Importance of Sacrotuberous Ligament in Transgluteal Approach for Sciatic Nerve Entrapment in the Greater Sciatic Notch (Piriformis Syndrome).

OBJECTIVE: The efficacy of sciatic nerve decompression via transgluteal approach for entrapment of the sciatic nerve at the greater sciatic notch, called piriformis syndrome, and factors affecting the surgical outcome were analyzed. METHODS: The outcome of pain reduction was analyzed in 81 patients with sciatic nerve entrapment who underwent decompression through a transgluteal approach. The patients were followed up for at least 6 months. The degree of pain reduction was analyzed using a numerical rating scale-11 (NRS-11) score and percent pain relief before and after last follow-up following surgery. Success was defined by at least 50% reduction in pain measured via NRS-11. To assess the degree of subjective satisfaction, a 10-point Likert scale was used. In addition, demographic characteristics, anatomical variations, and variations in surgical technique involving sacrotuberous ligamentectomy were analyzed as factors that affect the surgical outcome. RESULTS: At a follow-up of 17.5±12.5 months, sciatic nerve decompression was successful in 50 of 81 patients (61.7%), and the pain relief rate was 43.9±34.17. Subjective improvement based on a 10-point Likert scale was 4.90±3.43. Among the factors that affect the surgical outcome, only additional division of the sacrotuberous ligament during piriformis muscle resection played a significant role. The success rate was higher in the scarotuberous ligementectomy group (79.4%) than in the non-resection group (42.6%), resulting in statistically significant difference based on average NRS-11 score, percent pain relief, and subjective improvement (p<0.05, independent t-test). CONCLUSION: Sciatic nerve decompression is effective in pain relief in chronic sciatica due to sciatic nerve entrapment at the greater sciatic notch. Its effect was further enhanced by circumferential dissection of the sciatic nerve based on the compartment formed by the piriformis muscle and the sacrotuberous ligament in the greater sciatic notch.

Generalized Extension of Referred Trigeminal Pain due to Greater Occipital Nerve Entrapment.

We report a very rare case of referred pain caused by greater occipital nerve (GON) entrapment, inducing spontaneous pain in the whole body as well as in the trigeminal nerve region of the face and head. It has already been reported that entrapment of the GON can induce referred pain in the ipsilateral limb as well as the ipsilateral hemiface. A 42-year-old female patient presented with chronic pain in her gums, jaw angle, submandibular region, retro-auricular suboccipital, and temporo-occipital vertex that had been ongoing for four years. As the patient's head pain and facial pain became severe, severe spontaneous pain occurred in the arm, waist, and both lower extremities. This patient's pain in the occipital and neck, spontaneous pain in the face, jaw, and whole body improved with decompression of the GON. Anatomical basis of pain referral to the facial trigeminal area caused by chronic GON entrapment is convergence of nociceptive inflow from high cervical C1-C3 structures and trigeminal orofacial area in the dorsal horn of the cervical spinal cord from the C2 segment up to the medullary dorsal horn (MDH). The major afferent contribution among the suboccipital and high cervical structure is mediated by spinal root C2 that is peripherally represented by the GON. Chronic noxious input from GON entrapment can cause sensitization and hypersensitivity in second order neurons in the trigeminocervical complex (TCC) and MDH in the caudal trigeminal nucleus and high cervical cord. Generalized extension of referred pain due to GON entrapment is thought to involve two possible pathophysiologies. One is the possibility that generalized pain is caused by sensitization of third-order nociceptive neurons in the thalamus. Another speculation is that spontaneous pain may occur throughout the body due to dysfunction of the descending brain stem pain-modulating pathway by sensitization and hyperexcitation of the MDH and trigeminal brainstem sensory nuclear complex (TBSNC).

Increase in Trigeminal Nerve Cross-Sectional Area on Immediate Postoperative MRI Predicts Favorable Outcome After Microvascular Decompression for Classical Trigeminal Neuralgia.

BACKGROUND: Although distortion or indentation of a trigeminal nerve due to neurovascular compression (NVC) is associated with classical trigeminal neuralgia, whether morphological change in the trigeminal nerve is relieved by eliminating NVC has not been studied. OBJECTIVE: To estimate morphological change in the trigeminal nerve after microvascular decompression (MVD). METHODS: Fifty patients with classical trigeminal neuralgia who underwent MVD were included. Using coronal images in both preoperative and postoperative MRI, the trigeminal nerve cross-sectional area (CSA) was measured at 4 mm anterior to the nerve entry into the pons. Clinical outcomes were assessed using the Barrow Neurological Institute Pain Intensity Scale (BNI-PS) at the patient's latest follow-up. RESULTS: Forty-one patients achieved favorable outcomes without medication (BNI-PS I or II), and 9 patients had residual pain (BNI-PS ≥ 3A). The mean symptomatic trigeminal nerve CSA was increased by 51.47% after MVD in the favorable outcome group (preoperative: 4.37 ± 1.64 mm 2 vs postoperative: 6.26 ± 1.76 mm 2 , P < .01), whereas it was not significantly changed in the unfavorable outcome group (preoperative: 4.20 ± 1.19 mm 2 vs postoperative: 4.43 ± 1.24 mm 2 , P = .69). Kaplan-Meier survival analysis showed that the 3-year probability of maintaining a favorable outcome was 92.3 ± 7.4% and 56.1 ± 11.9%, for those whose symptomatic trigeminal nerve CSA was increased by over 20% and less than 20%, respectively ( P < .01). CONCLUSION: Morphological changes in the trigeminal nerve due to NVC could be recovered by MVD, and increases in the trigeminal nerve CSA predicted favorable outcomes.

Risk perceptions of a population living near a municipal waste incinerator and associated factors with the prevalence of environmental disease.

Background: This study investigated the risk perceptions, prevalence of environmental diseases (EDs) and associated factors with the prevalence of environmental disease among the population living near an incinerator. Methods: Study area were divided into 3 local areas near the incinerator by distance (A, B, C) and control area (D) by distance and geographic isolation. A Questionnaire was conducted with 1,380 in local residents (A, B, C) and 390 in control area (D), gathered information of demographic characteristics, lifestyle, perception of damage by incinerators, experience of EDs (atopic dermatitis, allergic rhinitis, asthma) diagnosed by physician. Analysis of variance, χ2 test, and Kruskal Wallis test was applied to determine the difference by area. Logistic regression analysis was performed to identify factors associated with the prevalence of allergic rhinitis. Results: Residents residing closer to the incinerator had negative perception in most items in questionnaire compared with control. The prevalence of allergic rhinitis was higher as they lived nearby the incinerator (p = 0.008). The associated factors with the prevalence of allergic rhinitis were carpet (odds ratio [OR]: 1.79, p = 0.001), residential area (marginally significant), duration of residence (OR: 1.09, p < 0.001). The perception of environmental pollution around the residential area was inversely associated with the prevalence of allergic rhinitis: perceived as very dissatisfied (OR: 4.21, p = 0.02) compared with very satisfied. Conclusions: As closer to the incinerator, the risk perception tend to negative and prevalence of EDs were increased. Carpet, residential area, duration of residence and perception of environmental air pollution around the residential area were associated with prevalence of allergic rhinitis. These results may be useful for the communication with residents to discuss the environmental problems caused by the incinerator.

Ipsilateral Limb Extension of Referred Trigeminal Facial Pain due to Greater Occipital Nerve Entrapment: A Case Report.

We report a very rare case of referred pain associated with entrapment of the greater occipital nerve (GON) occurring not only in the ipsilateral hemiface but also in the ipsilateral limb. There is an extensive convergence of cutaneous, tooth pulp, visceral, neck, and muscle afferents onto nociceptive and nonnociceptive neurons in the trigeminal nucleus caudalis (medullary dorsal horn). In addition, nociceptive input from trigeminal, meningeal afferents projects into trigeminal nucleus caudalis and dorsal horn of C1 and C2. Together, they form a functional unit, the trigeminocervical complex (TCC). The nociceptive inflow from suboccipital and high cervical structures is mediated with small-diameter afferent fibers in the upper cervical roots terminating in the dorsal horn of the cervical cord extending from the C2 segment up to the medullary dorsal horn. The major afferent contribution is mediated by the spinal root C2 that is peripherally represented by the greater occipital nerve (GON). Convergence of afferent signals from the trigeminal nerve and the GON onto the TCC is regarded as an anatomical basis of pain referral in craniofacial pain and primary headache syndrome. Ipsilateral limb pain occurs long before the onset of the referred facial pain. The subsequent severe hemifacial pain suggested GON entrapment. The occipital nerve block provided temporary relief from facial and extremity pain. Imaging studies found a benign osteoma in the ipsilateral suboccipital bone, but no direct contact with GON was identified. During GON decompression, severe entrapment of the GON was observed by the tendinous aponeurotic edge of the trapezius muscle, but the osteoma had no contact with the nerve. Following GON decompression, the referred trigeminal and extremity pain completely disappeared. The pain referral from GON entrapment seems to be attributed to the sensitization and hypersensitivity of the trigeminocervical complex (TCC). The clinical manifestations of TCC hypersensitivity induced by chronic entrapment of GONs are diverse when considering the occurrence of extremity pain as well as facial pain.

Piriformis Syndrome (Sciatic Nerve Entrapment) Associated With Type C Sciatic Nerve Variation: A Report of Two Cases and Literature Review.

Although anatomical variation of the sciatic nerve and piriformis muscle at the greater sciatic notch is considered an important cause of piriformis syndrome, there are few reports on the surgical treatment of piriformis syndrome owing to specific anatomical variations of the sciatic nerve and piriformis muscle. In this report, we describe 2 cases of piriformis syndrome caused by a rare type C sciatic nerve variation that were surgically treated using the transgluteal approach. The first patient reported unremitting left hip and leg pain that occurred following blunt trauma to the hip. The second patient complained of chronic pain in the buttocks and right leg, which persisted even after the patient underwent lumbar fusion surgery. Severe sitting pain and sciatica are symptomatic indications for the diagnosis of piriformis syndrome. A rare "C" type sciatic nerve variation was observed on the affected side under magnetic resonance imaging. Transgluteal sciatic nerve decompression provided significant pain relief. If severe sciatic nerve deformation due to a rare sciatic nerve variation can be confirmed with typical findings of piriformis syndrome, the possibility that sciatic nerve entrapment may have occurred in this variation should be considered.

Paralysis of the Upper Extremity Due to Acute Thoracic Outlet Syndrome Caused by the Subclavius Posticus Muscle: A Case Report With Literature Review.

The subclavius posticus muscle is a rare aberrant muscle that traverses from the costal cartilage of the first rib posterolaterally to the superior border of the scapula. We report a patient having persistent paralysis of shoulder abduction with wrist and finger extension after a humeral neck fracture. Electromyography (EMG) examination revealed injuries to several upper extremity peripheral nerves, including the radial, axillary, and musculocutaneous nerves. Magnetic resonance imaging (MRI) performed at 10 months post-injury showed severe entrapment of the left brachial plexus by the subclavius posticus muscle at the thoracic outlet. The diagnosis of brachial plexus injury due to a rare abnormal subclavius posticus muscle was typically delayed until the MRI was performed for unexplained multiple peripheral nerve palsy. Resection of the aberrant muscle and brachial plexus decompression did not yield significant improvement in the patient's radial nerve palsy until 6 months after surgery. Entrapment of the brachial plexus caused by the subclavius posticus muscle can cause symptoms of acute thoracic outlet syndrome following trauma to the upper extremity. In a case of inexplicable multiple peripheral nerve injuries in the upper extremity that are not proportional to the degree of trauma, MRI imaging along with EMG is required.

Long-Term Changes in Thecal Sac Compression and Decreased Cerebrospinal Fluid Space Following Paddle Lead Spinal Cord Stimulation at T9: A Long-Term Follow-Up via Three-Dimensional Myelographic Computed Tomography.

OBJECTIVES: To investigate the long-term changes in thecal sac compression following T9 paddle lead spinal cord stimulation (SCS) using three-dimensional myelographic computed tomography (CT). MATERIALS AND METHODS: Seventeen patients with five-column paddle lead SCS at T9 underwent three-dimensional myelographic CT scans preoperatively, immediately after surgery, and after an average of 11 months. The cross-sectional areas of thecal sac and spinal cord and the widths of anterior and posterior cerebrospinal fluid (CSF) spaces were repeatedly measured and compared. The contact angle of the lead with long-term pain relief was assessed. RESULTS: The cross-sectional areas of thecal sac and spinal cord decreased significantly after lead placement (30.47 ± 9.21% and 4.71 ± 9.84%, respectively). Even after 11 months, a significant reduction was found with the preoperative values (17.97 ± 12.32% and 2.88 ± 7.09%). The widths of anterior and posterior CSF spaces decreased significantly after surgery (43.53 ± 13.17% and 57.13 ± 13.17%, respectively) and the severe decrease persisted long-term (29.13 ± 21.54% and 50.99 ± 16.07%). The average pain relief was 42.27 ± 17.50% with no correlation between the rate of reduction in cross-sectional areas of thecal sac and the widths of CSF spaces. CONCLUSIONS: Significant early reduction and late partial restoration occurred in the thecal sac and spinal cord and the width of the anterior and posterior CSF spaces in the T9 5-column paddle lead SCS. Thecal sac compromise was expected to some extent after paddle lead implantation, but the degree is significant, and the cross-sectional area of the spinal cord as well as the thecal sac is affected. Fortunately, these anatomical changes did not cause any clinical problems except for intercostal root irritation. The shape and flat contours of the five-column paddle leads clearly affected the results.

Intrathecal Morphine Infusion for Trigeminal Deafferentation Pain Following Percutaneous Intervention for Unexplained Facial Pain: A Case Report.

Chronic pain in painful post-traumatic trigeminal neuropathy, formerly called trigeminal deafferentation pain (TDP) or anesthesia dolorosa, is virtually incurable neuropathic pain. In severe cases, no effective method has yet been established. A 58-year-old woman presented with chronic dysesthetic pain in the right side of her face that had persisted for 8 years. It was caused by percutaneous balloon compression for an unexplained, persistent right gingival pain. The TDP did not respond to any medications or radiosurgery. Considering the typical occipital neuralgia that occurred later, the incomprehensible gum pain was interpreted as referred trigeminal pain from occipital neuralgia. Decompression of the greater occipital nerve improved occipital neuralgia; however, TDP did not respond to internal neurolysis or invasive brain stimulation. The last attempt was made to administer an intrathecal opioid because of pain sufficiently severe to cause suicidal ideation. Trial administration of intrathecal opioids had some effect on pain relief. Although incomplete, the effects of intrathecal morphine infusion were maintained up to 1 year later. Invasive neurosurgical interventions should be cautiously performed for continuous pain in persistent idiopathic facial pain and referred facial pain cases that do not show typical neuralgic pain in primary trigeminal neuralgia because of the risk of TDP.

Decompression of the Greater Occipital Nerve for Occipital Neuralgia and Chronic Occipital Headache Caused by Entrapment of the Greater Occipital Nerve.

BACKGROUND: Chronic entrapment of the greater occipital nerve (GON) can not only manifest in typical stabbing pain of occipital neuralgia (ON) but also lead to continuous ache and pressure-like pain in the occipital and temporal areas. However, the effect of GON decompression on these symptoms has yet to be established. We report the follow-up results of GON decompression in typical cases of ON and chronic occipital headache due to GON entrapment (COHGONE). METHODS: A 1-year follow-up study of GON decompression was conducted on 11 patients with typical ON and 39 COHGONE patients with GON entrapment. The degree of pain reduction was analyzed using the numerical rating scale-11 (NRS-11) score and percent pain relief before and 1 year after surgery. A success was defined by at least a 50% reduction in pain measured via NRS-11 during the 12-month follow-up. To assess the degree of subjective satisfaction, a 10-point Likert scale was used. Postoperative outcome was also evaluated using the Barrow Neurological Institute (BNI) pain intensity score. The difference in GON decompression between the patients with typical ON and those with COHGONE was studied. RESULTS: GON decompression was successful in 43 of 50 patients (86.0%) and percent pain relief was 72.99 ± 25.53. Subjective improvement based on a 10-point Likert scale was 7.9 ± 2.42 and the BNI grade was 2.06 ± 1.04. It was effective in both the ON and COHGONE groups, but the success rate was higher in the ON group (90.9%) than in the COHGONE group (84.6%), showing statistically significant differences in the results based on average NRS-11 score, percent pain relief, subjective improvement, and BNI grades (p < 0.05, independent t-test). CONCLUSION: GON decompression is effective in chronic occipital headache and in ON symptoms induced by GON entrapment.

External Neurolysis in Microvascular Decompression for Magnetic Resonance Imaging-Negative Idiopathic Trigeminal Neuralgia.

OBJECTIVE: Internal neurolysis has been proposed as an alternative to microvascular decompression in patients with idiopathic trigeminal neuralgia (TN) in whom neurovascular compression is not confirmed by magnetic resonance imaging (MRI). External neurolysis, which straightens and realigns the trigeminal nerve root axis by dissecting the arachnoid membranes around the nerve, was reported 20 years ago in the context of so-called negative exploration when MRI did not confirm the absence of the offending vessel, but is not currently used. METHODS: External neurolysis was performed in 4 patients with idiopathic TN with typical evoked neuralgic pain despite the absence of suspected offending vessels on MRI. The surgical findings that caused TN were summarized and the outcomes were evaluated using the Barrow Neurological Institute Pain Intensity Scale (BNI-PS). RESULTS: Tethering and distortion of the nerve root by surrounding arachnoid membranes were commonly found. All 4 patients showed complete pain relief immediately after surgery. During the follow-up period of 26.5 ± 16.92 months (±standard deviation), 3 of 4 patients had no pain (score I, BNI-PS). One patient received a score of IIIa on the BNI-PS assessment. There was no instance of recurrence or side effects associated with the surgery. CONCLUSIONS: Idiopathic TN can be induced by individual variation of the surrounding inner arachnoid membranes supporting the trigeminal nerve root, and the condition cannot be identified by MRI. Intradural external neurolysis may be considered an effective treatment for MRI-negative idiopathic TN.

Decompression of the Greater Occipital Nerve for Persistent Headache Attributed to Whiplash Accompanying Referred Facial Trigeminal Pain.

OBJECTIVE: Persistent headache attributed to whiplash (PHAW) is defined as a headache that occurs for the first time in close temporal relation to whiplash lasting more than 3 months. We investigated the results of decompression of the greater occipital nerve (GON) in patients with PHAW who presented with referred trigeminal facial pain caused by sensitization of the trigeminocervical complex) along with occipital headache. METHODS: A 1-year follow-up study of GON decompression was conducted in 7 patients with PHAW manifesting referred facial trigeminal pain. The degree of pain reduction was analyzed using the numeric rating scale (NRS-11) and percent pain relief before and 1 year after surgery. Success was defined by at least 50% reduction in pain measured via NRS-11. To assess the degree of subjective satisfaction, a 10-point Likert scale was used. Clinical characteristics of headache and facial pain and surgical findings were studied. RESULTS: GON decompression was effective in all 7 patients with PHAW manifesting referred trigeminal pain, with a percent pain relief of 83.06 ± 17.30. The pain had disappeared in 3 of 7 patients (42.9%) within 6 months and no further treatment was needed. Patients' assessment of subjective improvement based on a 10-point Likert scale was 7.23 ± 1.25. It was effective in both occipital and facial pain. CONCLUSIONS: Although chronic GON entrapment itself is an individual constitutional issue, postwhiplash inflammatory changes seem to trigger chronic occipital headaches in GON distribution and unexplained referred trigeminal pain caused by sensitization of the trigeminocervical complex.

Development of a Chatbot Program for Follow-Up Management of Workers' General Health Examinations in Korea: A Pilot Study.

(1) Background: Follow-up management of workers' general health examination (WGHE) is important, but it is not currently well done. Chatbot, a type of digital healthcare tool, is used in various medical fields but has never been developed for follow-up management of WGHE in Korea. (2) Methods: The database containing results and explanations related to WGHE was constructed. Then, the channel, which connects users with the database was created. A user survey regarding effectiveness was administered to 23 healthcare providers. Additionally, interviews on applicability for occupational health services were conducted with six nurses in the agency of occupational health management. (3) Results: Chatbot was implemented on a small scale on the Amazon cloud service (AWS) EC2 using KaKaoTalk and Web Chat as user channels. Regarding the effectiveness, 21 (91.30%) rated the need for chatbots as very high; however, 11 (47.83%) rated the usability as not high. Of the 23 participants, 14 (60.87%) expressed overall satisfaction. Nurses appreciated the chatbot program as a method for resolving accessibility and as an aid for explaining examination results and follow-up management. (4) Conclusions: The effectiveness of WGHE and the applicability in the occupational health service of the chatbot program for follow-up management can be confirmed.

Entrapment of the Greater Occipital Nerve with Chronic Migraine and Severe Facial Pain: A Case Report.

Migraine is thought to be a primary neurovascular headache due to brain dysfunction and is known to involve peripheral and central sensitization. A female patient with chronic migraine symptoms for 30 years reported severe pain in the deep ear and face. This headache always showed the same pattern and temporal progression. The sudden onset of ache and throbbing pain in the right temporo-occipital area extended to the left temporo-occipital areas. She felt sick as if the head would burst, and nausea and vomiting occurred. During the last 3 years, the patient endured sharp pain in bilateral deep ears and severe pain in the face as if all the facial bones were broken, and tears flowed. Chronic disabling headache and facial pain improved with the decompression of the greater occipital nerve. This case suggests that peripheral sensitization may be related to the pathophysiology of migraine, especially in the migraine without aura.

Chronic Neuropathic Pain of Brachial Plexus Avulsion Mistaken for Amputation Stump Pain for 36 Years: A Case Report.

Following an amputation of the extremities, chronic neuropathic pain and discomfort, such as phantom limb pain (phantom pain), phantom sensation, and stump pain may occur. Clinical patterns of phantom pain, phantom sensation, and pump pain may overlap and these symptoms may also exist in one patient. Serious trauma to the upper limbs can result in brachial plexus avulsion (BPA). If BPA occurs at the same time as severe trauma of the upper extremity and the amputation of the upper limb is performed, chronic neuralgia caused by BPA may be mistaken for chronic amputation pain, such as phantom limb pain or stump pain. No major treatment advances in phantom pain have been made. However, unlike phantom limb pain, chronic neuropathic pain caused by BPA can be effectively treated with dorsal root entry zone lesioning (DREZ)-otomy. We report a patient who suffered for 34 years because the neuralgia caused by BPA was accompanied by an amputation of the arm, and so was thought to be amputation stump pain rather than BPA pain. The patient's chronic BPA pain improved with microsurgical DREZ-otomy.

Referred Trigeminal Facial Pain from Occipital Neuralgia Occurring Much Earlier than Occipital Neuralgia.

We report a very rare case in which a patient believed to have auriculotemporal neuralgia due to the repeated recurrence of paroxysmal stabbing pain in the preauricular temporal region for four years developed occipital neuralgia, which finally improved with decompression of the greater occipital nerve (GON). The pain of occipital neuralgia has been suggested to be referred to the frontoorbital (V1) region through trigeminocervical interneuronal connections in the trigeminal spinal nucleus. However, the reports of such cases are very rare. In occipital neuralgia, the pain referred to the ipsilateral facial trigeminal region reportedly also occurs in the V2 and V3 distributions in addition to that in the V1 region. In the existing cases of referred trigeminal pain from occipital neuralgia, continuous aching pain is usually induced, but in the present case, typical neuralgic pain was induced and diagnosed as idiopathic auriculotemporal neuralgia. In addition, recurrent trigeminal pain occurred for four years before the onset of occipital neuralgia. If the typical occipital neuralgia did not develop in four years, it would be impossible to infer an association with the GON. This case shows that the clinical manifestations of referred trigeminal pain caused by the sensitization of the trigeminocervical complex by chronic entrapment of the GON can be very diverse.

Validation of the Work Engagement Scale-3, used in the 5th Korean Working Conditions Survey.

BACKGROUND: The purpose of this study was to assess the reliability and validity of the 3-item version of the Work Engagement Scale (WES-3), which is based on the Job Demands-Resources (JD-R) model and was used in the 5th Korean Working Conditions Survey (KWCS). METHODS: This study used data from the 5th KWCS (n = 50,205), which was conducted in 2017 with a sample of the Korean working population. The survey gathered comprehensive information on working conditions to define workforce changes and the quality of work and life. The reliability and internal consistency of the WES-3 were assessed using the corrected item-total correlation and Cronbach's alpha coefficient. Confirmatory factor analysis (CFA) was used to test the construct validity of work engagement. The convergent validity was assessed using the correlation with the WHO-5 well-being index. Correlations between work engagement and JD-R factors were also calculated. RESULTS: The Cronbach's alpha for work engagement was 0.776, indicating acceptable internal consistency. The model comprising 3 work engagement and 2 burnout items showed an excellent fit (χ2: 382.05, Tucker-Lewis index: 0.984, comparative fit index: 0.994, root mean square error of approximation: 0.043). The convergent validity was significant (correlation coefficient: 0.42). Correlations with burnout and job demands were negligible, whereas correlations with job resources and job satisfaction were weakly positive. CONCLUSIONS: The results of our study confirm that the WES-3 has acceptable reliability and validity.

Korean translation and validation of the Workplace Positive emotion, Engagement, Relationships, Meaning, and Accomplishment (PERMA)-Profiler.

BACKGROUND: No tool is available for the multidimensional measurement of workplace well-being among Korean workers. In this study, the Workplace Positive emotion, Engagement, Relationships, Meaning, and Accomplishment (PERMA)-Profiler, a multidimensional workplace well-being measure, was translated into Korean, and its validity and reliability were assessed. METHODS: The Workplace PERMA-Profiler, including the positive emotion, engagement, relationships, meaning, and accomplishment domains, was translated according to international guidelines. The questionnaires included the Workplace PERMA-Profiler, Mental Health Continuum-Short Form, Utrecht Work Engagement Scale, Maslach Burnout Inventory-General Survey, Psychosocial Well-being Index-Short Form, and Korean Occupational Stress Scale-Short Form. A total of 316 Korean workers completed a web-based survey with adequate response. Cronbach's alpha values were calculated to assess scale reliability, and correlational and confirmatory factor analyses were used to assess validity. RESULTS: Cronbach's alpha values for the Korean Workplace PERMA-Profiler ranged from 0.70 to 0.95. Confirmatory factor analysis indicated that the 5-factor model had a marginally acceptable fit [χ2(80) = 383.04, comparative fit index = 0.909, Tucker-Lewis index = 0.881, root mean square error of approximation = 0.110, and standardized root mean square residual = 0.054]. The 5-factor PERMA domains were correlated positively with work engagement and mental well-being in life, and negatively with burnout, occupational stressors, and stress responses. These results showed that the Workplace PERMA-Profiler has good convergent and divergent validity. CONCLUSIONS: The Korean version of the Workplace PERMA-Profiler had good reliability and validity. It might be used as an indicator or evaluation tool for positive mental health interventions in the workplace.

Blood lead concentration and exposure related factors in Korea from the National Environmental Health Survey (KoNEHS) II (2012-2014).

This study evaluated lead concentrations in blood and related factors among the South Korean population based on data from the Korea National Environmental Health Survey (KoNEHS) II (2012-2014) conducted by the National Institute of Environmental Research and the Ministry of Environment. Personal data were obtained from non-institutionalized civilian Korean individuals in an interview with trained community surveyors using a structured questionnaire (n = 6,455, aged 19 or older, mean age 49.7 years). The lead concentrations in whole blood were analyzed by atomic absorption spectrophotometry (AAS) with a Zeeman-effect-based background corrector. The precision and accuracy of the analytical methods were verified by internal and external quality controls (G-EQUAS, Germany). Statistical analysis was performed using weighted KoNEHS II data separated by sex, and the lead concentration was expressed as a geometric mean (GM). Multiple linear regression was performed using the SPSS 23.0 software package (SPSS Inc., Chicago, IL, USA). The total GM of lead concentrations was 19.5 µg/L. Lead concentrations increased with age and were higher in males (22.8 µg/L) than in females (16.6 µg/L). Smokers and drinkers had higher concentrations than non-smokers and non-drinkers of both sexes. People who used herbal medications had higher concentrations than those who did not among females. People of both sexes living in rural areas had higher lead concentrations than those in urban areas. Lead concentrations also varied with educational level, total family income, the type of water regularly consumed, and occupation. The average lead concentration of the general adult population in Korea has rapidly decreased over time from 45.8 µg/L (1999) to 19.45 µg/L (2012-2014); however, it remains higher than that of the United States, Germany, and Canada. The factors significantly related to lead concentration in South Korea were age, sex, smoking and alcohol drinking status, herbal medication usage by females, residential area, drinking water at home, and occupation. These factors could be used to improve occupational and environmental hygiene among the Korean population.

Iatrogenic Injury to the Sciatic Nerve due to Intramuscular Injection: A Case Report.

Iatrogenic injuries due to intramuscular (IM) injection, although less frequently reported than before, are still common. The sciatic nerve is the most commonly injured nerve because of an IM injection owing to its large size and the buttock being a common injection site. Iatrogenic injury to the sciatic nerve resulting from a misplaced gluteal IM injection is a persistent problem worldwide affecting patients in economically rich and poor countries alike. The consequences of sciatic nerve injection injury (SNII) are potentially devastating and may result in serious neurological and medico-legal problems. A 68-year-old male presented with intractable neuropathic pain from SNII that occurred during gluteal IM injection of an analgesic for post-appendectomy pain. This chronic SNII pain did not improve despite his gradual recovery from weakness in the left foot. Partial improvement was seen following an external neurolysis, performed three months post-appendectomy. SNII is a preventable complication of gluteal IM injection. While the complete avoidance of gluteal IM injection is desirable, should need arise, the use of an appropriate administrative technique is recommended.