Risk Factors for Coronavirus Disease 2019 (COVID-19)-Associated Pulmonary Aspergillosis in Critically Ill Patients: A Nationwide, Multicenter, Retrospective Cohort Study

Background@#Coronavirus disease 2019 (COVID-19) is often accompanied by secondary infections, such as invasive aspergillosis. In this study, risk factors for developing COVID-19-associated pulmonary aspergillosis (CAPA) and their clinical outcomes were evaluated. @*Methods@#This multicenter retrospective cohort study included critically ill COVID-19 patients from July 2020 through March 2021. Critically ill patients were defined as patients requiring high-flow respiratory support or mechanical ventilation. CAPA was defined based on the 2020 European Confederation of Medical Mycology and the International Society for Human and Animal Mycology consensus criteria. Factors associated with CAPA were analyzed, and their clinical outcomes were adjusted by a propensity score-matched model. @*Results@#Among 187 eligible patients, 17 (9.1%) developed CAPA, which is equal to 33.10 per 10,000 patient-days. Sixteen patients received voriconazole-based antifungal treatment. In addition, 82.4% and 53.5% of patients with CAPA and without CAPA, respectively, received early high-dose corticosteroids (P = 0.022). In multivariable analysis, initial 10-day cumulative steroid dose > 60 mg of dexamethasone or dexamethasone equivalent dose) (adjusted odds ratio [OR], 3.77; 95% confidence interval [CI], 1.03–13.79) and chronic pulmonary disease (adjusted OR, 4.20; 95% CI, 1.26–14.02) were independently associated with CAPA. Tendencies of higher 90-day overall mortality (54.3% vs. 35.2%, P= 0.346) and lower respiratory support-free rate were observed in patients with CAPA (76.3% vs. 54.9%, P = 0.089). @*Conclusion@#Our study showed that the dose of corticosteroid use might be a risk factor for CAPA development and the possibility of CAPA contributing to adverse outcomes in critically ill COVID-19 patients.

Analysis of Surveys to Determine the Real Prices of Ingredients used in School Foodservice / 대한지역사회영양학회지

Objectives@#The purpose was to identify the ingredients that are usually surveyed for assessing real prices and to present the demand for such surveys by nutrition teachers and dietitians for ingredients used by school foodservice. @*Methods@#A survey was conducted online from December 2019 to January 2020. The survey questionnaire was distributed to 1,158 nutrition teachers and dietitians from elementary, middle, and high schools nationwide, and 439 (37.9% return rate) of the 1,158 were collected and used for data analysis. @*Results@#The ingredients which were investigated for price realities directly by schools were industrial products in 228 schools (51.8%), fruits in 169 schools (38.4%), and specialty crops in 166 schools (37.7%). Moreover, nutrition teachers and dietitians in elementary, middle, and high schools searched in different ways for the real prices of ingredients. In elementary schools, there was a high demand for price information about grains, vegetables or root and tuber crops, special crops, fruits, eggs, fishes, and organic and locally grown ingredients by the School Foodservice Support Centers. Real price information about meats, industrial products, and pickled processed products were sought from the external specialized institutions. In addition, nutrition teachers and dietitians in middle and high schools wanted to obtain prices of all of the ingredients from the Offices of Education or the District Office of Education. @*Conclusions@#Schools want to efficiently use the time or money spent on research for the real prices of ingredients through reputable organizations or to co-work with other nutrition teachers and dietitians. The results of this study will be useful in understanding the current status of the surveys carried out to determine the real price information for ingredients used by the school foodservice.

Epidemiology of Spinal Cord Injury: Changes to Its Cause Amid Aging Population, a Single Center Study

Objective@#To investigate the epidemiologic and demographic characteristics of patients with spinal cord injury (SCI) who were admitted to a department of rehabilitation of a university hospital. @*Methods@#This was a descriptive cross-sectional study. Medical records including sex, age at injury, type of disability, traumatic or non-traumatic etiology and presence of ossification of posterior longitudinal ligament (OPLL) of patients with SCI who were admitted to the department of rehabilitation between 2012 and 2018 were reviewed. @*Results@#Of the 221 cases of SCI, 161 were traumatic and 60 were non-traumatic. The mean age at injury was 52.8 years. People aged 40–49 years showed highest proportion among overall SCI patients (19.0%). The proportion of male patients was higher in traumatic SCI at 4.96:1 than in non-traumatic SCI at 1.30:1. The most common cause of traumatic SCI was falling off (37.3%), followed by motor vehicle crash (35.4%) and tripping over (19.3%). Meanwhile, the most common cause of non-traumatic SCI was neoplasm (35.0%). Tripping over was the leading cause of traumatic SCI in patients aged ≥60 years (42.6%). A high proportion of traumatic SCI patients were found to have underlying OPLL (26.1%), particularly those who were injured by tripping over (64.5%). @*Conclusion@#The mean age of SCI patients was higher than that of previous studies. Falls was the single most common cause of traumatic SCI, and tripping over was the most common cause of injury in the elderly patients. OPLL was prevalent in patients who were injured from tripping over.

Determinants of restaurant consumers' intention to practice COVID-19preventive behavior: an application of the theory of planned behavior

BACKGROUND/OBJECTIVES@#The purpose of this study was to examine the effects of knowledge about coronavirus disease 2019 (COVID-19), attitude, subjective norm, and perceived behavioral control on behavioral intentions to practice COVID-19 preventive behaviors using the theory of planned behavior (TPB). @*SUBJECTS/METHODS@#A total of 519 restaurant customers' responses was collected in this study through an online self-administered questionnaire. Descriptive statistical analysis was performed on socio-demographic factors. One-way analysis of variance and t-test were conducted to determine differences in the constructs from the TPB according to age and sex.The hypotheses were tested using structural equation modeling (SEM). @*RESULTS@#SEM revealed the positive effect of knowledge about COVID-19 on attitude, subjective norm, and perceived behavioral control to prevent the spread of COVID-19 in restaurants. Attitude, subjective norm, behavior intention, and knowledge positively affected COVID-19 preventive behavior intentions in restaurants. @*CONCLUSIONS@#The results of this study confirmed that the TPB is helpful in elucidating the determinants of consumers' intention to practice COVID-19 preventive behavior in restaurants. These findings can help policy makers and professionals provide material for further public health interventions and inform them about awareness-raising, guidelines, and health education programs.

Analysis of Surveys to Determine the Real Prices of Ingredients used in School Foodservice / 대한지역사회영양학회지

Objectives@#The purpose was to identify the ingredients that are usually surveyed for assessing real prices and to present the demand for such surveys by nutrition teachers and dietitians for ingredients used by school foodservice. @*Methods@#A survey was conducted online from December 2019 to January 2020. The survey questionnaire was distributed to 1,158 nutrition teachers and dietitians from elementary, middle, and high schools nationwide, and 439 (37.9% return rate) of the 1,158 were collected and used for data analysis. @*Results@#The ingredients which were investigated for price realities directly by schools were industrial products in 228 schools (51.8%), fruits in 169 schools (38.4%), and specialty crops in 166 schools (37.7%). Moreover, nutrition teachers and dietitians in elementary, middle, and high schools searched in different ways for the real prices of ingredients. In elementary schools, there was a high demand for price information about grains, vegetables or root and tuber crops, special crops, fruits, eggs, fishes, and organic and locally grown ingredients by the School Foodservice Support Centers. Real price information about meats, industrial products, and pickled processed products were sought from the external specialized institutions. In addition, nutrition teachers and dietitians in middle and high schools wanted to obtain prices of all of the ingredients from the Offices of Education or the District Office of Education. @*Conclusions@#Schools want to efficiently use the time or money spent on research for the real prices of ingredients through reputable organizations or to co-work with other nutrition teachers and dietitians. The results of this study will be useful in understanding the current status of the surveys carried out to determine the real price information for ingredients used by the school foodservice.

Sick Sinus Syndrome Combined with Wallenberg Syndrome: a Case Report

Cardiac arrhythmia is a rare manifestation of the Wallenberg syndrome; lesions are located in the brainstem, especially the lower medulla, which regulates sympathetic and parasympathetic activity. A 55-year-old man was admitted to the university hospital with symptoms including ataxia, left ptosis, decreased sensation of pain and temperature on the right side, left facial numbness, and dizziness. Brain magnetic resonance imaging revealed an infarction in the left dorsolateral medulla. Therefore, he was diagnosed with Wallenberg syndrome. While he underwent conservative treatment for Wallenberg syndrome, he experienced several events of self-limiting heart pounding, which required an evaluation of cardiac function. The 24-hour Holter monitor showed an increased RR interval with bradycardia and prolonged sinus pause. As a result, the diagnosis of sick sinus syndrome combined with Wallenberg syndrome was made. Sick sinus syndrome is a rare cardiac complication of the Wallenberg syndrome, and clinicians could overlook it when the initial electrocardiography shows a normal sinus rhythm. Sick sinus syndrome can cause sudden death without appropriate medical intervention. Therefore, clinicians should consider further evaluation, including a 24-hour Holter monitor, to check for the potential presence of sick sinus syndrome in the acute phase of Wallenberg syndrome.

Antimicrobial Susceptibility of Microorganisms Isolated from Patients with Intraabdominal Infection in Korea: a Multicenter Study

Effect of Social Identity on Customers' Behavioral Intention to Premium Food Markets

This study examined the effects of social identity (cognitive, affective, and evaluative social identity) on affective commitment and behavioral intention in premium food markets. Data were collected from customers who had visited the premium food markets within three months prior to the time of the survey. A total of 247 responses were analyzed using SPSS 25.0 for Windows. The three attributes of social identity (cognitive, affective, and evaluative social identity) had a significant positive effect on the affective commitment, while affective commitment had a positive effect on the behavioral intention in premium food markets. On the other hand, only evaluative social identity had a significant positive effect on the behavioral intention in premium food markets. These results revealed the mediating effect of affective commitment in the relationship between social identity and customers' behavioral intention. This suggests a positive affective commitment as a key factor for customers in premium food markets. The results would be applied to marketing strategies based on the attributes of premium food market customers.

Comparison of food involvement scale (FIS) and use intention for block type sauce between US and Japanese consumers / 한국영양학회지

PURPOSE: This study was conducted to compare the food involvement scale (FIS) of American and Japanese consumers. In addition, the effects of familiarity, likability, and expectations on willingness to use intentions for block type sauce by nationality were evaluated. METHODS: A total of 149 and 112 American and Japanese consumers, respectively, completed the survey. Consumers were asked about familiarity, likability, expectation, willing to use intention, and usage frequency of block type sauce, food involvement scale (FIS), and demographic information. RESULTS: There were differences in the using frequency of block type sauce according to nationality, with consumers in Japan showing significantly higher frequency of using block type sauce than those in the United States (US) (p < 0.001). According to the FIS, US consumers were more focused on how to provide food than food, such as cooking process, table setting, and food shopping, compared to Japanese consumers. In addition, ‘expectation’ and ‘likability’ among US consumers and ‘expectation’ and ‘familiarity’ among Japanese consumers were positive attributes for willing to use intention (p < 0.01). CONCLUSION: In the case of the US consumers, ‘familiarity’ was not significant because the using frequency of the block type sauce was lower than that of Japanese consumers. In the case of the Japanese consumers, ‘likability’ was not significant because they enjoy cooking itself according to the FIS. Therefore, it is necessary to recognize positive attributes as a key factor for block type sauce, as well as to search for ways to apply marketing strategies based on attributes by nationality.

Long Term Effect of Custom-Molded Foot Orthoses on Foot Pain and Balance in Children with Symptomatic Flexible Flat Feet

OBJECTIVE: To evaluate the long termeffect of custom-molded foot orthoses on foot pain and balance ability in children with symptomatic flexible flat feet after 1 year.METHOD: A total of 35 children over 6 year-old with flexible flat feet and foot pain for at least 6 months were recruited. Individual custom-molded rigid foot orthoses fabricated with the inverted orthotic technique was prescribed. Pain related parameters (pain sites, degree, and frequency) were obtained through questionnaires. Pain assessment was performed prior to application of the foot orthoses, and 1, 3, 6, 12 months after applying the orthoses. Balance ability was tested by computerized posturography. Such measures were evaluated prior to, 3 months, and 12 months after applying the foot orthoses. Additionally, the difference inbalance ability between barefoot and withfoot orthosesat 12 months was assessed to estimate carryover effect.RESULTS: 17 out of 35 children completed the study. Significant improvements were noted upto 12 months in pain parameters and balance ability. The carry over effect of the orthoses was confirmed.CONCLUSION: There were significant improvements offoot pain and balance ability in children with symptomatic flexible flat foot after wearing foot orthoses fabricated with the inverted orthotic technique over 1year period.

Clinical and Economic Evaluation of Multidrug-Resistant Acinetobacter baumannii Colonization in the Intensive Care Unit / 감염과화학요법

BACKGROUND: The clinical and economic impact of multidrug-resistant (MDR) Acinetobacter baumannii colonization remains unclear. This study aimed to estimate and compare the mortality rates, length of stay (LOS), and hospitalization costs in the intensive care unit (ICU) for MDR A. baumannii colonized patients and a matched population. MATERIALS AND METHODS: We performed a retrospective propensity score matched cohort study comparing the outcomes of patients with MDR A. baumannii colonization with those of uncolonized subjects matched at the time they were admitted to the ICU between January 2012 and December 2014. RESULTS: During the study period, 375 (7.5%) of the 4,779 patients were colonized with MDR A. baumannii. One hundred and twenty-two MDR A. baumannii colonized patients were compared with 122 uncolonized patients using propensity score matching. MDR A. baumannii colonized patients were likely to have a higher mortality rate compared to uncolonized patients (49.2% vs 32.0%; odds ratio [OR], 3.64). A longer ICU LOS and total admission days were observed in the MDR A. baumannii colonized patient group (4.14 and 4.67 days increase, OR 1.41 and 1.19). MDR A. baumannii colonization patients had an average extra ICU and total admission cost of $1,179 (₩1,261,334) and $1,333 (₩1,422,032) according to a multivariable regression model (OR, 1.27 and 1.17). Multivariable analysis identified the factors affecting ICU cost, which included, MDR A. baumannii colonization (OR = 1.33; P = 0.001), ICU LOS (OR = 1.97; P <0.001), valvular heart disease (OR = 1.12; P = 0.005), invasive devices (OR = 1.15; P = 0.018), and surgery (OR = 1.1; P <0.001). CONCLUSION: MDR A. baumannii colonization was associated with increased mortality, LOS, and costs in the ICU. A strict infection control program including preemptive isolation for high-risk groups would be helpful for reducing the burden of this infection.

Anatomic Feasibility of Posterior Cervical Pedicle Screw Placement in Children : Computerized Tomographic Analysis of Children Under 10 Years Old

OBJECTIVE: To evaluate the anatomical feasibility of 3.5 mm screw into the cervical spine in the pediatric population and to establish useful guidelines for their placement. METHODS: A total of 37 cervical spine computerized tomography scans (24 boys and 13 girls) were included in this study. All patients were younger than 10 years of age at the time of evaluation for the period of 2007-2011. RESULTS: For the C1 screw placement, entry point height (EPH) was the most restrictive factor (47.3% patients were larger than 3.5 mm). All C2 lamina had a height larger than 3.5 mm and 68.8% (51/74) of C2 lamina had a width thicker than 3.5 mm. For C2 pedicle width, 55.4% (41/74) of cases were larger than 3.5 mm, while 58.1% (43/74) of pedicle heights were larger than 3.5 mm. For pedicle width of subaxial spine, 75.7% (C3), 73% (C4), 82.4% (C5), 89.2% (C6), and 98.1% (C7, 1/54) were greater than 3.5 mm. Mean lamina width of subaxial cervical spine was 3.1 (C3), 2.7 (C4), 2.9 (C5), 3.8 (C6), and 4.0 mm (C7), respectively. Only 34.6% (127/370) of subaxial (C3-7) lamina thickness were greater than 3.5 mm. Mean length of lateral mass for the lateral mass screw placement was 9.28 (C3), 9.08 (C4), 8.81 (C5), 8.98 (C6), and 10.38 mm (C7). CONCLUSION: C1 lateral mass fixation could be limited by the morphometrics of lateral mass height. C2 trans-lamina approach is preferable to C2 pedicle screw fixation. In subaxial spines, pedicle screw placement was preferable to trans-lamina screw placement, except at C7.

Third-line docetaxel chemotherapy for recurrent and metastatic gastric cancer

BACKGROUND/AIMS: To determine the efficacy and toxicity of docetaxel as a third-line therapy for patients with relapsed gastric cancer who have undergone modified oxaliplatin-fluorouracil (m-FOLFOX)-4 and modified irinotecan-fluorouracil (m-FOLFIRI) regimens. METHODS: We analyzed 33 patients who had been histologically diagnosed with adenocarcinoma of the stomach and who had progressed after m-FOLFOX-4 and m-FOLFIRI regimens. Patients were treated with cycles of 75 mg/m2 docetaxel on day 1 every 3 weeks. RESULTS: The median age of the patients was 56.0 years (range, 31.0 to 74.0), and 73% of the patients (24/33) had an Eastern Cooperative Oncology Group performance status of 0 or 1. All patients were evaluated in terms of tumor response: five (15%), nine (27%), and 19 (58%) patients experienced a partial response, stable disease, and progressive disease, respectively. The median time to progression was 2.1 months (95% confidence interval [CI], 1.63 to 2.58), and overall survival was 4.7 months (95% CI, 3.20 to 6.20), from the start of the docetaxel regimen. Assessing patients' toxicity profiles, the median number of cycles was 2.0 (range, 1.0 to 12.0). The major hematologic toxicities included grade 3 to 4 neutropenia (19/33, 58%), grade 3 to 4 thrombocytopenia (2/33, 6%), and grade 3 to 4 anemia (5/33, 15%). Neutropenic fever developed in three patients (3/33, 9%). The nonhematological toxicities were nausea and vomiting (10/33, 30%), abdominal pain (4/33, 12%), skin rash (1/33, 3%), and fluid retention (3/33, 9%). CONCLUSIONS: Docetaxel is a feasible third-line therapy regimen for patients with advanced gastric cancer after m-FOLFIRI and m-FOLFOX-4 regimens.