Knee Pain and Its Severity in Elderly Koreans: Prevalence, Risk Factors and Impact on Quality of Life

This study investigated the epidemiology (prevalence, risk factors, and impact on quality of life) of knee pain and its severity in elderly Koreans. The subjects (n=3,054) were participants aged > or =50 yr from the fifth Korea National Health and Nutrition Examination Survey, conducted in 2010. Knee pain was defined as pain in the knee lasting > or =30 days during the most recent 3 months; severity was categorized as mild, moderate, or severe. EQ-5D was used to measure quality of life. The prevalence of knee pain was 23.1% (11.7% in men, 31.9% in women). The prevalences of mild, moderate, and severe knee pain were 4.3%, 9.1%, and 9.7%, respectively (2.8%, 5.4%, and 3.5% in men and 5.4%, 12.0%, and 14.4% in women). Old age, female gender, a low level of education, a manual occupation, obesity, and radiographic osteoarthritis were risk factors for knee pain, and were associated with increased severity of knee pain. Excluding men with mild knee pain, people with knee pain had significantly lower quality of life than those without knee pain. Early interventional approaches are needed to reduce the medical, social, and economic burden of knee pain in elderly Koreans.

Successful treatment of vulvodynia with dry needling using a specially designed needle: A case report

Vulvodynia is a chronic pain syndrome in female genitalia in the absence of visible infectious, inflammatory, or neoplastic findings or a clinically identifiable neurological disorder. We report a case of vulvodynia successfully treated with dry needling using a specially designed round needle (Ahn's needle). A 50-year-old woman was seen with 20-year-history of left-sided vulvar pain in the absence of infectious, inflammatory, neoplastic, or neurological disorder. We diagnosed her condition as vulvodynia and conducted dry needling using an Ahn's needle. Dry needling was performed along left upper and middle labiocrural fold. She reported 50% improvement of vulvodynia after the first treatment and 100% improvement after the second treatment. She remained symptom free 9 months after treatment. Our report suggests that dry needling using an Ahn's needle have clinical significance in managing vulvodynia.

Time Trend and Age-Period-Cohort Effects on Acute Myocardial Infarction Mortality in Korean Adults from 1988 to 2007

We examined time trend and age-period-cohort effects on acute myocardial infarction (AMI) mortality in Korean adults from 1988 to 2007. Annual AMI mortality data and population statistics from 1988 to 2007 were obtained from the STATISTICS KOREA website. Age adjusted mortality for four 5-yr calendar periods (1988-1992 to 2003-2007) was calculated by direct standardization using the Year 2000 WHO world standard population. A log-linear Poisson regression model was used to estimate age, period, and cohort effects on AMI mortality. In both genders, age-adjusted AMI mortality increased from period one (1988-1992) to period three (1998-2002) but decreased in period four (2003-2007). An exponential age effect was noted in both genders. The rate ratio of the cohort effect increased up to the 1943 birth cohort and decreased gradually thereafter, and the rate ratio of the period effect increased up to period three (1998-2002) and decreased thereafter. Our results suggest that AMI mortality in Korean adults has decreased since the period 1998-2002 and age, period, and cohort effects have influenced on AMI mortality.

Self-reported Smoking and Urinary Cotinine Levels among Pregnant Women in Korea and Factors Associated with Smoking during Pregnancy

This study examined urinary cotinine levels and self-reported smoking among pregnant women in Korea and the factors associated with smoking during pregnancy. The subjects were selected from pregnant women who visited 30 randomly sampled obstetric clinics and prenatal care hospitals in Korea in 2006. Smoking status was determined by self-reporting and urinary cotinine measurement. A total of 1,090 self-administered questionnaires and 1,057 urine samples were analyzed. The percentage of smoking revealed by self-reporting was 0.55% (95% confidence interval [CI], 0.11-0.99) and that revealed by urinary cotinine measurement (>100 ng/mL) was 3.03% (95% CI, 1.99-4.06). The kappa coefficient of agreement between self-reported smoking status and urinary cotinine measurement was 0.20 (95% CI, 0.03-0.37). Multiple logistic regression analysis revealed that early gestational period, low educational level, and being married to a smoker were significant risk factors for smoking during pregnancy. Smoking among pregnant women in Korea is not negligible, and those who are concerned to maternal and child health should be aware of this possibility among pregnant women in countries with similar cultural background.

Erratum: Estimated Number of Korean Adults with Back Pain and Population-Based Associated Factors of Back Pain : Data from the Fourth Korea National Health and Nutrition Examination Survey

No abstract available.

Estimation of the prevalence of osteoarthritis in Korean adults based on the data from the fourth Korea national health and nutrition examination survey

BACKGROUND: This study estimated the number of Korean adults with osteoarthritis from a representative sample. METHODS: We analyzed the data from phase 2 of the fourth Korea National Health and Nutrition Examination Survey conducted in 2008 using surveyfreq procedure of the SAS statistical package and estimated the number of Korean adults who reported that they experienced osteoarthritis lasting for three or more months during the past year (chronic patients) or were suffering from osteoarthritis at the time of survey (current patients). RESULTS: It was estimated that there were 3,597,774 (proportion, 9.8%; 95% confidence interval, 3,238,651-3,956,897) chronic patients and 3,916,417 (10.7%; 3,548,768-4,284,066) current patients among 36,744,994 Korean adults aged 20-89 years in 2008. CONCLUSIONS: Further efforts to investigate exact number of Korean adults with osteoarthritis and improve treatment outcomes of osteoarthritis are needed.

Interventional muscle and nerve stimulation for spasmodic torticollis: A case report

A 49-year-old woman with spasmodic torticollis was treated with interventional muscle and nerve stimulation (IMNS). Her neck was tilted to the left, and her chin was rotated and tilted to the right. Based on patient history, physical examination, and X-ray findings, the right C2-3, C3-4, C4-5 and C5-6 facet joints were selected for IMNS treatment. Under ultrasound guidance, an Ahn's Needle (a specially designed needle for IMNS) was inserted from the midline of the posterior neck and advanced toward a point over the capsule of the facet joints. The needle was moved gently forward and backward within a 1-2 mm range until no resistance was felt at the tip. After undergoing three rounds of IMNS treatment, the dystonic features were grossly normal but spontaneous activities of the muscles innervated by C6 remained. Although we did not demonstrate complete improvement of spasmodic torticollis, our report suggests that IMNS has therapeutic value for spasmodic torticollis.

A Case of Occupational Asthma and Rhinitis Suspected to be Caused by Exposure to Ethyl Cyanoacrylate / 대한산업의학회지

BACKGROUND: Ethyl cyanoacrylate is used as a component of adhesives used in the industrial, domestic, and medical fields. It is known to cause mucosal irritation, contact dermatitis and respiratory discomfort. However, reports of combined occupational asthma and rhinitis are rare, especially in Korea. We report a case of occupational asthma and rhinitis suspected to be caused by exposure to ethyl cyanoacrylate. CASE REPORT: A 36-year-old woman presented with rhinorrhea, cough, dyspnea and chest discomfort after exposure to ethyl cyanoacrylate adhesive at an assembly area of a plastic products manufacturing company. Nasal endoscopy revealed watery rhinorrhea and hypertrophy of nasal turbinates, which were compatible with rhinitis. The methacholine provocation test showed a positive result. Daily variability of peak expiratory flow increased on work days, but decreased during non-work days. Based on these findings, we diagnosed this case as a combination of occupational asthma and rhinitis suspected to be caused by exposure to ethyl cyanoacrylate. CONCLUSION: There needs to be increased awareness regarding occupational asth-ma and rhinitis caused by exposure to ethyl cyanoacrylate.

Successful treatment of spasmodic dysphonia using IMS :A case report

Spasmodic dysphonia is a voice disorder that's characterized by intermittent, involuntary tightening or constriction of the larynx during phonation.This paper describes the case of a 45-yr-old female who suffered from phonation difficulties along with posterior and anterior neck pain.She was diagnosed with adductor type spasmodic dysphonia, which is a chronic disorder involving hyperadduction of the vocal mechanism and a resultant vocal arrest.The neural innervation of the intrinsic laryngeal musculature and the cervical nerves too may well be amenable to intramuscular stimulation therapy.

Subcutaneous botulinum toxin type a injection for chronic medial knee pain with ostheoarthritis

BACKGROUND:This study was designed to evaluate the efficacy of subcutaneous Botulinum toxin type A (BoNT-A) injection for treating chronic medial knee pain with osteoarthritis. METHODS:A randomized, double-blind, placebo-controlled clinical trial was conducted at a university hospital in Korea.The subjects suffering from chronic medial knee pain with osteoarthritis were randomly allocated to either the BoNT-A (treatment, n = 23) group or the normal saline (placebo, n = 27) group.Injections were given to 10 points per unilateral knee along the course of the saphenous nerve.A total of 90 units of BoNT-A (60 units at baseline and 30 units after 1 week) was given for treating unilateral knee pain and a total of 180 units of BoNT-A was given for treating bilateral knee pain.The placebo group received the same volume of normal saline. RESULTS:The Visual Analog Scale (VAS) pain score was significantly decreased in both the BoNT-A and normal saline groups 1, 4 and 12 weeks after injection.After adjusting for covariates, BoNT-A had a 0.788 times higher effect to decrease the VAS score than did normal saline, but the effect was marginally significant (P = 0.050). CONCLUSIONS:Subcutaneous injection along the course of the saphenous nerve significantly reduces chronic medial knee pain. The pain reduction effect of BoNT-A is higher than that of placebo, but the effect is marginally significant

Successful treatment of spasmodic dysphonia using IMS :A case report

Spasmodic dysphonia is a voice disorder that's characterized by intermittent, involuntary tightening or constriction of the larynx during phonation.This paper describes the case of a 45-yr-old female who suffered from phonation difficulties along with posterior and anterior neck pain.She was diagnosed with adductor type spasmodic dysphonia, which is a chronic disorder involving hyperadduction of the vocal mechanism and a resultant vocal arrest.The neural innervation of the intrinsic laryngeal musculature and the cervical nerves too may well be amenable to intramuscular stimulation therapy.

Subcutaneous botulinum toxin type a injection for chronic medial knee pain with ostheoarthritis

BACKGROUND:This study was designed to evaluate the efficacy of subcutaneous Botulinum toxin type A (BoNT-A) injection for treating chronic medial knee pain with osteoarthritis. METHODS:A randomized, double-blind, placebo-controlled clinical trial was conducted at a university hospital in Korea.The subjects suffering from chronic medial knee pain with osteoarthritis were randomly allocated to either the BoNT-A (treatment, n = 23) group or the normal saline (placebo, n = 27) group.Injections were given to 10 points per unilateral knee along the course of the saphenous nerve.A total of 90 units of BoNT-A (60 units at baseline and 30 units after 1 week) was given for treating unilateral knee pain and a total of 180 units of BoNT-A was given for treating bilateral knee pain.The placebo group received the same volume of normal saline. RESULTS:The Visual Analog Scale (VAS) pain score was significantly decreased in both the BoNT-A and normal saline groups 1, 4 and 12 weeks after injection.After adjusting for covariates, BoNT-A had a 0.788 times higher effect to decrease the VAS score than did normal saline, but the effect was marginally significant (P = 0.050). CONCLUSIONS:Subcutaneous injection along the course of the saphenous nerve significantly reduces chronic medial knee pain. The pain reduction effect of BoNT-A is higher than that of placebo, but the effect is marginally significant

Estimated Number of Korean Adults with Back Pain and Population-Based Associated Factors of Back Pain: Data from the Fourth Korea National Health and Nutrition Examination Survey

OBJECTIVE: We estimated the number of Korean adults with back pain and evaluated population-based associated factors of back pain from a representative sample data from the Fourth Korea National Health and Nutrition Examination Survey. METHODS: The number of Korean adults who experienced back pain (experienced patients), those who experienced back pain lasting for three or more months during the past year (chronic patients), and those who were currently suffering from back pain (current patients) were estimated by analyzing the data from the fourth Korea National Health and Nutrition Examination Survey conducted in 2007 using surveyfreq procedure of the SAS statistical package. Population-based odds ratios for being experienced, chronic, and current patient according to demographic (age and gender), socioeconomic (education and occupation), and lifestyle factors (smoking, drinking, and exercise) were estimated using surveylogistic procedure. RESULTS: It was estimated that there were 5,554,256 (proportion, 15.4%; 95% CI, 4,809,466 - 6,299,046) experienced patients, 2,060,829 (5.7%; 1,557,413-2,564,246) chronic patients, and 3,084,188 (8.5%; 2,600,197 - 3,568,179) current patients among 36,107,225 Korean adults aged 20-89 years in 2007. Each of explanatory variables was significantly associated with at least one of the response variables for back pain. CONCLUSION: Based on our study results, further efforts to investigate epidemiology of back pain, to evaluate associated factors, and to improve treatment outcomes are needed.

Estimated number of self-reported intervertebral disc disorders in Korean adults based on the data from the third Korea national health and nutrition examination survey

BACKGROUND:This study estimated the number of self-reported intervertebral disc disorders in Korean adults from a representative sample. METHODS:We analyzed the data from the third Korea National Health and Nutrition Examination Survey conducted in 2005 using surveyfreq procedure of the SAS statistical package and estimated the number of Korean adults who reported that they experienced intervertebral disc disorders during their lifetime (lifetime patients) and those who reported that they experienced intervertebral disc disorders lasting for three or more months during the past year or were suffering from intervertebral disc disorders at the time of survey (one-year patients). RESULTS:It was estimated that there were 2,653,230 (proportion, 7.4%; 95% CI, 2,490,624-2,815,835) self-reported lifetime patients and 2,250,850 (6.3%; 2,102,714-2,398,986) self-reported one-year patients among 35,719,293 Korean adults aged 20?89 years in 2005. CONCLUSIONS:Further efforts to investigate exact number of Korean adults with intervertebral disc disorders and improve treatment outcomes of intervertebral disc disorders are needed.

Sonographically assisted minimally invasive release (interventional microadhesiolysis) of the A1 pulley to treat trigger digit

BACKGROUND: We developed a sonographically assisted minimally invasive release technique (entitled as interventional microadhesiolysis) of the A1 pulley to treat trigger digit. This paper introduces the procedure and evaluates the efficacy of the intervention for trigger digit. METHODS: Eleven trigger digits in nine patients were treated with a specially designed needle using ultrasonographic assistance. The technique includes subcutaneous and intrasheath release. Subcutaneous release was performed by obliquely inserting the needle into the interdigital space and advancing it to release the subcutaneous tissue overlying the affected area. If the A1 pulley was not completely released, intrasheath release was performed by advancing the needle into the flexor tendon sheath, and the operator fixed the needle while the digit was passively flexed and extended. RESULTS: After the patients underwent the technique, all of the patients reported a reduction in pain and improved range of motion. CONCLUSIONS: This study suggests that interventional microadhesiolysis is an effective treatment for trigger digit.

Estimated Number of Korean Workers with Back Pain and Population-based Associated Factors of Back Pain: Data from the Fourth Korea National Health and Nutrition Examination Survey / 대한산업의학회지

OBJECTIVES: We estimated the number of Korean workers with back pain and evaluated the populationbased factors associated with back pain from a representative sample. METHODS: The number of Korean workers who experienced back pain (back pain-experienced patients), those who had experienced back pain lasting for three or more months during the previous year (chronic patients), and those who were currently suffering from back pain (current patients) were estimated by analyzing the data from the fourth Korea National Health and Nutrition Examination Survey conducted in 2007 using the surveyfreq procedure of the SAS statistical package. Population-based odds ratios for being back pain-experienced, chronic, and current patient according to demographic (age, gender, and education), lifestyle (smoking, drinking, and exercise), and occupational (industrial class, employment status, occupation) factors were estimated using the surveylogistic procedure. RESULTS: Among 19,076,186 Korean workers aged 20~69 years in 2007, 2,473,997(proportion, 13.0%; 95% CI, 1,976,779~2,971,216) were estimated to be back pain-experienced patients, 692,046(3.6%; 417,726~966,366) chronic patients, and 1,206,704(6.3%; 893,475~1,519,933) current patients. Each of the explanatory variables was significantly associated with at least one of the response variables for back pain. CONCLUSIONS: Further efforts to investigate the epidemiology of back pain, evaluate the associated factors, and improve treatment outcomes are needed.

Alcohol Consumption and the CAGE Questionnaire in Korean Adults: Results from the Second Korea National Health and Nutrition Examination Survey

We evaluated alcohol consumption and alcohol-related problems in Korean adults by evaluating alcohol consumption and responses to the CAGE questionnaire obtained from the second Korea National Health and Nutrition Examination Survey. The age-adjusted prevalence of males who consumed 0, 0.1-20, 20.1-40, or >40 g/day of alcohol were 28.0, 51.5, 12.5, and 8.0%, respectively; 26.9% of male drinkers were CAGE-positive (> or =2 affirmative responses to the CAGE). The age-adjusted prevalence of females who consumed 0, 0.1-10, 10.1-20, or >20 g/day of alcohol were 67.7, 26.6, 3.9, and 1.8%; 11.9% of female drinkers were CAGE-positive. The risk factors for high alcohol consumption were old age, low education level, smoking, and drinking onset at young ages in male drinkers, whereas low education level and smoking in female drinkers. The risk factors for a positive CAGE were young age, marriage, low education level, smoking, high amount of alcohol consumed on a single occasion, and high drinking frequency in male drinkers, whereas high household income, ex-smoking, high amount of alcohol consumed on a single occasion, and high drinking frequency in female drinkers. Our results suggest that high alcohol consumption and alcohol-related problems in Korean adults are not negligible and require intervention.

Association between Job Stress and Alexithymic Traits / 대한산업의학회지

OBJECTIVES: We evaluated the association between job stress and alexithymic traits in Korean workers. METHODS: Workers (n=521) who visited two university hospitals for medical check-ups were recruited for this study. Job stress was evaluated using the Korean version of Karasek's Job Content Questionnaire (JCQ), and alexithymic traits were assessed using the Korean version of the Toronto Alexithymia Scale (TAS-20K). Crude and adjusted odds ratios (ORs) of job stress scales (job strain, job insecurity, and job dissatisfaction) with alexithymic traits(total TAS score > or =52) were calculated. RESULTS: High job strain compared with low strain had a high, but insignificant association with alexithymic traits (adjusted OR, 2.26; 95% CI, 0.93-5.44). High job insecurity (adjusted OR, 2.26; 95% CI, 1.21-4.22), and high job dissatisfaction (adjusted OR, 1.99; 95% CI, 1.06-3.74) had significant associations with alexithymic traits. CONCLUSIONS: This study suggests that job stress is associated with alexithymic traits in workers.

A Case of Trichloroethylene Intoxication with Neuropsychiatric Symptoms / 대한산업의학회지

BACKGROUND: Trichloroethylene (TCE) has been widely used as a typewriter correction fluid, paint remover, adhesive, spot removers and, particularly, as a degreasing agent in metal-fabricating operation. However, few studies have reported on the effects of TCE intoxication, in spite of numerous occupational accidents arising from TCE intoxication, even until quite recently used in small companies. TCE affects mainly the central nervous system (CNS) and is carcinogenic, even when carefully used and managed. CASE REPORT: A 48-year-old male worker visited our hospital complaining of decreased motivation and general weakness. In history taking, the patient had suffered insomnia, memory disturbance, stuttering, loss of interest and sexual desire, depressive mood for 4 years, dysesthesia with tingling sensation and pain in both extremities, and a nauseas feeling similar to a hangover which had been aggravated for 4 months before admission. The patient had been engaged in metal degreasing with TCE for 8 years. Electromyography indicated disturbance of autonomic function, but there was neither peripheral neuropathy nor cervical radiculopathy. Organic abnormalities including cerebellar atrophy and CNS infection were ruled out, while there was no indication of malignancy in magnetic resonance imaging (MRI) and metabolic disorders and electrolyte imbalances in laboratory test. The authors performed biological monitoring for the possible exposed chemicals. Urinary 2,5-hexanedione, a metabolite of n-hexane, was undetected but 3,331.1 mg/g creatinine of urinary trichloro-compounds, a metabolite of TCE, was detected. The patient was diagnosed as TCE intoxication due to a level of urinary trichloro-compounds in excess of the normal range (300 mg/g creatinine), in addition to an occupational history and clinical symptoms. TCE exposure was stopped in admission and the neuropsychiatric symptoms of the patient were improved as the urinary trichloro-compounds were decreased from 3,331.1 mg/g creatinine to 64.6 mg/g creatinine in 5 days. CONCLUSION: Low-dose, chronic TCE intoxication shows neuropsychiatric symptoms, which are often misrecognized merely as a psychiatric disorder; its appropriate diagnosis, early treatment and exposure assessment are therefore difficult. The neuropsychiatric symptoms in workers who have been exposed to TCE should be monitored, detailed job history should be taken and biological monitoring should be conducted to gain early insight of chronic TCE exposure.

A Case of Trichloroethylene Intoxication with Neuropsychiatric Symptoms / 대한산업의학회지

BACKGROUND: Trichloroethylene (TCE) has been widely used as a typewriter correction fluid, paint remover, adhesive, spot removers and, particularly, as a degreasing agent in metal-fabricating operation. However, few studies have reported on the effects of TCE intoxication, in spite of numerous occupational accidents arising from TCE intoxication, even until quite recently used in small companies. TCE affects mainly the central nervous system (CNS) and is carcinogenic, even when carefully used and managed. CASE REPORT: A 48-year-old male worker visited our hospital complaining of decreased motivation and general weakness. In history taking, the patient had suffered insomnia, memory disturbance, stuttering, loss of interest and sexual desire, depressive mood for 4 years, dysesthesia with tingling sensation and pain in both extremities, and a nauseas feeling similar to a hangover which had been aggravated for 4 months before admission. The patient had been engaged in metal degreasing with TCE for 8 years. Electromyography indicated disturbance of autonomic function, but there was neither peripheral neuropathy nor cervical radiculopathy. Organic abnormalities including cerebellar atrophy and CNS infection were ruled out, while there was no indication of malignancy in magnetic resonance imaging (MRI) and metabolic disorders and electrolyte imbalances in laboratory test. The authors performed biological monitoring for the possible exposed chemicals. Urinary 2,5-hexanedione, a metabolite of n-hexane, was undetected but 3,331.1 mg/g creatinine of urinary trichloro-compounds, a metabolite of TCE, was detected. The patient was diagnosed as TCE intoxication due to a level of urinary trichloro-compounds in excess of the normal range (300 mg/g creatinine), in addition to an occupational history and clinical symptoms. TCE exposure was stopped in admission and the neuropsychiatric symptoms of the patient were improved as the urinary trichloro-compounds were decreased from 3,331.1 mg/g creatinine to 64.6 mg/g creatinine in 5 days. CONCLUSION: Low-dose, chronic TCE intoxication shows neuropsychiatric symptoms, which are often misrecognized merely as a psychiatric disorder; its appropriate diagnosis, early treatment and exposure assessment are therefore difficult. The neuropsychiatric symptoms in workers who have been exposed to TCE should be monitored, detailed job history should be taken and biological monitoring should be conducted to gain early insight of chronic TCE exposure.