Objectives: South Korea has the highest suicide rate among Organisation for Economic Co-operation and Development countries; there is an increasing trend in suicide attempts among middle and high school students. Various factors contribute to the risk of suicide among adolescents, and the perception of suicide prevention has emerged as a significant factor. This study aimed to investigate the association between emotional and behavioral difficulties among middle and high school students and their perceptions of suicide prevention and to explore differences in suicide perception according to age. Methods: A survey was conducted among community middle and high school students, including 530 participants, between 2020 and 2021. Emotional and behavioral difficulties were assessed using the Strengths and Difficulties Questionnaire-Korean version, and participants were asked to complete a questionnaire on the importance and possibility of suicide prevention. A correlation test and analysis of variance were used to examine the relationships between the variables, and suicide awareness was compared according to age. Results: The participants who displayed higher strength or lower difficulty were more likely to respond positively to suicide prevention measures. They also exhibited high strength and low difficulty levels, thus agreeing with the importance of suicide prevention. Regarding age-related perceptions of suicide, adults aged 20–29 years reported the lowest probability of suicide prevention. Conclusion Suicide perceptions influence the incidence of suicide. Therefore, active societal engagement through suicide prevention campaigns and related education is essential to improve such perceptions. Continuous attention and support are required to address this issue.

Objective: We aimed to classify subgroups of suicidality among adolescents and identify the influencing factors of the classification of these latent classes. Methods: Suicidal thought, plans, and attempts as well as the feelings of sadness/hopelessness and loneliness were utilized as indicators to derive the suicidality classes. Additionally, health behaviors, such as dietary habits, physical activity, experiences of violence victimization, sexual activity, and deviant behavior, along with demographic factors, such as sex, school year, grades, and household income, were considered as influencing factors. The analysis utilized data from the 18th Youth Health Behavior Survey (2022) conducted by the Korea Disease Control and Prevention Agency, involving 51,850 middle and high school students. Results: The findings revealed three latent classes of suicidality among adolescents: “active suicidality,” “passive suicidality,” and “non-suicidality.” The influencing factor analysis indicated that all factors, with the exception of high-intensity physical activities, significantly influenced the classification of latent classes of suicidality. Notably, walking exercise and the frequency of exercise during physical education class were found to be factors that differentiated between active and passive suicidality within the suicidality classes. Conclusion This study employed nationwide data to identify the exhibited suicidality classes among adolescents and tested the influencing factors necessary for predicting such classes. The study’s findings offer valuable insights for policy development in suicide prevention and suggest the need for developing customized interventions tailored to each identified class.

Ectopic pancreas refers to presence of pancreatic tissue in locations other than the pancreas (the usual anatomical site). This condition is often asymptomatic but can occasionally cause abdominal pain or other gastrointestinal symptoms. Ectopic pancreatic tissue is mainly observed in the stomach and duodenum and may be accompanied by complications, such as hemorrhage, pancreatitis, gastric outlet obstruction due to pseudocyst, and malignant transformation. We report a rare case of gastric ectopic pancreas accompanied by a pseudocyst that led to gastric outlet obstruction, which improved after endoscopic ultrasonography guided fine-needle aspiration in a young woman with habitual excessive alcohol consumption.

Objectives: Endoscopic submucosal dissection (ESD) is a widely used approach for the resection of superficial gastric neoplastic lesions. Endoscopic mucosal resection (EMR) is acceptable for lesions <10–15 mm in size. Herein, we compared the clinical outcomes of ESD with those of EMR after circumferential precutting (EMR-P) for gastric adenomas ≤15 mm. Methods: We retrospectively analyzed the data of 213 patients with 228 gastric adenomas ≤15 mm in size who were treated endoscopically at a single tertiary hospital in Korea between November 2018 and October 2022. We evaluated the complete endoscopic resection rate, recurrence rate, procedurer-elated complications, and procedure time according to the procedure used. Results: Among the 228 gastric adenomas, 49 were treated with EMR-P and 179 with ESD. The histological complete resection rate was higher in the ESD group than in the EMR-P group (87% vs. 57%, p<0.001). No significant between-group differences were observed in endoscopic en bloc resection rates (ESD vs. EMR-P, 96% vs. 90%; p=0.081). The procedure time was significantly shorter in the EMR-P group than in the ESD group (28.9±19.7 min vs. 8.8±5.9 min, p<0.001). The local recurrence rate in patients with histologically incomplete resection did not differ between the two groups (ESD vs. EMR-P, 8.7% vs. 9.5%; p=0.924). Conclusions For gastric adenomas ≤15 mm, EMR-P may be the preferable treatment method considering the en bloc resection rate, procedure time, and local recurrence rate. However, considering the complete resection rate, ESD is recommended as the treatment of choice for high-grade adenomas and early gastric cancer lesions.

Phlebosclerotic colitis is a rare form of intestinal ischemia. It is caused by calcified peripheral mesenteric veins and a thickened colonic wall. These characteristic findings can be identified on CT and colonoscopy. A 37-year-old female with a history of long-term herbal medicine use presented with acute lower abdominal pain and vomiting of sudden onset. Colonoscopic findings showed dark-blue discolored edematous mucosa and multiple ulcers from the ascending colon to the sigmoid colon. Abdominal CT findings showed diffuse thickening of the colonic wall and calcifications of the peripheral mesenteric veins from the ascending colon to the sigmoid colon. Based on these findings, the patient was diagnosed with phlebosclerotic colitis. We report this rare case of phlebosclerotic colitis in a healthy young female patient with a history of long-term herbal medicine use and include a review of the relevant literature.

This study aimed to discuss mental health services for children and adolescents that are being implemented as initiatives of the Korean government and to review the functions and roles of these projects during the COVID-19 pandemic. Three government departments are in charge of providing mental health services for children and adolescents: Ministry of Education, Ministry of Gender Equality and Family, and Ministry of Health and Welfare. The Ministry of Education has implemented several policies to facilitate the early detection of mental health issues among school students (from preventive interventions to selective interventions for high-risk students). The Ministry of Gender Equality and Family additionally serves out-of-school children and adolescents by facilitating early identification of adolescents in crises and providing temporary protection or emergency assistance (as required) through the Community Youth Safety-Net Project. Furthermore, the Ministry of Health and Welfare operates relevant mental health agencies for individuals of all ages including children and adolescents. Any high-risk students who have been screened through the projects of the Ministry of Education are supported through referrals to the following institutions for appropriate treatment of their symptoms: specialized hospitals, the Youth Counseling and Welfare Center operated by the Ministry of Gender Equality and Family, the National Youth Healing Center, the Mental Health Welfare Center operated by the Ministry of Health and Welfare, the Suicide Prevention Center, and the Child Welfare Center. To assist students who are facing any psychological difficulties because of the COVID-19 pandemic, the Ministry of Education has established a psychiatric support group for providing emergency mental health care; furthermore, schools are promoting psychological surveillance (e.g., provision of non-face-to-face counseling services that are centered around the Wee Center). The Ministry of Education, Ministry of Gender Equality and Family, and Ministry of Health and Welfare have provided varied mental health support services in order to address the challenges faced by children and adolescents during the pandemic. Nevertheless, the mental health services operated by each ministry do show some limitations because their service provision system is insufficiently collaborative. The present study discussed the positive effects of each initiative as well as its limitations; furthermore, it suggested improvements for facilitating the healthy development of children and adolescents’ mental health.

Background: An association between environmental pollutants and alcohol-related liver disease (ALD) has not been determined until now. The objectives of this study were to examine the association of the pollutants with ALD, and whether the pollutants together increased the risk of ALD. Methods: Data were extracted from the Korea National Health and Nutrition Examination Survey (2010–2013 and 2016–2017; n = 11,993). Blood levels of lead, cadmium, and mercury were measured. ALD was defined by a combination of excessive alcohol consumption and ALDon-alcoholic fatty liver disease index > 0. The aspartate aminotransferase-to-platelet ratio index and fibrosis (FIB)-4 score were used to evaluate ALD FIB. Results: The odds ratios (ORs) of ALD for the highest versus the lowest quartiles of exposure were for lead, 7.39 (95% confidence interval [CI], 5.51–9.91); cadmium, 1.68 (95% CI, 1.32–2.14); and mercury, 5.03 (95% CI, 3.88–6.53). Adjusting for age, gender, smoking, occupation, education, and personal income attenuated the associations but indicated significant positive trends (all P trend < 0.001). A positive additive interaction between cadmium and lead was observed. The relative excess OR due to the interaction was 0.96 (95% CI, 0.41–1.51); synergy index = 2.92 (95% CI, 0.97–8.80). Among 951 subjects with ALD, advanced FIB was associated with lead and cadmium (OR, 3.46, 95% CI, 1.84–6.53; OR, 8.50, 95% CI, 2.54–28.42, respectively), but not with mercury. The effect estimates for lead and cadmium remained significant even after adjustment for daily alcohol intake. Conclusion Blood levels of lead, cadmium, and mercury were significantly associated not only with the risk of ALD but also with ALD FIB. Cadmium and lead have synergistic effects that increase the risk of ALD.

Objective: Owing to prolonged social distancing and the resultant isolation, the prevalence of depression and suicidality has increased during the COVID-19 pandemic. This study aimed to investigate the severity of depression and suicidality in Korean community populations and examine their awareness of suicide and suicide prevention during the pandemic. Methods: This study surveyed a community population in 2020 and 2021, involving 668 participants. We evaluated the severity of depression and suicidality using the Patient Health Questionnaire-9 and Beck Scale for Suicidal Ideation as well as questions about awareness of suicide. We performed a correlation analysis to confirm the association between variables, and compared participants’ suicide awareness according to the severity of depression. Results: The severity of depression and suicidality in the community population decreased in 2021 compared to 2020. Awareness of the importance of suicide prevention increased in 2021, but the percentage reporting that it is possible decreased slightly. The group with higher depressive symptoms reported a lower possibility of suicide prevention. Conclusion Increasing social interest in suicide, as well as awareness of suicide prevention, is important for reducing suicide rates. Suicide prevention campaigns, education, and social policies are needed, particularly during the pandemic.

Background/Aims: Steatohepatitis related to metabolic syndrome is a chronic liver disease prevalent in patients not only with non-alcoholic steatohepatitis but also with alcoholic liver disease and chronic viral hepatitis. On the other hand, there is limited data on the effects of hepatotonic agents in these patients. Therefore, this study evaluated the efficacy of a combined hepatotonic agent in this population. Methods: Thirty-three adults with chronic hepatitis and one or more components of metabolic syndrome were assigned randomly to receive biphenyl dimethyl dicarboxylate/ursodeoxycholic acid or a placebo for 24 weeks. The primary outcome was the normalization of ALT (≤40 U/L). The secondary outcomes were the change in controlled attenuation parameter, transient elastography, and Chronic Liver Disease Questionnaire score. Results: The 33 patients were assigned randomly to two groups. Eight (50%) of 16 patients who received the intervention drug showed the normalization of ALT, whereas only one (6%) of 17 patients in the placebo group did so. In contrast, the change in controlled attenuation, transient elastography, and Chronic Liver Disease Questionnaire were similar in the two groups. ALT was changed significantly during the four assessment periods, and this change was affected by the group. The interaction between the group and time was also significant. AST was changed significantly during the same period. This change was not affected by the group. Conclusions Biphenyl dimethyl dicarboxylate/ursodeoxycholic acid combination reduced ALT in chronic liver disease related to metabolic syndrome. On the other hand, there is no evidence that this leads to improved hepatic steatosis and fibrosis within 6 months.

Background/Aims: Inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, is a chronic inflammatory disorder of the gastrointestinal tract that requires lifetime management. Many studies have attempted to establish questionnaires and/or parameters to assess the quality of care for IBD patients. However, no study to date has investigated patients using the Q-methodology, which is subjective and has been studied systematically, to identify and categorize their opinions and subjective thinking about their disease and treatment. We have therefore aimed here to conduct a preliminary study of the Q-methodology to investigate the subjective thinking of IBD patients in Korea. Methods: Q-methodology, a method of analyzing the subjectivity of questionnaire items, was examined in this study. Inputs from 50 IBD patients were classified into 34 normalized statements using a 9-point scale with a normal distribution. The collected data were analyzed using the QUANL PC program. Results: Using the Q-methodology, IBD patients were classified into type I, II, III, and IV treatment needs: medical staff-dependent, relationship-oriented, information-driven, and social awareness, respectively. Conclusions The subjective needs of IBD patients and their thoughts about the treatment can be classified into four types. Our findings suggest that we can establish a systematic strategy for personalized care according to patient type.