Autonomic dysfunction is a common but frequently overlooked manifestation of systemic diseases. Because early manifestations are often nonspecific, including dizziness, fatigue, palpitations, exercise intolerance, and gastrointestinal dysmotility, clinicians need a structured approach to support timely recognition and risk stratification.Current concepts: Systemic disorders affect autonomic regulation through overlapping mechanisms, including metabolic injury, microvascular dysfunction, chronic inflammation, and impaired cardiovascular reflex control. In diabetes, autonomic nerve injury accumulates over time, and cardiovascular autonomic neuropathy is associated with increased cardiovascular events and mortality. In chronic kidney disease, persistent sympathetic activation, reduced vagal modulation, and baroreflex impairment contribute to hypertension, intradialytic hypotension, and arrhythmic risk. In heart failure and ischemic heart disease, sympathetic predominance and vagal withdrawal accelerate disease progression and are associated with malignant ventricular arrhythmias and sudden cardiac death. Systemic autoimmune disorders are also associated with impaired cardiovascular reflex control and small-fiber neuropathy.Discussion and conclusion: A practical evaluation begins with symptom screening and review of medications and comorbidities, followed by standardized autonomic testing. Cardiovascular autonomic reflex tests, together with scoring tools such as the composite autonomic scoring scale, help quantify the distribution and severity of autonomic involvement and support longitudinal monitoring. Management should integrate optimal control of the underlying systemic disease, non-pharmacological measures for orthostatic intolerance, and symptom-directed treatment for orthostatic hypotension.

Objectives: This study examined factors associated with health-related quality of life (HRQoL) in Korean adults. Methods: Using data from 5,620 participants in the 9th Korea National Health and Nutrition Examination Survey, obesity was defined as body mass index ≥25 kg/m2 and HRQoL assessed by the health-related quality of life instrument with 8 items (HINT-8). Complex survey weights were applied. Results: General linear and multiple regression analyses showed that among women, obesity was significantly associated with lower HINT-8 scores (B=-0.008, p=0.032), while no association was found in men. Age, household income, education, perceived stress, and smoking were also significantly related to HRQoL in both sexes. Conclusions HRQoL in Korean adults is influenced by obesity, socioeconomic status, and mental health indicators. The adverse effect of obesity observed only in women highlights the need for sex-specific public health strategies and the relevance of culturally adapted tools such as the HINT-8.

Background: Japan and South Korea, two advanced East Asian nations with universal health coverage and similar demographic challenges, have developed markedly different emergency medical services (EMS) systems. Despite growing interest in international benchmarking, structured, comparative studies that yield policy-relevant insights remain limited. Methods: We conducted a multisource comparative health-systems analysis using statutory laws, government publications, academic society reports, peer-reviewed literature, and national statistics. Key domains included EMS governance, workforce, prehospital organization, hospital-based emergency care, legal obligations for EMS patient transport and hospital acceptance, and governance and quality assurance mechanisms. Data were synthesized in comparative tables and narrative summaries to highlight structural and operational differences. Results: Japan’s EMS system operates under decentralized municipal control through 722 fire departments, serving 4,100 designated emergency institutions with 6,139 board-certified emergency physicians. In 2023, over 6.64 million ambulance dispatches occurred, and 8.6% were classified as critical cases (1.3% death and 7.3% severe). Korea’s EMS system is centrally governed with 412 designated facilities in a tiered system and 2,464 specialists. Annual ambulance activations exceeded 3.5 million, with severe cases accounting for approximately 5% to 10%. Japan employs a multilayered legal–institutional structure, primarily involving the Fire Service Act and the Medical Practitioners Act, allowing clinical discretion, whereas Korea enforces unified regulations with stricter obligations and criminal penalties for hospital refusal of emergency patients. Conclusion The contrasting systems suggest that hybrid governance that combines centralized standard settings with local operational flexibility may optimize EMS performance. These findings provide lessons for EMS reform, cross-border collaboration, and disaster preparedness in high-income nations facing similar demographic and healthcare challenges.

Background: Textile dyeing workers are at an increased risk of developing occupational respiratory diseases owing to frequent exposure to harmful chemicals, irritants, and high humidity in the workplace. Pulmonary rehabilitation is essential but associated with access and adherence challenges. This study aimed to evaluate the feasibility, effectiveness, accessibility, and safety of an app-based pulmonary telerehabilitation program for this population. Methods: Forty-five textile dyeing workers with respiratory symptoms underwent a 4-week pulmonary telerehabilitation program consisting of daily gamified respiratory muscle training using a Bluetooth-enabled device and video-guided flexibility exercises. The program was delivered through a mobile application and adherence was monitored using an online platform. Pulmonary function tests, 6-minute walk test, hand grip strength, and St. George’s Respiratory Questionnaire (SGRQ) scores were assessed at baseline (T0) and post-intervention (T1). The adherence, adverse events, and system usability were evaluated. Results: Improvements were observed in forced expiratory volume in 1 second (FEV1), FEV1/forced vital capacity, maximal inspiratory pressure, and maximal expiratory pressure at T1 compared to T0. The SGRQ activity scores improved after the intervention. The mean adherence rate was 95.69%; three participants had adherence rates <80% for ≥1 week each. The mean System Usability Scale score was high. Conclusion The program resulted in significant improvements in pulmonary function and quality of life with high adherence rates and good usability. This may be a promising approach for managing occupational respiratory diseases among textile dyeing workers. Further studies with larger sample sizes and longer follow-up periods are warranted to validate these results and assess the long-term outcomes.

Background: Opioids remain widely used for postoperative pain control after total knee arthroplasty (TKA); however, concerns about adverse effects and dependency drive interest in opioid-sparing alternatives. This study evaluated the efficacy and safety of opioid-sparing patient-controlled analgesia (PCA) after TKA. Methods: In this prospective, randomized, double-blind, non-inferiority study, 98 patients undergoing TKA under spinal anesthesia received either opioid-based PCA (continuous infusion of 1200 μg fentanyl, n = 49) or opioid-sparing PCA (continuous infusion of 150 mg ketorolac tromethamine and 100 mg nefopam hydrochloride, n = 49). Both groups received patient-controlled boluses of 300 μg fentanyl. The primary endpoint was the visual analog scale (VAS) pain score at rest on postoperative day (POD) 1, assessed using a 1.5-point non-inferiority margin. Secondary endpoints included additional analgesics, mobility, postoperative pain at rest and during ambulation, and adverse effects on PODs 1 and 2. Results: The mean VAS score at rest on POD 1 was 5.45 ± 2.48 in the opioid-based PCA group and 5.90 ± 2.31 in the opioid-sparing PCA group. The mean difference was 0.45 points (95% CI, −0.36 to 1.25), within the prespecified non-inferiority margin. Pain scores at each time point were non-inferior in the opioid-sparing group, whereas rescue analgesic requirements were significantly reduced on POD 2 (P = 0.006). Nausea and vomiting on POD 1 were more frequent with opioid-based group (34.7% vs. 12.2%, P = 0.009). Conclusions Opioid-sparing PCA with ketorolac and nefopam provides non-inferior analgesia to opioid-based PCA, while reducing opioid consumption and drug-related adverse effects after TKA.

Background: and Purpose: Tailored physical exercise interventions have the potential to promote cognitive health in older adults and offer significant advantages for those more vulnerable to decline. The specific relationship between physical fitness and cognition among the elderly has not been clearly established. The purpose of this investigation was to assess the relationship between physical fitness and cognitive function in older Korean adults. Methods: Eighty-four community-dwelling older adults (mean age: 70.7±5.3 years; 81.0% female) completed a standardized physical fitness battery assessing handgrip strength, sit-and-reach, 30-second sit-to-stand, 2-minute stationary march, 3-m sit-walk-and-return, figure-8-walk, and T-wall response time. Cognitive function was evaluated using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Descriptive statistics, partial correlation analyses, and stepwise multiple linear regression were conducted. Results: Slower T-wall response time was significantly correlated with lower RBANS total index, immediate memory, and delayed memory scores. In regression models, slower T-wall response time was independently associated with lower RBANS total index (β=−0.234, p=0.026) and delayed memory scores (β=−0.295, p=0.029). The regression model for immediate memory was not statistically significant overall; therefore, no predictive conclusion was drawn for this domain. Higher education showed a significant positive association with cognitive performance. Conclusions Coordination, as measured by T-wall response time, emerged as the only physical fitness component consistently associated with cognitive performance in older adults. Coordination-related fitness may be an important correlate of cognitive function in older adults and a promising target for future exercise interventions.

Background: Excess intake of added sugars contributes to obesity, type 2 diabetes mellitus (T2DM), cardiovascular disease (CVD), and premature mortality. Sugar-sweetened beverages (SSBs), the main source of added sugars, are consistently linked to adverse outcomes. Artificially sweetened beverages (ASBs) have been suggested as short-term substitutes, but evidence regarding benefits and harms remains inconclusive, and guidance is lacking. Methods: This consensus statement draws on a structured evidence review combining two approaches: an updated meta-analysis of randomized controlled trials (RCTs) assessing short- to intermediate-term effects of replacing SSBs with ASBs on weight and metabolic outcomes; and an umbrella review of systematic reviews of cohort studies evaluating long-term associations of SSBs and ASBs with major outcomes, including mortality, CVD, and T2DM. Results: In 14 RCTs (3–76 weeks), replacing SSBs with ASBs produced modest reductions in body weight (–0.73 kg) and body fat (–0.72%), with inconsistent effects on glycemic and cardiometabolic markers. Evidence from 20 systematic reviews of cohorts (up to 34 years follow-up) showed that higher intake of both SSBs and ASBs was associated with increased risks of T2DM, CVD, and mortality, with relative risks for ASBs similar to those for SSBs. Conclusion ASBs may serve as a short-term substitution for individuals with high SSB intake, particularly those at elevated metabolic risk. However, regular or long-term use is not recommended due to uncertain safety and potential reinforcement of sweet preference. Public health strategies should emphasize reducing both SSBs and ASBs, prioritizing water and unsweetened beverages as the ultimate goal.

Background/Aims: Helicobacter pylori is a pathogen that causes chronic gastritis and peptic ulcer diseases and is a carcinogen responsible for the development of malignancies, including gastric cancer. In the current era of high antimicrobial resistance, rifabutin-based triple therapy is recommended as a salvage therapy. Bismuth has not only a strong bacteriostatic effect but also a synergic effect when combined with antibiotics. Our study aimed to compare and evaluate the eradication rates between rifabutin-based triple therapy and rifabutin with bismuth-containing quadruple therapy as salvage treatments. Methods: In this single-center study, patients who received rifabutin-based triple therapy and rifabutin with bismuth-containing quadruple therapy after failure of conventional therapy, including first- and second-line treatment, between January 2016 and July 2024, were retrospectively investigated. A total of 53 patients who received rifabutin-based triple therapy and 50 who received bismuth-containing quadruple therapy were included. Results: In the rifabutin-based triple therapy group, eradication was achieved in 32 out of 53 patients (60.4%; 95% confidence interval [CI], 46.8% to 74.0%). In the bismuth-containing quadruple therapy group, eradication was achieved in 40 out of 50 patients (80.0%; 95% CI, 68.5% to 91.5%), demonstrating significant therapeutic benefit (p=0.030). Adverse events, including nausea, epigastric discomfort, and lethargy, were significantly more frequent in the bismuth-containing quadruple therapy group (p=0.007), but they were mild and tolerable enough not to affect compliance (p=0.329). Conclusions Rifabutin with bismuth-containing quadruple regimen as a salvage treatment achieved significantly superior eradication efficacy over the rifabutin-based triple regimen. Further multicenter prospective studies are needed to provide additional supporting evidence.

This study aimed to evaluate item-level reporting compliance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist among cross-sectional studies published in the Journal of Korean Biological Nursing Science (JKBNS) between 2011 and 2024, and to identify both strengths and gaps in reporting practices. Methods: A descriptive methodological review was conducted. Using the official JKBNS online archive, 192 cross-sectional survey studies published between 2011 and 2024 were identified and included in the analysis. Reporting compliance was evaluated using the STROBE checklist, and item-level mapping was performed between STROBE items and the Joanna Briggs Institute and National Institutes of Health (NIH) critical appraisal critical appraisal tools. Results: The mean overall STROBE compliance rate was 74.0%. Reporting of study objectives, outcome data, and interpretation was generally adequate across the included studies. However, substantial deficiencies were observed in the Methods domain. In particular, sample size justification, reporting of bias, handling of missing data, description of sampling strategies, sensitivity analyses, and inclusion of participant flow diagrams were rarely reported. Conclusion: The reporting quality of cross-sectional studies published in JKBNS was moderate, with notable weaknesses in methodological transparency. These deficiencies may limit the interpretability and applicability of research findings in nursing practice and policy contexts. Systematic and explicit application of the STROBE reporting guidelines, supported by guideline-based education and strengthened editorial policies, is essential for improving reporting transparency and methodological rigor in nursing research.

This study evaluated the reporting quality of systematic reviews (SRs) published in the Journal of Korean Biological Nursing Science (JKBNS) from 2011 to 2024 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guideline and examined conceptual alignment with A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2) and Risk of Bias in Systematic Reviews (ROBIS). Methods: A methodological review was conducted using articles retrieved from the JKBNS archive. The literature search was performed between October 7 and October 24, 2025. Two reviewers independently screened all records, and reporting quality was assessed using the 27 PRISMA items and 42 associated sub-items, which were scored as fully reported (1), partially reported (0.5), or not reported (0). Compliance rates were calculated, and PRISMA items were mapped to corresponding AMSTAR-2 and ROBIS domains. Results: Twenty SRs and meta-analyses met the inclusion criteria. The mean score across PRISMA sub-items was 23.58 ± 7.34 (range, 15~38). Ten sub-items—including rationale, objectives, information sources, search strategy, data collection, study selection and exclusion, study characteristics, and key discussion elements—were consistently reported. In contrast, protocol registration, protocol access, and sensitivity analyses were rarely reported, while certainty assessment, certainty of evidence, and protocol amendments were not reported in any study. Overall adherence to the 27 PRISMA items was 64.7 ± 14.9% (range, 44.4~92.6). Conclusion: Conceptual mapping demonstrated strong alignment between PRISMA methodology and results items and the domains of AMSTAR-2 and ROBIS; however, transparency-focused components newly introduced in PRISMA 2020 showed limited correspondence. These findings provide practical guidance for improving reporting transparency in future SRs published in JKBNS.