Young-Min Kim

Arthroscopic Posterior Labral Repair and Capsular Shift for Traumatic Unidirectional Recurrent Posterior Subluxation of the Shoulder

BACKGROUNDnThe purpose of this study was to evaluate the results of arthroscopic treatment of traumatic unidirectional recurrent posterior subluxation of the shoulder.nnnMETHODSnWe treated twenty-seven patients who had traumatic unidirectional recurrent posterior subluxation of the shoulder with arthroscopic labral repair and posterior capsular shift, and we evaluated them at a mean of thirty-nine months postoperatively. Patients who had posteroinferior instability, multidirectional instability, or an atraumatic onset or who were undergoing revision were excluded. There were twenty-five male and two female patients with a mean age of twenty-one years (range, fourteen to thirty-three years). All patients were involved in sports activity, and all had had a substantial injury prior to the onset of the instability. Results were assessed on the basis of stability, motion, and UCLA (University of California at Los Angeles), ASES (American Shoulder and Elbow Surgeons), and Rowe scores. Pain and function were also evaluated with visual analog scales.nnnRESULTSnAll patients had one or more lesions in the posteroinferior aspect of the labrum and capsule. The most common finding was incomplete stripping of the posteroinferior aspect of the labrum (eighteen patients). At the arthroscopy, the posteroinferior aspect of the capsule appeared to be stretched in twenty-two patients. At the time of follow-up, all patients had improved shoulder function and scores (p < 0.01). All patients also had a stable shoulder according to subjective and objective measurements, except for one patient who had recurrent subluxation. Except for that patient, all patients were able to return to their prior sports activity with little or no limitation. Shoulder function was graded as >90% of the preinjury level in twenty-four patients. There were twenty-one excellent UCLA scores, five good scores, and one fair score. The average pain score improved from 4.5 points preoperatively to 0.2 point at the time of follow-up (p < 0.0001). The mean loss of internal rotation was one vertebral level. There were no operative complications.nnnCONCLUSIONSnArthroscopic posterior labral repair and capsular shift to treat traumatic unidirectional recurrent posterior subluxation is a reliable procedure with respect to providing stability, pain relief, and functional restoration.

Estimation and uncertainty analysis of impacts of future heat waves on mortality in the eastern United States.

Background: Climate change is anticipated to influence heat-related mortality in the future. However, estimates of excess mortality attributable to future heat waves are subject to large uncertainties and have not been projected under the latest greenhouse gas emission scenarios. Objectives: We estimated future heat wave mortality in the eastern United States (approximately 1,700 counties) under two Representative Concentration Pathways (RCPs) and investigated sources of uncertainty. Methods: Using dynamically downscaled hourly temperature projections for 2057–2059, we projected heat wave days that were defined using four heat wave metrics and estimated the excess mortality attributable to them. We apportioned the sources of uncertainty in excess mortality estimates using a variance-decomposition method. Results: Estimates suggest that excess mortality attributable to heat waves in the eastern United States would result in 200–7,807 deaths/year (mean 2,379 deaths/year) in 2057–2059. Average excess mortality projections under RCP4.5 and RCP8.5 scenarios were 1,403 and 3,556 deaths/year, respectively. Excess mortality would be relatively high in the southern states and eastern coastal areas (excluding Maine). The major sources of uncertainty were the relative risk estimates for mortality on heat wave versus non–heat wave days, the RCP scenarios, and the heat wave definitions. Conclusions: Mortality risks from future heat waves may be an order of magnitude higher than the mortality risks reported in 2002–2004, with thousands of heat wave–related deaths per year in the study area projected under the RCP8.5 scenario. Substantial spatial variability in county-level heat mortality estimates suggests that effective mitigation and adaptation measures should be developed based on spatially resolved data. Citation: Wu J, Zhou Y, Gao Y, Fu JS, Johnson BA, Huang C, Kim YM, Liu Y. 2014. Estimation and uncertainty analysis of impacts of future heat waves on mortality in the eastern United States. Environ Health Perspect 122:10–16;u2002http://dx.doi.org/10.1289/ehp.1306670

Accelerated rehabilitation after arthroscopic bankart repair for selected cases: a prospective randomized clinical study

PURPOSEnIncreased stress within a certain limit enhances ligament healing and improves joint function. In this prospective randomized clinical trial, we compared the clinical results of early motion versus conventional immobilization after arthroscopic Bankart repair in a selected patient population.nnnTYPE OF STUDYnProspective randomized clinical trial.nnnMETHODSnWe performed an arthroscopic Bankart repair using suture anchors in 62 patients with traumatic recurrent anterior instability of the shoulder. Patients were randomized into 2 groups; group 1 (28 patients; mean age, 28 years) was managed with 3 weeks of immobilization using an abduction sling and conventional rehabilitation program, and group 2 (34 patients; mean age, 29 years) was managed with an accelerated rehabilitation program that consisted of staged range of motion and strengthening exercises from the immediate postoperative day. Selection criteria were nonathletes with recurrent anterior shoulder dislocation and a classic Bankart lesion with a robust labrum limited to 1 cm from the midglenoid notch. The patients were followed up for a mean of 31 months (range, 27 to 45 months; standard deviation, 9 months). Analysis of outcome included pain scores at 6 weeks and at final follow-up evaluation, range of motion, return to activity, recurrence rate, patient satisfaction with each rehabilitation program, and shoulder scores assessed by the American Shoulder and Elbow Surgeons Shoulder Index, the rating system of the University of California at Los Angeles, and another scoring system.nnnRESULTSnThe recurrence rate was not different between the 2 groups (P =.842). None of the groups developed recurrent dislocation. Two patients from each group were positive for anterior apprehension signs. Patients who underwent accelerated rehabilitation resumed functional range of motion faster (P <.001) and returned earlier to the functional level of activity (P <.001). Accelerated rehabilitation decreased postoperative pain (P =.013), and more patients were satisfied with this program (P <.001). Shoulder scores, return to activity, pain score, and range of motion were not different between the 2 groups at the final follow-up evaluation (P >.05).nnnCONCLUSIONSnEarly mobilization of the operated shoulder after arthroscopic Bankart repair does not increase the recurrence rate in a selected group of patients. Although the final outcomes are approximately the same for both groups, the accelerated rehabilitation program promotes functional recovery and reduces postoperative pain, which allows patients an early return to desired activities.

The time trend temperature-mortality as a factor of uncertainty analysis of impacts of future heat waves: Wu et al. respond.

We thank Linares et al. for their interest in our article and for broadening the discussion on the uncertainties in predicting the health impact of future heat waves. Linares et al. pointed out that the possible evolution over time can take place both in minimum mortality temperatures related to heat waves and in the modifications of these possible impacts due to socioeconomic improvements. Although such considerations were beyond the scope of our published analysis (Wu et al. 2014), we agree that socioeconomic and demographic factors can have profound impacts on the estimated excess mortality in a changing climate. n nA heat wave is defined as a period of consecutive days with temperatures exceeding a certain threshold based on physiologic effects (Robinson 2001). The threshold temperature is usually calculated based on local historical data, which can vary in both time and space. Linares et al. suggested that heat wave definition temperatures might be reduced to a consequence of population aging in time. Given these changes in the threshold temperature over time, the heat wave definition would indeed add an additional layer of uncertainty to the predicted health impact of future heat waves on top of what we have characterized in the paper. Such uncertainty, however, is difficult to quantify without detailed data on the structure of future populations, especially age. So far, the U.S. Census Bureau (2012) has issued only national-level, age-specific population projections. n nThe health impacts of heat waves can be modified by many factors, such as race, age, sex, socioeconomic status, and geographic location (Hajat and Kosatky 2010). The changing impacts of heat waves on cardiovascular/circulatory and respiratory mortality (Ha and Kim, 2013; Miron et al. 2008) seem to be related to the improvements in health care services and living conditions over time. These trends may be generalizable in space if we are willing to assume that the U.S. health care system has improved its service to cardiovascular patients over the years in a fashion similar to that of Spain, Italy, or other developed countries. However, it may not be justifiable to extrapolate them in time because the impact of these improvements is likely to taper off unless significant technological advancement takes place in the future. n nIn addition, early warning systems and adaptation strategies can strongly influence the impact of heat waves on a society (Lowe et al. 2011). However, the relative risk of heat waves must be estimated using existing health data records, making it very difficult to take any adaptation measures into consideration because we lack such examples in the past. In our study, we set future baseline mortality rate and relative health risk of heat waves as constant because robust estimates of these parameters for the 2050s are unavailable. Further research is needed to address these issues in order to provide a more comprehensive and realistic evaluation of the impact of future heat waves.

Estimated Effect of Climatic Variables on the Transmission of Plasmodium Vivax Malaria in the Republic of Korea

Background: Climate change may affect Plasmodium vivax malaria transmission in a wide region including both subtropical and temperate areas. Objectives: We aimed to estimate the effects of climatic variables on the transmission of P. vivax in temperate regions. Methods: We estimated the effects of climatic factors on P. vivax malaria transmission using data on weekly numbers of malaria cases for the years 2001–2009 in the Republic of Korea. Generalized linear Poisson models and distributed lag nonlinear models (DLNM) were adopted to estimate the effects of temperature, relative humidity, temperature fluctuation, duration of sunshine, and rainfall on malaria transmission while adjusting for seasonal variation, between-year variation, and other climatic factors. Results: A 1°C increase in temperature was associated with a 17.7% [95% confidence interval (CI): 16.9, 18.6%] increase in malaria incidence after a 3-week lag, a 10% rise in relative humidity was associated with 40.7% (95% CI: –44.3, –36.9%) decrease in malaria after a 7-week lag, a 1°C increase in the diurnal temperature range was associated with a 24.1% (95% CI: –26.7, –21.4%) decrease in malaria after a 7-week lag, and a 10-hr increase in sunshine per week was associated with a 5.1% (95% CI: –8.4, –1.7%) decrease in malaria after a 2-week lag. The cumulative relative risk for a 10-mm increase in rainfall (≤ 350 mm) on P. vivax malaria was 3.61 (95% CI: 1.69, 7.72) based on a DLNM with a 10-week maximum lag. Conclusions: Our findings suggest that malaria transmission in temperate areas is highly dependent on climate factors. In addition, lagged estimates of the effect of rainfall on malaria are consistent with the time necessary for mosquito development and P. vivax incubation.

Comparison of Temperature Indexes for the Impact Assessment of Heat Stress on Heat-Related Mortality

Objectives In order to evaluate which temperature index is the best predictor for the health impact assessment of heat stress in Korea, several indexes were compared. Methods We adopted temperature, perceived temperature (PT), and apparent temperature (AT), as a heat stress index, and changes in the risk of death for Seoul and Daegu were estimated with 1℃ increases in those temperature indexes using generalized additive model (GAM) adjusted for the non-temperature related factors: time trends, seasonality, and air pollution. The estimated excess mortality and Akaikes Information Criterion (AIC) due to the increased temperature indexes for the 75th percentile in the summers from 2001 to 2008 were compared and analyzed to define the best predictor. Results For Seoul, all-cause mortality presented the highest percent increase (2.99% [95% CI, 2.43 to 3.54%]) in maximum temperature while AIC showed the lowest value when the all-cause daily death counts were fitted with the maximum PT for the 75th percentile of summer. For Daegu, all-cause mortality presented the greatest percent increase (3.52% [95% CI, 2.23 to 4.80%]) in minimum temperature and AIC showed the lowest value in maximum temperature. No lag effect was found in the association between temperature and mortality for Seoul, whereas for Daegu one-day lag effect was noted. Conclusions There was no one temperature measure that was superior to the others in summer. To adopt an appropriate temperature index, regional meteorological characteristics and the disease status of population should be considered.

Burden of disease attributable to the Hebei Spirit oil spill in Taean, Korea

Objectives We aimed to assess the burden of disease (BOD) of the residents living in contaminated coastal area with oil spill and also analysed the BOD attributable to the oil spill by disease, age, sex and subregion. Design Health impact assessment by measuring years lived with disability (YLD) due to an oil spill. Setting A whole population of a community affected by an anthropogenic environmental disaster and secondary health outcome data. Participants Based on the health outcome survey including 10u2005171 individuals (male 4354; female 5817), BOD of 66u2005473 populations (male 33u2005441; female 33u2005032) was measured. Interventions None. Observational study on the effect of a specific environmental health hazard. Primary and secondary outcome measures Using disability adjusted life year (DALY) method, BOD including physical and mental diseases was measured. For the BOD measurement, excess incidences of illnesses related to oil spill were estimated from the comparison of prevalence of the health outcomes between contaminated areas and reference area without contamination. Results YLD attributable to the oil spill were estimated to be 14u2005724 DALYs (male 7425 DALYs; female 7299 DALYs) for the year 2008. The YLD of mental diseases including post-traumatic stress disorder (PTSD) and depression for men were higher than that for women. The YLD for women was higher in asthma and allergies (rhinitis, dermatitis, conjunctivitis) than that for men. The effects of asthma and allergies were the greatest for people in their 40s, with the burden of mental illness being the greatest for those in their 20s. Proximity to the spill site was associated with increased BOD. Conclusions An oil spill near a coastline can cause substantial adverse health effects. As the health effects of hazardous pollutants from oil spills are long-lasting, close follow-up studies are required to identify chronic health effects.

Indoor Air Pollution Aggravates Symptoms of Atopic Dermatitis in Children

Most of researches on the impact of indoor air pollutants on atopic dermatitis (AD) have been based upon animal models, in vitro experiments and case-control studies. However, human data to elucidate the role of indoor air pollution on worsening symptoms of pre-existing AD from a longitudinal study are scarce. The objective of this prospective study was to evaluate the effect of indoor air pollution on AD symptoms in children. We surveyed 30 children with AD in a day-care centre, which moved to a new building during the study. These children stayed there for 8 hours a day Monday through Friday, and their daily symptom scores were recorded. Indoor and outdoor air pollutant levels were continuously measured 24 hours a day for 12 months (Period 1 to 4). Data were analyzed using a generalized linear mixed model. Compared to the period before moving (Period 1), concentrations of indoor air pollutants mostly increased after moving (Period 2) and decreased by natural ventilation and bake-out (Periods 3 and 4). The rate of positive AD symptom increased from 32.8% (Period 1) up to 43.8% (Period 2) and 50.5% (Period 3), then decreased to 35.4% in Period 4 (P < 0.0001). When the delayed effects of indoor air pollutants on AD symptoms 2 days later were evaluated, AD symptoms significantly increased by 12.7% (95% CI: -0.01 to 27.1) as toluene levels increased by 1 ppb (P = 0.05). In conclusion, indoor air pollutants increase the risk of AD aggravation in children and toluene in the indoor environment might act as an aggravating factor.

Spatially resolved estimation of ozone-related mortality in the United States under two representative concentration pathways (RCPs) and their uncertainty

The spatial pattern of the uncertainty in air pollution-related health impacts due to climate change has rarely been studied due to the lack of high-resolution model simulations, especially under the Representative Concentration Pathways (RCPs), the latest greenhouse gas emission pathways. We estimated future tropospheric ozone (O3) and related excess mortality and evaluated the associated uncertainties in the continental United States under RCPs. Based on dynamically downscaled climate model simulations, we calculated changes in O3 level at 12xa0km resolution between the future (2057 and 2059) and base years (2001–2004) under a low-to-medium emission scenario (RCP4.5) and a fossil fuel intensive emission scenario (RCP8.5). We then estimated the excess mortality attributable to changes in O3. Finally, we analyzed the sensitivity of the excess mortality estimates to the input variables and the uncertainty in the excess mortality estimation using Monte Carlo simulations. O3-related premature deaths in the continental U.S. were estimated to be 1312 deaths/year under RCP8.5 (95xa0% confidence interval (CI): 427 to 2198) and −2118 deaths/year under RCP4.5 (95xa0% CI: −3021 to −1216), when allowing for climate change and emissions reduction. The uncertainty of O3-related excess mortality estimates was mainly caused by RCP emissions pathways. Excess mortality estimates attributable to the combined effect of climate and emission changes on O3 as well as the associated uncertainties vary substantially in space and so do the most influential input variables. Spatially resolved data is crucial to develop effective community level mitigation and adaptation policy.

Effects of Heat Wave on Body Temperature and Blood Pressure in the Poor and Elderly

Objectives We aimed to investigate the acute effects of heat stress on body temperature and blood pressure of elderly individuals living in poor housing conditions. Methods Repeated measurements of the indoor temperature, relative humidity, body temperature, and blood pressure were conducted for 20 elderly individuals living in low-cost dosshouses in Seoul during hot summer days in 2010. Changes in the body temperature, systolic blood pressure (SBP) and diastolic blood pressure (DBP) according to variations in the indoor and outdoor temperature and humidity were analyzed using a repeated-measures ANOVA controlling for age, sex, alcohol, and smoking. Results Average indoor and outdoor temperatures were 31.47℃ (standard deviation [SD], 0.97℃) and 28.15℃ (SD, 2.03℃), respectively. Body temperature increased by 0.21℃ (95% confidence interval [CI], 0.16 to 0.26℃) and 0.07℃ (95% CI, 0.04 to 0.10℃) with an increase in the indoor and outdoor temperature of 1℃. DBP decreased by 2.05 mmHg (95% CI, 0.05 to 4.05 mmHg), showing a statistical significance, as the indoor temperature increased by 1℃, while it increased by 0.20 mmHg (95% CI, -0.83 to 1.22 mmHg) as outdoor temperature increased by 1℃. SBP decreased by 1.75 mmHg (95% CI, -1.11 to 4.61 mmHg) and 0.35 mmHg (95% CI, -1.04 to 1.73 mmHg), as the indoor and outdoor temperature increased by 1℃, respectively. The effects of relative humidity on SBP and DBP were not statistically significant for both indoor and outdoor. Conclusions The poor and elderly are directly exposed to heat waves, while their vital signs respond sensitively to increase in temperature. Careful adaptation strategies to climate change considering socioeconomic status are therefore necessary.