The manifestation of behavioral and psychological symptoms of dementia (BPSD) poses a considerable care burden and precipitates adverse health outcomes. Despite the increasing development of digital interventions, their application in the dementia population, specifically regarding their effectiveness in addressing BPSD, remains limited. Therefore, in this study, we aimed to describe a study protocol for evaluating the effectiveness of a mobile app-based individualized non-pharmacological intervention to improve BPSD in community-dwelling older adults. Methods: Employing a randomized control group pretest-posttest design, 36 dyads comprising people living with dementia (PLWD) and their family caregivers will be assigned to either an experimental or control group. The experimental group will engage in a 4-week regimen using a mobile app-based individualized non-pharmacological intervention, which includes recording and predicting BPSD. The control group will use the BPSD record system without accessing the individualized interventions. Both groups will continue with their usual care practices throughout the study period. Subsequently, an evaluation of the effectiveness of the mobile app-based individualized non-pharmacological intervention on BPSD will be conducted, which will serve as the primary outcome. Discussion: We hypothesize that the implementation of the mobile app-based individualized non-pharmacological intervention will alleviate BPSD. However, the research team may encounter several challenges owing to the novelty of digitalized interventions. Nevertheless, the results of this study will provide robust evidence regarding the efficacy of mobile app-based individualized non-pharmacological interventions for community-dwelling older PLWD.Trial registration: This trial has been registered with the Clinical Research Information Service in South Korea (CRIS No. KCT0008713; registered August 18, 2023).

Purpose: This descriptive research study explores the relationship between remote online classes, nursing students’ self-determined learning motivation and learning flow, to identify the mediating effect of academic emotion regulation. Methods: The study sample comprised 147 third- and fourth-year nursing students from two universities in Jeonbuk State, all of whom had clinical practice experience. Descriptive statistics, independent t-tests, and one-way analysis of variance were conducted using SPSS/WIN 23.0 for data analysis. Hayes’ PROCESS macro Version 3.5 was used to verify the significance of the indirect effects of the variables. Results: Self-determined learning motivation had a significant positive effect on the mediating variable, academic emotion regulation(β=.21, p=.001), and on learning flow. Additionally, academic emotion regulation significantly positively influenced learning flow. When considering the mediating effect of academic emotion regulation, the indirect effect size between self-determined learning motivation and learning flow was .07, with a bootstrapping confidence interval ranging from 0.02 to 0.13, excluding zero, which was statistically significant, indicating a mediating effect. Conclusion The findings confirm that academic emotion regulation is a crucial variable that can enhance students’ learning flow, thereby maximizing educational effectiveness during rapid changes in online education methods. Consequently, educational programs should be developed that consider the emotional aspects of learning to improve academic emotion regulation. Furthermore, universities should establish educational policies and measures that expand various digital education platforms to reflect and respond to the online education environment.

OBJECTIVES: Proteinuria is widely used to predict cardiovascular risk. However, there is insufficient evidence to predict how changes in proteinuria may affect the incidence of cardiovascular disease. METHODS: The study included 265,236 Korean adults who underwent health checkups in 2003-2004 and 2007-2008. They were categorized into 4 groups based on changes in proteinuria (negative: negative → negative; resolved: proteinuria ≥1+ → negative; incident: negative → proteinuria ≥1+; persistent: proteinuria ≥1+ → proteinuria ≥1+). We conducted 6 years of follow-up to identify the risks of developing ischemic heart disease (IHD), acute myocardial infarction (AMI), and angina pectoris according to changes in proteinuria. A multivariate Cox proportional-hazards model was used to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for incident IHD, AMI, and angina pectoris. RESULTS: The IHD risk (expressed as HR [95% CI]) was the highest for persistent proteinuria, followed in descending order by incident and resolved proteinuria, compared with negative proteinuria (negative: reference, resolved: 1.211 [95% CI, 1.104 to 1.329], incident: 1.288 [95% CI, 1.184 to 1.400], and persistent: 1.578 [95% CI, 1.324 to 1.881]). The same pattern was associated with AMI (negative: reference, resolved: 1.401 [95% CI, 1.048 to 1.872], incident: 1.606 [95% CI, 1.268 to 2.035], and persistent: 2.069 [95% CI, 1.281 to 3.342]) and angina pectoris (negative: reference, resolved: 1.184 [95% CI, 1.065 to 1.316], incident: 1.275 [95% CI, 1.160 to 1.401], and persistent: 1.554 [95% CI, 1.272 to 1.899]). CONCLUSIONS Experiencing proteinuria increased the risks of IHD, AMI, and angina pectoris even after proteinuria resolved.

Objective: Facial affect recognition is associated with neuropsychological status and psychiatric diseases. We hypothesized that facial affect recognition is associated with psychological status and perception of other affects. Methods: A total of 80 images depicting facial affect, including 20 Neutral, 20 Angry, 20 Fear, and 20 Sad, were screened for use in our research. A total of 100 healthy individuals were asked to rate these images using a 10-point Likert scale and complete psychological scales assessing the emotional statuses and cognitive functions. Results: The participants’ emotional state of aggression, attention, and impulsivity may have been associated with their interpretation of the Angry facial expressions. The participants often rated the Angry facial expressions as Fear. The participants rated Fear images as Angry or Sad. In response to a Sad facial expression, the participants reported psychological statuses of attention and impulsivity which were associated with the facial expression rating. The participants rated the Sad expression as Angry or Fear. Conclusion The psychological statuses of the participants were significantly correlated with their interpretation of facial affects. In particular, a psychological state of attention was often correlated with incorrect affect ratings. Attention and impulsivity could affect the rating of the sad facial expressions.

OBJECTIVES: Our study examined the dose-response relationship between smoking amounts (pack-years) and the risk of developing pancreatic cancer in Korean men. METHODS: Of 125,743 participants who underwent medical health checkups in 2009, 121,408 were included in the final analysis and observed for the development of pancreatic cancer. We evaluated the associations between smoking amounts and incident pancreatic cancer in 4 groups classified by pack-year amounts. Cox proportional hazards models were used to estimate the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of incident pancreatic cancer by comparing groups 2 (<20 pack-year smokers), 3 (20-≤40 pack-year smokers), and 4 (>40 pack-year smokers) with group 1 (never smokers). RESULTS: During 527,974.5 person-years of follow-up, 245 incident cases of pancreatic cancer developed between 2009 and 2013. The multivariate-adjusted HRs (95% CIs) for incident pancreatic cancer in groups 2, 3, and 4 were 1.05 (0.76 to 1.45), 1.28 (0.91 to 1.80), and 1.57 (1.00 to 2.46), respectively (p for trend=0.025). The HR (95% CI) of former smokers showed a dose-response relationship in the unadjusted model, but did not show a statistically significant association in the multivariate-adjusted model. The HR (95% CI) of current smokers showed a dose-response relationship in both the unadjusted (p for trend=0.020) and multivariate-adjusted models (p for trend=0.050). CONCLUSIONS The risk of developing pancreatic cancer was higher in current smokers status than in former smokers among Korean men, indicating that smoking cessation may have a protective effect.

Background: This study aimed to investigate the association between e-cigarette (EC) use and development of acute severe pneumonia in the Korean population using a national database. Methods: We conducted a retrospective analysis using linkage of data between the Korean National Health and Nutrition Examination Survey (KNHANES) and the National Health Insurance Service (NHIS) administrative claims database. The primary endpoint of this study was development of severe pneumonia requiring hospital admission according to EC use during the study period. The secondary endpoints were in-hospital mortality, intensive care unit (ICU) admission, ventilator care, and days of hospital stay. Results: The final analysis included 28,950 individuals, of which 578 (2.0%) were EC users.EC users were younger and more often male than non-EC users. The EC users showed higher level of education and household income and had fewer comorbidities. Severe pneumonia was noted in 37 of 28,372 non-EC users (0.13%), but there were no occurrences of severe pneumonia in EC users. The incidence of pneumonia occurrence was not different between the two groups (P = 1.000). Conclusions Since e-cigarette or vaping use-associated lung injury (EVALI) is most likely included in acute severe pneumonia occurring within 3 months of EC use, it is considered that there might be no EVALI patients in Korea during the investigation period. A large-scale, prospective study is necessary to evaluate the association between EC use and acute lung injury.

Purpose: This study was carried out to investigate the effect of amaranth seed extracts on glycemic regulation in HepG2 cells. The 80% ethanol extracts of amaranth seeds were used to evaluate α-amylase and α-glucosidase activities, cell viability, glucose uptake and messenger RNA (mRNA) expression levels of acetyl-CoA carboxylase (ACC), glucose transporter (GLUT)-2, GLUT-4, insulin receptor substrate (IRS)-1 and IRS-2. Methods: The samples were prepared and divided into 4 groups, including germinated black amaranth (GBA), black amaranth (BA), germinated yellow amaranth (GYA) and yellow amaranth (YA). Glucose hydrolytic enzyme, α-amylase and α-glucosidase activities were examined using a proper protocol. In addition, cell viability was measured by MTT assay. Glucose uptake in cells was measured using an assay kit. The mRNA expression levels of ACC, GLUT-2, GLUT-4, IRS-1 and IRS-2 were measured by reverse transcription polymerase chain reaction. Results: The inhibitory activities of α-amylase and α-glucosidase were highly observed in GBA, followed by BA, GYA and YA. Similar results were observed for glucose. The GBA effect was similar compared to the positive control group. The mRNA expression levels of ACC, GLUT-2, GLUT-4, IRS-1, and IRS-2 were significantly increased. The potential hypoglycemic effects of amaranth seed extracts were observed due to the increase in glucose metabolic enzyme activity, and glucose uptake was mediated through the upregulation of ACC, GLUT-2, GLUT-4, IRS-1, and IRS-2 expression levels. Conclusion Our findings suggest that the amaranth seed is a potential candidate to prevent a diabetes. The present study demonstrated the possibility of using amaranth seeds, especially GBA and BA for glycemic control.

Background: This systematic review and meta-analysis aimed at investigating the current status and prevalence of sleep disturbance in Korean university students and provide evidence to develop appropriate strategies for improving sleep disturbance. Methods: Pooled prevalence of sleep disturbance in Korean university students was assessed using PubMed, CINAHL, Research Information Sharing Service, National Assembly Library, Korean studies Information Service System, and Korea Citation Index databases. A total of 1,843 studies were retrieved from the literature search, and 14 studies were included in the analysis. Statistical analysis was performed using comprehensive meta-analysis software. Results: The overall pooled prevalence was 48.9% (95% confidence interval [CI], 41.6-56.3%). Subgroup analyses revealed that the pooled prevalence rates were 59.2% (95% CI, 38.8-50.7%) in the Pittsburgh Sleep Quality Index (PSQI)-based and 26.0% (95% CI, 19.5-33.9%) in non-PSQI-based studies, 23.2% (95% CI, 15.6-33.1%) in low-quality and 56.9% (95% CI, 49.3-64.2%) in moderate-quality studies, 35.6% (95% CI, 33.4-37.8%) in studies published before 2010 and 51.4% (95% CI, 42.9-59.8%) in studies published since 2011. Conclusions The prevalence of sleep disturbance is higher in university students. Therefore, further studies are needed to identify sleep problems of university students and gain future-oriented insights to develop mediation strategies.