Earticle

Objectives: To develop a two-year early warning model of financial distress in Korean regional public hospitals and identify its predictors. Methods: Thirty-five regional public hospitals were followed from 2019 to 2025 using public disclosures(174 hospital-years). Three escalating events two years later, equity decline over 20%, negative equity, and liquidity crisis(<15 days cash on hand) — were stacked into one logistic model with hospital-clustered standard errors and split-sample validation. Results: Event rates were 46.6%, 36.8%, and 10.3%. AUC was 0.755 overall and 0.718 in validation. Operating cash flow ratio (OR=0.90) and total accruals (OR=0.98) predicted distress; subsidy ratio did not (OR=1.01). Net profit margin was significant alone (OR=0.96) but not with cash flow added (OR=1.05). Population-declining area raised risk most (OR=3.45). Conclusions: Cash flow and regional conditions predicted crisis, whereas profitability did not once cash flow was accounted for. Monitoring and subsidy allocation should reflect both.

Objectives: Using public data, this study examined the redistribution of imaging utilization and regional reading burden after Korea’s 2024 mass resignation of resident physicians and the conditions that increase reliance on outsourced/remote reading. Methods: Procedure, workforce, and population data (2020–2025) for six imaging groups were analyzed, and pre-crisis (2022–2023) and post-crisis (2024–2025) means were compared; interrupted time-series analysis and negative binomial regression were also conducted as supplementary analyses. Results: Utilization decreased by 14.5% in tertiary hospitals but increased in hospital- and clinic-level institutions. Non-capital regions showed a persistently higher per-radiologist burden (IRR=1.139, p=.001), and the gap did not widen post-crisis (p=.799). Conclusions: The findings do not directly measure outsourced reading, but show that crisis-driven redistribution compounds a pre-existing regional imbalance, increasing reliance on outsourced/remote reading. Therefore, reader traceability and quality management are essential factors.

Objectives: This study examined factors associated with hospice use decedents with solid cancers. Methods: We analyzed 2,886 adults who died from solid cancer between February 2018 and December 2019 using the National Health Insurance Service(NHIS) Sample Cohort 2.2. Multivariable logistic regression models adjusted for demographic and baseline clinical characteristics were used to identify factors associated with hospice use. Results: Overall, 480 patients (16.6%) used hospice services. Older age, male sex, disability, and ICU admission were associated with lower hospice use, whereas receiving care at general hospital or hospital as the last healthcare institution and making self- or family-based end-of-life decisions were associated with higher hospice use. Conclusions: Hospice use was associated with patient characteristics, healthcare settings, end-of-life decision-making, and ICU utilization. These findings may help inform hospice access and referral practices in end-of-life care.

Objectives: This study examined how health screening relates to self-rated health and medical expenditure in older adults, and whether subjective class identity moderates these. Methods: Using the 10th wave of the KLoSA (2024), 5,562 adults aged 55+ were analyzed. Class identity was reverse-coded so higher scores denote higher class, and hierarchical regression with simple slope analysis was used. Results: The non-participation rate was 22.6%; leading reasons were a prior examination without problems and no perceived need, not cost. Net of covariates, screening was associated with self-rated health (b=−0.194) and higher medical expenditure (b=0.554; both p<.001); class identity moderated both, with larger associations among higher-class adults. Conclusions: Health screening relates to self-rated health and short-term medical expenditure, and these associations differ by subjective class identity. The cross-sectional findings indicate associations, not causal effects.

Objectives: This study examined sociodemographic and self-rated health factors associated with health literacy, late-life function (LF-10), and oral health status among older Korean adults. Methods: Data from 1,754 adults aged ≥65 years in the 9th Korea National Health and Nutrition Examination Survey (2022–2024) were analyzed using complex sample analyses and regression models. Results: The mean LF-10 score was 84.89, and the mean number of existing natural teeth was 18.94. Health literacy, LF-10, and oral health status differed significantly by sociodemographic characteristics and self-rated health. Age, education, health insurance type, and self-rated health were significantly associated with one or more outcomes. Older age, lower education, and Medical Aid status were associated with less favorable outcomes in the respective analyses. Conclusions: Sociodemographic characteristics and self-rated health were associated with health literacy, LF-10, and oral health status. These findings support tailored health and oral health promotion programs for socially vulnerable older adults.

Objectives: This study examined the structural pathways from smartphone use duration and dependency to subjective well-being through health behaviors and emotional problems among adolescents. Methods: Wave 7 data from the 2018 Korean Children and Youth Panel Survey were analyzed using structural equation modeling maximum likelihood estimation, and bootstrapping for indirect effects. Results: The modified model showed acceptable fit. Smartphone use duration was negatively associated with health behaviors and emotional problems, and positively associated with subjective well-being. Smartphone dependency was positively associated with emotional problems and negatively associated with subjective well-being. Health behaviors were indirectly associated with subjective well-being through emotional problems. Further, smartphone use duration showed negative direct and positive indirect associations with emotional problems. Conclusions: These findings support a multidomain pathway model linking adolescent digital use and wellness. Digital health promotion should distinguish use duration from and jointly address dependency, emotional problems, sleep, physical activity, and breakfast regularity.

Objectives: This study examined the mediating effect of patient safety silence on the relationship between patient safety culture and near-miss reporting barriers among general hospital nurses. Methods: A descriptive correlational study was conducted with 179 nurses using structured questionnaires; the data were analyzed using descriptive statistics, t-test, ANOVA, Pearson's correlation, multiple regression, Harman's single-factor test, and the Baron and Kenny hierarchical regression procedure with the Sobel test. Results: Patient safety culture was negatively correlated with silence (r=-.56, p<.001) and reporting barriers (r=-.44, p<.001); silence was positively correlated with barriers (r=.43, p<.001). Culture (β=-.29, p<.001) and silence (β=.27, p=.001) together explained 24.3% of the reporting barriers (F=28.20, p<.001). Silence partially mediated the culture-barrier relationship (Z=-3.16, p=.002), accounting for 34.0% of the total effect. Conclusions: In this cross-sectional sample, a positive safety culture was associated with lower reporting barriers both directly and indirectly through reduced silence; Given the cross-sectional design, these findings should be interpreted as associations instead of confirmed causal pathways. Nonpunitive, psychologically safe environments appear to be especially important for early-career nurses.

Objectives: This study investigated factors associated with breastfeeding practices among mothers who participated in the 2024 Seoul home-visit breastfeeding support service. Methods: Data from 485 mothers were analyzed using descriptive statistics, chi-square tests, and univariable binary, multinomial logistic regression, and ordinal logistic regression. Results: Intended breastfeeding duration was the strongest predictor ofmost strongly associated with breastfeeding practice level. Compared with mothers planningintending to breastfeed for ≤ 3 months, those planningintending to breastfeed for about 6 months (OR = 8.182) andor ≥ 1 year (OR = 18.784) had significantly higher odds of achieving a higher breastfeeding practice levels (p < .001). Satisfaction with breastfeeding education was also positively associated with breastfeeding practice level (OR = 1.808, p = .036), whereas delivery mode and residential regionzone were not significant after adjustment. Conclusions: Intended breastfeeding duration and satisfaction with home-visit breastfeeding education provided through home-visit services were key factors associated with successful breastfeeding practice level.

Objectives: This study aimed identify the characteristics of the marine therapy programs for the general population and general patients and to analyze their outcome variables and effects. It focused on program type, intervention duration, frequency, and exercise intensity. Methods: A literature search was conducted using riss4U, ScienceOn and Scholar for studies published between January 2016 and April 2026. In total 243 studies were identified and 12 matched the selection criteria and were included in the final analysis. Results: Marine therapy programs comprised the following interventions aerobic exercise, resistance exercise, relaxation, meditation and nutrition. The programs improved body composition, blood lipid, peak expiratory flow, Forced expiratory volume in one second, sleep quality, quality of life, depression, cognitive function and physical signs. Program duration ranged from a minimum of twice a day to a maximum of eight weeks, and the frequency ranged from minimum of twice a month to a maximum of five times a week. The duration of each session ranged from a minimum of 50minutes to a maximum of nine hours. Exercise intensity was measured by a heat rate range of 40-60% and a rate of perceived exertion with a minimum of 11 and a maximum of 14. The current the lack of studies limits the strength of the results, and calls for further trials. Conclusions: This study delivers informative evidence on the effectiveness marine therapy programs for the general population and general patients. the study indicates the need to develop different marine programs.