161. Aluminum-Adsorbed Vaccines and Chronic Diseases in Childhood : A Nationwide Cohort Study.
作者: Niklas Worm Andersson.;Ingrid Bech Svalgaard.;Stine Skovbo Hoffmann.;Anders Hviid.
来源: Ann Intern Med. 2025年178卷10期1369-1377页
Aluminum is used as an adjuvant in nonlive vaccines administered in early childhood. Concerns persist about potential associations between vaccination with aluminum-adsorbed vaccines and increased risk for chronic autoimmunity, atopy or allergy, and neurodevelopmental disorders. Large-scale safety data remain limited.
162. Evaluation of a Region-Wide Hospital-Based Violence Intervention Program : A Pilot Cohort Study.
作者: Kristen L Mueller.;Taylor M Kaser.;Benjamin P Cooper.;Daphne Lew.;Vicki Moran.;Rachel M Ancona.;Kateri Chapman-Kramer.;Melik Coffey.;Keyria Page.;Abigail Batha.;Stephanie Harris.;Larita Rice-Barnes.;Marsha Williams.;Lindsay M Kranker.;Marguerite W Spruce.;Christopher Behr.;Michael A Mancini.;Douglas J E Schuerer.;Lindsay D Clukies.;Nicole Santucci.;Anne Trolard.;Victoria Anwuri.;Megan L Ranney.;Randi E Foraker.;Matt Vogel.
来源: Ann Intern Med. 2025年178卷8期1116-1126页
Violent injury survivors are at risk for revictimization. The St. Louis area hospital-based violence intervention program (HVIP), Life Outside of Violence (LOV), is the first multisystem, region-wide HVIP in the United States.
163. Development and Validation of Body Mass Index-Specific Waist Circumference Thresholds in Postmenopausal Women : A Prospective Cohort Study.
作者: Aaron K Aragaki.;JoAnn E Manson.;Erin S LeBlanc.;Rowan T Chlebowski.;Lesley F Tinker.;Matthew A Allison.;Bernhard Haring.;Andrew O Odegaard.;Sylvia Wassertheil-Smoller.;Nazmus Saquib.;Kamal Masaki.;Holly R Harris.;Leah R Jager.;Jennifer W Bea.;Jean Wactawski-Wende.;Garnet L Anderson.
来源: Ann Intern Med. 2025年178卷8期1073-1084页
A 2020 consensus statement proposed body mass index (BMI)-specific waist circumference (WC) thresholds to improve patient care.
168. Modernizing Risk Adjustment in Health Care: A Position Paper of the American College of Physicians.
作者: Brian E Outland.;Joshua M Liao.;Jason M Goldman.;Anne F Schultz.;William Fox.; .
来源: Ann Intern Med. 2025年178卷8期1157-1159页
Risk adjustment is a critical component of health care reimbursement aimed at ensuring fair compensation on the basis of the characteristics of patients receiving care. Optimizing risk adjustment is not just a matter of improving efficiency or predictive accuracy; it is a crucial step toward achieving health equity by ensuring that resources are directed toward patients who need them most and reducing incentives to exclude or neglect high-risk patients. The authors reviewed available publications from PubMed and Google Scholar published between 2000 and 2025, as well as relevant news articles, policy documents, websites, and other sources related to risk adjustment and application areas. This process yielded 8 recommendations related to standardizing risk adjustment methods, promoting data interoperability, implementing strategies to enable more accurate and continuous reflections of patients' health status, integrating valid and reliable metrics into regular evaluation and feedback mechanisms, limiting "gaming" opportunities and incentives, creating valid ways to measure costs of caring for patients who are experiencing health care disparities and inequities and/or are disproportionately affected by social drivers of health, evaluating and leveraging advanced analytics and machine learning when able to improve risk adjustment models, and promoting research and implementation methods that combine elements of both prospective and concurrent risk adjustment. Implementation of these risk adjustment recommendations has broad implications for various entities in the health care ecosystem.
171. GRADE Certainty Ratings: Thresholds Rather Than Categories of Contextualization (GRADE Guidance 41).
作者: Monica Hultcrantz.;Holger J Schünemann.;Reem A Mustafa.;David M Rind.;M Hassan Murad.;Martin Mayer.;David Tovey.;Brian S Alper.;Elie A Akl.;K M Saif-Ur-Rahman.;Bernardo Sousa-Pinto.;Ignacio Neumann.;Ariel Izcovich.;Gordon Guyatt.
来源: Ann Intern Med. 2025年178卷8期1183-1186页
In 2017, the GRADE (Grading of Recommendations Assessment, Development and Evaluation) working group defined the certainty of evidence as the certainty that the true effect lies on one side of a threshold or in a particular range. This definition has proved useful as the basis for rating certainty, facilitating the interpretation of the results for the target audience. However, the categorization of suggested thresholds and ranges as levels of contextualization led to inconsistencies between the initial and subsequent papers and has proved confusing for some GRADE users. Although considering context in choosing thresholds remains worthwhile, the GRADE working group will no longer use the categorization of contextualization. It will instead refer simply to chosen thresholds or ranges for determining the target of certainty rating.
172. Heat-Related Illnesses.
Climate change is anticipated to continue to adversely affect public health, with heat stress the predominant threat. Accordingly, heat-related illness is predicted to increase as extremely hot days become more frequent. Heat stroke, the most serious heat-related illness, is a medical emergency that may be fatal if it is not promptly recognized, addressed with early and rapid cooling, and accompanied by multidisciplinary supportive care as clinically indicated. Heat stroke is a preventable illness that occurs in 2 distinct forms-classic and exertional-that have distinct demographic profiles and clinical courses but similar management paradigms.
178. Projected Effects of Proposed Cuts in Federal Medicaid Expenditures on Medicaid Enrollment, Uninsurance, Health Care, and Health.
作者: Adam Gaffney.;David U Himmelstein.;Steffie Woolhandler.
来源: Ann Intern Med. 2025年178卷9期1334-1342页
In January 2025, the Republican majority in the House of Representatives' Budget Committee offered a list of possible spending reductions to offset revenue losses from proposed tax cuts. In May, the Committee advanced a bill incorporating several reductions on the list. The Committee estimated that the 6 largest potential Medicaid cuts (for example, work requirements for some Medicaid enrollees) would each reduce the federal government's Medicaid outlays by at least $100 billion over 10 years. On the basis of the Committee's estimates of savings; Congressional Budget Office analyses; and peer-reviewed studies of the coverage, financial, and health impacts of past Medicaid expansions and contractions, the authors project the likely effects of each option and of the House bill advanced by the Budget Committee in May. Each option individually would reduce federal Medicaid outlays by between $100 billion and $900 billion over a decade, increase the ranks of the uninsured by between 600 000 and 3 900 000 and the annual number of persons forgoing needed medical care by 129 060 to 838 890, and result in 651 to 12 626 medically preventable deaths annually. Enactment of the House bill advanced in May would increase the number of uninsured persons by 7.6 million and the number of deaths by 16 642 annually, according to a mid-range estimate. These figures exclude harms from lowering provider payments and shrinking benefits, as well as possible repercussions from states increasing taxes or shifting expenditures from other needs to make up for shortfalls in federal Medicaid funding. Policy makers should weigh the likely health and financial harms to patients and providers of reducing Medicaid expenditures against the desirability of tax reductions, which would accrue mostly to wealthy Americans.
|