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The two key mechanisms affected by internet gaming disorder (IGD) are cognitive and reward processing. Despite their significance, little is known about neurophysiological features as determined using resting-state electroencephalography (EEG) source functional connectivity (FC). We compared resting-state EEG source FC within the default mode network (DMN) and reward/salience network (RSN) between patients with IGD and healthy controls (HCs) to identify neurophysiological markers associated with cognitive and reward processing. A total of 158 young male adults (79 patients with IGD and 79 HCs) were included, and the source FC of the DMN and RSN in five spectral bands (delta, theta, alpha, beta, and gamma) were assessed. Patients with IGD showed increased theta, alpha, and beta connectivity within the DMN between the orbitofrontal cortex and parietal regions compared with HCs. In terms of RSN, patients with IGD exhibited elevated alpha and beta connectivity between the anterior cingulate gyrus and temporal regions compared with HCs. Furthermore, patients with IGD showed negative correlations between the severity of IGD symptoms and/or weekly gaming time and theta and alpha connectivity within the DMN and theta, alpha, and beta connectivity within the RSN. However, the duration of IGD was not associated with EEG source FC. Hyper-connectivities within the DMN and RSN may be considered potential state markers associated with symptom severity and gaming time in IGD.

Background The Korean government implemented mandatory hospital isolation in the early phase of the COVID-19 pandemic. This study investigated the mental health of children and caregivers who underwent mandatory hospital isolation due to COVID-19. Methods This prospective study examined the physical condition and mental health of children under 7 years of age with COVID-19 and the mental health of their caregivers who underwent isolation in negative pressure rooms at two hospitals in Korea from April to September 2021. Caregivers received a self-report questionnaire via text message. Their responses were analyzed to compare the physical condition and mental health of children with COVID-19 and the mental health of their caregivers during and after isolation and identify factors influencing caregivers’ mental health. Results Sixty caregivers participated in the study. More than half of the caregivers perceived their children’s disease severity as mild. During hospital isolation, 36.4% of the children experienced decreased oral intake, which improved significantly post-isolation (8.7%, P  = 0.014). During isolation, approximately 22.2% of the children frequently awoke from sleep, 20.0% displayed irritability, and 70.8% had symptoms of depression. Approximately 36.7% of caregivers showed at least moderate levels of depression during isolation, which significantly decreased to 14.3% three months after discharge ( P  = 0.032). Factors associated with caregivers’ mental health included child-related issues, such as difficulty concentrating, frequent awakenings, and irritability. Conclusion Mandatory hospital isolation has a significantly negative psychological impact on children and caregivers during pandemics. Isolation decisions must be carefully considered during pandemics, especially those concerning young children. Heightened vigilance is warranted for the early detection and intervention of mental health issues in children and their caregivers.

Background Nonsuicidal self-injury (NSSI) combined with suicide ideation increases the risk of suicidal behaviors. Depression and posttraumatic stress disorder (PTSD) are comorbidities of NSSI compounding this relationship. The present study compared diagnostic subgroups of NSSI based on current depression and PTSD on psychological correlates (i.e., vulnerabilities and impairment) and suicidal presentations (i.e., suicidal cognitions and behaviors) in a psychiatric sample of adolescents. Methods Eighty-seven adolescents meeting DSM-5 criteria for NSSI and 104 age-range-matched nonclinical controls (NC) participated. Participants completed self-report measures on psychological vulnerabilities and impairment (e.g., emotion regulation difficulties, negative cognitions). Adolescents with NSSI also completed clinical interviews on psychiatric diagnoses and a recent self-injurious behavior (SIB). Scores on the psychological correlates of NSSI were compared between adolescents with NSSI and NC, and across three diagnostic subgroups of NSSI (A: NSSI+/depression-/PTSD-, n  = 14; B: NSSI+/depression+/PTSD-, n  = 57; C: NSSI+/depression+/PTSD+, n  = 14). Differences between NSSI diagnostic subgroups were tested on the motives for SIB and accompanying suicidal presentations (e.g., desire, intent, motive, lethality). Results Common comorbidities of NSSI included depression, panic disorder, generalized anxiety disorder, and PTSD. The NSSI subgroup classification was significantly associated with panic disorder, which was controlled for in the subsequent group comparisons. Overall, adolescents who engage in NSSI with vs. without depression reported more psychological vulnerabilities and impairment and a greater degree of suicidal thoughts/desire in SIB (i.e., groups B, C >A), which remained significant after controlling for panic disorder. An increased odds of the suicidal motive for SIB was found in adolescents with all three conditions (i.e., group C: NSSI+/depression+/PTSD+) compared to those with NSSI but neither depression nor PTSD (i.e., group A: NSSI+/depression-/PTSD-); however, this was not significant after controlling for panic disorder. Conclusions Psychological underpinnings of adolescent NSSI in clinical contexts may be largely associated with concurrent depression. Suicidal motives in adolescents who engage in NSSI in the presence of depression and PTSD may be confounded by the co-occurrence of panic disorder. This study warrants the importance of attending to the comorbid depression with NSSI in adolescents as it is related to an increase in suicidal desire accompanying SIB.

Non-suicidal self-injury (NSSI) among adolescents continues to be a significant public health concern worldwide. A recent systematic review and meta-analysis found that the global prevalence of NSSI in adolescents aged 12–18 years was 17.2%, with higher rates reported among females (19.7%) than males (14.8%). This behavior has been linked to several negative outcomes, such as depression, anxiety, substance abuse, and suicidal ideation. The present study aimed to classify adolescents based on intrapersonal and interpersonal factors associated with NSSI proposed in Nock’s (2009) integrated model of NSSI, to identify distinct clusters targeting specific risk factors. This encompassed negative cognition, emotional vulnerability, poor coping skill, peer-victimization, family adaptability, and perceived stress. A total of 881 adolescents aged 11–16 years in South Korea completed self-reported questionnaires on automatic thoughts, depression, emotional regulation, peer victimization, family adaptability and perceived stress. Latent profile analysis (LPA) revealed three distinct classes: “the severe group”, “the moderate group”, “the mild group”. Class 3 (“severe group”: N  =  127 ) exhibited greater severity related to NSSI, including negative cognition, emotional vulnerability, poor coping skills, peer victimization, and perceived stress, with weaker levels of factors that can prevent NSSI compared to class 1 (“mild group”: N  =  416 ) and class 2 (“moderated group”: N  = 338). The present study emphasizes the importance of considering both intrapersonal (e.g., negative automatic thoughts & emotional dysregulation) and interpersonal factors (i.e., peer victimization) when understanding NSSI - among adolescents. These findings can be utilized to develop interventions aimed at reducing the prevalence and severity of NSSI among adolescents.

Background Patellofemoral pain is a prevalent knee condition affecting up to 40% of individuals, especially females aged teens to 50 s. Standard treatments, including exercise therapy, often yield insufficient long-term results, partly due to low compliance and psychological factors like depression and catastrophizing of pain. A digital therapeutics “MORA Cure PFP,” which combines structured progressive exercise and cognitive behavioral therapy via an app, offers a solution to overcome the limitations of conventional treatment for patellofemoral pain patients. Methods To evaluate the safety and efficacy of MORA Cure PFP, a two-arm controlled trial will enroll 216 patients diagnosed with patellofemoral pain randomly assigned in a 1:1 ratio to treatment and control groups. The treatment group will use the app, while the control group will perform self-guided exercises using educational materials. This trial aims to determine if the treatment group shows greater reduction in usual pain intensity scores at 8 weeks compared to the control group. Additional assessments include worst pain, knee function, depression, and pain catastrophizing levels. Discussion Key design elements of the clinical trial, such as control group selection, inclusion/exclusion criteria, number of patients, and primary endpoint, were designed with consideration for not only medical perspectives but also regulatory aspects of software as a medical device, including device approval and health technology assessment. Trial registration ClinicalTrials.gov., NCT06260865, registered 15th February 2024.

Background/Objectives: Accurate postural assessment is essential for managing musculoskeletal disorders; however, routine screening is often limited by radiation exposure, cost, and accessibility constraints of radiography. Recent advances in artificial intelligence (AI) have enabled automated, marker-free analysis using two-dimensional photographs. This study evaluated the validity and reliability of MORA Vu, an AI-based posture estimation software, against radiographic parameters. Methods: A prospective pilot study was conducted with 72 participants, divided equally into the cervical and lower-limb alignment groups. Forward head posture (FHP) and digital hip–knee–ankle (DHKA) angles were measured using MORA Vu and compared with corresponding radiographic parameters. Three healthcare professionals independently conducted the AI-based assessments. Correlations were analyzed, and interrater reliability was assessed using the intraclass correlation coefficient (ICC). Results: FHP showed the strongest correlation with the craniovertebral angle (r = −0.712) and C2–7 sagittal vertical axis (r = 0.704). The DHKA angle strongly correlated with the radiographic hip–knee–ankle angle (r = 0.754). Interrater reliability demonstrated high agreement (ICC: 0.84 FHP, 0.90 DHKA). Conclusions: MORA Vu demonstrated strong validity and high reliability, supporting its potential as a noninvasive screening tool for postural assessment. Given its accessibility and radiation-free nature, it may serve as a viable alternative for routine postural evaluation.

Background The aim of this study was to examine the psychometric properties of the Korean version of Screen for Child Anxiety Related Emotional Disorders (SCARED) on a sample of Korean youths and to examine the cross-cultural differences in adolescents’ anxiety. Methods Our study included 147 adolescents (ages 12–17, 92 girls), 93 with major depressive disorder and 54 as controls. Participants were evaluated using the Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL), SCARED, Child Behavior Checklist (CBCL), Disruptive Behavioral Disorder Scale (DBD) and Attention Deficit Hyperactivity Disorder Rating Scale (ADHD-RS). Pearson’s r and Cronbach’s α values of the SCARED were calculated, and exploratory factor analysis was conducted. Results The Korean SCARED scores were correlated with the total anxiety scores of K-SADS-PL ( r  = 0.74) and the CBCL anxious/depressed subscale scores ( r  = 0.35). Results showed a five-factor structure with good internal consistency, in which some items were loaded on different factors compared to previous studies. Conclusions The Korean SCARED demonstrated promising psychometric properties, and could be a valid scale for screening anxiety symptoms in primary care. The fact that different items comprised the factors may reflect the cultural difference between United States and Korea in experiencing anxiety.

Patellofemoral pain (PFP) is a common musculoskeletal disorder characterized by persistent knee pain, often without any structural abnormalities. Conservative treatments, particularly exercise therapy, are widely recommended; however, adherence remains generally low, and full recovery is often not achieved. Psychological interventions can aid in symptom management; however, studies integrating cognitive behavioral therapy (CBT), which is known to be effective for chronic pain, with exercise therapy for patients with PFP are limited. This study examined the impact of MORA Cure (PFP), a multidisciplinary digital therapeutics (DTx) app that integrates exercise and CBT, in comparison with conventional treatments for PFP management. This study aimed to evaluate the efficacy and safety of an 8-week DTx intervention incorporating exercise and CBT compared with in-person exercise education in patients with PFP. A parallel-group randomized controlled trial was conducted with 35 patients diagnosed with PFP recruited from orthopedic outpatient clinics. Participants were randomly assigned to either the DTx group (n=18, 51%) or the control group (n=17, 49%). The DTx group received an 8-week intervention via the MORA Cure (PFP) app incorporating home-based exercises and weekly CBT modules with daily worksheets. The control group received conventional treatment, including disease education, a single in-person exercise education session conducted by a medical professional, and encouragement to continue self-exercising throughout the study period. The outcome measures included pain severity (usual and worst, assessed using the numeric pain rating scale), functional disability (Anterior Knee Pain Scale), knee extension strength (measured using an isokinetic dynamometer), health-related quality of life (EQ-5D), and mental health status (9-item Patient Health Questionnaire). Assessments were conducted from baseline at 4-week intervals for up to 12 weeks. The DTx group showed significant reductions in usual pain at each time point (4 weeks: mean score 2.2, SD 1.5, and P=.006; 8 weeks: mean 2.3, SD 1.7, and P=.003; 12 weeks: mean 1.2, SD 1.8, and P=.008), whereas the control group exhibited no changes. The knee extension strength in the DTx group increased significantly at both 8 and 12 weeks (P<.001), with greater improvement than that in the control group at 8 weeks (P=.04). Both groups showed significant improvements in functional disability at 12 weeks (DTx: mean score 85.2, SD 12.7, and P=.006; control: mean 84.5, SD 13.0, and P=.01). Health-related quality of life (EQ-5D) also improved in the DTx group at 8 and 12 weeks, whereas the control group showed improvement only at 12 weeks. This multidisciplinary DTx intervention was associated with significant pain reduction, improved functional disability, and increased knee extension strength in patients with PFP. These findings underscore the promise of DTx in PFP management and their potential to enhance patient outcomes. ClinicalTrials.gov NCT05614583; https://clinicaltrials.gov/study/NCT05614583.

Background: Chronic lower back pain (CLBP) is a global health issue leading to significant disability and socioeconomic burden. Traditional treatments, including exercise and cognitive behavioral therapy (CBT), are often limited by physical and temporal constraints. This study aimed to evaluate the efficacy of multidisciplinary digital therapeutics (MORA Cure LBP) compared to conventional treatments. Methods: This multicenter, randomized, controlled pilot study enrolled 46 participants. Participants were randomly assigned in a 1:1 ratio to either a MORA Cure LBP group or control group, which received conventional treatment. Results: At eight weeks, both groups demonstrated improvements compared to baseline. No statistically significant differences were observed between the MORA Cure LBP and control groups in reductions in usual pain intensity (MORA Cure LBP: 3.1 ± 1.9 vs. control: 3.0 ± 1.5, p = 0.809), worst pain intensity (MORA Cure LBP: 5.00 ± 2.18 vs. control: 4.27 ± 1.83, p = 0.247), and functional disability (ODI, MORA Cure LBP: 15.6 ± 9.6 vs. control: 15.6 ± 10.0, p > 0.999). Compliance was significantly higher in the MORA Cure LBP group during the first 4 weeks (MORA Cure LBP: 74.7% ± 27.4 vs. control: 53.1% ± 28.6, p < 0.001). Conclusions: Both multidisciplinary digital therapeutics (MORA Cure LBP) and conventional treatments were effective in reducing pain and functional disability in patients with CLBP, with no significant differences between the two groups. Digital therapeutics, particularly those that integrate CBT and exercise, offer promising alternatives to conventional therapies by improving accessibility and potentially enhancing patient engagement.