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Accurate and timely interpretation of microcytic anemia can be diagnostically challenging in the primary care setting. We sought to develop a novel model for distinguishing iron-deficiency anemia from thalassemia trait in the modern pediatric population. Demographic history and red blood cell indices were retrospectively characterized for 76 children referred to our pediatric hematology clinic for evaluation of microcytic anemia. Statistically significant variables were sequentially added into a logistic regression model to develop the final model. The final discriminating model incorporates red cell distribution width, mean corpuscular hemoglobin concentration, and red blood cell values. Favorable predictive performance is seen in the initial (sensitivity 89.2%, specificity 92.3%) and external validation cohort (sensitivity 84.4%, specificity 88.9%). This novel tool may aid in determining the cause of hypochromic, microcytic anemia in the primary care setting. Finally, the study cohort reflects an underrepresented group in the development of screening tools, and thus offers generalizability. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of screening and treating asymptomatic pregnant women for Chlamydia (C.) trachomatis and Neisseria (N.) gonorrhoeae infections on the frequency of preterm birth or low birthweight infants in Botswana. Design: Non‐randomised, cluster‐controlled trial. Setting: Four antenatal care clinics in Gaborone, Botswana. Population: Pregnant women aged ≥15 years, attending a first antenatal care visit, ≤27 weeks of gestation and without urogenital symptoms were eligible. Methods: Participants in the intervention clinics received screening (GeneXpert®, Cepheid) during pregnancy and at the postnatal visit. Participants in the standard‐of‐care clinics received screening at the postnatal visit only. We used multivariable logistic regression and post‐estimation predictive margins analysis. Post‐hoc analysis was conducted among sub‐samples stratified by parity. Main outcome measures: Preterm birth (<37 weeks of gestation) and low birthweight (<2500 g). Results: After controlling for parity, hypertension, antenatal care visits and clinic site, the predicted prevalence of preterm birth or low birthweight was lower in the intervention arm (11%) compared with the standard‐of‐care arm (16%) (adjusted odds ratio [aOR] 0.59; 95% confidence interval [CI] 0.28–1.24). In post‐hoc analysis, the intervention was more effective than the standard‐of‐care (aOR 0.20; 95% CI 0.07–0.64) among nulliparous participants. Conclusion: A C. trachomatis and N. gonorrhoeae infection screening and treatment intervention among asymptomatic pregnant women may have reduced preterm birth or low birthweight outcomes, but results were not statistically significant. Post‐hoc analysis found that the intervention reduced adverse outcomes among nulliparous participants. [ABSTRACT FROM AUTHOR]

Introduction: Treatment of vestibular schwannoma (VS) has been extensively studied, but a gap in knowledge exists demonstrating how racial and socioeconomic status influence VS presentation. Our institution has a unique setting with a public safety net hospital (PSNH) and tertiary academic medical center (TAMC) in the same zip code, which we study to evaluate initial VS presentation disparities in patient populations presenting to these hospital settings. Methods: Retrospective chart review was performed of all adult patients (n = 531) presenting 2010 to 2020 for initial VS evaluation at TAMC (n = 462) and PSNH (n = 69). Ethnicity, insurance, maximum tumor size, audiometry, initial treatment recommendation, treatment received, and follow up were recorded and statistical analysis performed to determine differences. Results: Average age at diagnosis (51.7 ± 13.6 TAMC vs 52.3 ± 12.4 PSNH) and gender (58.4% TAMC vs 52.2% PSNH female) were similar. Patients' insurance (TAMC 75.9% privately insured vs PSNH 82% Medicaid) and racial/ethnic profiles (TAMC 67.7% White and 10.0% Hispanic/Latinx, vs PSNH 4.8% White but 59.7% Hispanic/Latinx) were significantly different. Tumor size was larger at PSNH (20.2 ± 13.3 mm) than TAMC (16.6 ± 10.0 mm). Hearing was more impaired at PSNH than TAMC (mean pure tone average 58.3 dB vs 43.9 dB, word recognition scores 52.3% vs 68.2%, respectively). Initial treatment recommendations and treatment received may include more than 1 modality. TAMC patients were offered 66.7% surgery, 31.2% observation, and 5.2% radiation, while PSNH patients offered 50.7% observation, 49.3% surgery, and 8.7% radiation. TAMC patients received 62.9% surgery, 32.5% observation, and 5.3% radiation, while PSNH patients received 36.2% surgery, 59.4% observation, and 14.5% radiation. Follow up and treatment at the same facility was not significantly different between hospitals. Conclusions: Hearing was worse and tumor size larger in patients presenting to PSNH. Despite worse hearing status and larger tumor size, the majority of PSNH patients were initially offered observation, compared to TAMC where most patients were initially offered surgery. [ABSTRACT FROM AUTHOR]

BackgroundPublic health organizations have begun to use social media to increase awareness of health harm and positively improve health behavior. Little is known about effective strategies to disseminate health education messages digitally and ultimately achieve optimal audience engagement. ObjectiveThis study aims to assess the difference in audience engagement with identical antismoking health messages on three social media sites (Twitter, Facebook, and Instagram) and with a referring link to a tobacco prevention website cited in these messages. We hypothesized that health messages might not receive the same user engagement on these media, although these messages were identical and distributed at the same time. MethodsWe measured the effect of health promotion messages on the risk of smoking among users of three social media sites (Twitter, Facebook, and Instagram) and disseminated 1275 health messages between April 19 and July 12, 2017 (85 days). The identical messages were distributed at the same time and as organic (unpaid) and advertised (paid) messages, each including a link to an educational website with more information about the topic. Outcome measures included message engagement (ie, the click-through rate [CTR] of the social media messages) and educational website engagement (ie, the CTR on the educational website [wCTR]). To analyze the data and model relationships, we used mixed effects negative binomial regression, z-statistic, and the Hosmer-Lemeshow goodness-of-fit test. ResultsComparisons between social media sites showed that CTRs for identical antitobacco health messages differed significantly across social media (P

The current study examined the role of internalized HIV-related stigma in antiretroviral therapy adherence, viral load, and retention in care among women of color living with HIV in Los Angeles County, California. African American and Hispanic/Latino women 18 years of age and older completed a one-time brief survey between September 2017 and February 2018. Descriptive statistics, and univariable and multivariable logistic regressions were used to analyze the data. Seventy-six participants enrolled in the study and 74 completed the entire survey. Seventy-six percent of respondents were Hispanic/Latino, 24% were African American, 71% were unemployed, and 54% had less than a high school education. Thirty-five percent were defined as having "high" stigma with a score in the upper quartile of the scale. Being unemployed, having a high school education or less, and not meeting the Health Resources and Services Administration's annual retention in care measure were associated with "high" stigma. When controlling for education and employment status, those reporting "high" stigma vs. "low" stigma were 18.8 times more likely to not meet the criteria for annual retention in care (OR = 18.8, 95% CI = 1.9–189.2, p = 0.013). Stigma-reduction interventions targeting healthcare settings may be necessary to improve patient retention and engagement in care. [ABSTRACT FROM AUTHOR]

Irrigated potato (Solanum tuberosum L.) production requires large inputs of N, and therefore has high potential for N loss including emissions of [N.sub.2]O. Two strategies for reducing N loss include split applications of conventional fertilizers, and single applications of polymer-coated urea (PCU), both of which aim to better match the timing of N availability with plant demand. The objective of this 3-yr study was to compare [N.sub.2]O emissions and potato yields following a conventional split application (CSA) using multiple additions of soluble fertilizers with single preplant applications of two different PCUs (PCU-1 and PCU-2) in a loamy sand in Minnesota. Each treatment received 270 kg of fertilizer N [ha.sup.-1] per season. An unfertilized control treatment was included in 2 of 3 yr. Tuber yields did not vary among fertilizer treatments, but [N.sub.2]O emissions were significantly higher with CSA than PCU-1. During 3 consecutive yr, mean growing season emissions were 1.36, 0.83, and 1.13 kg [N.sub.2]O-N [ha.sup.-1] with CSA, PCU-1, and PCU-2, respectively, compared with emissions of 0.79 and 0.42 kg [N.sub.2]O-N [ha.sup.-1] in the control. The PCU-1 released N more slowly during in situ incubation than PCU-2, although differences in [N.sub.2]O emitted by the two PCUs were not generally significant. Fertilizer-induced emissions were relatively low, ranging from 0.10 to 0.15% of applied N with PCU-1 up to 0.25 to 0.49% with CSA. These results show that N application strategies utilizing PCUs can maintain yields, reduce costs associated with split applications, and also reduce [N.sub.2]O emissions. Abbreviations: AN, ammonium nitrate; BMP, best management practice; CSA, conventional split application; PCU, polymer-coated urea. doi:10.2136/sssaj2009.0126