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This study aimed to determine whether certain lifestyle factors, specifically alcohol consumption, smoking, physical activity, sleep duration and sleep quality, are associated with an increased risk of metabolic syndrome (MetS) and to assess how changes in lifestyle behaviours over time influence MetS prevalence in the middle-aged Korean population.
Community-based, prospective cohort study.
South Korea, baseline in 2017–2019 and follow-up in 2020–2022.
The study included 1436 adult individuals aged ≥30–59 years.
The primary outcome of this study was the prevalence of MetS at follow-up, determined according to established diagnostic criteria. Secondary outcomes included the association between MetS and five key lifestyle factors: alcohol consumption, smoking, physical activity, sleep quality and sleep duration. Lifestyle changes were categorised into four groups based on stability between baseline and follow-up assessments. Outcome measures remained consistent with the study’s initial protocol, with no modifications to the planned variables or measured criteria.
The prevalence of MetS increased from 15.3% at baseline to 19.6% at follow-up. At follow-up, insufficient physical activity (OR=1.42, 95% CI 1.06 to 1.92) and poor sleep quality (OR=1.37, 95% CI 1.02 to 1.84) were significantly associated with MetS. Among lifestyle change patterns, long-term unhealthy physical activity (OR=1.57, 95% CI 1.03 to 2.39) and sleep quality (OR=1.50, 95% CI 1.01 to 2.24) behaviours were associated with an increased risk of MetS. Poisson regression analyses of incident cases showed that only unfavourable changes in sleep duration were significantly associated with incident MetS (rate ratios=1.74, 95% CI 1.02 to 2.95). However, no significant associations were observed for other lifestyle change patterns, including behaviours that improved or worsened over time, and no meaningful associations were identified for non-significant lifestyle factors, such as smoking and alcohol consumption.
The prevalence of MetS was associated not only with individual lifestyle factors but also with long-term patterns of unhealthy behaviours, with persistent shortage of physical activity, poor sleep quality and inadequate sleep duration identified as significant contributors to increased MetS risk. Future research should explore a broader range of risk factors over longer follow-up periods to better understand the long-term impact of lifestyle modifications on MetS development.
Considering that suicide has remained a public health challenge in South Korea since 2009, the development of a real-time monitoring system for suicide risk is urgently needed, especially for those living in the community. The aims of this study were to explore the 28-day longitudinal pattern of suicidal ideation, compare momentary depression, anxiety and stress between different risk groups, and identify the association of suicidal ideation with momentary indicators in community-dwelling outpatients at risk of suicide.
Observational and longitudinal investigation.
A total of 50 community-dwelling psychiatric outpatients were included herein. Those with a history of suicide attempts were classified into the high-risk group (n = 40, 80%), whereas the rest were classified into the low-risk group (n = 10, 20%). Real-time data on depression, anxiety, stress and suicidal ideation were collected from May 2021 to July 2023 based on ecological momentary assessment. Each participant provided reports at least three times a day for 4 weeks. A total of 3195 ecological momentary assessment responses were collected, among which 1345 with the highest mood intensity per day were selected for analysis. Panel mixed-effect linear regression models examined differences in ecological momentary assessment responses between high- and low-risk groups and elucidated the separate effects of depression, anxiety and stress on suicidal ideation in each risk group.
Momentary depression, anxiety and stress were positively associated with momentary suicidal ideation in both risk groups, with these associations being higher among the high-risk group. In both risk groups, momentary suicidal ideation was more strongly associated with momentary depression than with momentary anxiety and stress.
Psychosocial stress indicators were associated with momentary suicidal ideation. Moreover, a strong association was observed between momentary depression and suicide attempts. Further research with larger samples should be conducted to evaluate whether depression interventions could reduce momentary suicidal ideation.
No Patient or Public Contribution.
Cardiovascular disease (CVD) risk remains high but unevenly distributed in patients with type 2 diabetes mellitus (T2DM). Current risk stratification strategies are far from optimal, leading to both undertreatment and overtreatment of patients. The STENO INTEN-CT trial aims to evaluate a strategy of improved CVD risk management by using cardiac CT (coronary artery calcification (CAC)) for stratification and tailoring of multifactorial cardiovascular treatment based on CAC score. We hypothesise that (1) intensified medical treatment will lower CVD event rates in high-risk patients (CAC≥100), and (2) less intensive multifactorial treatment is safe in very low-risk patients (CAC=0).
The Steno INTEN-CT trial is an investigator-initiated, pragmatic, open-label, event-driven randomised controlled trial including patients with T2DM without known CVD. All participants (expected n=7300) will be invited for a non-contrast coronary CT scan. After the scan, participants will be randomised to either standard treatment (blinded for CAC results) or CAC-based treatment. Participants in CAC-based treatment and their general practitioner (GP) will receive information on CAC and a recommendation of multifactorial treatment. High-risk participants in the interventional arm will be invited for one or more initial study visits to intensify treatment with a combination of sodium glucose co-transporter 2 inhibitors, glucagon-like peptide 1 receptor agonists, high-dose lipid-lowering, antihypertensive and antithrombotic treatment. Very low-risk patients in the interventional arm will be recommended less intensive treatment targets. After initial study-related activities, all participants will continue to be taken care of by their GP guided by specific treatment recommendations. The primary outcome in the primary hierarchical analysis (the rate of the combined CVD endpoint of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke and hospitalisation for heart failure) will be monitored through national health registries. The trial is event-driven, but a median follow-up of 5 years is expected. Key secondary outcomes include patient-reported outcomes, quality-adjusted life years and healthcare costs.
The protocol V.1.9 is approved by the Research Ethics Committee and the Danish Medicines Agency and the Danish Data Protection Agency. The results of the study—positive, negative or neutral—will be published in peer-reviewed journals and through www.clinicaltrials.org.
A large bowel cancer chemoprevention potential has been demonstrated by the consumption of carrots, which represent the major dietary source of polyacetylenes. Their interaction with cancer cells and enzyme systems of animals and humans has been systematically investigated over the last 15 years and has now been characterised as anti-inflammatory compounds with antineoplastic effect. Our objective is to investigate whether selected carrot species with a high content of the polyacetylenes falcarinol (FaOH) and falcarindiol (FaDOH) prevent neoplastic transformation and growth in humans, without side effects.
We will conduct a multicentre prospective binational (Denmark and Sweden) randomised controlled trial, with the aim to test the clinical effects of adjuvant treatment with carrot juice in patients who had an excision of high-risk colon adenomas. Patients from six centres will be randomised to receive either anti-inflammatory juice made of carrots high in FaOH and FaDOH or placebo. We will compare the proportion of participants with recurrent adenoma and mean size of them, found in the 1-year follow-up colonoscopy between the two randomised groups.
Informed written consent will be obtained from all participants before randomisation. The study was approved by the regional ethics committee in Denmark (ref. S-20230072) and Sweden (ref. 2024-04732-01). After completion of the trial, we plan to publish two articles in high-impact journals: one article on primary and secondary outcomes, respectively.
To describe the development and refinement of the Flinders Fundamentals of Care Assessment Tool for Clinical Practice through stakeholder feedback. The tool, based on the Fundamentals of Care Framework, supports healthcare leaders and clinicians in assessing fundamental care in a practical and user-friendly manner that embraces rather than minimises the inherent complexity of this care delivery as it occurs in practice.
Multi-method study informed by participatory action principles.
Data collection involved an anonymous online survey and cognitive interviews with key stakeholders internationally to gauge perspectives on the clarity, usability, and acceptability of the tool. Data were collected between October–December 2023. Quantitative, categorical data were analysed using descriptive statistics. Qualitative data were analysed via content analysis.
Participants described the Tool as Comprehensive, Practical, and Useful. Participants liked the visual representation of results in the form of bar and radar diagrams, which aided in interpreting the outcomes. The main suggestions for improvement were: (1) Simplifying items relating to the ‘Context of Care’ dimension of the Fundamentals of Care Framework; (2) Reducing similarity between some items; (3) Separating or simplifying items with multiple components; and (4) Clarifying terminology.
Based on stakeholder feedback, the Flinders Fundamentals of Care Assessment Tool for Clinical Practice is now digitised and includes a comprehensive instruction manual and definitions for each element of the Fundamentals of Care Framework assessed within the tool. The tool supports healthcare leaders and clinicians to assess fundamental care delivery at multiple levels—individual, team, unit/ward, organisational—identifying areas of strength and improvement to inform decision-making, planning, and quality improvement. The tool offers a way of assessing fundamental care holistically as a multi-dimensional construct rather than as a series of disaggregated tasks, better reflecting and capturing the complex reality of fundamental care delivery.
The Flinders Fundamentals of Care Assessment Tool for Clinical Practice supports real-time feedback (i.e., immediate visualisation of results), facilitating its integration in clinical practice to support enhanced fundamental care delivery.
Seeking stakeholder feedback has enhanced the relevance, acceptability, and feasibility of the Flinders Fundamentals of Care Assessment Tool for Clinical Practice, facilitating its use as a decision-making and planning tool to support improved fundamental care delivery across clinical settings.
This study is reported using the CROSS and SRQR guidelines.
No Patient or Public Contribution.
The aim of this study is to identify the factors associated with nurses' perceptions and behaviours related to climate change and health (PBCH) according to their PBCH levels.
A cross-sectional study was used.
This study included a sample of 499 Korean nurses and adhered to the STROBE checklist. Data were collected from March 23 to May 10, 2023. Quantile regression analysis was performed, and PBCH levels were measured using the Korean version of the Climate Health and Nursing Tool.
Across all quantile groups, the experience of extreme weather events and awareness of climate change-coping facilitators were associated with PBCH. Differences were observed in factors associated with PBCH levels. Significant associations with PBCH were observed within the 75th percentile group, for having a religion, household income, and workplace climate friendliness. In the 25th percentile group, having a child, the number of sources for climate change–health-related information, and experience in setting climate change–health goals and strategies significantly influenced PBCH.
We propose a differentiated strategy by elucidating the factors associated with high and low quantiles of PBCH levels.
By verifying specific factors associated with PBCH levels, nurses can enhance their preparedness to respond to the health risks posed by climate change in their clients.
Identifying common factors associated with all quantiles of nurses is important for establishing universal PBCH characteristics. Recognising the distinctions between high and low PBCH levels can aid in developing tailored nursing strategies to enhance PBCH among nurses.
This study adhered to the STROBE guidelines.
No Patient or Public Contribution.
To investigate the frequency and associated factors of interruptions initiated by human and environmental sources during the medication administration process among nurses in South Korea.
A cross-sectional descriptive study.
Data were collected from January to March 2022 through an online survey administered to nurses working in tertiary hospitals in South Korea. The survey assessed interruptions during the medication administration process, nursing work environments and organisational culture. Descriptive statistics and regression analysis were used to identify factors associated with interruptions.
Human-initiated interruptions were more frequent than those initiated by environmental sources. Human-initiated interruptions increased with a higher patient load and a relation-oriented organisational culture but decreased with adequate staffing and resources, as well as an innovation-oriented culture. Environment-initiated interruptions were more frequent in settings with a task-oriented culture and less frequent among female nurses.
The findings highlight the importance of understanding the distinct characteristics of interruptions and developing targeted strategies based on their sources and contributing factors. Creating supportive environments and fostering an organisational culture that actively prevents unnecessary interruptions are essential for enhancing medication safety and workflow efficiency.
To apply these findings in clinical practice, it is necessary to allocate staffing resources appropriately to reduce interruptions. Providing education on the importance of maintaining uninterrupted medication administration processes is essential to reduce human-initiated interruptions.
This study provides practical evidence that organisational culture and staffing are associated with interruptions in clinical nursing practice. Nurse managers should apply these findings by promoting staffing adequacy and fostering a collaborative, innovative environment that encourages continuous improvement and openness to change. Tailored strategies that reflect the specific characteristics of different types of interruptions can help reduce their occurrence and improve medication safety.
STROBE checklist.
No patient or public contribution.
The evidence for the optimal duration of psychotherapy for borderline personality disorder (BPD) is scarce. Two previous trials have compared different durations of psychotherapy. The first compared 6 months versus 12 months of dialectical behaviour therapy for BPD (the FASTER trial). The second compared 5 months versus 14 months of mentalisation-based therapy for BPD (the MBT-RCT trial). The primary objective of the present study will be to provide an individual patient data pooled analysis of two randomised clinical trials by combining the two short-term groups and the two long-term groups from the FASTER and MBT-RCT trials, thereby providing greater statistical power than the individual trials. Accordingly, we will evaluate the overall evidence on the effects of short-term versus long-term psychotherapy for BPD and investigate whether certain subgroups might benefit from short-term versus long-term psychotherapy.
An individual patient data pooled analysis of the FASTER trial and the MBT-RCT trial will be conducted. The primary outcome will be a composite of the proportion of participants with a suicide, a suicide attempt or a psychiatric hospitalisation. The secondary outcome will be the proportion of participants with self-harm. Exploratory outcomes will be BPD symptoms, symptom distress, level of functioning and quality of life. We will primarily assess outcomes at 15 months after randomisation for the FASTER trial and at 16 months after randomisation for the MBT-RCT trial. Predefined subgroups based on the design variables in the original trials will be tested for interaction with the intervention as follows: trial, sex (male compared with female), age (below or at 30 years compared with above 30 years) and baseline level of functioning (Global Assessment of Functioning baseline score at 0–49 compared with 50–100).
The statistical analyses will be performed on anonymised trial data that have already been approved by the respective ethical committees that originally assessed the included trials. The final analysis will be published in a peer-reviewed scientific journal and the results will be presented at national seminars and international conferences.
CRD42024612840.
To examine trends in Chuna manual therapy utilisation for musculoskeletal disorders (MSDs) following its inclusion in the National Health Insurance (NHI) system in Korea in 2019 using claims data from the Health Insurance Review & Assessment Service (HIRA).
Retrospective analysis of NHI claims data.
Nationwide medical institutions, based on HIRA claims data from April 2019 to December 2021.
All patients who received at least one Chuna therapy session during the study period.
Primary outcome: Annual trends in Chuna manual therapy claims. Secondary outcome: Patient demographics, therapy frequency, MSD diagnoses and concurrent therapies.
A total of 12 729 625 Chuna therapy claims were analysed, showing a gradual annual increase in utilisation from 2019 to 2021. The most common age group was 45–54 years (22.3%), with female patients comprising a higher proportion (55.8%) than male patients.
Low back pain (M54.5), lumbar sprain and strain (S33.5) and cervicalgia (M54.2) were the most common diagnoses. Patients receiving Complex Chuna (50% co-payment) had more treatment sessions than those receiving Simple Chuna or Complex Chuna (80% co-payment), with spinal disorders such as spinal stenosis (M48.0) and intervertebral disc disorders (M51.1, M50.1) associated with higher treatment frequency. Acupuncture was the most common concurrent therapy (97.4%).
This study is the first to comprehensively analyse Chuna therapy utilisation using nationwide NHI claims data. The findings confirm that Chuna therapy is widely used for MSDs, particularly among middle-aged and elderly patients with spinal or muscle-related conditions. Patients with severe or chronic spinal diseases were more likely to receive frequent Chuna therapy sessions. These results provide insights into the utilisation patterns of Chuna therapy and highlight the need for further research to refine reimbursement policies based on disease severity and patient characteristics.
Elder neglect by both informal and formal caregivers is common, particularly among persons with dementia, and has serious health consequences but is under-recognised and under-reported. Persons with dementia are often unable to report neglect due to memory and language impairments, increasing their vulnerability. Screening for elder mistreatment and initiation of intervention in primary care clinics may be helpful, but few evidence-based tools or strategies exist. We plan to: (1) develop a novel primary care screening tool to identify elder neglect in persons with dementia, (2) develop an innovative technology-driven intervention for caregivers and (3) pilot both for feasibility and acceptability in primary care.
We will use a multistep process to develop a screening tool, including a modified Delphi approach with experts, and multivariable analysis comparing confirmed cases of neglect in patients with dementia from the existing data registry to non-neglected controls. We will develop an evidence-based, technology-driven caregiving intervention for neglect with an expert panel and iterative beta testing. Following the development of the protocol for implementation of the tool and intervention with associated training, we will pilot test both the tool and intervention in older adult patients and caregivers. We will conduct provider focus groups and interviews with patients and caregivers to assess usability and will modify the tool and intervention. These studies are in preparation for a future randomised trial.
Initial phases of this project have been reviewed and approved by the Weill Cornell Medicine Institutional Review Board, protocol #22-06024967, with initial approval on 1 July 2022. We aim to disseminate our results in peer-reviewed journals, at national and international conferences and among interested patient groups and the public.
To describe self-reported treatment and exercise strategies among patients with long-lasting low back pain (LBP) 1 month after consultation at a specialised hospital-based Medical Spine Clinic and evaluate their associations with changes in pain and disability 1 and 3 months after consultation.
Prospective cohort study using questionnaire data before consultation (baseline) and 1 and 3 months after consultation.
Specialised hospital-based Medical Spine Clinic, Denmark.
1686 patients with long-lasting LBP completed the baseline questionnaire; 908 patients responded at 1 month, of them 623 responded at 3 month.
Patients were categorised by treatment (physiotherapy, chiropractic treatment, physiotherapy+chiropractic treatment and no recommended treatment) and exercise strategy (exercise continued, exercise ceased, exercise initiated and not exercising).
Pain was assessed by the numeric rating scale (NRS: 0–10), and disability was assessed by the Oswestry disability index (ODI: 0–100).
1-month postconsultation, half of the patients received no recommended treatment; most others received physiotherapy (42%). Nearly half of the patients continued exercise, 28% continued to be inactive, and 22% initiated exercise. For the population as a whole, pain changed by –0.74 (95% CI –0.90; –0.58) and –1.02 (95% CI –1.22; –0.83) points on the NRS at 1- and 3-month follow-up, respectively, and disability by –2.65 (95% CI –3.51; –1.78) and –4.48 (95% CI –5.59; –3.38) points on the ODI. Differences between treatment strategies were small. However, the two groups not exercising improved less compared with those who continued exercise when adjusted for age, sex and baseline level (order of magnitude from 0.07 to 1.18 points on the NRS and from 4.01 to 9.08 points on the ODI). For pain, these group differences were statistically significant at 1 month (p
Mean improvement was negligible, with no differences between treatment strategies. However, patients not exercising showed no or less improvement, highlighting the importance of exercise in managing long-lasting LBP.
This study aimed to explore digital literacy among community-dwelling older adults in urban South Korea. A semistructured interview guide was developed using the Digital Competence ( 2.0 framework, which emphasizes the competencies for full digital participation in five categories: information and data literacy, communication and collaboration, content creation, safety, and problem-solving. The data were analyzed using combined inductive and deductive content analysis. Inductive analysis identified three main categories: perceived ability to use digital technology, responses to digital technology, and contextual factors. In the results of deductive analysis, participants reported varying abilities in using digital technologies for information and data literacy, communication or collaboration, and problem-solving. However, their abilities were limited in handling the safety or security of digital technology and lacked in creating digital content. Responses to digital technology contain subcategories of perception (positive or negative) and behavior (trying or avoidance). Regarding contextual factors, aging-related physical and cognitive changes were identified as barriers to digital literacy. The influence of families or peers was viewed as both a facilitator and a barrier. Our participants recognized the importance of using digital devices to keep up with the trend of digitalization, but their digital literacy was mostly limited to relatively simple levels. 
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