Sociodemographic disparities in preterm birth and low birthweight in the State of Georgia: Results from the 2017-2018 Pregnancy Risk Assessment Monitoring System.

PURPOSE: To update the overall prevalence of preterm birth (PTB) (<37 weeks gestation) and low birthweight (LBW) (<2,500 g) in the State of Georgia, including rural and urban counties. METHODS: A sample was drawn from the 2017-2018 Georgia Pregnancy Risk Assessment Monitoring System (PRAMS). In the complete-case data of singleton births (n=1,258), we estimated the weighted percentage prevalence of PTB, LBW, early/late PTB, and moderately/very LBW subcategories in association with maternal sociodemographic characteristics, and the prevalence stratified by rural/urban county of residence. Univariate and multivariate logistic regression models were fitted to estimate the odds ratios (ORs) of PTB and LBW adjusting for selected covariates. Logistic regression results from multiple imputation by chained equations (MICE) were used for comparison. FINDINGS: The overall rate for PTB was 9.3% and 6.8% for LBW and among them, 2.3% were early PTB, 7.0% were late PTB, 5.4% were moderately LBW (MLBW), and 1.3% were very LBW (VLBW). Non-Hispanic Black women had the highest prevalence of PTB, LBW, early PTB, MLBW, and VLBW, as well as PTB and LBW in urban counties and LBW in rural counties. The odds of PTB (aOR 1.38; 95% CI: 0.81, 2.35) and LBW (aOR 2.68; 95% CI: 1.32, 5.43) were also higher among non-Hispanic Black relative to non-Hispanic White women and among women who received adequate-plus prenatal care compared to inadequate prenatal care. CONCLUSIONS: Socioeconomic and health disparities created by disadvantage should be a focus of state policy to improve neonatal outcomes in the State of Georgia.

Interaction Effects of Maternal Sexually Transmitted Infections with Prenatal Care Utilization Status on Preterm Birth and Low Birthweight: U.S. National Data.

This case-control study aimed to test interaction between the most common sexually transmitted infections (STIs) (i.e., chlamydia, gonorrhea, and syphilis) and prenatal care (PNC) utilization status on preterm birth (PTB) (<37 weeks gestation) and low birthweight (LBW) (<2500 g). We used data of participants with singleton live births (N = 3,418,028) from the 2019 United States National Vital Statistics System. There were 280,206 participants in the PTB group and 3,137,822 in the control group, and 221,260 participants in the LBW group and 3,196,768 in the control group. Nearly 1.9% of the participants had chlamydia, 0.3% had gonorrhea, and 0.2% had syphilis. Interaction effects of STIs with PNC utilization status on the risk of PTB and LBW were tested on the multiplicative and additive scales. Using measures of the relative excess risk of interaction (RERI), the attributable proportion of interaction (AP), and the synergy index (S), we observed the highest significant synergistic interaction between syphilis and inadequate PNC utilization increasing the risk of PTB (RERI 2.12, AP 38%, and SI 1.88), and between gonorrhea and inadequate PNC utilization increasing the risk of LBW (RERI 1.03, AP 28%, and SI 1.64). Findings from this study help improve our understanding of disease etiology and inform prevention planning.

Addressing Family Medicine's Capacity to Improve Health Equity Through Collaboration, Accountability and Coalition-Building.

Achieving health equity requires an evaluation of social, economic, environmental, and other factors that impede optimal health for all. Family medicine has long valued an ecological perspective of health, partnering with families and communities. However, both the quantity and degree of continued health disparities requires that family medicine intentionally work toward improvement in health equity. In recognition of this, Family Medicine for America's Health (FMAHealth) formed a Health Equity Tactic Team (HETT). The team's charge was to address primary care's capacity to improve health equity by developing action-oriented approaches accessible to all family physicians. The HETT has produced a number of projects. These include the Starfield II Summit, the focus of which was "Primary Care's Role in Achieving Health Equity." Multidisciplinary thought leaders shared their work around health equity, and actionable interventions were developed. These formed the basis of subsequent work by the HETT. This includes the Health Equity Toolkit, designed for a broad interdisciplinary audience of learners to learn to improve care systems, reduce disparities, and improve patient outcomes. The HETT is also building a business case for health equity. This has focused efforts on demonstrating to the private sector an economic argument for health equity. The HETT has formed a close partnership with the American Academy of Family Physicians' (AAFP's) Center for Diversity and Health Equity (CDHE), collaborating on numerous efforts to increase awareness of health equity. The team has also focused on engaging leadership in all eight US national family medicine organizations to participate in its activities and to ensure that health equity remains a top priority in its leadership. Looking ahead, family medicine will be required to continuously engage with government and nongovernment agencies, academic centers, and the private sector to create partnerships to systematically tackle health inequities.

The impact of pneumonia guidelines and core measures on patient-oriented outcomes.

Over the past decade, evidence-based guidelines have led to the development of national core measures for the management of pneumonia. Although it does not signify causation, implementation of these standards strongly correlates with a decrease in the incidence of pneumonia and with decreasing death rates from pneumonia.

Clinical inquiries: What blood tests help diagnose celiac disease?

Histological confirmation of infiltrative lesions via small bowel biopsy is the gold standard for diagnosing celiac disease. Four serum antibody assays may serve as a first-step diagnostic tool to identify biopsy candidates: immunoglobulin A tissue transglutaminase (IgA tTG), IgA endomysial antibody (IgA EMA), IgA antigliadin antibody (IgA AGA), and IgG antigliadin antibody (IgG AGA). IgA tTG and IgA EMA offer the best diagnostic accuracy. Patients with selective IgA deficiency may have falsely negative IgA assays (strength of recommendation [SOR]: B, based on a systematic review, multiple small cross-sectional studies, and expert opinion).