Background/Aims: Patients with concurrent type 2 diabetes mellitus (T2DM) and metabolic dysfunction-associated steatotic liver disease (MASLD) face elevated cardiovascular risks. However, optimal oral antidiabetic drug (OAD) selection for this population remains unclear. Methods: Using the Korean National Health Information Database, we conducted a target trial emulation comparing cardiovascular outcomes among patients with T2DM and MASLD (defined by fatty liver index ≥30) who initiated sodium-glucose cotransporter 2 (SGLT2) inhibitors, thiazolidinediones, dipeptidyl peptidase-4 (DPP-4) inhibitors, or sulfonylureas with metformin. The primary outcome was major adverse cardiovascular events (MACE), including cardiovascular mortality, nonfatal myocardial infarction, and nonfatal stroke. Results: Among 71,071 patients (331,726 person-years), SGLT2 inhibitor users experienced a significantly lower MACE risk compared to sulfonylurea users (adjusted subdistribution hazard ratio [aSHR], 0.44; 95% confidence interval [CI], 0.31–0.62). SGLT2 inhibitors also demonstrated a lower MACE risk compared to thiazolidinediones (aSHR, 0.61; 95% CI, 0.39–0.96) and DPP-4 inhibitors (aSHR, 0.59; 95% CI, 0.42–0.96). Cardiovascular mortality risk was notably reduced with SGLT2 inhibitors compared to sulfonylureas (aSHR, 0.13; 95% CI, 0.03–0.50), thiazolidinediones (aSHR, 0.19; 95% CI, 0.04–0.86), and DPP-4 inhibitors (aSHR, 0.22; 95% CI, 0.06–0.84). Mediation analysis revealed that MASLD regression accounted for 8.7% of the total cardiovascular benefit when comparing SGLT2 inhibitors to sulfonylureas. Conclusions In patients with concurrent T2DM and MASLD, SGLT2 inhibitors demonstrated better cardiovascular outcomes compared to other OADs. These findings suggest that SGLT2 inhibitors may be the preferred OAD choice for cardiovascular risk reduction in this high-risk population.

OBJECTIVES: Poor cardiovascular health (CVH) and the high prevalence of depressive symptoms represent significant public health concerns, underscoring the importance of examining their association. This study aimed to investigate the association between CVH, as defined by the American Heart Association’s 2022 Life’s Essential 8 (LE8) framework, and depressive symptoms. METHODS: This study used data from the 2014, 2016, 2018, and 2020 Korea National Health and Nutrition Examination Survey. Overall CVH, measured using LE8, was categorized into 3 groups: low score (0–<50), moderate score (50–<80), and high score (80–100). LE8 comprises 2 subdomains: health behaviors and health factors. Depressive symptoms were defined as a total score ≥10 on the Patient Health Questionnaire-9. Multiple logistic regression analyses were performed, adjusting for sex, age, socioeconomic status, and current drinking status. RESULTS: Among 17,294 adults, 257 male and 681 female reported significant depressive symptoms. Compared with individuals in the low LE8 category (reference), the odds ratio (OR) for depressive symptoms was 0.29 (95% confidence interval [CI], 0.21 to 0.40) for those in the high LE8 category. The OR for depressive symptoms was 0.39 (95% CI, 0.29 to 0.53) for individuals with a high health behavior score compared with those with a low health behavior score. In contrast, the health factor score was not significantly associated with depressive symptoms. CONCLUSIONS These findings suggest that overall CVH, particularly the health behavior subdomain, was associated with lower odds of depressive symptoms. Prospective longitudinal studies are warranted to validate these findings and clarify the directionality of the observed associations.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic had direct effects on population health through infection and morbidity, as well as indirect effects on population mental health. We estimated the network structure of post-traumatic stress symptoms (PTSS) and depressive symptoms throughout the pandemic in Korea and aimed to identify the most central and bridging symptoms. METHODS: Participants aged 30–64 years completed mental health surveys across 3 phases of the COVID-19 pandemic: March 2020 (n=1,925), February–March 2021 (n=1,754), and December 2021–January 2022 (n=1,595). Using PTSS and depressive symptom data, we conducted network analyses, and the primary measures of symptom importance (centrality) were expected influence and bridge expected influence. RESULTS: In the comorbidity network, although the most central symptoms fluctuated over the course of the pandemic, sleep problems were consistently identified as the most influential bridge symptoms throughout. The symptom network structure differed between the subacute and chronic phases of the pandemic. CONCLUSIONS We found evidence of changes in the network structure of PTSS and depressive symptoms, even as sleep problems retained a consistent role as a bridging symptom. Although overall network structures varied across phases of the pandemic, the bridging role of sleep-related symptoms remained consistently strong, suggesting that sleep problems may represent a general and enduring mechanism underlying PTSS–depression comorbidity. During future pandemics, prompt screening for sleep problems may help prevent the development of comorbidity between PTSS and depressive symptoms.

Background and Objectives: We evaluated 20-year trends in heart failure (HF) epidemiology in Korea to quantify changes in its burden from 2002 to 2023. Methods: A nationwide analysis was conducted using a random 50% sample from the Korean National Health Information Database linked to mortality records (2002–2023). HF was defined using diagnostic codes recorded as a primary or secondary condition. We calculated crude and age-standardized rates of prevalence, incidence, hospitalization, and mortality. Survival was assessed using the Kaplan–Meier method, stratified by inpatient versus outpatient diagnosis.Trends in heart transplantation and left ventricular assist device implantations were also examined. Results: By 2023, approximately 1,750,228 individuals had HF (3.41% prevalence). The age-standardized prevalence has more than doubled from 2002 to 2023. The crude incidence increased over time; the age-standardized incidence remained stable in men and declined in women.Hospitalization rates for any cause or secondary HF diagnoses have increased substantially, whereas primary HF hospitalization rates have remained relatively stable. The annual mortality rate in patients with HF was approximately 6.0% in 2023, being markedly higher in older adults.Although short-term survival has improved, particularly in hospitalized patients, long-term survival remains limited. Use of advanced therapies significantly increased. Conclusions The burden of HF in Korea has increased substantially over the past two decades, driven primarily by population aging and improved survival rather than increasing age-adjusted incidence. Despite therapeutic advances, hospitalization and long-term mortality rates remain high, highlighting the need for comprehensive HF strategies in aging societies.

Objective: Depression involves mood-related behavioral changes typically monitored through subjective reports, which are limited by recall bias and low temporal resolution. Digital mental health tools offer objective, continuous monitoring, but prior studies have focused on outpatients subject to environmental variability. In this preliminary feasibility study, we examined psychiatric inpatients in a controlled setting to assess associations between behavioral regularity and depression severity, highlighting the clinical potential of digital phenotyping. Methods: Thirty-five adults from a closed psychiatric ward were recruited, and data from 10 inpatients with ≥7 days of valid monitoring were analyzed. Depression severity was assessed weekly using the Hamilton Depression Rating Scale (HAMD) and Dysfunctional Self-focus Attributes Scale, yielding 18 samples. Hourly accelerometer and location data from wearable devices and ward sensors were processed to generate digital phenotypes—interdaily stability (IS), intradaily variability (IV), ratio of IS to IV (ISV), entropy (EN), and normalized entropy (NE)—segmented into daytime and nighttime. Linear mixed models assessed group differences, and correlation and multiple regression examined associations with depression. Results: Patients with asymptomatic/mild depression showed significantly higher IS_day and ISV_day, and lower EN_night, and NE_night (all p<0.05). These four features correlated with HAMD after false discovery rate (all p<0.05) correction. A regression model including IS_day and NE_night explained 60.6% of HAMD variance (p<0.05). Conclusion Digital monitoring provides an objective and continuous method to assess depression severity. By capturing macro- and micro-level movement regularity across day and night in an inpatient environment, this approach offers practical relevance for psychiatric care. However, results should be considered preliminary due to the limited sample size.

Objective: Adolescent depressive symptoms are increasingly recognized as a global concern for youth mental health. Female adolescents consistently report higher levels of depressive symptoms than their male counterparts, yet the psychological mechanisms underlying depressive symptoms remain insufficiently understood. Our longitudinal study examined the relationship between loneliness and depressive symptoms in female adolescents and investigated the mediating effect of subjective well-being (SWB) and the moderating influence of the parental relationship. Methods: Data were drawn from the Korean Study of Adolescent Health, a longitudinal study on adolescent mental health. The sample included 104 female high school students (mean age=15.33 years) who completed self-report surveys at three time points between April 2022 and July 2023. Measures assessed loneliness, SWB, depressive symptoms, and relationships with mothers and fathers. Mediation and moderated mediation analyses were conducted using SPSS PROCESS (Models 4 and 14), controlling for age, socioeconomic status, and baseline depressive symptoms. Results: Mediation analyses indicated that SWB fully mediated the longitudinal association between loneliness and depressive symptoms. Loneliness predicted lower SWB, which subsequently predicted more depressive symptoms. Moderated mediation analysis revealed that maternal, but not paternal, relationship quality significantly moderated the SWB-depressive symptoms link. The indirect effect was significant only among adolescents reporting stronger maternal relationships. Conclusion These findings underscore the importance of SWB in the link between loneliness and depressive symptoms among female adolescents and highlight the protective role of a positive maternal relationship. The results have implications for targeted prevention and intervention strategies to enhance emotional well-being in female adolescents.

Objective: Recognizing discrimination as a significant public health risk during the coronavirus disease 2019 (COVID-19) pandemic, which coincided with increased drug use and heightened awareness of structural disparities in the United States, we investigated its association with the odds of drug use in a large and diverse cohort from the All of Us Research Program. Methods: In this cross-sectional study, data from 68,976 participants completed the COVID-19 participant experiences (COPE) survey. We applied logistic regression models with propensity score-based overlap weighting to examine associations between everyday discrimination and drug use. Self-reported everyday discrimination score and drug use were the primary exposure and outcome measures, respectively. Results: Of the 67,662 COPE respondents (mean [standard deviation] age, 57.5 [15.9] years; female sex at birth, 43,658 [64.5%]), we identified 15,493 participants with no reported discrimination and 15,493 participants with reported discrimination, after overlap weighting. The odds of drug use in those who reported discrimination was 1.38 (95% confidence interval, 1.32–1.43), with a dose-dependent association based on discrimination score. Participants who experienced discrimination had significantly higher odds of using drugs and this association was particularly pronounced in those under 40 years of age, those assigned female sex at birth, current smokers, individuals undergoing chemotherapy or immunotherapy, and those experiencing unemployment or COVID-19/flu-like symptoms. Conclusion This relationship was observed across various types of drugs and different reasons for discrimination, and it was particularly pronounced in specific subgroups. These findings provide critical evidence for developing targeted preventive interventions; however, further longitudinal studies for causality are warranted.

Objective: Suicide is a leading cause of death among adolescents, and despite the need to distinguish between suicidal consideration and suicide attempts, research focused on suicide attempts remains insufficient. Therefore, this study aims to investigate the influence of self-perceived weight on suicide attempts. Methods: This study utilized data from the Korea Youth Risk Behavior Web-based Survey for its analysis from 2005 to 2023, including a total of 1,156,728 participants. This study utilized various analytical methods to examine the influence of self-perceived weight on suicide attempts. We estimated weighted prevalence and used linear regression to assess temporal trend β coefficients and their differences (βdiff) with 95% confidence intervals (CIs), and survey-weighted logistic regression to estimate weighted odds ratios (wORs) and 95% CIs for the association between self-perceived weight and suicide attempts. Results: A comparison of suicide attempts based on self-perceived weight suggested that individuals who perceived themselves as overweight (weighted prevalence, 3.97% [95% CI, 3.89 to 4.04]) had the highest rate of suicide attempts, followed by those who perceived themselves as underweight (3.36% [95% CI, 3.28 to 3.44]), while those who perceived themselves as having a normal weight (3.20% [95% CI, 3.14 to 3.27]) had the lowest rate. Additionally, females (underweight: 4.47% [95% CI, 4.32 to 4.62]; normal weight: 3.91% [95% CI, 3.81 to 4.01]; overweight: 5.23% [5.11 to 5.35]) experienced more suicide attempts than males (underweight: 2.73% [95% CI, 2.65 to 2.82]; normal weight: 2.43% [95% CI, 2.35 to 2.51]; overweight: 2.60% [95% CI, 2.52 to 2.69]). Conclusion Findings from the present study suggest that self-perceived weight was associated with suicide attempts and interaction analyses indicated a potential sex-based difference in the impact of body image distortion. Therefore, this study suggests the introduction of programs and campaigns aimed at correcting distorted self-perceived weight.

Objectives: In alignment with the World Health Organization’s goal of eliminating hepatitis C, this study assessed the current treatment status and reasons for non-treatment among patients with hepatitis C in Jeonbuk State, Republic of Korea, to inform strategies for improving care engagement. Methods: Among 311 individuals diagnosed with hepatitis C and reported through the NationalNotifiable Infectious Disease Surveillance system between January 2023 and June 2024, 208 patients were surveyed after excluding those who had died or could not be contacted.Statistical analyses included the chi-square test, the Cochran-Armitage test for trend, and logistic regression. Results: Overall, 116 participants (55.8%) reported having received antiviral therapy. Among the 92 untreated individuals, the most common reason for non-treatment was the absence of symptoms (n = 23; 25.0%), followed by the burden of drug costs (n = 21; 22.8%). Conclusion These findings highlight suboptimal treatment uptake and key barriers that may hinder progress toward hepatitis C elimination. Expanding screening and strengthening linkage-to-care strategies, while addressing financial barriers, will be essential to achievingnational elimination targets.

Background: The accurate laboratory-based detection of respiratory viruses, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is essential for effective patient management and infection control in the post–coronavirus disease 2019 era. In this study, the performance of the PowerChek Respiratory Virus Panels 1–4 assay (Kogene Biotech) in detecting non-SARS-CoV-2 respiratory viruses and SARS-CoV-2 was compared with those of two established commercial assays. Methods: Residual clinical respiratory specimens collected between December 2023 and February 2024 were retested using the PowerChek assay. Of the 129 specimens retested, 80 had tested positive for 14 non-SARS-CoV-2 respiratory virus targets in the Allplex Respiratory Panels 1–3 assay (Seegene) and 49 had been tested using the Alinity m SARS-CoV-2 assay (Abbott; 20 positive and 29 negative for SARS-CoV-2). Agreement, Cohen’s kappa, and discordant results were assessed. Results: For the 14 non-SARS-CoV-2 respiratory virus targets, the virus-specific overall percent agreement (OPA) ranged from 95.0% to 100%, the positive percent agreement (PPA) ranged from 66.7% to 100%, and the negative percent agreement (NPA) ranged from 96.0% to 100%, with kappa values of 0.64–1.00. Lower agreements were observed for human coronavirus OC43 and influenza A virus. For SARS-CoV-2 detection, the OPA was 98.0% (PPA, 95.0%; NPA, 100%; kappa, 0.96). Conclusion The detection performance of the PowerChek assay was comparable to those of the established assays for most respiratory virus targets, with lower agreement observed for some targets. These features support its practical utility for the routine multiplex molecular detection of respiratory viruses, including SARS-CoV-2.