Background/Aims: Patients with atrial fibrillation (AF) and end-stage kidney disease (ESKD) require careful anticoagulation because thrombotic and bleeding risks are both elevated. We evaluated the efficacy and safety of warfarin, direct oral anticoagulants (DOACs), and no anticoagulation in Korean patients with ESKD and AF. Methods: In this multicenter retrospective study, we included 933 patients with ESKD and nonvalvular AF treated between 2010 and 2023. Patients were assigned to three groups by initial treatment: no anticoagulation (n = 604), warfarin (n = 197), or DOACs (n = 132). The primary efficacy outcome was ischemic stroke or systemic embolism (IS/SE); the primary safety outcome was major bleeding (MB). Secondary outcomes were intracranial hemorrhage (ICH), gastrointestinal bleeding (GIB), and all-cause mortality. Inverse probability of treatment weighting was used to adjust for confounding. Results: Both warfarin (adjusted hazard ratio [aHR], 0.55) and DOACs (aHR, 0.36) significantly reduced the risk of IS/SE compared with no anticoagulation. However, warfarin increased MB risk compared with no anticoagulation (aHR, 2.69), including ICH and GIB. DOACs also increased MB risk versus no anticoagulation (aHR, 1.37), driven primarily by ICH. Compared with warfarin, DOACs showed a lower MB risk (aHR, 0.51). Both warfarin and DOACs reduced all-cause mortality relative to no anticoagulation (aHR, 0.53 and 0.57, respectively). Conclusions Among Korean patients with ESKD and AF, both warfarin and DOACs reduced IS/SE but increased MB. Given their lower MB risk than warfarin, DOACs may be preferable for anticoagulation in this high-risk population.

Objectives: Korea is one of the fastest-aging societies, and a large proportion of its older population lives alone. This study examined the impact of family interaction frequency on the association between living alone and depressive symptoms among older adults aged ≥80 years using nationally representative survey data. Methods: Among the 229 099 participants of the 2019 Korea Community Health Survey, 15 672 participants aged ≥80 years who either lived with close family or lived alone were included in the analysis. Participants living alone were classified according to the frequency of family interaction, ranging from less than once a month to more than once a week. The outcome variable was moderate to severe depressive symptoms, defined as a Patient Health Questionnaire-9 score of ≥10. Results: The prevalence of depressive symptoms was higher among older adults living alone (9.4–14.1%, depending on the frequency of family interaction) than among those living with close family (6.5%). Older adults living alone who interacted with family less than once a month were more likely to report depressive symptoms compared with those living with close family (adjusted odds ratio [aOR], 1.71; 95% confidence interval [CI], 1.36 to 2.15). Weekly family interaction mitigated the impact of living alone on the prevalence of depressive symptoms (aOR 1.10; 95% CI, 0.84 to 1.42). The influence of family interaction on the association between living alone and depressive symptoms remained consistent across subgroups of men, women, and those with difficulty in daily activities. Conclusions Encouraging regular interaction among family members could serve as an effective strategy to protect the mental health of older adults.

Purpose: To investigate effects of client violence and supervision on burnout of mental health professionals working in communities. Methods: This was a descriptive study. Data from 170 participants were collected through a self-reported online survey using a convenience sampling method. The survey was conducted from November 2023 to March 2024. Results: Multiple regression analysis revealed that client violence (β=.22, p=.006) was a predictor of burnout, whereas supervision had no significant effect. Conclusion Findings of this study revealed that factors exacerbating burnout, such as client violence, significantly affected the burnout of community mental health professionals. In contrast, factors mitigating burnout, such as supervision, did not have a significant impact. Accordingly, strategies aimed at mitigating and eliminating factors that contribute to increased burnout must be prioritized to alleviate burnout among professionals working in community mental health facilities.

Purpose: To investigate effects of client violence and supervision on burnout of mental health professionals working in communities. Methods: This was a descriptive study. Data from 170 participants were collected through a self-reported online survey using a convenience sampling method. The survey was conducted from November 2023 to March 2024. Results: Multiple regression analysis revealed that client violence (β=.22, p=.006) was a predictor of burnout, whereas supervision had no significant effect. Conclusion Findings of this study revealed that factors exacerbating burnout, such as client violence, significantly affected the burnout of community mental health professionals. In contrast, factors mitigating burnout, such as supervision, did not have a significant impact. Accordingly, strategies aimed at mitigating and eliminating factors that contribute to increased burnout must be prioritized to alleviate burnout among professionals working in community mental health facilities.

Purpose: To investigate effects of client violence and supervision on burnout of mental health professionals working in communities. Methods: This was a descriptive study. Data from 170 participants were collected through a self-reported online survey using a convenience sampling method. The survey was conducted from November 2023 to March 2024. Results: Multiple regression analysis revealed that client violence (β=.22, p=.006) was a predictor of burnout, whereas supervision had no significant effect. Conclusion Findings of this study revealed that factors exacerbating burnout, such as client violence, significantly affected the burnout of community mental health professionals. In contrast, factors mitigating burnout, such as supervision, did not have a significant impact. Accordingly, strategies aimed at mitigating and eliminating factors that contribute to increased burnout must be prioritized to alleviate burnout among professionals working in community mental health facilities.

Purpose: To investigate effects of client violence and supervision on burnout of mental health professionals working in communities. Methods: This was a descriptive study. Data from 170 participants were collected through a self-reported online survey using a convenience sampling method. The survey was conducted from November 2023 to March 2024. Results: Multiple regression analysis revealed that client violence (β=.22, p=.006) was a predictor of burnout, whereas supervision had no significant effect. Conclusion Findings of this study revealed that factors exacerbating burnout, such as client violence, significantly affected the burnout of community mental health professionals. In contrast, factors mitigating burnout, such as supervision, did not have a significant impact. Accordingly, strategies aimed at mitigating and eliminating factors that contribute to increased burnout must be prioritized to alleviate burnout among professionals working in community mental health facilities.

Chronic kidney disease (CKD) patients are hospitalized for various conditions. Hospitalization increases the readmission rate and mortality rate, seriously deteriorating patients’ quality of life. Consequently, it is crucial to analyze the reasons for hospitalization in CKD patients from a broader perspective according to CKD grade. Methods: This is a prospective cohort study of CKD patients entitled the KoreaN cohort study for Outcomes in patients With Chronic Kidney Disease (KNOW-CKD). A total of 2,238 patients were examined, and the reasons for hospitalization were classified into 16 disease categories. The incidence rate ratio (IRR) according to CKD stage was compared using negative bimodal regression analysis. Results: The all-cause hospitalization incidence was 184.96 per 1,000 person-years. The most common reason for hospitalization was circulatory system disease, followed by infection and digestive system disease. Among hospitalizations for acute kidney injury, endocrine-nutrition-metabolic–related illness, blood-related disease, and diseases of the nervous system and sensory organs, IRR increased as CKD grade advanced. The incidence of ophthalmologic surgery during hospitalization increased according to the CKD stage. The IRR of KNOW-CKD patients was 6.19 (95% confidence interval, 5.92–6.48; p < 0.001) compared with the general population. Conclusion: This in-depth analysis of hospitalizations among CKD patients confirmed that CKD patients were hospitalized for various reasons, such as metabolic, ophthalmic, and hematologic diseases. Early detection and intervention regarding causative diseases of CKD are important to reduce the hospitalization burden and improve patients’ quality of life.

27-Hydroxycholesterol (27OHChol), a prominent cholesterol metabolite present in the bloodstream and peripheral tissues, is a kind of immune oxysterol that elicits immune response. Recent research indicates the involvement of 27OHChol in metabolic inflammation (meta-inflammation) characterized by chronic responses associated with metabolic irregularities. 27OHChol activates monocytic cells such that they secrete pro-inflammatory cytokines and chemokines, and increase the expression of cell surface molecules such as pattern-recognition receptors that play key roles in immune cell-cell communication and sensing metabolism-associated danger signals. Levels of 27OHChol increase when cholesterol metabolism is disrupted, and the resulting inflammatory responses can contribute to the development and complications of metabolic syndrome, including obesity, insulin resistance, and cardiovascular diseases. Since 27OHChol can induce chronic immune response by activating monocyte-macrophage lineage cells that play a crucial role in meta-inflammation, it is essential to understand the 27OHChol-induced inflammatory responses to unravel the roles and mechanisms of action of this cholesterol metabolite in chronic metabolic disorders.

Background: Although numerous studies have indicated that lower levels of physical activity correlate with a higher risk of depression, an association between the type of physical activity and depression has not been identified in Korea. This study aimed to examine whether the type and intensity of physical activity are associated with depression in Korean adults. Methods: This cross-sectional study used data from the Korea National Health and Nutrition Examination Survey (KNHANES). A total of 11,679 individuals were analyzed using multiple logistic regression analyses to identify any association between the type of physical activity and depressive disorders in the sample subjects. Results: Measured weekly in units of energy expenditure, known as metabolic equivalents (METs), the amount of work-related physical activity was higher in individuals with depression according to the Patient Health Questionnaire- 9 than the participants without depression (386.7 vs. 206.7 MET-min/wk, P=0.01). Those diagnosed with depression tended to engage in less recreational activity per week (143.7 vs. 316.3 MET-min/wk, P<0.001) than those without depression. After controlling for covariates, the risk of depression among all participants was 1.012 times higher with a 100-unit increase in total work-related activity measured in METs (95% confidence interval [CI], 1.006–1.017; P<0.001) and 0.962 times lower with a 100-unit increase in total leisure activity measured in METs (95% CI, 0.937–0.987; P=0.003). Conclusion Different types of physical activity were shown to be differently associated with depressive disorders in Korean adults. This study might guide in reducing work-related physical activity and increasing leisure activity to prevent the occurrence of depression.