JAMA (Journal of the American Medical Association)

Insufficient Sleep Among US Adolescents—Reply https://jamanetwork.com/journals/jama/fullarticle/2850723 In Reply In his thoughtful comments on our Research Letter examining trends in insufficient sleep among US adolescents, Dr White raises an important point regarding the comparability of the 2021 and 2023 screen time measures with those used in prior years (2007-2019).

Primary Composite Outcome Corrected in a Trial of Transfusion Strategy https://jamanetwork.com/journals/jama/fullarticle/2850724 To the Editor We wish to report corrections to our study of a restrictive vs liberal blood transfusion strategy on major cardiovascular events among patients with acute myocardial infarction and anemia. During secondary analyses of the trial results related to heart failure, it became apparent that the original analysis of the primary composite outcome had mistakenly included heart failure events as a component of the primary outcome (although heart failure events were adjudicated, they were not part of the prespecified primary composite outcome, which included all-cause death, stroke, recurrent myocardial infarction, or emergency revascularization prompted by ischemia at 30 days). In addition, the date of consent withdrawal was recorded incorrectly for 4 patients (before 30 days rather than after 30 days). Thus, as specified in the protocol and statistical analysis plan, they should have been considered missing, but had been coded as “no event.”

Insufficient Sleep Among US Adolescents https://jamanetwork.com/journals/jama/fullarticle/2850725 To the Editor A recent Research Letter examined trends in adolescent sleep using biennial Youth Risk Behavior Survey (YRBS) data from 2007 to 2023. For most of that period, the relevant YRBS question items are nearly identical, with 1 notable exception. The screen-time question in the 2023 YRBS is substantially different from the screen time questions used in prior years. From 2007 through 2019, the YRBS asked “On the average school day, how many hours do you play video or computer games or use a computer for something that is not school work? (Include activities such as Nintendo, Game Boy, PlayStation, Xbox, computer games, and the internet).” The examples provided in parentheses changed over time, with later iterations of the YRBS citing examples such as social media, texting, and tablet use. However, the underlying construct remained largely unchanged. In contrast, the only screen-related question item in the 2023 YRBS was “How often do you use social media?” In this case, respondents were asked to give a frequency-based response (eg, “A few times a month,” “Several times a day,” etc) rather than an estimate of hours.

End-of-Life and Hospice Care for People Who Are Incarcerated https://jamanetwork.com/journals/jama/fullarticle/2850726 This JAMA Insights discusses the need to expand prison hospice and compassionate release and enrich clinician understanding of the needs of dying patients who are incarcerated to provide compassionate and appropriate end-of-life care.

Correction to Primary Composite Outcome in a Trial of Transfusion Strategy https://jamanetwork.com/journals/jama/fullarticle/2850727 The Original Investigation titled “Effect of a Restrictive vs Liberal Blood Transfusion Strategy on Major Cardiovascular Events Among Patients With Acute Myocardial Infarction and Anemia: The REALITY Randomized Clinical Trial” published February 9, 2021, was corrected to fix the number of events for the primary outcome. Calculation of the primary composite outcome had mistakenly included heart failure events as a component, and the date of consent withdrawal was recorded incorrectly for 4 patients (before 30 days rather than after 30 days). Thus, as specified in the protocol and statistical analysis plan, they should have been considered missing, but had been coded as “no event.” After correction, the number of events for the primary outcome is slightly lower than in the original analysis (29 vs 36 for the restrictive transfusion group and 36 vs 45 for the liberal group). This change does not impact the main conclusion: the restrictive strategy resulted in a noninferior rate of major adverse cardiovascular events after 30 days compared with the liberal strategy. This article has been corrected online; a letter of explanation appears in this issue.

Seven-Year Valve Durability With TAVR https://jamanetwork.com/journals/jamacardiology/fullarticle/2850866 This ad hoc analysis of a randomized clinical trial reports on the 7-year outcomes among a group of low-risk patients with symptomatic severe aortic stenosis treated with transcatheter aortic valve replacement vs surgery.

Toward a Lifetime Strategy for Aortic Valve Replacement—Ariadne’s Thread https://jamanetwork.com/journals/jamacardiology/fullarticle/2850867 The expansion of transcatheter aortic valve replacement (TAVR) into younger and lower-risk populations has fundamentally reshaped the central question in the management of aortic stenosis (AS). Procedural safety and early outcomes are no longer the dominant concerns. Instead, the focus has shifted toward durability and, more importantly, toward how the initial intervention fits within a lifetime treatment strategy. In this context, the 7-year durability analysis from the Placement of Aortic Transcatheter Valves 3 (PARTNER 3) randomized clinical trial provides reassuring comparative results.

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Stopping Alzheimer Disease https://jamanetwork.com/journals/jama/fullarticle/2850604 This Perspective discusses progress made in Alzheimer disease prevention during the last 50 years.

Trends in Newborn Hepatitis B Virus Vaccination—Reply https://jamanetwork.com/journals/jama/fullarticle/2850605 In Reply We appreciate the thoughtful comments of Dr Dysart and colleagues regarding our Research Letter on US newborn HBV vaccination rates. Their observations highlight important considerations for research using aggregated electronic health record data, and we welcome the opportunity to clarify several methodological points.

Trends in Newborn Hepatitis B Virus Vaccination https://jamanetwork.com/journals/jama/fullarticle/2850606 To the Editor Dr Rothman and colleagues reported trends in newborn hepatitis B virus (HBV) vaccination in Epic Cosmos, a large-scale electronic health record database. They found that vaccinations rose from 67.5% in January 2017, peaked at 83.5% in February 2023, and then declined to 73.2% in August 2025. As pediatricians and neonatologists who observe HBV vaccine declination, we applaud the authors for quantifying this public health issue.

National Trends in Patient-Clinician Communication https://jamanetwork.com/journals/jama/fullarticle/2850607 This cross-sectional study examines trends in US patient portal messaging, telehealth and telephone encounters, and office visits, assessing differences in messaging by various patient sociodemographic characteristics.

National Trends in Patient Messaging https://jamanetwork.com/journals/jama/fullarticle/2850608 Over the past decade, the electronic inbox has become a defining feature of modern clinical practice. Patient portal messaging—direct communication between patients and clinicians via a portal in the electronic health record—has evolved from a supplementary communication tool to a central modality of care delivery. Prior studies have linked growing message volume to increased after-hours use of the electronic health record and clinician burnout, raising concerns that asynchronous communication, while convenient for patients, may contribute to unsustainable workloads. The COVID-19 pandemic accelerated these changes through both telehealth visits and patient portal messaging. Yet despite widespread recognition of this shift, national trends in patient portal messaging have not been described, nor how messaging relates to more traditional care modalities, such as telephone encounters and office visits.

Toward Inclusive Clinical Trials https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2850554 Clinical research plays a foundational role in advancing medical knowledge, improving care delivery, and refining treatment strategies. Yet, disparities in research participation compromise fairness, generalizability, and trustworthiness of findings. Using data from the RETAIN (Randomized Evaluation of Trial Acceptability by Incentive) study, which assessed the impact of $0, $200, and $500 incentives on enrollment in a smoking cessation trial among participants with major depressive disorder, Benson et al explore in this issue of JAMA Internal Medicine whether financial incentives are associated with reduced enrollment disparities in randomized clinical trials. Of note, of 3 trials originally included in RETAIN, only findings from the smoking cessation trial were included in this secondary analysis. The current analysis revealed that greater financial incentives significantly mitigated enrollment gaps between Black and White participants. Specifically, Black participants had a 15.9–percentage point lower enrollment rate than White participants without an incentive, but this gap was eliminated with $200 and $500 incentives. However, incentives did not significantly impact enrollment disparities by sex, educational level, or age.

Deprescribing Inappropriate Medicines Across a Health System https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2850555 Less is More

APOL1 and Black Kidney Donors—Reducing Risk or Opportunity? https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2850556 Apolipoprotein L1 (APOL1) is a human serum protein that acts as an innate immune defense against African trypanosomes, protecting against sleeping sickness (human African trypanosomiasis). Through evolutionary pressure, specific APOL1 gene variants (G1/G2) evolved in sub-Saharan Africa to counteract parasite resistance and are found almost exclusively in people of African or Caribbean heritage. However, the presence of 2 APOL1 alleles (G1/G1, G1/G2, or G2/G2) has shown a 51% increased risk for chronic kidney disease (CKD) and 2-fold increased risk of progression to kidney failure vs zero or 1 allele; increased risk is confined to 2 APOL1 alleles (high-risk genotype), with a kidney failure incidence of 35.22 per 100 person-years, vs 15.22 per 100 person-years and 12.69 per 100 person-years for 0 or 1 APOL1 allele, respectively. For potential living kidney donors, there is limited evidence to guide risk assessment for donation in the presence of 2 APOL1 alleles. Informing that need, in this issue of JAMA Internal Medicine, Hsu and colleagues from the APOL1 Long-Term Kidney Transplantation Outcomes Network present results from the Living Donor Extended Time Outcomes study. In this retrospective cohort study, previous living kidney donors (445 Black donors and 208 White donors) were contacted and invited to participate in a home-based research visit approximately 2 decades after donation. The critical finding is that Black kidney donors with 2 APOL1 alleles had considerably increased risk of developing an estimated glomerular filtration rate (eGFR) lower than 45 mL/min/1.73 m2 (relative risk, 2.31; 95% CI, 1.16-4.61) compared to Black kidney donors with 0 or 1 APOL1 allele. After adjusting for eGFR at time of donation, there remained statistically significant associations between APOL1 high-risk genotypes and higher risk of developing eGFR lower than 60 mL/min/1.73 m2 among Black kidney donors (relative risk, 1.50; 95% CI, 1.18-1.90).

The Sky He Never Saw Again https://jamanetwork.com/journals/jamaneurology/fullarticle/2850586 This essay descibes the author’s experience of her father’s time in an intensive care unit.

Clinical Associations of Cerebrospinal Fluid TMEM106B in Familial and Sporadic Frontotemporal Dementia https://jamanetwork.com/journals/jamaneurology/fullarticle/2850587 This cross-sectional study among 2 independent cohorts investigates the clinical associations of cerebrospinal fluid TMEM106B protein levels in frontotemporal lobar degeneration.

Reversible Bilateral Hypoglossal Palsy and Peripheral Nerve Vasculitis https://jamanetwork.com/journals/jamaneurology/fullarticle/2850588 This case report discusses an unusual presentation of peripheral nervous system vasculitis with bilateral hypoglossal nerve involvement in a woman aged 50 years who presented with subacute asymmetric weakness, severe neuropathic pain, and dysarthria.

FDA Advises Against Over-the-Counter Skin Lightening Products https://jamanetwork.com/journals/jama/fullarticle/2850664 The US Food and Drug Administration (FDA) released a warning advising consumers against using over-the-counter skin lightening products, which may contain high levels of mercury or hydroquinone.