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Background The incidence of internal hemorrhoids is high. Internal hemorrhoids often cause hematochezia. Medication and minimally invasive surgery are effective therapies for internal hemorrhoids, but these two treatments have high rates of recurrence. Objective To evaluate the efficacy of a Chinese medicine, Huazhi suppository, combined with cap assisted endoscopic sclerotherapy (CAES) for symptomatic internal hemorrhoids and its long-term recurrence rate. Methods This study selected 104 patients (older than 18 years) with grade Ⅰ-Ⅲ internal hemorrhoids admitted to Guangdong Provincial People's Hospital from January 2018 to June 2020. These patients were randomly assigned into 3 groups by using the single-blind envelope method: medication group (n=31) , CAES group (n=38) and combined group (n=35) . Patients in the medication group received one Huazhi Suppository per time, twice daily for 7 days. Patients in the CAES group received sclerosing agent injection into the hemorrhoidal vein or hemorrhoids exposed by a short transparent cap under the direct vision of flexible endoscope. Patients in the combination group received one Huazhi Suppositoryper time, twice daily for 7 days after the CAES treatment. This study collected the data about clinical efficacy, complications and the satisfaction degree of these three groups, and followed up the recurrence of internal hemorrhoids at one year after treatment. Results The rates of overall symptom remission in medication group, CAES group and combined group were 71.0% (22/31) , 100.0% (38/38) and 100.0% (35/35) , respectively. The CAES group and combined group had significant higher rates of overall symptom remission compared with medication group (P

Background: Low birthweight (LBW), infants weighing less than 2,500 g, is a global health concern associated with high infant morbidity and mortality rates. This study investigates LBW prevalence and its relation to maternal sociodemographic characteristics and lifestyle behaviors factors in the United States (US). Methods: This analysis used the National Survey of Children's Health (NSCH) data from 2016 to 2021, including n = 225,443 children aged 0–17 years. 18,131 had LBW (<2,500 g), and 2810 had very LBW (VLBW) (<1,500 g). Logistic regression calculated odds ratios (OR) using LBW as the dependent variable, adjusting for various factors. Results: Between 2016 and 2021 in the United States, LBW prevalence averaged 9.31%, with VLBW at 1.50%. Mothers aged 18–35, White, had the lowest LBW (7.63%) and VLBW (1.17%) rates. Mothers aged ≤18 years, black, had the highest LBW (15.45%) and VLBW infants (4.70%). Maternal age emerged as a significant LBW factor, with an OR of 1.27 for ≤18 and 1.19 for >35. Children in poor health had the highest OR (2.87). Race/ethnicity and other disparities were observed. Conclusion: Our study highlights LBW risk among non‐White mothers with specific criteria, emphasizing the need for continued exploration of intersectional targets for change that are exacerbating LBW disparities among marginalized populations which may be artificially attributed to biologic determinants and individual‐level risk factors. In‐depth analysis of repressive structures at the root of inequalities demand continued research on macro levels of influence. Customized healthcare reform holds the greatest potential to disrupt the patterns contributing to poor health outcomes among LBW children, and will ultimately maximize the reach and effectiveness of health promotion strategies and clinical practices aimed to improve universal maternal and infant health. [ABSTRACT FROM AUTHOR]

Introduction: The aging population is a rapidly growing demographic in the United States. Isolation, limited autonomy, and declining physical and mental health render many older adults vulnerable to elder mistreatment (EM). The purpose of this study was to assess the prevalence and correlates of EM among a sample of older adults using legal assistance services in Atlanta, Georgia.Methods: Researchers administered surveys to consenting older adults (aged 60þ) in 5 metro Atlanta community centers that hosted legal assistance information sessions as part of the Elderly Legal Assistance Program. The surveys screened for risk factors and prevalence of EM risk using valid and reliable measures and included additional questions regarding demographics characteristics and healthcare use behaviors.Results: Surveys were completed by 112 participants. Findings reveal that 32 (28.6%) respondents met the criteria for elder abuse / neglect risk; 17 (15.2%) respondents met criteria for depression; and 105 (93.7%) had visited a healthcare provider during the past 6 months.Conclusion: The rates of EM risk in this sample were higher than those previously reported in research. Findings support continued examination of unique risks that may be present among older adults who may be possibly facing legal issues. Additionally, the reported frequency of healthcare visits among participants reveals a promising opportunity to examine development of a more widespread EM screening approach to be conducted in non-emergency settings. Interdisciplinary collaboration is required to inform screening approaches that account for complexities that EM cases present. [West J Emerg Med. 2013;14(4):309–315.]

Introduction: Much of the international community has an increased awareness of potential biologic, chemical, and nuclear threats and the need for physicians to rapidly acquire new knowledge and skills in order to protect the public's health. The present study evaluated the educational effectiveness of an online bioterrorism continuing medical education (CME) activity designed to address clinical issues involving suspected bioterrorism and reporting procedures in the United States. Methods: This was a retrospective survey of physicians who had completed an online CME activity on bioterrorism compared with a nonparticipant group who had completed at least 1 unrelated online CME course from the same medical school Web site and were matched on similar characteristics. An online survey instrument was developed to assess clinical and systems knowledge and confidence in recognition of illnesses associated with a potential bioterrorism attack. A power calculation indicated that a sample size of 100 (50 in each group) would achieve 90% power to detect a 10% to 15% difference in test scores between the two groups. Results: Compared with nonparticipant physicians, participants correctly diagnosed anthrax (p = 0.01) and viral exanthem (p = 0.01), but not smallpox, more frequently than nonparticipants. Participants knew more frequently than nonparticipants who to contact regarding a potential bioterrorism event (p = 0.03) Participants were more confident than nonparticipants about finding information to guide diagnoses of patients with biologic exposure (p = 0.01), chemical exposure (p = 0.02), and radiation exposure (p = 0.04). Discussion: An online bioterrorism course shows promise as an educational intervention in preparing physicians to better diagnose emerging rare infections, including those that may be associated with a bioterrorist event, in increasing confidence in diagnosing these infections, and in reporting of such infections for practicing physicians.

Introduction: As they care for patients, physicians raise questions, but they pursue only a portion of them. Without the best information and evidence, care and patient safety may be compromised. Understanding when and why problems prompt physicians to look for information and integrate results into their knowledge base is critical and shapes one part of reflection about care. This study explores the role of the Internet in gathering medical information as one step in that reflective practice, the barriers to its use, and changes in utilization over time. Methods: A questionnaire with 18 items adapted from previous studies was sent by facsimile to a randomly selected sample of U.S. physicians in all specialties and active in practice. Results: Specific patient problems and latest research in a specific topic most often prompt physicians to search on the Internet. Younger physicians and female physicians were most likely to seek information on a specific patient problem. Only 9% of all respondents (n = 2, 500) searched for information during a patient encounter. When unsure about diagnostic and management issues for a complex case, 41.3% chose to consult with a colleague or read from a text (22.8%). Searching most often occurred at home after work (38.2%) or during breaks in the day (35.7%). Most (68.7%) found the information they were looking for more than 51% of the time. Searching was facilitated by knowing preferred sites and access in the clinical setting. The greatest barriers to answering clinical questions included a lack of specific information and too much information to scan. Discussion: Although physicians are increasingly successful and confident in their Internet searching to answer questions raised in patient care, few choose to seek medical information during a patient encounter. Internet information access may facilitate overall reflection on practice; physicians do not yet use this access in a just-in-time manner for immediately solving difficult patient problems but instead continue to rely on consultation with colleagues. Professional association Web sites and point-of-care databases are helpful. From physicians' use of the Internet, professionals in continuing medical education must learn which search engines and sites are trusted and preferred.

To examine the association between maternal depressive symptoms during early childhood of their offspring and later overweight in the children. Only children (n = 1,090) whose weights and heights were measured at least once for three time points (grades one, three and six) from the National Institute of Child Health and Human Development Study were included. Maternal depressive symptoms, defined as a Center for Epidemiologic Studies Depression Scale (CES-D) score of 16 or greater, were assessed using CES-D when the child was 1, 24, and 36 months. Childhood overweight was based on standardized height and weight measures taken during the interviews, and was defined according to appropriate CDC age-and sex-specific BMI percentiles. Generalized estimating equation was used to examine the impact of maternal depressive symptoms on the childhood overweight after adjusting for covariates. Compared to children of mothers without depression at any of the three time points, when children were one, 24 and 36 months of age, children of mothers with depression at all three time points were 1.695 times more likely to be overweight after adjusting for other child characteristics (95% CI = 1.001-2.869). When further adjusted for maternal characteristics, children of mothers with depression at all three time points were 2.13 times more likely to be overweight (95% CI = 1.05-4.31). Persistent maternal depressive symptoms may be associated with an increased risk of childhood overweight in their offspring. Children of mothers with depression may benefit from special attention in terms of obesity prevention. Keywords Maternal depressive symptoms * Overweight * Childhood, Introduction Childhood obesity is a significant public health problem in the United States (US). Ogden and colleagues have reported that approximately one in four US children aged 2-5 years and [...]