Effect of coronavirus disease 2019 pandemic on children’s visits to the emergency department

Purpose@#In the coronavirus disease 2019 pandemic, it is essential to supplement the changes in visiting patterns of individual emergency departments (EDs) to determine how to allocate emergency medicine resources. We compared the clinical features of children visiting the ED before and during the pandemic. @*Methods@#Children younger than 18 years who visited the ED from February 2019 through December 2020, except January 2020, were enrolled, and divided into those who visited before and after January 2020 (the pre-pandemic and pandemic groups, respectively). We compared the 2 groups in terms of the baseline characteristics (age, sex, mode and route of arrival, cause of visit, and time of visit), chief complaint, ED diagnosis, initial acuity and its accuracy, and ED outcomes (length of stay and disposition). @*Results@#The 31,036 children were categorized into the pre-pandemic (21,027 [67.8%]) and pandemic (10,009 [32.2%]) groups with a 52.4% decrease in the number of visits to the ED in the latter group. This decrease was more prominent in age 2-5 years (from 37.3% to 33.2%; P < 0.001), fever as a chief complaint (from 27.8% to 16.5%), diagnoses related to infection or the respiratory system (from 36.8% to 14.3%) or transfer to the ED (from 8.1% to 6.4%; P < 0.001). In contrast, increases were noted in age 12-17 years (from 14.9% to 17.4%; P < 0.001), injury (from 36.5% to 52.5%; P < 0.001), visits in the evening (from 54.9% to 57.4%; P < 0.001), length of stay longer than 6 hours (from 3.5% to 6.3%; P = 0.033), and low acuity (from 97.8% to 98.2%; P = 0.031). @*Conclusion@#The pandemic has brought about changes in visiting patterns of the ED. This study may help prepare strategies for the appropriate allocation and deployment of emergency medicine resources in the pandemic era.

Association between Serum Insulin-Like Growth Factor-1and Neurological Severity in Acute Ischemic Stroke

Background@#and Purpose Serum insulin-like growth factor-1 (IGF-1) is known to have a neuroprotective effect. This study aimed to determine the effects of serum IGF-1 on the severity and clinical outcome of acute ischemic stroke (AIS). @*Methods@#This study included 446 patients with AIS who were admitted to Hallym University Sacred Heart Hospital within 7 days of stroke onset from February 2014 to June 2017. Serum IGF-1 levels were measured within 24 hours of admission. Stroke severity was measured using the National Institutes of Health Stroke Scale (NIHSS) score at admission, and the functional outcome at 3 months after symptom onset was assessed using the modified Rankin Scale score. The effects of serum IGF-1 levels on stroke severity and 3-month functional outcomes were analyzed using multivariate logistic regression analysis. @*Results@#This study evaluated 379 patients with AIS (age 67.2±12.6 years, mean±standard deviation; 59.9% males) after excluding 67 patients who had a history of previous stroke (n=25) or were lost to follow-up at 3 months (n=42). After adjusting for clinically relevant covariates, a higher serum IGF-1 level was associated with a lower NIHSS score at admission (adjusted odds ratio=0.44, 95% confidence interval=0.24–0.80, p=0.01), while there was no significant association at 3 months. @*Conclusions@#This study showed that a higher serum IGF-1 level is associated with a lower NIHSS score at admission but not at 3 months. Further studies are required to clarify the usefulness of the serum IGF-1 level as a prognostic marker for ischemic stroke.

Association between Serum Insulin-Like Growth Factor-1and Neurological Severity in Acute Ischemic Stroke

Background@#and Purpose Serum insulin-like growth factor-1 (IGF-1) is known to have a neuroprotective effect. This study aimed to determine the effects of serum IGF-1 on the severity and clinical outcome of acute ischemic stroke (AIS). @*Methods@#This study included 446 patients with AIS who were admitted to Hallym University Sacred Heart Hospital within 7 days of stroke onset from February 2014 to June 2017. Serum IGF-1 levels were measured within 24 hours of admission. Stroke severity was measured using the National Institutes of Health Stroke Scale (NIHSS) score at admission, and the functional outcome at 3 months after symptom onset was assessed using the modified Rankin Scale score. The effects of serum IGF-1 levels on stroke severity and 3-month functional outcomes were analyzed using multivariate logistic regression analysis. @*Results@#This study evaluated 379 patients with AIS (age 67.2±12.6 years, mean±standard deviation; 59.9% males) after excluding 67 patients who had a history of previous stroke (n=25) or were lost to follow-up at 3 months (n=42). After adjusting for clinically relevant covariates, a higher serum IGF-1 level was associated with a lower NIHSS score at admission (adjusted odds ratio=0.44, 95% confidence interval=0.24–0.80, p=0.01), while there was no significant association at 3 months. @*Conclusions@#This study showed that a higher serum IGF-1 level is associated with a lower NIHSS score at admission but not at 3 months. Further studies are required to clarify the usefulness of the serum IGF-1 level as a prognostic marker for ischemic stroke.

The Socialist Camp's North Korean Medical Support and Exchange (1945–1958): Between Learning from the Soviet Union and Independent Course / 의사학

This study focused on the socialist camp's North Korean medical support and its effects on North Korean medical field from liberation to 1958. Except for the Soviet assistance from liberation to the Korean War, existing studies mainly have paid attention to the ‘autonomous’ growth of the North Korean medical field. The studies on the medical support of the Eastern European countries during the Korean War have only focused on one-sided support and neglected the interactions with the North Korean medical field. Failing in utilizing the materials produced in North Korea has led to the omission of detailed circumstances of providing support. Since the review of China's support and the North Korea-China medical exchanges has been concentrated in the period after the mid-1950s, the impacts of China's medical support on North Korea during the Korean War period and the post-war recovery period have not been taken into account. In terms of these limitations, this study examined the medical activities by the Socialist camp of the Eastern European countries in North Korea after the Korean War. The medical aid teams from Hungary, Romania, Bulgaria, Czechoslovakia, Poland, and East Germany that came to North Korea in the wake of the Korean War continued to stay in North Korea after the war to build hospitals and train medical personnel. In the hospitals operated by these countries, cooperative medical care with North Korean medical personnel and medical technology education were conducted. Moreover, medical teams from each country in North Korea held seminars and conferences and exchanged knowledge with the North Korean medical field staffs. These activities by the Socialist countries in North Korea provided the North Korean medical personnel with the opportunity to directly experience the medical technology of each country. China's support was crucial to North Korea's ‘rediscovery’ of Korean medicine in the mid-1950s. After the Korean War, North Korea began to apply the Chinese-Western medicine integration policy, which was performed in China at that time, to the North Korean health care field through China's medical support and exchanges. In other words, China's emphasis on Chinese medicine and the integration of the Chinese-Western medicine were presented as one of the directions for medical development of North Korea in the 1950s, and the experiences of China in this process convinced North Korea that Korean medicine policy was appropriate. The decision-makers of the North Korean medical policies, who returned to North Korea after studying abroad in China at that time, actively introduced the experiences from China and constantly sought to learn about them. This study identified that a variety of external stimuli had complex impacts on the North Korean medical field in the gap between ‘Soviet learning’ in the late 1940s and the ‘autonomous’ medical development since the 1960s. The North Korean medical field was formed not by the unilateral or dominant influences of a single nation but by the stimulation from many nations and the various interactions in the process.

Epidermiological and Clinical Features of Occlusive Cerebrovascular Disease

Stroke is one of the leading causes of deaths in Korea. According to the report from Korean National Statistical Office, the mortality rate of stroke was 77.2/100,000 persons in 2002. In the past, hemorrhagic stroke was more prevalent than ischemic stroke in Korea. However, the ratio of hemorrhagic to ischemic stroke has been reversed since late-1980s. This trend might be due to the westernization of lifestyle as well as better control of stroke risk factors such as hypertension and diabetes. Of ischemic stroke, the incidence of cardioembolism is relatively low in Korea compared with in Western countries, especially in posterior circulation disorders. This observation reflects the epidemiologic characteristic of stroke in Korea where the prevalence of cardiac diseases is relatively low. The case fatality rate from one of the largest hospital-based stroke registries was 7.7% within 30 days after the onset of acute ischemic stroke, which is similar to those from other series in western countries with advanced medical care systems. However, the delay of hospital visit after the onset of stroke and the lower compliance for secondary prevention remain obstacles in managing stroke patients in Korea.