Characteristics and Trends of Pediatric Trauma in Jeju Island, South Korea: A Community Level Serial Cross-sectional study.

Objective: This study aimed to investigate the characteristics and epidemiological trends of pediatric injuries among patients visiting emergency departments (EDs) on Jeju Island. Method: Employing a community-level serial cross-sectional analysis, we targeted pediatric patients aged 18 years or younger who visited EDs for injuries over a ten-year period. The data, sourced from the Jeju Injury Surveillance System (JISS), facilitated a comprehensive examination of injury characteristics and epidemiological trends. This included an evaluation of the annual incidence and overall trends in pediatric injury cases. Results: The study found toddlers (42.5% of cases) to be the most frequently injured age group. Males were more prone to injuries, with a male-to-female ratio of 1.7:1. Injuries among visitors accounted for 17.3% of cases, with a seasonal spike in Summer, evenings and weekends. Most incidents occurred at home, predominantly accidental in nature, with adolescents more likely to require EMS services. The common mechanisms of injuries were blunt force (49.2%), slips/falls (22.0%), and motor vehicle collisions (13.2%), leading to bruises, cuts, and sprains. Over the decade, a general increase in pediatric injuries was observed. Accidental injuries initially surged but later stabilized, while self-harm/suicide and assault/violence injuries showed a concerning upward trend. Age-specific analysis revealed increasing trends in infants and adolescents. Conclusion: The study underscores the crucial need for targeted injury prevention and resource allocation strategies, particularly for high-risk groups and times, to effectively mitigate pediatric trauma on Jeju Island.

Prevalence of shoulder pain and its correlates in Jeju agricultural population: A retrospective cross-sectional study.

The aim of this study was to investigate the prevalence of shoulder pain and analyze its association with socio-demographic factors, agricultural work-related conditions, and biomechanical factors among farmers on Jeju Island. We utilized initial survey data from the Safety for Agricultural Injury of Farmers' cohort study involving adult farmers on Jeju Island. The presence and characteristics of shoulder pain, socio-demographics, agricultural work-related conditions, and biomechanical factors were assessed using semi-structured questionnaires. A total of 1206 participants were analyzed for prevalence and associated risk factors using frequency and multivariate logistic regression analyses. The overall prevalence of shoulder pain was 17%. Multivariate logistic regression analysis, adjusted for significant socio-demographic and agricultural work-related condition variables, revealed that stress level, type of farming, and experiencing an agricultural injury within the preceding year were significantly associated with shoulder pain (stress level: "occasional," adjusted odds ratio [aOR], 1.581; 95% confidence interval [CI], 1.079-2.318; "frequent," aOR, 1.964; 95% CI, 1.205-3.200; and "extreme," aOR, 2.999; 95% CI, 1.480-6.074 vs "rarely"; type of farming: "orchard," aOR, 0.82; 95% CI, 0.597-1.124; "livestock," aOR, 0.225; 95% CI, 0.079-0.641 vs "field"; and experienced an agricultural injury within the past year: "yes," aOR, 2.078; 95% CI, 1.269-3.405). In addition, 3 biomechanical factors significantly contributed to shoulder pain: activities requiring significant power such as shoveling, pickaxing, and hammering; repetitive use of a particular body part; and constant elevation of the arm above the head. The findings highlight the importance of postural education, injury prevention, and psychological support in managing shoulder pain among farmers.

Clinical characteristics and outcomes of injuries in agricultural and nonagricultural workers visiting the emergency department: a propensity-matched analysis.

OBJECTIVE: Agriculture is a hazardous industry. However, previous studies have focused on injuries to agricultural workers without comparison with injuries to nonagricultural workers. Therefore, we compared the clinical characteristics and outcomes of injuries reported at an emergency department (ED) between agricultural workers and nonagricultural workers. METHODS: We established a prospective ED-based agricultural injury surveillance system at a tertiary university hospital. Adult patients visiting the ED for an injury were divided into farmer and non-farmer groups depending on their engagement with agriculture. Using an adjusted multivariate analysis and propensity score matching (age, sex, inhabitant, and insurance type), we compared the clinical characteristics and outcomes of injuries between the farmer and non-farmer groups. RESULTS: In total, 38,556 injured adult patients (37,746 in the non-farmer group and 810 in the farmer group) were available for the unmatched sample analysis. The 1,620 matched subjects were equally classified after one-to-one nearest-neighbor propensity score matching. A multivariate logistic regression analysis of the unmatched sample revealed higher adjusted odds ratios (ORs) for intensive care unit admission (adjusted OR, 1.752; P=0.003) and overall surgery (adjusted OR, 1.870; P<0.001) in the farmer group. In contrast, univariate logistic regression analyses of the propensity score-matched sample found a higher OR in the farmer group only for overall surgery (OR, 1.786; P<0.001). CONCLUSION: Injuries of agricultural workers had higher odds only of requiring surgery; differences in injury-related mortality between groups were not statistically significant in either the matched or unmatched sample analyses.

Uncooperative patients suspected of acute stroke ineligible for prehospital stroke screening test by emergency medical service providers: final hospital diagnoses and characteristics.

OBJECTIVE: This study investigated the hospital diagnoses and characteristics of uncooperative prehospital patients suspected of acute stroke who could not undergo a prehospital stroke screening test (PHSST). METHODS: This retrospective observational study was conducted at a single academic hospital with a regional stroke center. We analyzed three scenario-based prehospital stroke screening performances using the final hospital diagnoses: (1) a conservative approach only in patients who underwent the PHSST, (2) a real-world approach that considered all uncooperative patients as screening positive, and (3) a contrapositive approach that all uncooperative patients were considered as negative. RESULTS: Of the 2,836 emergency medical services (EMS)-transported adult patients who met the prehospital criteria for suspicion of acute stroke, 486 (17.1%) were uncooperative, and 570 (20.1%) had a confirmed final diagnosis of acute stroke. The diagnosis in the uncooperative group did not differ from that in the cooperative group (22.0% vs. 19.7%, P=0.246). The diagnostic performances of the PHSST in the conservative approach were as follows: 79.5% sensitivity (95% confidence interval [CI], 75.5%-83.1%), 90.2% specificity (95% CI, 88.8%-91.6%), and 0.849 area under the receiver operating characteristic curve (AUC; 95% CI, 0.829-0.868). The sensitivity and specificity were 83.3% (95% CI, 80.0%-86.3%) and 75.2% (95% CI, 73.3%-76.9%), respectively, in the real-world approach and 64.6% (95% CI, 60.5%-68.5%) and 91.9% (95% CI, 90.7%-93.0%), respectively, in the contrapositive approach. No significant difference was evident in the AUC between the real-world approach and the contrapositive approach (0.792 [95% CI, 0.775-0.810] vs. 0.782 [95% CI, 0.762-0.803], P>0.05). CONCLUSION: We found overestimation (false positive) and underestimation (false negative) in the uncooperative group depending on the scenario-based EMS stroke screening policy for uncooperative prehospital patients suspected of acute stroke.

Prevalence of Low Back Pain and Associated Risk Factors among Farmers in Jeju.

BACKGROUND: We aimed to investigate the prevalence of low back pain (LBP) and its associated agricultural work-related, biomechanical factors among this population. METHODS: We analyzed initial survey data from the Safety for Agricultural Injury of Farmers cohort study involving adult farmers in Jeju Island. The prevalence of LBP was calculated with associated factors. RESULTS: In total, 1,209 participants were included in the analysis. The overall prevalence of LBP was 23.7%. Significant associations for LBP were the type of farming activity, length of farming career, prior agricultural injury within 1 year, and stress levels. Multivariate logistic regression analysis revealed three biomechanical factors significantly related to LBP: repetitive use of particular body parts; the inappropriate posture of the lower back and neck. CONCLUSIONS: Some occupational, and biomechanical risk factors contribute to LBP. Therefore, postural education, injury prevention education, and psychological support will be needed to prevent LBP.

Seroreactivity to Coxiella burnetii in an Agricultural Population and Prevalence of Coxiella burnetii Infection in Ticks of a Non-Endemic Region for Q Fever in South Korea.

Coxiella burnetii infects humans and wild and domesticated animals. Although reported cases on Jeju Island, off the coast of South Korea, are rare, the region is considered to have a high potential for Q fever. We investigated the seroprevalence of antibodies to C. burnetii in 230 farmers living in ten rural areas on Jeju Island between January 2015 and December 2019. Blood samples were collected and examined for C. burnetii Phase I/II IgM and IgG antibodies. Trained researchers collected ticks from rural areas. Clone XCP-1 16S ribosomal RNA gene sequencing was performed to identify Coxiella species from the collected ticks. The overall seroprevalence of antibodies to C. burnetii in farmers was 35.7%. The seroprevalence was significantly higher in fruit farmers. Of the collected ticks, 5.4% (19/351) of the Haemaphysalis longicornis ticks harbored C. burnetti. A high seroprevalence of antibodies to C. burnetii was observed in this region of Jeju Island, confirming that C. burnetti is endemic. Physicians should thus consider Q fever in the differential diagnosis of patients that present with acute fever after participating in outdoor activities.

Traumatic brain injury in patients aged ≥65 years versus patients aged ≥80 years: a multicenter prospective study of mortality and medical resource utilization.

OBJECTIVE: This study aimed to determine whether there is a difference in mortality and medical resource utilization between geriatric (aged ≥65 years) and super-geriatric patients (aged ≥80 years) with traumatic brain injury (TBI). METHODS: We obtained comprehensive data (demographics, injury characteristics, injury severities, and outcomes) of geriatric and super-geriatric TBI patients from an emergency department-based injury surveillance system database from 2011 to 2016. Multivariate logistic regression analysis was performed to compare the mortality and nonroutine discharge (NRDC) status between both groups. RESULTS: Among 442,533 TBI patients, 48,624 were older than 65 years. A total of 48,446 patients (37,140 geriatric and 11,306 super-geriatric) without exclusion criteria were included in the final analysis. Both overall in-hospital mortality (adjusted odds ratio, 1.88; 95% confidence interval [CI], 1.28 to 2.74; P=0.001) and NRDC (adjusted odds ratio, 1.35; 95% CI, 1.07 to 1.71; P=0.011) were significantly higher in the super-geriatric group. In the stratified analysis, there were no significant differences in NRDC rate for all stratifications of treatment timing (emergency department vs. ward admission), but mortality remained to be significant for all stratifications. CONCLUSION: Super-geriatric TBI patients showed a significantly higher risk-adjusted overall mortality and more inadequate medical resource utilization than did geriatric TBI patients. However, super-geriatric patients were more likely to undergo NRDC after admission; thus, further research about age-related health inequalities is needed in the treatment of super-geriatric patients.

Prolonged cognitive dysfunction in patient with splenial lesion of the corpus callosum caused by glufosinate ammonium poisoning.

Glufosinate ammonium (GLA) is widely used as a commercial herbicide in many countries. Neurotoxicity of GLA has been associated with serious neurological complications such as loss of consciousness, convulsions, and memory impairment. Late-onset memory impairment due to GLA-induced hippocampal lesions is the most distinct clinical feature in GLA poisoning. However, the lesion of the splenium of the corpus callosum (SCC) is a rare condition in GLA poisoning, so the clinical features are not well known. We report the case of a 57-year-old male patient who developed SCC damage after GLA poisoning. The patient had various late-onset neurotoxic symptoms, including prolonged overall cognitive dysfunction and psychosis-like symptoms. Emergency physicians should be aware that GLA-induced SCC lesions may be associated with various late-onset neurotoxic symptoms.

Relationship Between Sleep Duration and Suicidal Ideation Among Farmers: Safety for Agricultural Injuries of Farmers Cohort Study of Jeju, Korea.

BACKGROUND: This study was conducted to identify the association between sleep duration and suicidal ideation among farmers in Korea. METHODS: We used Safety for Agricultural Injuries of Farmers cohort data collected from September 2015 to June 2018, which was an agricultural survey on the health and behaviors of adult farmers in Jeju island, Korea. RESULTS: A total of 964 participants were included in the analysis, and 3.7% of them were identified with having suicidal ideation. The frequencies of average daily sleep duration of <6 h (short sleep), 6-8 h (normal sleep), and >8 h (long sleep) were 24.4%, 70%, and 5.6%, respectively. Multivariate analyses revealed that short sleep duration was significantly associated with suicidal ideation compared with normal sleep duration (odds ratio = 2.49, 95% confidence interval = 1.07-5.77). CONCLUSION: Our findings suggest that short sleep duration in farmers result in higher suicidal ideation. Because individuals who have suicidal ideation often commit suicide, careful monitoring is required to prevent suicide in farmers with short sleep duration.

A rare case of intestinal obstruction: Sclerosing encapsulating peritonitis of unknown cause.

Sclerosing encapsulating peritonitis (SEP) is characterized by the partial or complete enclosing of the small intestines by a thick fibro-collagenous membrane, which can cause recurrent intestinal obstruction. SEP is a clinically rare disease, and the major risk factor is peritoneal dialysis (PD). Early diagnosis of SEP is an important factor in the patient's prognosis, but it is clinically difficult. A 52-year-old woman visited the emergency department (ED) with a 2-day history of abdominal pain and vomiting. She had a history of liver cirrhosis with chronic hepatitis B, but no history of PD, and she underwent a biopsy of the peritoneum by laparoscopy a month ago. On physical examination, there were peritoneal irritation signs on the right lower quadrant (RLQ). Abdominal computed tomography (CT) showed dilated small intestinal loops clustered in the RLQ, which were surrounded by a sac-like, thick fibrous membrane. Based on CT findings, small intestinal obstruction due to SEP was early diagnosed in the ED. Emergency physicians should include SEP in the differential diagnosis of the cause of intestinal obstruction. Abdominal CT is a useful modality for the early diagnosis of SEP in the ED.

Osteochondrolipoma Presenting as a Popliteal Cyst.

Here, we describe a popliteal mass that was initially misdiagnosed as a simple popliteal cyst, which finally turned out to be osteochondrolipoma. A 63-year-old housewife presented with sustained knee pain in association with a palpable mass on the popliteal fossa. The mass was in the posteromedial area and soft, non-tender, non-movable in the posteromedial area. Using plain radiography, the mass appeared as a round, soft tissue density lesion containing bony fragments. We performed an ultrasound-guided needle biopsy in conjunction with magnetic resonance imaging, followed by an open excisional biopsy. Microscopically, histological sections showed a lipoma with cartilaginous and osseous differentiation, finally diagnosed as osteochondrolipoma. In conclusion, popliteal masses are not always simple cysts, and the evaluation of masses in the popliteal fossa is always necessary.

Surgical Ligation on Significant Patent Ductus Arteriosus in Very Low Birth Weight Infants: Comparison between Early and Late Ligations.

BACKGROUND: We aimed to evaluate the efficacy and safety of early surgical ligation (within 15 days of age) over late surgical ligation (after 15 days of age) by a comparative analysis of very low birth weight (VLBW) infants undergoing surgical correction for symptomatic patent ductus arteriosus (PDA) over the course of 6 years in our hospital. METHODS: We retrospectively reviewed all the medical records in the neonatal intensive care unit at Hanyang University Seoul Hospital, from March 2007 to May 2013, to identify VLBW infants (< 1,500 g) who underwent surgical PDA ligation. RESULTS: The gestational age (GA) in the late ligation (LL) group was significantly younger than in the early ligation (EL) group (p=0.010). The other baseline characteristics and preoperative conditions did not differ significantly between the two groups. The intubation period before surgery (p < 0.001) and the age at surgery (p < 0.001) were significantly different. The postoperative clinical outcomes of the study patients, including major morbidity and mortality, are summarized. There were no significant differences in bronchopulmonary dysplasia, sepsis, or mortality between the EL and the LL groups. However, the LL group was significantly associated with an increased risk of necrotizing enterocolitis (p=0.037) and with a prolonged duration of the total parenteral nutrition (p=0.046) after adjusting for GA. CONCLUSION: Early surgical ligation for the treatment of PDA that failed to close after medical treatment or in cases contraindicated for medical treatment might be desirable to reduce the incidence of necrotizing enterocolitis and to alleviate feeding intolerance in preterm infants.

Emergent surgical intervention for embolization of atrial septal defect closure device.

The percutaneous transcatheter closure of secundum atrial septal defect has recently become an increasingly widespread alternative to surgical closure in many centers. Although immediate, short, and intermediate term results of percutaneous transcatheter septal closure are promising, the procedure is not free from inherent complications that could be lethal. We report a case of device embolization necessitating emergent surgical retrieval.

Long-term Results of Hybrid Total Knee Arthroplasty: Minimum 10-years Follow-up.

PURPOSE: To evaluate the survival rate and long term clinical outcomes of hybrid total knee arthroplasty (TKA). MATERIALS AND METHODS: We retrospectively analyzed 113 hybrid TKAs (NexGen) in 86 patients that were followed for more than 10 years. Kaplan-Meier survival curves were generated using revision as an end point. Knee Society Score (KSS) and range of motion were evaluated for clinical assessment and plane radiographs were used to evaluate implant problems. RESULTS: At 11.2 years (range, 10 to 12.2 years) of follow-up on average, 7 knees required revision. The reason for revision was aseptic loosening in 4 knees (1 in femoral and tibial component and 3 in tibial component only) and infection in 3 knees. The survival rate was 93.8% at 12 years for all knees, and 96.5% when septic loosening was excluded. The KSS improved from 29.3 to 91.5 in the Cruciate-Retaining type (CR) and from 21.5 to 90.3 in the posterior stabilizing type (PS) at latest follow-up. The average range of motion was improved from 120.6° to 133.8° in the CR type and 119.5° to 135.5° in the PS type. CONCLUSIONS: Hybrid TKA provides good survival rates and clinical results comparable to cemented TKA.

Postinfarct ventricular septal defect after coronary covered stent implantation.

We report a case of a postinfarction ventricular septal defect caused by an acute recurrent occlusion after the implantation of a covered stent, which was performed as a rescue procedure for the ruptured left anterior descending artery during a percutaneous coronary intervention. Although the emergent implantation of a covered stent for the ruptured coronary arteries such as the left main coronary artery or the origins of the left anterior descending artery can be performed during a percutaneous coronary intervention, and a coronary bypass surgery should be considered in order to decrease the risk of complete occlusion, thus providing a superior long term patency.

Silastic molding method for pectus excavatum correction using a polyvinyl alcohol (ivalon) sponge.

Pectus excavatum is rare, but it is the most common type of sternal congenital disorder. There are many surgical methods to correct pectus excavatum such as the Ravitch method, Wada method, Silastic mold method, and the Nuss operation. We report a case of minimal invasive surgery for pectus excavatum using a polyvinyl alcohol sponge.