tbuckley/cabot-search huggingface dataset:
Postoperative Aspiration Pneumonia Among Adults Using GLP-1 Receptor Agonists
Authors: Yuan-Hsin Chen, Thomas Zink, Ya-Wen Chen, Darren Z. Nin, Carl T. Talmo, Brian L. Hollenbeck, Andrew R. Grant, Ruijia Niu, David C. Chang, Eric L. Smith
Journal: JAMA Network Open (2025)

Importance Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been increasingly prescribed for weight management in recent years. However, little is known about whether preoperative GLP-1 RA use is associated with a greater risk of complications after surgery. Objective To investigate whether preoperative GLP-1 RA use is associated with postoperative aspiration pneumonia among patients undergoing common surgical procedures. Design, Setting, and Participants This retrospective cohort study, conducted using MarketScan commercial claims databases, included patients who underwent 1 of 14 common surgical procedures from April 1, 2020, to September 30, 2022. Individuals who were younger than 18 years, underwent multiple surgical procedures, or had a preoperative history of pneumonia or acute respiratory failure in the 90 days preceding surgery were excluded. Data were analyzed from December 2023 to March 2024. Main Outcome and Measures The primary outcome was aspiration pneumonia in the 30-day postoperative period. Multivariable logistic regressions were performed, adjusting for patient and surgical characteristics. Results This study included 366 476 patients (median age, 53 years [IQR, 43-62 years]), of whom 56.4% were women. In the cohort, 5931 patients (1.6%) had a preoperative prescription for a GLP-1 RA. Patients using GLP-1 RAs were more likely to be female (3502 [59.0%] vs 203 288 [56.4%]) and diagnosed with both obesity and diabetes (2819 [47.5%] vs 24 635 [6.8%]) compared with nonusers. Adjusted analysis showed no significant differences in the odds of postoperative pneumonia (odds ratio, 0.78; 95% CI, 0.57-1.06; P = .12) between GLP-1 RA users and nonusers. Conclusions and Relevance This cohort study found no significant association between the preoperative use of GLP-1 RAs and short-term postoperative aspiration pneumonia despite growing concerns about the adverse effects of these medications after surgery. This finding suggests that it may be beneficial to reassess the preoperative withholding guidelines for GLP-1 RAs.
Veterans at High Risk for Post–COVID-19 Suicide Attempts or Other Self-Directed Violence
Authors: David P. Bui, Meike Niederhausen, Alex W. Hickok, Diana J. Govier, Mazhgan Rowneki, Jennifer C. Naylor, Eric Hawkins, Edward J. Boyko, Theodore J. Iwashyna, Elizabeth M. Viglianti, George N. Ioannou, Jason I. Chen, Denise M. Hynes
Journal: JAMA Network Open (2025)

Importance US veterans have a higher risk of suicide than the general civilian population. Research suggests that COVID-19 infection is associated with increased risk of suicide attempts or other forms of self-directed violence (SDV) among veterans. Objective To identify subgroups of veterans with high risk of post–COVID-19 suicide attempts or SDV. Design, Setting, and Participants This is a retrospective cohort study conducted using data from the Veteran Health Administration (VHA). Participants included VHA enrollees with a first case of COVID-19 between May 1, 2021, and April 30, 2022, residing in the 50 states or Washington, DC. Exposure COVID-19 infection. Main Outcomes and Measures The main outcome was a suicide attempt or SDV 12 months after COVID-19 infection. Latent class analysis was used to identify subgroups. Outcome rates and 95% CIs per 10 000 veterans were calculated. Multinomial regressions were used to model outcome risk and marginal risk ratios with 99.5% CIs to compare outcome risk across latent classes. Results The cohort included 285 235 veterans with COVID-19 and was predominantly male (248 118 veterans [87.0%]) and younger than 65 years (171 636 veterans [60.2%]). Chronic pain (152 788 veterans [53.6%]), depression (98 093 veterans [34.4%]), and posttraumatic stress disorder (79 462 veterans [27.9%]) diagnoses were common. The 12-month outcome rate was 73.8 events per 10 000 (95% CI, 70.7-77.0 events per 10 000). Two latent classes with high rates of suicide attempt or SDV were identified. The first high-risk subgroup (46 693 veterans [16.4%]) was older (34 472 veterans [73.8%] aged ≥65 years) and had a high prevalence of physical conditions (43 329 veterans [92.8%] had hypertension, and 36 824 veterans [78.9%] had chronic pain); the 12-month outcome rate was 103.7 events per 10 000 (95% CI, 94.7-113.3 events per 10 000). The second high-risk subgroup (82 309 veterans [28.9%]) was generally younger (68 822 veterans [83.6%] aged &amp;amp;lt;65 years) with a lower prevalence of physical conditions but high prevalence of mental health conditions (61 367 veterans [74.6%] had depression, and 50 073 veterans [60.8%] had posttraumatic stress disorder); the 12-month outcome rate was 162.9 events per 10 000 (95% CI, 154.5-171.8 events per 10 000), and compared with the lowest risk subgroup, the 12-month risk of suicide attempts or SDV was 14 times higher in this subgroup (risk ratio, 14.23; 99.5% CI, 10.22-19.80). Conclusions and Relevance In this cohort study of veterans with COVID-19, 2 veteran subgroups with distinct health profiles had high rates of suicide attempts and SDV, suggesting that different groups may require different approaches to suicide prevention after COVID-19.
Dementia Diagnoses Matter—More Work To Be Done and Not Just in Hospice
Authors: Greg A. Sachs
Journal: JAMA Network Open (2025)

Meredith Bock, MD; Siqi Gan, MPH; Melissa Aldridge, PhD; Krista L. Harrison, PhD; Kristine Yaffe, MD; Alexander K. Smith, MD; John Boscardin, PhD; Lauren J. Hunt, PhD
A Virtual Cardiometabolic Health Program Among African Immigrants in the US
Authors: Oluwabunmi Ogungbe, Thomas Hinneh, Ruth-Alma N. Turkson-Ocran, Loretta Owusu, Baridosia Kumbe, Erin M. Spaulding, Serina Gbaba, Adeline Assani-Uva, Jasmine Mensah, Yvette Yeboah-Kordieh, Aminata Sinyan, Margaret Ampofo, Faith Oyedepo, Yvonne Commodore-Mensah
Journal: JAMA Network Open (2025)

Importance Black persons, including immigrants, in the US disparately experience poor cardiometabolic health (CMH). Limited research on the effect of lifestyle interventions that improve CMH among African immigrant populations is available. Objective To test the effectiveness of a culturally adapted, virtual lifestyle intervention on control of blood pressure (BP) and hemoglobin A 1c (HbA 1c ) levels among African immigrants with CMH risk factors. Design, Setting, and Participants Afro-DPP (Diabetes Prevention Program), a pilot cluster-randomized clinical trial, evaluated the effectiveness of a multicomponent CMH intervention. The study took place in 2 churches with predominantly African immigrant congregations in the Baltimore–Washington, DC, metropolitan area from January 1, 2022, to July 31, 2023. Participants were adults aged 25 to 75 years with at least 2 CMH risk factors who self-identified as African immigrants and belonged to the participating churches. Analyses followed the intention-to-treat principle. Intervention Participants received a 6-month culturally adapted lifestyle intervention based on the National DPP curriculum, delivered via virtual group sessions by a lifestyle coach of African origin. The delayed intervention began 6 months later with a follow-up time of 6 months. The intervention also included remote BP and weight monitoring. Main Outcome and Measures Primary outcomes were changes in systolic and diastolic BP and HbA 1c levels from baseline to 6 months. Secondary outcomes included reduced body weight and body mass index (BMI; calculated as weight in kilograms divided by height in meters squared). Results The analytic population included 60 participants (mean [SD] age, 50.6 [11.9] years; 40 [66.7%] women). In the first intervention group (n = 30), systolic BP decreased by 9.2 (95% CI, 2.5-15.9) mm Hg, diastolic BP by 6.1 (95% CI, 2.1-10.0) mm Hg, body weight by 4.9 (95% CI, 1.0-8.7) kg, and BMI by 1.1 (95% CI, 0.4-1.7) at 6 months. In the delayed intervention group (n = 30), systolic BP decreased by 11.4 (95% CI, 2.4-20.5) mm Hg, diastolic BP by 10.3 (95% CI, 5.4-15.2) mm Hg, and body weight by 3.3 (95% CI, 0.01-6.5) kg, while BMI increased by 0.3 (95% CI, −1.5 to 2.0). Conclusions and Relevance Trial findings indicate that interventions incorporating cultural adaptation and virtual components could help address CMH disparities in this population. Trial Registration ClincalTrials.gov Identifier NCT05144737
Co-Occurrence of Stunting and Off-Track Early Child Development in Low- and Middle-Income Countries
Authors: Joshua Jeong, Hyejun Chi, Lilia Bliznashka, Helen O. Pitchik, Rockli Kim
Journal: JAMA Network Open (2025)

Importance Although children across low- and middle-income countries (LMICs) are increasingly surviving, many are not fully thriving. Both stunting and off-track early child development (ECD) hinder children’s potential to thrive. Objectives To estimate the global prevalence of the co-occurrence of stunting and off-track ECD and explore its association with nurturing care and sociodemographic factors. Design, Setting, and Participants This cross-sectional study pooled data from the most recent Demographic and Health Surveys and Multiple Indicator Cluster Surveys (2010-2020) on 173 416 children aged 36-59 months in 41 LMICs. Statistical analysis was conducted from February to December 2024. Exposure Risk factors pertaining to inadequate nurturing care, low socioeconomic status, and other sociodemographic characteristics. Main Outcomes and Measures Children were classified into 4 groups with respect to thriving: children who were stunted only (height-for-age z score &amp;amp;lt;−2 SD), off-track ECD only (measured using the Early Childhood Development Index), both stunted and off-track ECD (co-occurrence), or neither. Results In the pooled sample of 173 416 children, the mean (SD) child age was 47.1 (6.8) months, and 88 242 (50.9%) were boys. Approximately 1 in 6 children (17.0% [95% CI, 16.8%-17.2%]) were both stunted and had off-track ECD, 17.1% (95% CI, 16.9%-17.3%) were stunted only, 27.8% (95% CI, 27.6%-28.0%) had off-track ECD only, and 38.1% (95% CI, 37.9%-38.4%) were neither stunted nor had off-track ECD. Socioeconomic gradients were observed, with more co-occurrence in lower-income countries (18.2% [95% CI, 17.9%-18.6%]), poorer households (22.1% [95% CI, 21.7%-22.5%] for poorest wealth quintile), mothers with lower educational levels (20.8% [95% CI, 20.6%-21.0%] for primary education or less), and rural settings (19.3% [95% CI, 19.1%-19.6%]). Various indicators of inadequate nurturing care along with low socioeconomic status were associated with co-occurrence. The top 5 factors associated with co-occurrence were poorest wealth quintile (adjusted odds ratio [AOR], 2.75; 95% CI, 2.53-2.99), no early childhood education (AOR, 2.22; 95% CI, 2.10-2.34), low maternal educational level (AOR, 1.44; 95% CI, 1.37-1.51), no toys at home (AOR, 1.43; 95% CI, 1.35-1.51), and diarrhea (AOR, 1.38; 95% CI, 1.31-1.45). The associations of poor household wealth, no birth registration, and no early childhood education with co-occurrence were significantly larger than their associations with stunting only or off-track ECD only. Conclusions and Relevance This cross-sectional study of young children in LMICs suggests that a significant proportion were both stunted and had off-track ECD. These findings underscore the need for multisectoral interventions that holistically target nutrition, health, and ECD risks to ensure that all children globally can thrive, especially those facing the double burden of stunting and off-track ECD.
Postoperative Outcomes Following Preweekend Surgery
Authors: Sanjana Ranganathan, Carlos Riveros, Yusuke Tsugawa, Michael Geng, Vatsala Mundra, Zachary Melchiode, Bheeshma Ravi, Natalie Coburn, Angela Jerath, Allan S. Detsky, Christopher J. D. Wallis, Raj Satkunasivam
Journal: JAMA Network Open (2025)

Importance The phenomenon of a weekend effect refers to a higher potential for adverse outcomes in patients receiving care over the weekend. Few prior studies have comprehensively investigated the effects of postoperative weekend care on surgical outcomes in a generalizable cohort. Objective To examine differences in short-term and long-term postoperative outcomes of patients undergoing surgical procedures immediately before vs after the weekend. Design, Setting, and Participants This is a population-based, retrospective cohort secondary analysis of adult patients in Ontario, Canada, undergoing 1 of 25 common surgical procedures between January 1, 2007, to December 31, 2019, with 1 year of follow-up. Data analysis was performed from October to November 2022. Exposure Undergoing surgery before (1 day before) vs after (1 day after) the weekend. Main Outcomes and Measures The primary outcome was a composite of death, readmission, and complications at 30 days, 90 days, and 1 year. Multivariable generalized estimating equations with an independent correlation structure, accounting for covariates, with clustering on surgical procedure were used to estimate the association between day of surgery in relation to the weekend and the outcomes. Results Of the 429 691 patients (mean [SD] age, 58.6 [16.9] years; 270 002 female patients [62.8%]) in the study cohort, 199 744 (46.5%) underwent surgery before the weekend, and 229 947 (53.5%) underwent surgery after the weekend. Patients in the preweekend group were more likely than those in the postweekend group to experience the composite outcome of death, complications, and readmissions at 30 days (adjusted odds ratio [aOR], 1.05; 95% CI, 1.02-1.08), 90 days (aOR, 1.06; 95% CI, 1.03-1.09), and 1 year (aOR, 1.05; 95% CI, 1.02-1.09) after surgery. Odds of mortality were increased in the preweekend group vs the postweekend group at 30 days (aOR, 1.09; 95% CI, 1.03-1.16), 90 days (aOR, 1.10; 95% CI, 1.03-1.17), and 1 year (aOR, 1.12; 95% CI, 1.08-1.17). Conclusions and Relevance In this retrospective multi-institutional study, patients who underwent surgery immediately preceding the weekend had a significantly increased risk of complications, readmissions, and mortality compared with those treated after the weekend. Further study is needed to understand differences in care that may underpin these observations and ensure that patients receive high-quality care regardless of the day of the week.
Hospice Use Among Medicare Beneficiaries With Parkinson Disease and Dementia With Lewy Bodies
Authors: Meredith Bock, Siqi Gan, Melissa Aldridge, Krista L. Harrison, Kristine Yaffe, Alexander K. Smith, John Boscardin, Lauren J. Hunt
Journal: JAMA Network Open (2025)

Importance Neurodegenerative disorders are now the most common reason that Medicare beneficiaries enroll in hospice for end-of-life care. People with all-cause dementia have high rates of suboptimal hospice use, but little is known about hospice use patterns in Lewy body disease, which includes both Parkinson disease (PD) and dementia with Lewy bodies (DLB). Objective To compare patient characteristics, hospice agency characteristics, and patterns of use for beneficiaries with PD and DLB vs Alzheimer disease (AD). Design, Setting, and Participants A retrospective cohort study including a 100% sample of national 2010-2020 calendar year Medicare data on hospice enrollees was performed. Data analysis was conducted from November 2023 to May 2024. Exposures A diagnosis of PD or DLB, compared with AD as the reference group. Main Outcomes and Measures Proportion of enrollees with short stays (&amp;amp;lt;7 days), proportion with long stays (&amp;amp;gt;180 days), proportion disenrolled for any reason before death, and disenrollment by type. Results Of 11 327 324 Medicare beneficiaries enrolled in hospice between 2010 and 2020 who met eligibility criteria (mean [SD] age, 85.2 [7.5] years; 781 763 [63.0%] female), there were 958 182 (8.4%) with a primary diagnosis of AD, 232 864 (2.1%) with PD, and 49 340 (0.4%) with DLB. People with PD were more likely to experience a long stay (odds ratio [OR], 1.15; 95% CI, 1.13-1.16) compared with AD, whereas the odds for those with DLB were not increased. However, people with either PD or DLB were less likely to be disenrolled for extended prognosis compared with AD (OR for DLB, 0.82; 95% CI, 0.79-0.85; OR for PD, 0.86; 95% CI, 0.85-0.88). People with PD were more likely to revoke hospice (OR, 1.29; 95% CI, 1.27-1.32) compared with AD. Conclusions and Relevance In this cohort study of Medicare beneficiaries, hospice use patterns differed by dementia subtype. Higher likelihood of hospice revocation in PD raises important questions about unmet needs and highlights the need for more research around the experience of the end of life in this growing population.
Perceived Discrimination in Health Care Settings and Care Delays in Patients With Diabetes and Hypertension
Authors: Maryam Jafari Bidgoli, Hui Wang, Casey Macander, Abbey Gregg
Journal: JAMA Network Open (2025)

Importance Some US populations experience perceived discrimination in health care settings (PDHS) that may lead to delaying health care and worse health outcomes. It is crucial to understand potential mechanisms, such as patient-clinician communication (PCC), that may reduce these disparities. Objective To examine PCC as a mediating pathway between PDHS and health care delays due to nervousness about seeing a health care professional while considering the moderating roles of age and race and ethnicity. Design, Setting, and Participants This cross-sectional study examined data from the All of Us Research Program between May 31, 2017, and April 30, 2022. Included participants were adults aged 18 years or older with type 2 diabetes and/or hypertension. The data analysis was performed between February 20 and April 29, 2024. Exposure Perceived discrimination in the health care setting. Main Outcome and Measures The study outcome was health care delays due to being nervous about seeing a health care professional. The association between PDHS and health care delays was examined through PCC using a structural equation model with moderated mediation analysis. Results The analytic sample comprised 25 581 participants (mean [SD] age, 62.4 [12.8] years; 58.1% women; and 9.5% of Black, 6.3% of Hispanic, 81.3% of White, and 2.9% of other race and ethnicity). Delaying health care due to feeling nervous about seeing a health care professional was reported by 2300 participants (8.9%). Patient-clinician communication mediated the association between PDHS and delayed care. Mediation proportions decreased with age across all racial and ethnic groups, with the highest proportions observed among participants aged 18 to 44 years (Black participants, 19.5% [95% CI, 14.9%-24.1%]; Hispanic participants, 20.3% [95% CI, 15.6%-25.1%]; White participants, 19.0% [95% CI, 14.7%-23.2%]; participants of other race and ethnicity, 18.3% [95% CI, 13.2%-23.5%]). Within each age group, the highest mediation proportions were observed among Hispanic participants, followed by Black and White participants, and participants of other race and ethnicity. Conclusions and Relevance These findings suggest that higher PDHS is positively associated with delaying health care due to nervousness about seeing a health care professional. The largest mediation proportion observed was among younger adults and racial and ethnic minority groups. By prioritizing better PCC, health care delays associated with patient apprehension related to perceived discrimination may be reduced.
Cost-Effectiveness of Pembrolizumab With Chemoradiotherapy for Locally Advanced Cervical Cancer
Authors: P. Travis Courtney, Puja S. Venkat, Ya-Chen Tina Shih, Albert J. Chang, Alan Lee, Michael L. Steinberg, Ann C. Raldow
Journal: JAMA Network Open (2025)

Importance The KEYNOTE-A18 trial demonstrated that adding concurrent and adjuvant pembrolizumab to chemoradiotherapy and brachytherapy significantly improved survival in patients with newly diagnosed, locally advanced cervical cancer. However, considering the annual global incidence of 660 000 cases of cervical cancer, including 13 820 in the US in 2024, incorporating this regimen into the standard of care could have substantial health care economic implications for both patients and the health care system. Objective To determine the cost-effectiveness of adding pembrolizumab to the first-line treatment of newly diagnosed, locally advanced cervical cancer. Design, Setting, and Participants This economic evaluation created a Markov model simulating 50-year outcomes to evaluate cost-effectiveness from the payer perspective for patients receiving either pembrolizumab or placebo in addition to chemoradiotherapy plus brachytherapy. Probabilities, including disease progression, survival, and treatment-related toxic effects, were derived from KEYNOTE-A18 clinical trial data in patients with newly diagnosed, locally advanced cervical cancer. Costs and health utilities were obtained from published literature; 1-way, 3-way, and probabilistic sensitivity analyses were used to assess model uncertainty. Data analyses were conducted from April to November 2024. Exposure Pembrolizumab. Main Outcomes and Measures Costs, measured in 2024 US dollars, and effectiveness, measured in quality-adjusted life-years (QALYs) were used to calculate an incremental cost-effectiveness ratio (ICER). A willingness-to-pay threshold of $100 000 per QALY was chosen, below which pembrolizumab would be considered cost-effective. Results KEYNOTE-A18 enrolled 1060 patients (529 in pembrolizumab group, 531 in placebo group). The median age was 50 years. Pembrolizumab increased costs by $257 000 and effectiveness by 1.40 QALYs, yielding an incremental cost-effectiveness ratio of $183 400 per QALY. The addition of pembrolizumab became cost-effective if its monthly cost was decreased from $16 990 to $9190 (a 45.6% reduction) or its maximum duration of 24 months was decreased to 10 months. The model was insensitive to assumptions about treatment-related toxic effects, progression-free survival, and overall survival. Probabilistic sensitivity analysis indicated that at a willingness-to-pay threshold of $100 000 per QALY, the addition of pembrolizumab was cost-effective 37.3% of the time. Conclusions and Relevance In this economic evaluation of adding concurrent and adjuvant pembrolizumab to first-line treatment of newly diagnosed, locally advanced cervical cancer, this regimen was not cost-effective at current prices despite data demonstrating improved survival with this regimen.