Purpose: Early adolescence is a pivotal developmental stage characterized by rapid physical, emotional, and social changes. Happiness during this period is crucial as it influences later life outcomes. This study examined 4-year changes in happiness and identified predictors among Korean early adolescents. Methods: A secondary analysis of longitudinal panel data was conducted using latent growth modeling to assess changes in happiness over 4 years, utilizing data from the Panel Study on Korean Children (11th–14th waves) with a total of 1,177 participants. Descriptive statistics were computed using IBM SPSS ver. 29.0, and latent growth modeling, including unconditional and conditional models with associated factors variables, was conducted using IBM AMOS ver. 29.0. Results: A nonlinear trajectory was identified with a sharp decline in happiness, particularly between the ages of 11 and 12 years. Self-esteem, peer attachment, and a creative school environment emerged as protective factors mitigating this decline, whereas parental attachment influenced baseline happiness but not its trajectory. Higher self-esteem, stronger peer attachment, and supportive school environments were associated with a slower decline in happiness. Conclusions Our findings highlight the importance of early interventions beginning around the age of 11 years, a critical period when happiness decreases more steeply. Practical implications include developing school-based and psychosocial programs that strengthen self-esteem and positive peer relationships, and fostering autonomy-supportive, creative educational environments. Coordinated efforts between schools and families are essential to promote adolescents’ emotional well-being and ensure balanced development in academic and socio-emotional domains.

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.

Objective: This study aimed to establish baseline ultrasonographic parameters for GI wall thickness and assess differences based on sex, gastric distension, body weight, and the presence of GI symptoms. Methods: A retrospective analysis was conducted on 42 Korean raccoon dogs (35 healthy, seven symptomatic). Total and individual layer thicknesses (mucosa, submucosa, muscularis, and serosa) were measured for the stomach, duodenum, jejunum, ileum (folded and interfolded regions), and colon. Statistical analyses were performed to assess the effects of sex, body weight, gastric distension, and GI symptoms on wall thickness. Results: All Korean raccoon dogs exhibited a five-layer GI wall and echogenicity similar to that of domestic dogs. Mean total wall thickness values were: stomach (2.77 ± 0.74 mm), duodenum (2.19 ± 0.31 mm), jejunum (2.06 ± 0.35 mm), ileum (folded, 1.75 ± 0.35 mm, interfolded, 2.31 ± 0.24 mm), and colon (1.06 ± 0.37 mm). Stomach wall thickness was greater in collapsed (3.31 ± 0.37 mm) than in distended (2.15 ± 0.52 mm) states.No statistically significant differences in GI wall thickness were observed based on sex or body weight. Symptomatic Korean raccoon dogs exhibited significant thickening of the duodenum, jejunum, and colon, along with increased mucosal echogenicity, loss of normal wall layering, and intestinal corrugation. Conclusions and Relevance: These findings provide essential reference values for GI ultrasonographic evaluation in Korean raccoon dogs, with implications for diagnostic accuracy.

Objective: Primary frozen shoulder causes significant pain and progressively restricts shoulder movements. Diagnosis is made clinically based on patient history and physical examination. Management is mainly non-invasive owing to its self-limiting clinical course. However, clinical practice guidelines for frozen shoulder have not yet been developed in Korea. The developed guidelines aim to provide evidence-based recommendations for the diagnosis and treatment of frozen shoulder. Methods: A guideline development committee reviewed the literature from four databases (PubMed, Embase, Cochrane Library, and KMbase). Using the Population, Intervention, Comparator, and Outcome (PICO) framework, the committee formulated two backgrounds and 16 key questions to address common clinical concerns. Recommendations were made using the Grading of Recommendations, Assessment, Development, and Evaluation framework. Results: Diabetes, thyroid disease, and dyslipidemia significantly increase the risk of developing a frozen shoulder. Although frozen shoulder is often self-limiting, some patients may experience long-term functional disabilities. Ultrasound and magnetic resonance imaging should be used as adjunctive tools alongside clinical diagnosis, and rather than as independent diagnostic methods. Noninvasive approaches, such as medications, physical modalities, exercises, electrical stimulation, and manual therapy, may reduce pain and improve shoulder function. Other noninvasive interventions have limited evidence, and their application should be based on clinical judgment. Intra-articular steroid injections are recommended for treatment, and physiotherapy or hydrodilation with steroid injections can also be beneficial. Conclusion These guidelines provide evidence-based recommendations for diagnosing and treating primary frozen shoulder.

Purpose: Providing continuous self-care support to the growing diabetes population is challenging. Strategies are needed to enhance engagement in self-care, utilizing innovative technologies for personalized feedback. This study aimed to assess the feasibility of the Automated Personalized Self-Care program among type 2 diabetes patients and evaluate its preliminary effectiveness. Methods: A parallel randomized pilot trial with qualitative interviews occurred from May 3, 2022, to September 27, 2022. Participants aged 40e69 years with type 2 diabetes and HbA1c ! 7.0% were recruited. The three-month program involved automated personalized goal setting, education, monitoring, and feedback. Feasibility was measured by participants' engagement and intervention usability. Preliminary effectiveness was examined through self-care self-efficacy, self-care behaviors, and health outcomes. Qualitative interviews were conducted with the intervention group. Results: A total of 404 patients were screened. Out of the 61 eligible patients, 32 were enrolled, resulting in a recruitment rate of 52.5%. Retention rates at three months were 84.2% and 84.6% in the intervention and control groups, respectively. Among the intervention group, 81.3% satisfied adherence criteria.Mobile application's usability scored 66.25, and participants' satisfaction was 8.06. Intention-to-treat analysis showed improvements in self-measured blood glucose testing, grain intake, and HbA1c in the intervention group. Qualitative content analysis identified nine themes. Conclusion Feasibility of the program was verified. A larger randomized controlled trial is needed to determine its effectiveness in self-care self-efficacy, self-care behaviors, and health outcomes among type 2 diabetes patients. This study offers insights for optimizing future trials assessing clinical effectiveness.

Purpose: This study aimed to investigate the influence of uncertainty-related factors on the health behavior of individuals with coronary artery disease (CAD) based on Mishel’s uncertainty in illness theory (UIT). Methods: We conducted a cross-sectional study and path analysis to investigate uncertainty and factors related to health behavior. The study participants were 228 CAD patients who visited the outpatient cardiology department between September 2020 and June 2021. We used SPSS 25.0 and AMOS 25.0 software to analyze the data. Results: The final model demonstrated a good fit with the data. Eleven of the twelve paths were significant. Uncertainty positively affected danger and negatively affected self-efficacy and opportunity. Danger had a positive effect on perceived risk. Opportunity positively affected social support, self-efficacy, perceived benefit and intention, whereas it negatively affected perceived risk. Social support, self-efficacy, perceived benefit and intention had a positive effect on health behavior. We found that perceived benefit and intention had the most significant direct effects, whereas self-efficacy indirectly affected the relationship between uncertainty and health behavior. Conclusion The path model is suitable for predicting the health behavior of CAD patients who experience uncertainty. When patients experience uncertainty, interventions to increase their self-efficacy are required first. Additionally, we need to develop programs that quickly shift to appraisal uncertainty as an opportunity, increase perceived benefits of health behavior, and improve intentions.

Purpose: This study aimed to explore the mediating role of organizational silence in the effect of leader-member exchange on patient safety culture among perioperative nurses. Methods: This descriptive study surveyed 201 perioperative nurses from five university hospitals. Data were collected via online questionnaires from November 8, 2022, to February 6, 2023, measuring demographics, work-related factors, leader-member exchange, organizational silence, and patient safety culture. The Data were analyzed using SPSS 26.0 and PROCESS Macro model 4. Results: Leader-member exchange showed a significant direct effect on patient safety culture (β=.44, p<.001). The indirect effect of leader-member exchange on patient safety culture through acquiescent silence was also significant (β=.05, 95% CI: 0.02 to 0.13).The total effect of leader-member exchange on patient safety culture (β=.52, p<.001) was larger than its direct effect, indicating that acquiescent silence partially mediated the relationship between leader-member exchange and patient safety culture. Conclusion To improve perioperative nurses perception of patient safety culture, healthcare organizations should enhance leader-member exchange by promoting strong emotional connections and open communication between nurse managers and staff nurses. Additionally, encouraging autonomous decision-making and reducing acquiescent silence are essential to facilitate the active expression of patient safety concerns.

Purpose: This study aimed to identify the factors influencing nurses’ perceptions of the disclosure of patient safety incidents in tertiary hospitals. Methods: As a descriptive study, data were collected from 315 nurses working in two tertiary hospitals in Busan via structured self-report questionnaires from June 28 to September 3, 2023, through an online survey. Data were analyzed using descriptive statistics, t-test, one-way ANOVA, Pearson’s correlation coefficients, and hierarchical regression analysis with SPSS/WIN 27.0. Results: Analysis was conducted by controlling for the characteristics of the study participants, which revealed significant differences in their perceptions of the disclosure of patient safety incidents. Ethical nursing competence (β=.30, p<.001) and patient safety culture (β=.15, p=.012) were significant influencing factors on the perception of such disclosure, and the explanatory power of the regression model was 21.0% (F=14.63, p<.001). Conclusion To enhance the aforementioned perception among nurses in tertiary hospitals, healthcare institutions should provide learning opportunities to improve their ethical nursing competence. Fostering an organizational culture that promotes and encourages open disclosure of patient safety incidents is also essential.

Purpose: This study aimed to explore the mediating role of organizational silence in the effect of leader-member exchange on patient safety culture among perioperative nurses. Methods: This descriptive study surveyed 201 perioperative nurses from five university hospitals. Data were collected via online questionnaires from November 8, 2022, to February 6, 2023, measuring demographics, work-related factors, leader-member exchange, organizational silence, and patient safety culture. The Data were analyzed using SPSS 26.0 and PROCESS Macro model 4. Results: Leader-member exchange showed a significant direct effect on patient safety culture (β=.44, p<.001). The indirect effect of leader-member exchange on patient safety culture through acquiescent silence was also significant (β=.05, 95% CI: 0.02 to 0.13).The total effect of leader-member exchange on patient safety culture (β=.52, p<.001) was larger than its direct effect, indicating that acquiescent silence partially mediated the relationship between leader-member exchange and patient safety culture. Conclusion To improve perioperative nurses perception of patient safety culture, healthcare organizations should enhance leader-member exchange by promoting strong emotional connections and open communication between nurse managers and staff nurses. Additionally, encouraging autonomous decision-making and reducing acquiescent silence are essential to facilitate the active expression of patient safety concerns.

Purpose: This study aimed to identify the factors influencing nurses’ perceptions of the disclosure of patient safety incidents in tertiary hospitals. Methods: As a descriptive study, data were collected from 315 nurses working in two tertiary hospitals in Busan via structured self-report questionnaires from June 28 to September 3, 2023, through an online survey. Data were analyzed using descriptive statistics, t-test, one-way ANOVA, Pearson’s correlation coefficients, and hierarchical regression analysis with SPSS/WIN 27.0. Results: Analysis was conducted by controlling for the characteristics of the study participants, which revealed significant differences in their perceptions of the disclosure of patient safety incidents. Ethical nursing competence (β=.30, p<.001) and patient safety culture (β=.15, p=.012) were significant influencing factors on the perception of such disclosure, and the explanatory power of the regression model was 21.0% (F=14.63, p<.001). Conclusion To enhance the aforementioned perception among nurses in tertiary hospitals, healthcare institutions should provide learning opportunities to improve their ethical nursing competence. Fostering an organizational culture that promotes and encourages open disclosure of patient safety incidents is also essential.