Value of Ultrasound for Stability Assessment of Isolated Lateral Malleolar Fractures Compared to Stress Radiography and Arthroscopy.

BACKGROUND: This study was performed to evaluate the value of using ultrasound for stability assessment of isolated lateral malleolar fractures compared to simple X-ray, stress radiography, and arthroscopy. METHODS: This is a prospective cohort study with 25 consecutive patients who underwent an arthroscopic examination and subsequent surgery for isolated lateral malleolar ankle fractures. Before operation, simple and external rotation stress radiographs were obtained. Ultrasound was performed to assess the medial deltoid ligament prior to operation. Arthroscopic findings were used as reference standards. Sensitivity, specificity, and positive and negative predictability were calculated and compared using receiver operating characteristic (ROC) curve analysis for simple radiography, stress radiography, and ultrasound examination. RESULTS: The sensitivity and specificity of ultrasound for tears of the deep deltoid ligament were 94.74% and 66.67%, respectively. But, they were both 100% for complete tears of the ligament. ROC curve analysis showed that the ultrasound examination was significantly more accurate than simple and stress radiography. CONCLUSIONS: Ultrasound could be used to assess the instability of isolated lateral malleolar fractures. Commonly used stress radiography appears to overrate the need for operative treatment.

Long-Term Effect of Income Level on Mortality after Stroke: A Nationwide Cohort Study in South Korea.

We investigated whether income level has long-term effects on mortality rate in stroke patients and whether this varies with time after the first stroke event, using the National Health Insurance Service National Sample Cohort data from 2002 to 2015 in South Korea. The study population was new-onset stroke patients ≥18 years of age. Patients were categorized into Category (1) insured employees and Category (2) insured self-employed/Medical Aid beneficiaries. Each category was divided into three and four income level groups, retrospectively. The study population comprised of 11,668 patients. Among the Category 1 patients (n = 7720), the low-income group's post-stroke mortality was 1.15-fold higher than the high-income group. Among the Category 2 patients (n = 3948), the lower income groups had higher post-stroke mortality than the high-income group (middle-income, aOR (adjusted odds ratio) 1.29; low-income, aOR 1.70; Medical Aid beneficiaries, aOR 2.19). In this category, the lower income groups' post-stroke mortality risks compared to the high-income group were highest at 13-36 months after the first stroke event(middle-income, aOR 1.52; low-income, aOR 2.31; Medical Aid beneficiaries, aOR 2.53). Medical Aid beneficiaries had a significantly higher post-stroke mortality risk than the high-income group at all time points.

Poor People and Poor Health: Examining the Mediating Effect of Unmet Healthcare Needs in Korea.

OBJECTIVES: The purpose of this study was to estimate the mediating effect of subjective unmet healthcare needs on poor health. The mediating effect of unmet needs on health outcomes was estimated. METHODS: Cross-sectional research method was used to analyze Korea Health Panel data from 2011 to 2015, investigating the mediating effect for each annual dataset and lagged dependent variables. RESULTS: The magnitude of the effect of low income on poor health and the mediating effect of unmet needs were estimated using age, sex, education level, employment status, healthcare insurance status, disability, and chronic disease as control variables and selfrated health as the dependent variable. The mediating effect of unmet needs due to financial reasons was between 14.7% to 32.9% of the total marginal effect, and 7.2% to 18.7% in lagged model. CONCLUSIONS: The fixed-effect logit model demonstrated that the existence of unmet needs raised the likelihood of poor self-rated health. However, only a small proportion of the effects of low income on health was mediated by unmet needs, and the results varied annually. Further studies are necessary to search for ways to explain the varying results in the Korea Health Panel data, as well as to consider a time series analysis of the mediating effect. The results of this study present the clear implication that even though it is crucial to address the unmet needs, but it is not enough to tackle the income related health inequalities.

Effect of prohibiting the use of Paraquat on pesticide-associated mortality.

BACKGROUND: Paraquat is associated with a high rate of fatalities in acute poisoning. This study aimed to examine the association between the national public health policy that banned the use of paraquat and the incidence of pesticide-associated mortality. METHODS: All external causes of death from 2009 to 2013 of Korea were analyzed. The intervention was a national public health policy that annulled the authorized use (2011) and banned the purchase of paraquat (2012). Two periods were compared as follows: before (2009-2010) and after (2012-2013) the intervention period. The main outcome was pesticide-associated death coded on the death certificate. Multivariable logistic regression analysis adjustment for gender, age, season and weekday of death, province, education level, marital status, and occupation was performed to calculate adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for pesticide-associated mortality. The effect sizes of the intervention across all intents (Accident, Suicide, Homicide, and Undetermined) were compared by adding an interaction term (intervention*intent group) to the above model. RESULTS: A total of 127,866 deaths from for all external causes were analyzed, including 65,538 from 2009 to 2010 and 62,373 from 2012 to 2013. Pesticide-associated mortality decreased from 9.7% (2009-2010) to 6.5% (2012-2013) (p < 0.001). The AOR (95% CI) of the intervention on pesticide-associated mortality was 0.59 (0.56-0.62). The AORs of the intervention according to intent were 0.72 (0.55-0.96) in the Accident group, 0.61 (0.58-0.64) in the Suicide group, 1.29 (0.43-3.87) in the Homicide group, and 0.44 (0.38-0.50) in the Undetermined group. CONCLUSION: The national public health policy that banned paraquat resulted in a significant decrease in pesticide-associated mortality.