotypes and Pain Multimorbidity Among Medicare Beneficiaries With Cerebral Palsy

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Early Childhood Screen Use Contexts and Cognitive and Psychosocial Outcomes

JAMA Pediatrics

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, AUGUST 5, 2024

Media advisory: The full study is linked to this news release.

Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time https://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/jamapediatrics.2024.2620?guestAccessKey=d9ef3589-dc0a-4a60-8704-9cfabb94ca76&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=080524

 

About The Study: The findings of this study show small to moderate effect sizes that highlight the need to consider screen use contexts (i.e., type, content, co-use, and purpose of use) when making recommendations for families, clinicians, and educators beyond screen time limits; including encouraging intentional and productive screen use, age-appropriate content, and co-use with caregivers.

Corresponding Author: To contact the corresponding author, Sumudu Mallawaarachchi, PhD, email sumudu@uow.edu.au.

 

(doi:10.1001/jamapediatrics.2024.2620)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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Modernizing the Data Infrastructure for Clinical Research to Meet Evolving Demands for Evidence

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Advancing Health Policy and Outcomes for People With Intellectual or Developmental Disabilities

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About JAMA Health Forum: JAMA Health Forum is an international, peer-reviewed, online, open access journal that addresses health policy and strategies affecting medicine, health and health care. The journal publishes original research, evidence-based reports and opinion about national and global health policy; innovative approaches to health care delivery; and health care economics, access, quality, safety, equity and reform. Its distribution will be solely digital and all content will be freely available for anyone to read.

Prescription Fills for Semaglutide Products

JAMA Health Forum

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, AUGUST 2, 2024

Media advisory: The full study is linked to this news release.

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About JAMA Health Forum: JAMA Health Forum is an international, peer-reviewed, online, open access journal that addresses health policy and strategies affecting medicine, health and health care. The journal publishes original research, evidence-based reports and opinion about national and global health policy; innovative approaches to health care delivery; and health care economics, access, quality, safety, equity and reform. Its distribution will be solely digital and all content will be freely available for anyone to read.

 

About The Study: The number of prescriptions filled for semaglutide has increased substantially, reaching 2.6 million prescriptions filled at retail pharmacies by December 2023. While Ozempic persistently accounted for most semaglutide fills, increases were considerably greater for Wegovy since its approval for weight loss in June 2021. These increases, which primarily occurred following increased awareness of weight-loss benefits in late 2022, are likely contributing to the FDA-reported shortage of Ozempic and Wegovy first issued in March 2022. Despite the disproportionate burden of obesity in Medicaid and Medicare Part D populations, and recent increases in public spending on weight-loss medications, most Wegovy fills were for the commercially insured.

Corresponding Author: To contact the corresponding author, Dima M. Qato, PharmD, MPH, PhD, email qato@usc.edu.

 

(doi:10.1001/jamahealthforum.2024.2026)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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Glycated Hemoglobin A1c Time in Range and Dementia in Older Adults With Diabetes

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. ET, FRIDAY, AUGUST 2, 2024

Media advisory: The full study is linked to this news release.

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About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication. 

 

About The Study: The findings of this study suggest that for older adults with diabetes, maintaining hemoglobin A1c (HbA1c) stability in individualized target ranges over time is associated with a lower risk of Alzheimer disease and related dementias. Lower HbA1c time in range may identify patients at increased risk of Alzheimer disease and related dementias.

Corresponding Author: To contact the corresponding author, Paul R. Conlin, MD, email paul.conlin@va.gov.

 

(doi:10.1001/jamanetworkopen.2024.25354)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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Safety and Risk Assessment of No-Prescription Online Semaglutide Purchases

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. ET, FRIDAY, AUGUST 2, 2024

Media advisory: The full study is linked to this news release.

Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2024.28280?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=080224

About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication. 

 

About The Study: This qualitative study found that semaglutide products are actively being sold without prescription by illegal online pharmacies, with vendors shipping unregistered and falsified products. Two websites evaluated were sent FDA warning letters for unlawful sale of unapproved and misbranded semaglutide. U.S. poison centers have reported a 1500% increase in calls related to semaglutide, highlighting the need for enhanced pharmacovigilance including for online sourcing harms.

Corresponding Author: To contact the corresponding author, Tim K. Mackey, MAS, PhD, email tkmackey@ucsd.edu.

 

(doi:10.1001/jamanetworkopen.2024.28280)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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Predictors of Response to Cognitive Behavioral Therapy in Patients With Tinnitus

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Aspirin Use and Incidence of Colorectal Cancer According to Lifestyle Risk

JAMA Oncology

EMBARGOED FOR RELEASE: 11 A.M. (ET), THURSDAY, AUGUST 1, 2024

Media advisory: The full study is linked to this news release.

Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time https://jamanetwork.com/journals/jamaoncology/fullarticle/10.1001/jamaoncol.2024.2503?guestAccessKey=272cd587-5b58-46d3-88ff-96c77577f1cc&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=080124

 

About The Study: Aspirin use was associated with a greater absolute reduction in risk of colorectal cancer among individuals with less healthy lifestyles in this cohort study. The findings of the study suggest that lifestyle risk factors may be useful to identify individuals who may have a more favorable risk-benefit profile for cancer prevention with aspirin. 

Corresponding Authors: To contact the corresponding authors, email Andrew T. Chan, MD, MPH (achan@mgh.harvard.edu) and Long H. Nguyen, MD, MS (lnguyen24@mgh.harvard.edu).

 

(doi:10.1001/jamaoncol.2024.2503)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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State Abortion Policy and Moral Distress Among Clinicians Providing Abortion After the Dobbs Decision

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. ET, THURSDAY, AUGUST 1, 2024

Media advisory: The full study is linked to this news release.

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About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication. 

 

About The Study: In this purposive national survey study of clinicians providing abortion, moral distress was elevated among all clinicians and more than twice as high among those practicing in states that restrict abortion compared with those in states that protect abortion. The findings suggest that structural changes addressing bans on necessary health care, such as federal protections for abortion, are needed at institutional, state, and federal policy levels to combat widespread moral distress. 

Corresponding Author: To contact the corresponding author, Katherine Rivlin, M.D., M.Sc., email krivlin@bsd.uchicago.edu.

 

(doi:10.1001/jamanetworkopen.2024.26248)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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Universal Background Checks, Permit Requirements, and Firearm Homicide Rates

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. ET, THURSDAY, AUGUST 1, 2024

Media advisory: The full study is linked to this news release.

Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2024.25025?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=080124

About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication. 

 

About The Study: This cross-sectional study found that universal background checks alone were not associated with firearm homicide rates, but a permit requirement for the purchase and possession of firearms was associated with substantially reduced rates of firearm homicide. The findings suggest that combining universal background checks and permit-to-purchase requirements is an effective strategy for firearm-related fatality reduction. 

Corresponding Author: To contact the corresponding author, Michael Siegel, MD, MPH, email mike.siegel@tufts.edu.

 

(doi:10.1001/jamanetworkopen.2024.25025)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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Diagnostic Accuracy of an Integrated AI Tool to Estimate Gestational Age From Blind Ultrasound Sweeps

JAMA

EMBARGOED FOR RELEASE: 11 A.M. ET, THURSDAY, AUGUST 1, 2024

Media advisory: The full study and editorial are linked to this news release.

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About The Study: Between 14 and 27 weeks’ gestation, novice users with no prior training in ultrasonography estimated gestational age as accurately with the low-cost, point-of-care artificial intelligence (AI) tool as credentialed sonographers performing standard biometry on high-specification machines. These findings have immediate implications for obstetrical care in low-resource settings, advancing the World Health Organization goal of ultrasonography estimation of gestational age for all pregnant people.

 

Quote from corresponding author Jeffrey S. A. Stringer, MD:

“Our study demonstrates that an AI-enabled, portable ultrasound device can estimate gestational age as accurately as an expert sonographer using an expensive, high-specification machine. This high degree of accuracy was obtained even though the users of the device had no formal training in sonography.

“The most important takeaway is the potential democratization of a critical prenatal diagnostic tool. By enabling accurate gestational age estimation without the need for expensive equipment or specialized training, this technology could significantly expand access to quality prenatal care in resource-limited settings worldwide.

“This research could transform prenatal care delivery globally. In areas where ultrasound was previously unavailable, patients can now receive timely, accurate gestational age estimates, crucial for identifying high-risk pregnancies and guiding appropriate care. Health care providers in remote or underserved areas can offer expert-level diagnostics without extensive training, potentially leading to improved maternal and neonatal outcomes on a large scale.”

 

Contact information for Jeffrey S. A. Stringer, MD: email jeffrey_stringer@med.unc.edu.

 

(doi:10.1001/jama.2024.10770)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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Social Determinants of Health and Surgical Desirability of Outcome Ranking in Older Veterans

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Immune-Mediated and Psychiatric Comorbidities Among Patients Newly Diagnosed With Alopecia Areata

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Factors Underlying Reduced Hospitalizations for Myocardial Infarction During the COVID-19 Pandemic

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State Policies Regulating Firearms and Changes in Firearm Mortality

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. ET, WEDNESDAY, JULY 31, 2024

Media advisory: The full study and commentary are linked to this news release.

Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2024.22948?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=073124

About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication. 

 

About The Study: In this comparative effectiveness study of state firearm policies, the joint effect estimates of combinations of firearm laws were calculated, showing that restrictive firearm policies were associated with substantial reductions in firearm mortality. Although policymakers would benefit from knowing the effects of individual policies, the estimated changes in firearm mortality following implementation of individual policies were often small and uncertain. 

Corresponding Author: To contact the corresponding author, Terry L. Schell, PhD, email tschell@rand.org.

 

(doi:10.1001/jamanetworkopen.2024.22948)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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Trust in Physicians and Hospitals During the COVID-19 Pandemic in a 50-State Survey of US Adults

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. ET, WEDNESDAY, JULY 31, 2024

Media advisory: The full study is linked to this news release.

Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2024.24984?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=073124

About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication. 

 

About The Study: The results of this survey study of U.S. adults suggest that trust in physicians and hospitals decreased during the COVID-19 pandemic. As lower levels of trust were associated with lesser likelihood of pursuing vaccination, restoring trust may represent a public health imperative. 

Corresponding Author: To contact the corresponding author, Roy H. Perlis, MD, MSc, email rperlis@mgh.harvard.edu.

 

(doi:10.1001/jamanetworkopen.2024.24984)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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City-Level Sugar-Sweetened Beverage Taxes and Youth Body Mass Index Percentile

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. ET, WEDNESDAY, JULY 31, 2024

Media advisory: The full study is linked to this news release.

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About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication. 

 

About The Study: Sugar-sweetened beverage excise taxes were associated with lower body mass index percentile among youth in this cohort study. Policymakers should consider implementing sugar-sweetened beverage excise taxes to prevent or reduce youth overweight and obesity and, ultimately, chronic disease, particularly among children younger than 12 years. 

Corresponding Author: To contact the corresponding author, Deborah Rohm Young, PhD, email deborah.r.young@kp.org.

 

(doi:10.1001/jamanetworkopen.2024.24822)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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Blood Biomarkers to Detect Alzheimer Disease in Primary Care and Secondary Care

JAMA

EMBARGOED FOR RELEASE: 7 A.M. ET, SUNDAY, JULY 28, 2024

Media advisory: The full study and editorial are linked to this news release. This study is being presented at the Alzheimer’s Association International Conference.

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About The Study: The amyloid probability score 2 (APS2) blood test and percentage of p-tau217 alone had high diagnostic accuracy for identifying Alzheimer disease among individuals with cognitive symptoms in primary and secondary care using predefined cutoff values. Future studies should evaluate how the use of blood tests for these biomarkers influences clinical care. 

Corresponding Authors: To contact the corresponding authors, email Sebastian Palmqvist, M.D., Ph.D. (sebastian.palmqvist@med.lu.se) and Oskar Hansson, M.D., Ph.D. (oskar.hansson@med.lu.se).

 

(doi:10.1001/jama.2024.13855)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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Changes in Alzheimer Disease Blood Biomarkers and Associations With Incident All-Cause Dementia

JAMA

EMBARGOED FOR RELEASE: 7 A.M. ET, SUNDAY, JULY 28, 2024

Media advisory: The full study and editorial are linked to this news release.

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About The Study: Plasma biomarkers of Alzheimer disease (AD) neuropathology, neuronal injury, and astrogliosis increase with age and are associated with known dementia risk factors. AD-specific biomarkers’ association with dementia starts in midlife whereas late-life measures of AD, neuronal injury, and astrogliosis biomarkers are all associated with dementia. 

Corresponding Author: To contact the corresponding author, Priya Palta, Ph.D., M.H.S., email priya_palta@med.unc.edu.

 

(doi:10.1001/jama.2024.6619)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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Self-Managed Abortion Attempts Before vs After Changes in Federal Abortion Protections in the US

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, JULY 30, 2024

Media advisory: The full study and commentary are linked to this news release.

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About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

 

About The Study: In this serial nationally representative survey study, increased self-managed abortion (SMA) was observed following the loss of federal abortion protections. The findings revealed increased SMA use among marginalized groups, most often with ineffective methods. These findings suggest the need to expand access to alternative models of safe and effective abortion care and ensure those seeking health care post-SMA do not face legal risks.

Corresponding author: To contact the corresponding author, Lauren Ralph, Ph.D., email lauren.ralph@ucsf.edu.

 

(doi: 10.1001/jamanetworkopen.2024.24310)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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Youth Suicide and Preceding Mental Health Diagnosis

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, JULY 30, 2024

Media advisory: The full study and commentary are linked to this news release.

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About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

 

About The Study: In this cross-sectional study, 3 of 5 youth suicide decedents did not have a documented preceding mental health diagnosis; the odds of having a mental health diagnosis were lower among racially and ethnically minoritized youths than white youths and among firearm suicides compared with other mechanisms. These findings underscore the need for equitable identification of mental health needs and universal lethal means counseling as strategies to prevent youth suicide.

Corresponding author: To contact the corresponding author, Sofia Chaudhary, M.D., email sofia.s.chaudhary@emory.edu.

 

(doi: 10.1001/jamanetworkopen.2024.23996)

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Suicide in US Preteens Ages 8 to 12, 2001 to 2022

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, JULY 30, 2024

Media advisory: The full study is linked to this news release.

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About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

 

About The Study: The findings of this study revealed a significant increase in the suicide rate among U.S. preteens between the 2001-2007 and 2008-2022 periods. Results showing a disproportionate increase in female suicide rates relative to male expand on existing evidence depicting a narrowing of the historically large gap in youth suicide rates between sexes. Suicide was the 11th leading cause of death in female preteens between 2001 and 2007 and the 5th leading cause of death between 2008 and 2022, while suicide in male preteens ranked consistently as the 5th leading cause of death.

Corresponding author: To contact the corresponding author, Donna A. Ruch, Ph.D., email donna.ruch@nationwidechildrens.org.

 

(doi: 10.1001/jamanetworkopen.2024.24664)

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Plasma Phosphorylated Tau 217 and Aβ42/40 to Predict Early Brain Aβ Accumulation in People Without Cognitive Impairment

JAMA Neurology

EMBARGOED FOR RELEASE: 2:10 P.M. (ET), SUNDAY, JULY 28, 2024

Media advisory: The full study is linked to this news release. This study is being presented at the Alzheimer’s Association International Conference.

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About The Study: The results of this cohort study suggest that combining plasma p-tau217 and Aβ42/40 levels could be useful for predicting development of Aβ pathology in people with early stages of subthreshold Aβ accumulation. These biomarkers might thus facilitate screening of participants for future primary prevention trials.

Corresponding Authors: To contact the corresponding authors, email Oskar Hansson, M.D, Ph.D. (Oskar.Hansson@med.lu.se) and Shorena Janelidze, Ph.D. (shorena.janelidze@med.lu.se).

 

(doi:10.1001/jamaneurol.2024.2619)

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MRI Signature of α-Synuclein Pathology in Asymptomatic Stages and a Memory Clinic Population

JAMA Neurology

EMBARGOED FOR RELEASE: 2:50 P.M. (ET), SUNDAY, JULY 28, 2024

Media advisory: The full study is linked to this news release. This study is being presented at the Alzheimer’s Association International Conference.

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About The Study: In this cohort study, seed amplification assays (SAA) α-syn+ was consistently associated with nucleus basalis of Meynert (NBM) atrophy already during asymptomatic stages. Further, in memory clinic cognitively impaired populations, SAA α-syn+ was associated with NBM atrophy, which partially mediated α-syn–induced attention/executive impairment. 

Corresponding Authors: To contact the corresponding authors, email Laura E.M. Wisse, Ph.D. (laura.wisse@med.lu.se) and Oskar Hansson, M.D., Ph.D. (oskar.hansson@med.lu.se).

 

(doi:10.1001/jamaneurol.2024.2713)

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Advancing Health Disparities Science Through Social Epigenomics Research

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. ET, MONDAY, JULY 29, 2024

Media advisory: The full article is linked to this news release.

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About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication. 

 

About The Article: The studies highlighted in this special issue of JAMA Network Open demonstrate important scientific progress in the complex integration of social determinants of health and health disparities with biological pathways and health outcomes to improve understanding of the mechanisms underlying health disparities among various underserved populations. Continued progress remains important in integrating different disciplines to transform the field of health disparities research.

Corresponding Author: To contact the corresponding author, Arielle S. Gillman, Ph.D., M.P.H., email arielle.gillman@nih.gov.

 

(doi:10.1001/jamanetworkopen.2024.28992)

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Fecal Microbiota Transplantation for Treatment of Parkinson Disease

JAMA Neurology

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, JULY 29, 2024

Media advisory: The full study and editorial are linked to this news release.

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About The Study: Fecal microbiota transplantation (FMT) was safe but did not offer clinically meaningful improvements. Further studies—for example, through modified FMT approaches or bowel cleansing—are warranted regarding the specific impact of donor microbiota composition and dysbiosis conversion on motor and nonmotor outcomes as well as medication needs in Parkinson disease.

Corresponding Author: To contact the corresponding author, Filip Scheperjans, M.D., Ph.D., email filip.scheperjans@hus.fi.

 

(doi:10.1001/jamaneurol.2024.2305)

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Maternal Obesity and Risk of Sudden Unexpected Infant Death

JAMA Pediatrics

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, JULY 29, 2024

Media advisory: The full study and editorial are linked to this news release.

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About The Study: The findings of this study suggest that infants born to mothers with obesity are at increased risk of sudden unexpected infant death (SUID), with a dose-dependent association between increasing maternal body mass index and SUID risk. Maternal obesity should be added to the list of known risk factors for SUID. With maternal obesity rates increasing, research should identify potential causal mechanisms for this association.

Corresponding Author: To contact the corresponding author, Darren Tanner, Ph.D., email darren.tanner@microsoft.com.

 

(doi:10.1001/jamapediatrics.2024.2455)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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Posttraumatic Stress Disorder Among Adults in Communities With Mass Violence Incidents

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. ET, FRIDAY, JULY 26, 2024

Media advisory: The full study and commentary are linked to this news release.

Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2024.23539?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=072624

About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

  

About The Study: In this survey study of 5,991 participants, presumptive posttraumatic stress disorder (PTSD) was quite prevalent long after the mass violence incident (MVI) among adults in communities that have experienced an MVI, suggesting that MVIs have persistent and pervasive public health impacts on communities, particularly among those with prior exposure to physical or sexual assault and other potentially traumatic events. Focusing exclusively on direct exposure to MVIs is not sufficient. Incorporating these findings into screening should improve efforts to identify the individuals most in need of prevention or mental health service after MVIs. 

Corresponding Author: To contact the corresponding author, Angela D. Moreland, Ph.D., email moreland@musc.edu.

 

(doi:10.1001/jamanetworkopen.2024.23539)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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Naloxone Availability and Cost After Transition to an Over-the-Counter Product

Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time https://jamanetwork.com/journals/jama-health-forum/fullarticle/10.1001/jamahealthforum.2024.1920?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=072624

About JAMA Health Forum: JAMA Health Forum is an international, peer-reviewed, online, open access journal that addresses health policy and strategies affecting medicine, health and health care. The journal publishes original research, evidence-based reports and opinion about national and global health policy; innovative approaches to health care delivery; and health care economics, access, quality, safety, equity and reform. Its distribution will be solely digital and all content will be freely available for anyone to read.

US State Restrictions and Excess COVID-19 Pandemic Deaths

JAMA Health Forum

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, JULY 26, 2024

Media advisory: The full study is linked to this news release.

Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time https://jamanetwork.com/journals/jama-health-forum/fullarticle/10.1001/jamahealthforum.2024.2006?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=072624

About JAMA Health Forum: JAMA Health Forum is an international, peer-reviewed, online, open access journal that addresses health policy and strategies affecting medicine, health and health care. The journal publishes original research, evidence-based reports and opinion about national and global health policy; innovative approaches to health care delivery; and health care economics, access, quality, safety, equity and reform. Its distribution will be solely digital and all content will be freely available for anyone to read.

 

About The Study: This cross-sectional study indicates that stringent COVID-19 restrictions, as a group, were associated with substantial decreases in pandemic mortality, with behavior changes plausibly serving as an important explanatory mechanism. These findings do not support the views that COVID-19 restrictions were ineffective. However, not all restrictions were equally effective; some, such as school closings, likely provided minimal benefit while imposing substantial cost. 

Corresponding Author: To contact the corresponding author, Christopher J. Ruhm, Ph.D., email ruhm@virginia.edu.

 

(doi:10.1001/jamahealthforum.2024.2006)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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Medical and Educational Indebtedness Among Health Care Workers

JAMA Health Forum

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, JULY 26, 2024

Media advisory: The full study is linked to this news release.

Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time https://jamanetwork.com/journals/jama-health-forum/fullarticle/10.1001/jamahealthforum.2024.1917?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=072624

About JAMA Health Forum: JAMA Health Forum is an international, peer-reviewed, online, open access journal that addresses health policy and strategies affecting medicine, health and health care. The journal publishes original research, evidence-based reports and opinion about national and global health policy; innovative approaches to health care delivery; and health care economics, access, quality, safety, equity and reform. Its distribution will be solely digital and all content will be freely available for anyone to read.

 

About The Study: U.S. health care workers are more likely than other workers to carry medical and educational debt, collectively owing more than $150 billion. This study found that medical debt was more prevalent among women, home health and nursing home personnel, uninsured individuals, and those with recent hospitalization. Educational debts disproportionately burdened Black workers and younger workers and those with higher education.

Corresponding Author: To contact the corresponding author, Kathryn E.W. Himmelstein, M.D., M.S.Ed., email khimmelstein@mgb.org.

 

(doi:10.1001/jamahealthforum.2024.1917)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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Projected Changes in Statin and Antihypertensive Therapy Eligibility With the AHA PREVENT Cardiovascular Risk Equations

JAMA

EMBARGOED FOR RELEASE: 11 A.M. ET, MONDAY, JULY 29, 2024

Media advisory: The full study and editorial are linked to this news release.

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About The Study: By assigning lower atherosclerotic cardiovascular disease risk predictions, application of the Predicting Risk of cardiovascular disease EVENTs (PREVENT) equations to existing treatment thresholds could reduce eligibility for statin and antihypertensive therapy among 15.8 million U.S. adults. 

Corresponding Author: To contact the corresponding author, Arjun K. Manrai, Ph.D., email Arjun_Manrai@hms.harvard.edu.

 

(doi:10.1001/jama.2024.12537)

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Provision of Stroke Care Services by Community Disadvantage Status

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. ET, THURSDAY, JULY 25, 2024

Media advisory: The full study is linked to this news release.

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About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication. 

 

About The Study: Hospitals in communities with the greatest level of socioeconomic disadvantage had the lowest likelihood of becoming stroke certified while hospitals in the most advantaged communities had the highest likelihood in this cohort study. These findings suggest that there is a need to support hospitals in disadvantaged communities to obtain stroke certification as a way to reduce stroke disparities.

Corresponding Author: To contact the corresponding author, Renee Y. Hsia, M.D., M.Sc., email renee.hsia@ucsf.edu.

 

(doi:10.1001/jamanetworkopen.2024.21010)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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