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Physical activity and mental health trends in Korean adolescents: Analyzing the impact of the COVID-19 pandemic from 2018 to 2022

  • Kyungsik Kim , Zixiang Zhou EMAIL logo , Xiao Ren , Xiuxiu Bu , Xiaodai Jia and Qingyang Shao
Published/Copyright: July 10, 2024
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Open Medicine
From the journal Open Medicine Volume 19 Issue 1

Abstract

Objective

Mental health significantly affects the physical and emotional development of adolescents. The aim of the current study was to examine how physical activity (PA) and mental health among Korean adolescents changed before and after the start of the COVID-19 pandemic.

Methods

We used comparative cross-sectional methods, gathering information from the Korea Disease Control and Prevention Agency databases and conducting Chi-square testing and correlation analysis for evaluation.

Results

The findings indicate that before and during the pandemic, participation in both moderate- and high-intensity PA, as well as strength training, mitigated stress, depression, and suicidal ideation. Furthermore, the findings confirm the beneficial effects of various physical activities on mental well-being.

Conclusions

These insights emphasize the vital role of regular PA in improving mental health among adolescents, particularly during a health crisis such as the pandemic.

Keywords: adolescents; COVID-19; depression; mental health; physical activity; stress

1 Introduction

The COVID-19 pandemic has had a vast global impact, with over 760 million cases, marking its place as a significant event in history. COVID-19 continues to pose threats to the health of adolescents and young people [1]. To combat its spread, governments implemented various temporary measures during high-risk phases of the pandemic, such as community quarantines, school closures, and activity restrictions [2]. These interventions significantly altered the daily lives of many adolescents, with notable re-percussions on mental health [3]. In January 2022, the Centers for Disease Control and Prevention released data highlighting the mental health risks posed by the pandemic to adolescents. Their analysis shows that 37% of high school students reported poor mental health and that 44% felt sad or hopeless in the preceding year [1]. Concurrently, multiple findings underscore the decline in physical performance among adolescents, likely due to reduced physical activity (PA) during the pandemic [4–7]. These data indicate that both the physical and mental well-being of adolescents faced unparalleled challenges during the COVID-19 outbreak.

Periods of heightened COVID-19 risk have had an impact on several aspects of adolescents’ daily lives. Restrictions on activities in community and public places, for example, decreased outdoor PA among this group [8]. Furthermore, measures to contain the outbreak had adverse psychological consequences for adolescents. Factors include stress from social distancing policies, academic pressures stemming from subpar distance learning experiences, and heightened anxiety from extensive outbreak information campaigns [9–11].

Contextualizing these findings within a broader perspective is crucial. While numerous findings highlight the negative impact of the pandemic on adolescent mental health [12,13], the prevalence of mental health issues among adolescents differs significantly across countries [14]. For instance, findings from a multi-country cross-sectional study by Nguyen et al. [15] demonstrate varying correlations between the impact of the pandemic and adolescent stress. The correlations were positive and moderate in Morocco and Serbia, positive and weak in Vietnam and the United States, and negative and weak in Sweden [15]. These differences suggest that the effects of COVID-19 on adolescents, particularly concerning stress, depend on their respective locales.

Although many scholars have presented findings on the association between COVID-19 and Korean adolescent mental health (e.g., stress, depression, and suicidal ideation) and PA, these studies have important limitations. Some scholars analyzed the mental health of Korean adolescents during the COVID-19 pandemic and summarized positive findings in comparison to the past, as reflected in decreases in subjective stress, depression, and suicide [16–19]. However, other findings indicate an increase in the prevalence of depression and anxiety among Korean adolescents during the COVID-19 pandemic, as well as an increase in the rate of medical visits due to mental illness [20]. These inconsistencies suggest that scholars need to consider other factors in mental health changes. To this end, some scholars have analyzed the association between PA and mental health among Korean adolescents. The findings show that PA positively influenced mental health [21] and that higher levels of PA were related to lower COVID-19 stress [22]. Various findings confirm that PA had a negative impact on stress and that groups participating in moderate PA typically had lower stress levels [23,24]. In terms of depression, some findings show that PA interventions reduced depressive symptoms in adolescents [25,26]. Previous findings also show that increasing PA is an effective way to prevent suicide [27,28].

A correlation also exists between reduced PA, deteriorating mental health, and confinement due to infectious diseases [8,29,30]. However, these studies have significant limitations. Notably, many scholars did not conduct comparative analysis of periods before and during the COVID-19 pandemic and often did not use national data in their sampling. Without such pre-pandemic comparisons, ascertaining whether observed changes in mental health and PA directly result from the pandemic or depend on other external factors is difficult. Moreover, the absence of nationwide data in many of these studies hampers the generalizability of the findings. Regional variations and cultural differences can profoundly influence the relationship between PA and mental health. To address these shortcomings, we used nationwide data sourced from the Korea Centers for Disease Control and Prevention (KCDC). By comparing data from before and during the COVID-19 pandemic, we sought a holistic understanding of how the pandemic affected the mental health and PA of Korean adolescents.

PA plays a pivotal role in sustaining physical health and fostering mental development. However, epidemic-related restrictions can curtail opportunities for such activity, thereby challenging both physical and mental well-being [31]. Reduced PA can result in a decline in mental health, manifesting as symptoms of anxiety, depression, and stress, which in turn increase the risk of more severe mental illnesses [32]. Given these relationships, examining alterations in PA and mental health among adolescents can help policymakers tailor health promotion and PA initiatives to the needs of adolescents. Resulting interventions would not only benefit their immediate well-being but also strengthen overall epidemic response strategy. Hence, delving into the shifts in PA and mental health among Korean adolescents during the COVID-19 pandemic can promote holistic health and well-being. To address the shortcomings of previous studies, we identified changes in and the relationship between PA and mental health among adolescents before and during the COVID-19 pandemic using nationwide data. We proposed the following hypotheses:

H1. PA level before and during the COVID-19 pandemic will differ.

H2. Adolescents participating in moderate- and high-intensity PA and strength training will experience lower stress levels than those who do not participate in such activities.

H3. Adolescents participating in moderate- and high-intensity PA and strength training will experience lower depression levels than those who do not participate in such activities.

H4. Adolescents participating in moderate- and high-intensity PA and strength training will experience lower suicidal ideation levels than those who do not participate in such activities.

H5. Correlations will emerge among pandemic, age, PA, and mental health for adolescents.

2 Methods

2.1 Study design and data collection

We used raw data from the annual Adolescent Health Behavior Survey conducted by the KCDC, which provides survey data to support research on adolescent health. We used this data in accordance with KCDC guidelines. We adopted a comparative cross-sectional approach to assess shifts in PA and mental health among Korean adolescents, analyzing data spanning several intervals. Comparative cross-sectional analysis considers different populations or groups within those populations to identify changes in the prevalence or distribution of specific characteristics or conditions. This type of research helps researchers understand the differences and similarities between groups and explore factors that influence these disparities. We divided the timeline into two periods: pre-pandemic (2018–2019) and pandemic (2020–2022). Due to KCDC’s practice of sampling new research subjects annually, the data used to compare the two periods did not come from the same subjects.

KCDC designated middle and high-school students across the nation as their research demographic. The administrative divisions included 39 regional clusters across 17 cities and provinces, with an equal allocation of middle and high schools in each region, maintaining a 50:50 ratio. Subsequently, schools from each city or province were sampled, encompassing 2,400 classes across 800 schools: 1,200 classes from 400 middle schools and 1,200 classes from 400 high schools, one class per grade. All students enrolled in these classes were included in the survey. KCDC also facilitated survey-training sessions for the respective teachers, who were then responsible for administering the surveys to their students (Figure 1).

Figure 1 Flow diagram.
Figure 1

Flow diagram.

By comparing data from 2018 and 2019 (before the pandemic) with data from 2020 and 2021 (during the pandemic), we examined PA and mental health among adolescents. After excluding missing values for each year, the final dataset included 60,040 responses from 2018, 57,303 responses from 2019, 54,948 responses from 2020, and 54,848 responses from 2021. The total number of responses before the pandemic was 117,343, and total number of responses during the pandemic was 109,796. The data were approved for use by KCDC’s Adolescent Health Behavior Survey (National Statistics No. 117058), which is publicly available and not subject to review by the Institutional Review Board. The data were collected through an anonymous self-administered online survey of students and includes essential health indicators for understanding the current health status of Korean adolescents.

The subject of this study includes both middle and high-school students in Korea. Middle-school students typically range in age from 12 to 15, entering school at about 12–13 years old and finishing at 15–16 years old. In contrast, high-school students begin their education at approximately 15–16 years old and graduate at 18–19 years old. The sample for the period before the COVID-19 pandemic consisted of 60,054 middle-school students and 57,289 high-school students. During the pandemic, the sample included 59,315 middle-school students and 50,481 high-school students. The average age of middle-school students was 13.62 years (SD = 0.957), and the average age of high-school students was 16.60 years (SD = 0.948).

2.2 Measures

The questionnaires we used for PA, stress, depression, and suicidal ideation were validated through previous research and confirmed in the annual survey conducted by KCDC in 2021. Reliability was further reinforced through their application up to the 17th survey. KCDC used various response standards for survey items. Consequently, we were not able to use uniform measurement units.

Demographic characteristics included gender, age, height, and weight. Age, height, and weight were collected through direct input from respondents. PA was measured by the number of days of moderate and high-intensity exercise, as well as frequency of strength training, within the previous 7 days. Moderate-intensity PA involved elevated heart rate or shortness of breath for more than 60 min, regardless of the type of exercise. This 8-point scale ranged from “not in the last 7 days” (1 point) to “7 days a week” (8 points). High-intensity PA involved shortness of breath or body sweating for more than 20 min (e.g., including jogging, soccer, basketball, taekwondo, mountain climbing, brisk cycling, brisk swimming, and heavy lifting. This 6-point scale ranged from “not in the last 7 days” (1 point) to “more than 5 days a week” (6 points). Strength training involved muscle-strengthening exercises, such as push-ups, sit-ups, weight lifting, dumbbells, iron bars, and parallel bars. This 6-point scale ranged from “not in the last 7 days” (1 point) to “at least 5 days a week” (6 points).

To analyze the difference in mental health according to regular moderate and high-intensity PA and strength training, we defined participants who engaged in PA less than once a week as non-participants and those who participated more than twice a week as regular participants. This criterion aligns with the standards used by the Korean government’s National Sport for All Participation Survey.

Mental health consisted of three variables: stress, depression, and suicidal ideation. Stress refers to the level of stress felt in everyday life, typically measured on a 5-point scale from “not felt at all” (1 point) to “very much felt” (5 points). In the current study, categorized responses such as “I don’t feel stress at all” and “I feel any stress” as “I don’t feel stress” (0 points) and responses such as “I feel a little stress,” “I feel a lot,” and “I feel a lot of stress” as “I feel stress” (1 point). The measure for incidence of depression and suicidal ideation was a dichotomous scale (0 = absence, 1 = presence). To ensure consistency across variables measuring mental health conditions and to enhance comparability, we use the same approach to measure stress. Depression was assessed based on whether respondents experienced sadness or despair to the extent that it disrupted their daily life for 2 weeks over the previous 12 months. Options were “not in the past 12 months” (0 points) and “present in the past 12 months” (1 point). Suicidal ideation refers to the presence of serious suicidal thoughts in the past 12 months. Options were “not in the past 12 months” (0 points) and “present in the past 12 months” (1 point). The higher the score in a given period, the higher the perceived level of stress, depression, and suicidal ideation.

2.3 Statistical analysis

The data were analyzed using the chi-square (χ 2) test and correlation analysis with SPSSWIN software (version 24.0; IBM Co., Armonk, NY, USA). Non-responses were excluded from analysis. Specific details are marked with asterisks in Figure 1. To analyze variations between two distinct timeframes, we divided the population (N = 239,862) into two groups: before COVID-19 (2018 and 2019) and during COVID-19 (2020 and 2021). Before COVID-19, the population numbers were 62,823 in 2018 and 60,100 in 2019. During COVID-19, the numbers were 57,900 in 2020 and 59,039 in 2021. During the follow-up phase, after adjusting for non-responses, the sample sizes were 60,040 in 2018, 57,303 in 2019, 54,948 in 2020, and 54,848 in 2021. In the final stage of analysis, we used data from 117,343 individuals before COVID-19 and 109,796 individuals during COVID-19 (Figure 1).

The chi-square test was used to examine changes in PA and mental health including stress, depression, and suicidal ideation among adolescents before and during the pandemic. Furthermore, correlation analysis was used to explore the relationship between regular PA and mental health in adolescents. Typically, if the absolute value of the correlation coefficient falls between 0.20 and 0.39, it indicates weak correlation. A value between 0.40 and 0.59 indicates moderate correlation, and a value above 0.60 indicates strong correlation. Since statistical significance level of 5% (0.05) is commonly used, this study also adheres to this standard.

Cramer’s V coefficient was used to assess the effect size (ES) of the chi-square test results for independence. Cramer’s V serves as a measure of the ES for the chi-square test, indicating the strength of the relationship between variables. When ES is less than or equal to 0.2, it suggests weak results. This means that even though the results are statistically significant, the fields are only weakly correlated. When ES falls within the range of 0.2–0.6, it is considered acceptable, indicating that the fields are appropriately related. ES greater than 0.6 signifies robust results, indicating a strong relationship between the fields. The goal in using non-parametric statistics (i.e., Cramer’s V) was to accommodate the data while ensuring accuracy and robustness in our analysis.

3 Results

3.1 Changes in PA before and during the pandemic

PA levels underwent noticeable changes from the period before the pandemic to the period during the pandemic (Figure 2). The statistically significant results are as follows. High-intensity PA participation experienced a significant decrease from 53.7% (n = 63,036) to 45.9% (n = 50,383), and non-participation increased significantly from 46.3% (n = 54,307) to 54.1% (n = 59,413) (p < 0.05, ES = 0.078).

Figure 2 Changes in PA before and during COVID-19.
Figure 2

Changes in PA before and during COVID-19.

3.2 Changes in stress before and during the pandemic

Both participants and non-participants in moderate-intensity PA experienced a decrease in stress, with participants showing consistently lower stress than non-participants (p < 0.05, ES = 0.053). Specifically, stress among participants decreased from 38.8 to 38.0%, while stress among non-participants decreased from 42.3 to 41.7% (Table 1). Participants in high-intensity PA experienced higher stress before the pandemic than non-participants (p < 0.05, ES = 0.080), but during the pandemic, their stress became lower than non-participants (p < 0.05, ES = 0.008). When comparing change in stress before and during the pandemic, participants in high-intensity PA decreased from 42.0 to 35.5%, while non-participants increased from 39.1 to 44.2%. Notably, before the pandemic, participants were more likely to experience stress than non-participants, but this trend reversed during the pandemic. Prior to the pandemic, participants in strength training were significantly less likely to experience stress than non-participants (p < 0.05, ES = 0.082); this pattern continued during the pandemic. Both groups showed a decrease in stress, from 26.0 to 25.8% for participants and from 55.1 to 53.9% for non-participants.

Table 1

Changes in stress by PA before and during COVID-19

Before COVID-19 During COVID-19 p-value
Variable Stress non-experience Stress experience Stress non-experience Stress experience
Moderate-intensity Non-participants 10,093 (8.6%) 49,620 (42.3%) 10,489 (9.6%) 45,785 (41.7%) 0.000
Participants 12,119 (10.3%) 45,511 (38.8%) 11,795 (10.7%) 41,727 (38.0%) 0.000
High-intensity Non-participants 8,454 (7.2%) 45,853 (39.1%) 10,833 (9.9%) 48,580 (44.2%) 0.000
Participants 13,758 (11.7%) 49,278 (42.0%) 11,451 (10.4%) 38,932 (35.5%) 0.005
Strength training Non-participants 12,905 (11.0%) 64,647 (55.1%) 13,175 (12.0%) 59,175 (53.9%) 0.000
Participants 9,307 (7.9%) 30,484 (26.0%) 9,109 (8.3%) 28,337 (25.8%) 0.304
Total 22,212 (18.9%) 95,131 (81.1%) 22,284 (20.3%) 87,512 (79.7%)

3.3 Changes in depression before and during the pandemic

Before the pandemic, participants who engaged in moderate-intensity PA were less likely to experience depression than non-participants (p < 0.05, ES = 0.007), and this trend continued during the pandemic (p < 0.05, ES = 0.013). Both participants and non-participants in moderate-intensity PA demonstrated a decrease in depression during the pandemic (Table 2). Before the pandemic, participants engaging in high-intensity PA had a higher rate of depression than non-participants (p < 0.05, ES = 0.022), but during the pandemic, their rate of depression was lower than non-participants (p < 0.05, ES = 0.008). Specifically, depression decreased from 14.3 to 12.1% in high-intensity PA participants and slightly increased from 13.2 to 13.9% in non-participants. Participants who engaged in strength training before and after the pandemic had significantly lower rates of depression than those who did not engage in strength training (p < 0.05, ES = 0.010). Depression among strength training participants decreased from 9.1 to 8.8%, while among non-participants, it decreased from 18.4 to 17.2%. These findings provide evidence that regular strength training can have a positive impact on mental health, even during a pandemic.

Table 2

Changes in depression by PA before and during COVID-19

Before COVID-19 During COVID-19 p-value
Variable Depression non-experience Depression experience Depression non-experience Depression experience
Moderate-intensity Non-participants 43,129 (36.8%) 16,584 (14.1%) 41,959 (38.2%) 14,315 (13.0%) 0.019
Participants 41,978 (35.8%) 15,652 (13.3%) 39,305 (35.8%) 14,217 (12.9%) 0.000
High-intensity Non-participants 38,826 (33.1%) 15,481 (13.2%) 44,176 (40.2%) 15,237 (13.9%) 0.000
Participants 46,281 (39.4%) 16,755 (14.3%) 37,088 (33.8%) 13,295 (12.1%) 0.005
Strength training Non-participants 56,001 (47.7%) 21,551 (18.4%) 53,478 (48.7%) 18,872 (17.2%) 0.001
Participants 29,106 (24.8%) 10,685 (9.1%) 27,786 (25.3%) 9,660 (8.8%) 0.304
Total 85,107 (72.5%) 32,236 (27.5%) 81,264 (74.0%) 28,532 (26.0%)

3.4 Changes in suicidal ideation before and during the pandemic

Suicidal ideation among moderate-intensity PA participants was significantly lower before and during the pandemic than non-participants (p < 0.05, ES = before 0.021, during 0.012). During the pandemic, the rate of suicidal ideation decreased from 6.1 to 5.6% for participants and from 7.1 to 6.2% for non-participants (Table 3). High-intensity PA participants had the same rate of suicidal ideation as non-participants before the pandemic at 6.6% (p < 0.05, ES = 0.031). However, during the pandemic, the rate of not experiencing suicidal ideation was higher for participants than non-participants (p < 0.05, ES = 0.014). During the pandemic, suicidal ideation decreased from 6.6 to 5.2% among participants and remained unchanged at 6.6% among non-participants. For strength training participants, suicidal ideation was more than half that of non-participants before and during the pandemic (p < 0.05, ES = before 0.022, during 0.022). During the pandemic, participants decreased from 4.1 to 3.7%, and non-participants decreased from 9.1 to 8.1%. A notable result is that overall, the rate of suicidal ideation decreased for all types of PA during the pandemic.

Table 3

Changes in suicidal ideation by PA before and during COVID-19

Before COVID-19 During COVID-19 p-value
Variable Suicidal ideation non-experience Suicidal ideation experience Suicidal ideation non-experience Suicidal ideation experience
Moderate-intensity Non-participants 51,419 (43.8%) 8,294 (7.1%) 49,436 (45.0%) 6,838 (6.2%) 0.000
Participants 50,450 (43.0%) 7,180 (6.1%) 47,425 (43.2%) 6,097 (5.6%) 0.000
High-intensity Non-participants 46,531 (39.7%) 7,776 (6.6%) 52,170 (47.5%) 7,243 (6.6%) 0.000
Participants 55,338 (47.2%) 7,698 (6.6%) 44,691 (40.7%) 5,692 (5.2%) 0.000
Strength exercise Non-participants 66,909 (57.0%) 10,643 (9.1%) 63,449 (57.8%) 8,901 (8.1%) 0.000
Participants 34,960 (29.8%) 4,831 (4.1%) 33,412 (30.4%) 4,034 (3.7%) 0.000
Total 101,869 (86.8%) 15,474 (13.2%) 96,861 (88.2%) 12,935 (11.8%)

3.5 Correlation among the pandemic, age, PA, and mental health

We made the pandemic a dummy variable, assigning a score of 0 to “before the pandemic” and a score of 1 to “during the pandemic,” for correlation analysis with other variables.

The findings indicate a negative correlation between the pandemic and high-intensity PA (r = −0.078), stress (r = −0.017), depression (r = −0.017), and suicidal ideation (r = −0.021). These findings suggest that during the pandemic, high-intensity PA, stress, depression, and suicidal ideation decreased. Although the correlation coefficient seems small, this trend is notable.

Age showed a negative correlation with moderate intensity PA (r = −0.084), high-intensity PA (r = −0.116), and strength training (r = −0.041). Conversely, age showed a positive correlation with stress (r = 0.068) and depression (r = 0.046) but a negative correlation with suicidal ideation (r = −0.004). These results suggest that a decrease in exercise frequency and suicidal ideation with increasing age might relate to increases in stress and depression (Table 4).

Table 4

Correlation analysis on COVID-19, PA, and mental health

1 2 3 4 5 6 7 8
1. COVID-19 1 　 　 　 　 　 　 　
2. Age 0.0290*** 1.000 　 　 　 　 　 　
3. Moderate-intensity −0.004 −0.084*** 1.000 　 　 　 　 　
4. High-intensity −0.078*** −0.116*** 0.522*** 1.000 　 　 　 　
5. Strength training 0.002 −0.041*** 0.353*** 0.436*** 1.000 　 　 　
6. Stress −0.017*** 0.068*** −0.047*** −0.066*** −0.077*** 1.000 　 　
7. Depression −0.017*** 0.046*** 0.003 −0.006** −0.007** 0.224*** 1.000 　
8. Suicidal ideation −0.021*** −0.004* −0.017*** −0.021*** −0.022*** 0.156** 0.402*** 1.000

COVID-19 was made variable by assigning 0 points for before COVID-19 and 1 point for during COVID-19; **p < 0.01 ***p < 0.001.

Moderate-intensity PA had a weak negative correlation with stress (r = −0.047) and suicidal ideation (r = −0.017), while high-intensity PA had negative correlations with stress (r = −0.066), depression (r = −0.006), and suicidal ideation (r = −0.021). Similarly, strength training had a negative correlation with stress (r = −0.077), depression (r = −0.007), and suicidal ideation (r = −0.022).

Significantly, a positive correlation emerged among the mental health sub-variables, with a relatively high correlation (r = 0.402) between depression and suicidal ideation. These results suggest that regular PA is directly related to various mental health variables and could reduce suicidal ideation by relieving stress and depression. Overall, the findings highlight the potential benefits of regular PA for mental health, especially during a pandemic.

4 Discussion

We examined the association between moderate-intensity PA and mental health (i.e., stress, depression, and suicidal ideation) in Korean adolescents before and during the COVID-19 pandemic. To this end, we used nationwide data obtained from KCDC. Leveraging nationwide data rectified, to some extent, the shortcomings of previous studies and provided a valuable reference point for investigating similar situations in the future. The findings also provide insights for developing effective interventions and strategies to meet the needs of adolescents.

4.1 PA level before and during pandemic

Levels of moderate- and high-intensity PA were significantly different before and during the pandemic, supporting H1, which proposed that PA level before and during the COVID-19 pandemic would differ. Among non-participants in high-intensity PA before the pandemic, high-intensity PA level increased by 7.8% during the pandemic, a change influenced by government policies and recommendations [33], as well as additional leisure time resulting from remote schooling [34]. Previous findings confirm the same [35]. Among non-participants in moderate-intensity PA before the pandemic, moderate-intensity PA level increased by 0.4% during the pandemic, while decreasing by 0.4% among participants. Previous findings indicate the same among university students in Australia, Croatia, England, Hungary, Italy, Mexico, Spain, and the United States [36–38]. On the one hand, PA level among moderate-intensity PA participants slightly decreased during the pandemic, likely due to restrictions such as home quarantine and suspension of operation of sports venues [4–7,36–38]. On the other hand, PA level among non-participants in moderate-intensity PA slightly increased during the pandemic, likely because isolation at home made people crave health and regular moderate-intensity exercise [34,36–38].

Notably, among participants in high-intensity PA before the pandemic, high-intensity PA level decreased by 7.8% during the pandemic. In extensive descriptive studies involving nearly 500,000 participants from the United Kingdom, Ireland, New Zealand, and Australia during the initial stages of COVID-19 containment by national governments, individuals with pre-existing exercise habits experienced a decrease in PA level [39,40]. This observation suggests that during national efforts to contain COVID-19, individuals who did not normally engage in PA found opportunities to change their exercise behaviors, potentially leading to long-term health benefits. Meanwhile, our findings also underscore the importance of reinforcing public health policies to encourage Korean youth to be more active in sports, especially during and after a pandemic such as influenza [33].

4.2 Stress by PA level

Given different intensities of PA, participants had significantly different stress levels before and during the pandemic, supporting H2, which proposed that adolescents participating in moderate- and high-intensity PA and strength training would experience lower stress levels than those who did not participate in such activities. This result suggests the impact of PA level on stress among Korean adolescents before and during the pandemic. Notably, we found that adolescents who participated in moderate-intensity PA consistently exhibited lower stress than those who did not engage in such activities. This pivotal finding indicates that PA can positively influence mental health among adolescents.

Moreover, adolescents engaging in high-intensity PA experienced higher stress levels before the pandemic than during the pandemic and experienced lower stress during the pandemic than non-participants. These shifts could be due to the impact of alterations in daily routine (e.g., transition to online classes and school closures) on both PA level and stress. Previous findings demonstrate that PA can have a positive impact on mental health [20,21], with higher levels of PA associated with lower stress related to COVID-19 [22]. Regarding the relationship between PA and stress, behaviors such as reducing academic and social burdens, enhancing family coherence, and promoting health seeking could mediate the alleviation of severe stress and suicidality in youths [41]. Furthermore, engaging in sufficient and regular PA can release psychological tension and enhance mental stability. Previous findings highlight the detrimental mental health effects associated with low PA, including higher stress [29,42–44].

4.3 Depression by PA level

Given different intensities of PA, participants had significantly different depression rates before and during the pandemic, supporting H3, which proposed that adolescents participating in moderate- and high-intensity PA and strength training would experience lower depression levels than those who did not participate in such activities. Exercise and PA have beneficial effects that are often comparable to antidepressant treatment [45,46]. Before the pandemic, rates of depression were lower in both participants and non-participants in moderate-intensity PA, and high-intensity PA participants had lower rates of depression during the pandemic than non-participants. The intensity of PA not significantly affects depression rates under typical conditions. However, participants in high-intensity PA during the pandemic had lower rates of depression than non-participants, suggesting that during stressful conditions such as a pandemic, intensity of PA might have a more pronounced impact on mental health [47], raising the possibility that high-intensity PA might be more effective in preventing depression. High-intensity interval training and moderate-intensity training can reduce stress, anxiety, and depression and improve recovery, but improvement in depression in the high-intensity interval trainers was greater than in the moderate-intensity trainers. Indeed, short recovery periods can alleviate the stress of intense exercise [48–51].

These insights clarify the relationship between PA and mental health, providing valuable guidance for developing health management strategies, especially in stressful environments. However, participants in high-intensity PA before the pandemic had higher rates of depression than non-participants, suggesting that an individual’s physical condition, frequency of exercise, and stress level all affect the effectiveness of PA. Participants in strength training before and after the pandemic had significantly lower rates of depression than non-participants, suggesting this form of exercise might prevent depression through mechanisms such as relieving stress, enhancing self-esteem, and improving overall physical health [52].

4.4 Suicidal ideation by PA level

Given different intensities of PA, participants had significantly different suicidal ideation before and during the pandemic, supporting H4, which proposed that adolescents participating in moderate- and high-intensity PA and strength training would experience lower suicidal ideation levels than those who did not participate in such activities. When faced with a highly contagious disease, people might experience intolerable psychological distress that triggers harmful behaviors [53]. These feelings might lead to anxiety, depression, and poor mental health; in some cases, it can also lead to suicidal ideation [54,55]. Regular participation in PA is often the first step in preventing and managing chronic disease [56]. Regular PA can alleviate the impact of depressive symptoms resulting from the psychological burden of the COVID-19 situation [47]. PA is an important factor in managing mental and physical health [57], and regular participation in PA can reduce the risk of suicide-related outcomes [58], increasing mental stability during a pandemic.

Our findings show a decrease in the incidence of suicidal ideation across all types of PA [27]. Participants who engaged in moderate-intensity PA before and during the pandemic had significantly lower suicidal ideation than non-participants, suggesting that PA can have a positive impact on mental health during stressful situations. Notably, rates of suicidal ideation decreased during the pandemic among participants, while rates remained the same among non-participants. This finding highlights the role of PA in maintaining mental health during stressful times, perhaps because participation in PA can cultivate positive emotions that are often lacking in people with high levels of depression [59]. Mental health was an important preventive factor for suicidal ideation during the pandemic, as low levels of positive mental health relate to high levels of depressive symptoms [60]. Our findings suggest that PA might reduce suicidal ideation by reducing stress responses, enhancing self-esteem, and improving overall mental health. Additionally, the findings suggest that PA can manage risk of depression and suicide, particularly in stressful situations.

During the pandemic, rates of suicidal ideation decreased significantly among PA participants, while rates remained stable among non-participants. Although these results suggest an association between PA participation and lower suicidal ideation, determining causality remains challenging. In other words, scholars should consider randomized controlled trials to determine whether this relationship is causal. Nonetheless, PA has positive effects such as reducing stress, improving mood, and alleviating anxiety, all of which might help prevent suicidal thoughts. Furthermore, PA can induce physiological changes that positively influence mental health. Those who did not participate in strength training, before and during the pandemic, had rates of suicidal ideation more than twice as high as those who did participate in strength training. However, both groups experienced lower suicidal ideation during the pandemic. The observed association between strength training (a form of PA) and suicidal ideation requires further investigation to determine whether a causal relationship exists. In addition, exploring the links between various types and intensities of exercise and factors such as mental health status, social support, and economic status, and suicidal ideation would be worthwhile. At the same time, the significant decline in suicidal ideation in PA participants and non-participants during the pandemic is worthy of attention. This observed decline might be attributable to higher social, economic, and psychological support or to individual adaptation to the pandemic.

We found an overall negative correlation between moderate-intensity PA, high-intensity PA, and strength training and mental health indicators such as stress, depression, and suicidal ideation. These findings suggest that PA can significantly contribute to reductions in stress, depression, and suicidal ideation, thereby enhancing overall mental health. Furthermore, the observed efficacy of moderate and vigorous exercise in reducing stress implies that all forms of PA are beneficial; therefore, individuals can choose PA based on personal preference and circumstance. The most significant correlation observed between PA and stress suggests that PA has the potential to reduce stress hormones, enhance positive mood, and relieve stress symptoms by inducing changes in neurotransmitters in the brain. These findings highlight the critical role that various forms of PA can play in reducing stress, pointing to the development of preventive health management strategies.

4.5 Relationships among pandemic, age, PA level, and mental health

Our findings support H5, revealing associations among pandemic, age, PA, and mental health in adolescents. Pandemic had negative relationships with moderate- and high-intensity PA and mental health (e.g., stress, depression, and suicidal ideation). These results suggest that the pandemic reduced PA, primarily due to social distancing and restricted access to or closures of sports facilities. The paradoxical positive relationship between the pandemic and mental health improvement is attributable to Korea’s special situation. Korean adolescents tend to experience academic stress due to the demands of studying and private academy attendance after regular school hours. The pandemic reduced this burden by forcing schools and private academies to move online. Previous findings confirm that the transition to online courses and the closure of schools and universities during the pandemic alleviated academic burdens on Korean adolescents and improved their mental health [16–19,41].

In the case of Korea, PA decreased as adolescents needed to manage more academic work in preparation for college entrance exams as they reach higher grades. Although only to a small degree, suicidal ideation decreased with age and maturity, suggesting that the ability to cope improved. However, Korean adolescents still experienced higher levels of stress and depression as they aged. This increase might relate to changes in environment and identity [61], suggesting the need to develop mental health interventions and support systems appropriate for adolescents.

Additionally, PA level had a positive correlation with overall mental health in terms of stress, depression, and suicidal ideation. This relationship reveals the value and importance of PA for mental health. Regular PA during adolescence could be a meaningful mental health intervention. Kim et al. found that PA lowered stress and depression in adolescents [20]. During a pandemic, PA at all levels could be an effective way to improve adolescent mental health [21–24].

Considering the above results and discussions, we obtain the following implications. COVID-19 is a virus that we needed to fight for a long time. In order to promote better mental health among adolescents, the government and health departments need to formulate effective and reasonable epidemic prevention policies, facilitate health and fitness based on the growth characteristics of adolescents, advocate for sports activities, develop reasonable PA and mental health training prescriptions, actively encourage adolescents to participate in PA, help adolescents maintain mental health, reduce the prevalence of mental diseases, and improve awareness of healthy behaviors among adolescents. The findings of this study also provide a valuable reference point for managing similar challenging situations in the future.

5 Conclusion

The objective of this study was to analyze changes in PA and mental health among Korean adolescents before and during the COVID-19 pandemic. Based on data from the KCDC Adolescent Health Behavior Survey, our findings indicate significant trends. A modest decline in moderate-intensity PA and a significant rise in non-participation emerged during the pandemic. A notable decrease in high-intensity PA and a marked increase in non-participation were also evident. However, participation in strength training slightly increased, with only a minor decrease in non-participation.

Adolescents who participated in moderate-to-high-intensity PA reported less frequent stress than non-participants, marking a shift from before the pandemic. Although stress among strength training participants was not conclusively lower, those who were active before the pandemic experienced a notable reduction. Similarly, adolescents involved in moderate-to-high-intensity PA experienced fewer depressive episodes both before and during the pandemic. Interestingly, before the pandemic, high-intensity PA participants reported higher rates of depression than non-participants, but this trend reversed during the pandemic. Individuals who participated in strength training before the pandemic showed significantly lower rates of depression during the pandemic, suggesting that regular strength training might prevent depression.

Furthermore, suicidal ideation decreased among moderate-intensity PA participants both before and during the pandemic. In contrast, while high-intensity PA participants initially showed rates similar to non-participants, their rates significantly dropped during the pandemic, unlike those of non-participants. Participation in strength training consistently correlated with lower suicide ideation.

Pandemic is negatively related to moderate- and high-intensity PA and mental health (e.g., stress, depression, and suicidal ideation). As age increased, PA and suicidal ideations decreased, while stress and depression increased. Overall, mental health tended to improve as adolescents participated in PA.

Developing and implementing tailored guidelines for PA and strength training is crucial to adolescent well-being, especially during a crisis like a pandemic. Encouraging moderate-intensity PA is vital due to its pandemic-induced decline, and efforts to counteract the increase in non-participation are necessary. Accessible, engaging opportunities for moderate-intensity PA within schools and communities are essential. Moreover, promoting diverse PA, including alternatives such as strength training, and highlighting the mental health benefits of PA in educational and community settings are potentially helpful. Developing and disseminating evidence-based PA and strength-training guidelines, tailored to the needs and preferences of adolescents, are paramount. A holistic approach, integrating social and family support, is likely to enhance the well-being of young people.

The current study has two important limitations. First, while the findings provide valuable insights into Korean adolescents, cultural factors influencing PA participation and mental health perceptions might not translate directly to adolescents in other cultural contexts. In this way, the findings have limited generalizability. Second, our comparative cross-sectional design prevented comparison of the same subjects before and during the pandemic. For this reason, the findings might reflect variations between different groups of subjects rather than longitudinal evolution of individual behaviors and mental health states. In future studies, scholars should seek data that more reliably permits longitudinal analysis.

# These authors contributed equally to this work.

tel: +86-156-1628-5230

  1. Funding information: This research received no external funding.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and consented to its submission to the journal. They reviewed all the results and approved the final version of the manuscript. KKS developed research topics and plans, organized research teams, analyzed the data, participated in methods, and prepared original drafts and revisions. ZZX wrote the introduction and contributed to manuscript editing and revision. RX helped write the discussion and contributed to the revision. BXX also contributed to writing the discussion. JXD wrote the conclusion and implications and contributed to the revision. SQY interpreted the results, created figures, produced tables, and proofread the manuscript.

  3. Conflict of interest: Authors state conflict of interest.

  4. Data availability statement: The data on which the study is based were accessed from the annual Adolescent Health Behavior Survey conducted by KCDC and are available for download through the following link (https://www.kdca.go.kr/yhs/home.jsp).

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Received: 2023-12-26
Revised: 2024-04-29
Accepted: 2024-05-13
Published Online: 2024-07-10

© 2024 the author(s), published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

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  24. Changes of serum CA125 and PGE2 before and after high-intensity focused ultrasound combined with GnRH-a in treatment of patients with adenomyosis
  25. The clinical value of the hepatic venous pressure gradient in patients undergoing hepatic resection for hepatocellular carcinoma with or without liver cirrhosis
  26. Development and validation of a novel model to predict pulmonary embolism in cardiology suspected patients: A 10-year retrospective analysis
  27. Downregulation of lncRNA XLOC_032768 in diabetic patients predicts the occurrence of diabetic nephropathy
  28. Circ_0051428 targeting miR-885-3p/MMP2 axis enhances the malignancy of cervical cancer
  29. Effectiveness of ginkgo diterpene lactone meglumine on cognitive function in patients with acute ischemic stroke
  30. The construction of a novel prognostic prediction model for glioma based on GWAS-identified prognostic-related risk loci
  31. Evaluating the impact of childhood BMI on the risk of coronavirus disease 2019: A Mendelian randomization study
  32. Lactate dehydrogenase to albumin ratio is associated with in-hospital mortality in patients with acute heart failure: Data from the MIMIC-III database
  33. CD36-mediated podocyte lipotoxicity promotes foot process effacement
  34. Efficacy of etonogestrel subcutaneous implants versus the levonorgestrel-releasing intrauterine system in the conservative treatment of adenomyosis
  35. FLRT2 mediates chondrogenesis of nasal septal cartilage and mandibular condyle cartilage
  36. Challenges in treating primary immune thrombocytopenia patients undergoing COVID-19 vaccination: A retrospective study
  37. Let-7 family regulates HaCaT cell proliferation and apoptosis via the ΔNp63/PI3K/AKT pathway
  38. Phospholipid transfer protein ameliorates sepsis-induced cardiac dysfunction through NLRP3 inflammasome inhibition
  39. Postoperative cognitive dysfunction in elderly patients with colorectal cancer: A randomized controlled study comparing goal-directed and conventional fluid therapy
  40. Long-pulsed ultrasound-mediated microbubble thrombolysis in a rat model of microvascular obstruction
  41. High SEC61A1 expression predicts poor outcome of acute myeloid leukemia
  42. Comparison of polymerase chain reaction and next-generation sequencing with conventional urine culture for the diagnosis of urinary tract infections: A meta-analysis
  43. Secreted frizzled-related protein 5 protects against renal fibrosis by inhibiting Wnt/β-catenin pathway
  44. Pan-cancer and single-cell analysis of actin cytoskeleton genes related to disulfidptosis
  45. Overexpression of miR-532-5p restrains oxidative stress response of chondrocytes in nontraumatic osteonecrosis of the femoral head by inhibiting ABL1
  46. Autologous liver transplantation for unresectable hepatobiliary malignancies in enhanced recovery after surgery model
  47. Clinical analysis of incomplete rupture of the uterus secondary to previous cesarean section
  48. Abnormal sleep duration is associated with sarcopenia in older Chinese people: A large retrospective cross-sectional study
  49. No genetic causality between obesity and benign paroxysmal vertigo: A two-sample Mendelian randomization study
  50. Identification and validation of autophagy-related genes in SSc
  51. Long non-coding RNA SRA1 suppresses radiotherapy resistance in esophageal squamous cell carcinoma by modulating glycolytic reprogramming
  52. Evaluation of quality of life in patients with schizophrenia: An inpatient social welfare institution-based cross-sectional study
  53. The possible role of oxidative stress marker glutathione in the assessment of cognitive impairment in multiple sclerosis
  54. Compilation of a self-management assessment scale for postoperative patients with aortic dissection
  55. Left atrial appendage closure in conjunction with radiofrequency ablation: Effects on left atrial functioning in patients with paroxysmal atrial fibrillation
  56. Effect of anterior femoral cortical notch grade on postoperative function and complications during TKA surgery: A multicenter, retrospective study
  57. Clinical characteristics and assessment of risk factors in patients with influenza A-induced severe pneumonia after the prevalence of SARS-CoV-2
  58. Analgesia nociception index is an indicator of laparoscopic trocar insertion-induced transient nociceptive stimuli
  59. High STAT4 expression correlates with poor prognosis in acute myeloid leukemia and facilitates disease progression by upregulating VEGFA expression
  60. Factors influencing cardiovascular system-related post-COVID-19 sequelae: A single-center cohort study
  61. HOXD10 regulates intestinal permeability and inhibits inflammation of dextran sulfate sodium-induced ulcerative colitis through the inactivation of the Rho/ROCK/MMPs axis
  62. Mesenchymal stem cell-derived exosomal miR-26a induces ferroptosis, suppresses hepatic stellate cell activation, and ameliorates liver fibrosis by modulating SLC7A11
  63. Endovascular thrombectomy versus intravenous thrombolysis for primary distal, medium vessel occlusion in acute ischemic stroke
  64. ANO6 (TMEM16F) inhibits gastrointestinal stromal tumor growth and induces ferroptosis
  65. Prognostic value of EIF5A2 in solid tumors: A meta-analysis and bioinformatics analysis
  66. The role of enhanced expression of Cx43 in patients with ulcerative colitis
  67. Choosing a COVID-19 vaccination site might be driven by anxiety and body vigilance
  68. Role of ICAM-1 in triple-negative breast cancer
  69. Cost-effectiveness of ambroxol in the treatment of Gaucher disease type 2
  70. HLA-DRB5 promotes immune thrombocytopenia via activating CD8+ T cells
  71. Efficacy and factors of myofascial release therapy combined with electrical and magnetic stimulation in the treatment of chronic pelvic pain syndrome
  72. Efficacy of tacrolimus monotherapy in primary membranous nephropathy
  73. Mechanisms of Tripterygium wilfordii Hook F on treating rheumatoid arthritis explored by network pharmacology analysis and molecular docking
  74. FBXO45 levels regulated ferroptosis renal tubular epithelial cells in a model of diabetic nephropathy by PLK1
  75. Optimizing anesthesia strategies to NSCLC patients in VATS procedures: Insights from drug requirements and patient recovery patterns
  76. Alpha-lipoic acid upregulates the PPARγ/NRF2/GPX4 signal pathway to inhibit ferroptosis in the pathogenesis of unexplained recurrent pregnancy loss
  77. Correlation between fat-soluble vitamin levels and inflammatory factors in paediatric community-acquired pneumonia: A prospective study
  78. CD1d affects the proliferation, migration, and apoptosis of human papillary thyroid carcinoma TPC-1 cells via regulating MAPK/NF-κB signaling pathway
  79. miR-let-7a inhibits sympathetic nerve remodeling after myocardial infarction by downregulating the expression of nerve growth factor
  80. Immune response analysis of solid organ transplantation recipients inoculated with inactivated COVID-19 vaccine: A retrospective analysis
  81. The H2Valdien derivatives regulate the epithelial–mesenchymal transition of hepatoma carcinoma cells through the Hedgehog signaling pathway
  82. Clinical efficacy of dexamethasone combined with isoniazid in the treatment of tuberculous meningitis and its effect on peripheral blood T cell subsets
  83. Comparison of short-segment and long-segment fixation in treatment of degenerative scoliosis and analysis of factors associated with adjacent spondylolisthesis
  84. Lycopene inhibits pyroptosis of endothelial progenitor cells induced by ox-LDL through the AMPK/mTOR/NLRP3 pathway
  85. Methylation regulation for FUNDC1 stability in childhood leukemia was up-regulated and facilitates metastasis and reduces ferroptosis of leukemia through mitochondrial damage by FBXL2
  86. Correlation of single-fiber electromyography studies and functional status in patients with amyotrophic lateral sclerosis
  87. Risk factors of postoperative airway obstruction complications in children with oral floor mass
  88. Expression levels and clinical significance of serum miR-19a/CCL20 in patients with acute cerebral infarction
  89. Physical activity and mental health trends in Korean adolescents: Analyzing the impact of the COVID-19 pandemic from 2018 to 2022
  90. Evaluating anemia in HIV-infected patients using chest CT
  91. Ponticulus posticus and skeletal malocclusion: A pilot study in a Southern Italian pre-orthodontic court
  92. Causal association of circulating immune cells and lymphoma: A Mendelian randomization study
  93. Assessment of the renal function and fibrosis indexes of conventional western medicine with Chinese medicine for dredging collaterals on treating renal fibrosis: A systematic review and meta-analysis
  94. Comprehensive landscape of integrator complex subunits and their association with prognosis and tumor microenvironment in gastric cancer
  95. New target-HMGCR inhibitors for the treatment of primary sclerosing cholangitis: A drug Mendelian randomization study
  96. Population pharmacokinetics of meropenem in critically ill patients
  97. Comparison of the ability of newly inflammatory markers to predict complicated appendicitis
  98. Comparative morphology of the cruciate ligaments: A radiological study
  99. Immune landscape of hepatocellular carcinoma: The central role of TP53-inducible glycolysis and apoptosis regulator
  100. Serum SIRT3 levels in epilepsy patients and its association with clinical outcomes and severity: A prospective observational study
  101. SHP-1 mediates cigarette smoke extract-induced epithelial–mesenchymal transformation and inflammation in 16HBE cells
  102. Acute hyper-hypoxia accelerates the development of depression in mice via the IL-6/PGC1α/MFN2 signaling pathway
  103. The GJB3 correlates with the prognosis, immune cell infiltration, and therapeutic responses in lung adenocarcinoma
  104. Physical fitness and blood parameters outcomes of breast cancer survivor in a low-intensity circuit resistance exercise program
  105. Exploring anesthetic-induced gene expression changes and immune cell dynamics in atrial tissue post-coronary artery bypass graft surgery
  106. Empagliflozin improves aortic injury in obese mice by regulating fatty acid metabolism
  107. Analysis of the risk factors of the radiation-induced encephalopathy in nasopharyngeal carcinoma: A retrospective cohort study
  108. Reproductive outcomes in women with BRCA 1/2 germline mutations: A retrospective observational study and literature review
  109. Evaluation of upper airway ultrasonographic measurements in predicting difficult intubation: A cross-section of the Turkish population
  110. Prognostic and diagnostic value of circulating IGFBP2 in pancreatic cancer
  111. Postural stability after operative reconstruction of the AFTL in chronic ankle instability comparing three different surgical techniques
  112. Research trends related to emergence agitation in the post-anaesthesia care unit from 2001 to 2023: A bibliometric analysis
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  114. ACSL4 mediates inflammatory bowel disease and contributes to LPS-induced intestinal epithelial cell dysfunction by activating ferroptosis and inflammation
  115. Affibody-based molecular probe 99mTc-(HE)3ZHER2:V2 for non-invasive HER2 detection in ovarian and breast cancer xenografts
  116. Effectiveness of nutritional support for clinical outcomes in gastric cancer patients: A meta-analysis of randomized controlled trials
  117. The relationship between IFN-γ, IL-10, IL-6 cytokines, and severity of the condition with serum zinc and Fe in children infected with Mycoplasma pneumoniae
  118. Paraquat disrupts the blood–brain barrier by increasing IL-6 expression and oxidative stress through the activation of PI3K/AKT signaling pathway
  119. Sleep quality associate with the increased prevalence of cognitive impairment in coronary artery disease patients: A retrospective case–control study
  120. Dioscin protects against chronic prostatitis through the TLR4/NF-κB pathway
  121. Association of polymorphisms in FBN1, MYH11, and TGF-β signaling-related genes with susceptibility of sporadic thoracic aortic aneurysm and dissection in the Zhejiang Han population
  122. Application value of multi-parameter magnetic resonance image-transrectal ultrasound cognitive fusion in prostate biopsy
  123. Laboratory variables‐based artificial neural network models for predicting fatty liver disease: A retrospective study
  124. Decreased BIRC5-206 promotes epithelial–mesenchymal transition in nasopharyngeal carcinoma through sponging miR-145-5p
  125. Sepsis induces the cardiomyocyte apoptosis and cardiac dysfunction through activation of YAP1/Serpine1/caspase-3 pathway
  126. Assessment of iron metabolism and iron deficiency in incident patients on incident continuous ambulatory peritoneal dialysis
  127. Tibial periosteum flap combined with autologous bone grafting in the treatment of Gustilo-IIIB/IIIC open tibial fractures
  128. The application of intravenous general anesthesia under nasopharyngeal airway assisted ventilation undergoing ureteroscopic holmium laser lithotripsy: A prospective, single-center, controlled trial
  129. Long intergenic noncoding RNA for IGF2BP2 stability suppresses gastric cancer cell apoptosis by inhibiting the maturation of microRNA-34a
  130. Role of FOXM1 and AURKB in regulating keratinocyte function in psoriasis
  131. Parental control attitudes over their pre-school children’s diet
  132. The role of auto-HSCT in extranodal natural killer/T cell lymphoma
  133. Significance of negative cervical cytology and positive HPV in the diagnosis of cervical lesions by colposcopy
  134. Echinacoside inhibits PASMCs calcium overload to prevent hypoxic pulmonary artery remodeling by regulating TRPC1/4/6 and calmodulin
  135. ADAR1 plays a protective role in proximal tubular cells under high glucose conditions by attenuating the PI3K/AKT/mTOR signaling pathway
  136. The risk of cancer among insulin glargine users in Lithuania: A retrospective population-based study
  137. The unusual location of primary hydatid cyst: A case series study
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  140. Shikonin alleviates asthma phenotypes in mice via an airway epithelial STAT3-dependent mechanism
  141. NSUN6 and HTR7 disturbed the stability of carotid atherosclerotic plaques by regulating the immune responses of macrophages
  142. The effect of COVID-19 lockdown on admission rates in Maternity Hospital
  143. Temporal muscle thickness is not a prognostic predictor in patients with high-grade glioma, an experience at two centers in China
  144. Luteolin alleviates cerebral ischemia/reperfusion injury by regulating cell pyroptosis
  145. Therapeutic role of respiratory exercise in patients with tuberculous pleurisy
  146. Effects of CFTR-ENaC on spinal cord edema after spinal cord injury
  147. Irisin-regulated lncRNAs and their potential regulatory functions in chondrogenic differentiation of human mesenchymal stem cells
  148. DMD mutations in pediatric patients with phenotypes of Duchenne/Becker muscular dystrophy
  149. Combination of C-reactive protein and fibrinogen-to-albumin ratio as a novel predictor of all-cause mortality in heart failure patients
  150. Significant role and the underly mechanism of cullin-1 in chronic obstructive pulmonary disease
  151. Ferroptosis-related prognostic model of mantle cell lymphoma
  152. Observation of choking reaction and other related indexes in elderly painless fiberoptic bronchoscopy with transnasal high-flow humidification oxygen therapy
  153. A bibliometric analysis of Prader-Willi syndrome from 2002 to 2022
  154. The causal effects of childhood sunburn occasions on melanoma: A univariable and multivariable Mendelian randomization study
  155. Oxidative stress regulates glycogen synthase kinase-3 in lymphocytes of diabetes mellitus patients complicated with cerebral infarction
  156. Role of COX6C and NDUFB3 in septic shock and stroke
  157. Trends in disease burden of type 2 diabetes, stroke, and hypertensive heart disease attributable to high BMI in China: 1990–2019
  158. Purinergic P2X7 receptor mediates hyperoxia-induced injury in pulmonary microvascular endothelial cells via NLRP3-mediated pyroptotic pathway
  159. Investigating the role of oviductal mucosa–endometrial co-culture in modulating factors relevant to embryo implantation
  160. Analgesic effect of external oblique intercostal block in laparoscopic cholecystectomy: A retrospective study
  161. Elevated serum miR-142-5p correlates with ischemic lesions and both NSE and S100β in ischemic stroke patients
  162. Correlation between the mechanism of arteriopathy in IgA nephropathy and blood stasis syndrome: A cohort study
  163. Risk factors for progressive kyphosis after percutaneous kyphoplasty in osteoporotic vertebral compression fracture
  164. Predictive role of neuron-specific enolase and S100-β in early neurological deterioration and unfavorable prognosis in patients with ischemic stroke
  165. The potential risk factors of postoperative cognitive dysfunction for endovascular therapy in acute ischemic stroke with general anesthesia
  166. Fluoxetine inhibited RANKL-induced osteoclastic differentiation in vitro
  167. Detection of serum FOXM1 and IGF2 in patients with ARDS and their correlation with disease and prognosis
  168. Rhein promotes skin wound healing by activating the PI3K/AKT signaling pathway
  169. Differences in mortality risk by levels of physical activity among persons with disabilities in South Korea
  170. Review Articles
  171. Cutaneous signs of selected cardiovascular disorders: A narrative review
  172. XRCC1 and hOGG1 polymorphisms and endometrial carcinoma: A meta-analysis
  173. A narrative review on adverse drug reactions of COVID-19 treatments on the kidney
  174. Emerging role and function of SPDL1 in human health and diseases
  175. Adverse reactions of piperacillin: A literature review of case reports
  176. Molecular mechanism and intervention measures of microvascular complications in diabetes
  177. Regulation of mesenchymal stem cell differentiation by autophagy
  178. Molecular landscape of borderline ovarian tumours: A systematic review
  179. Advances in synthetic lethality modalities for glioblastoma multiforme
  180. Investigating hormesis, aging, and neurodegeneration: From bench to clinics
  181. Frankincense: A neuronutrient to approach Parkinson’s disease treatment
  182. Sox9: A potential regulator of cancer stem cells in osteosarcoma
  183. Early detection of cardiovascular risk markers through non-invasive ultrasound methodologies in periodontitis patients
  184. Advanced neuroimaging and criminal interrogation in lie detection
  185. Maternal factors for neural tube defects in offspring: An umbrella review
  186. The chemoprotective hormetic effects of rosmarinic acid
  187. CBD’s potential impact on Parkinson’s disease: An updated overview
  188. Progress in cytokine research for ARDS: A comprehensive review
  189. Utilizing reactive oxygen species-scavenging nanoparticles for targeting oxidative stress in the treatment of ischemic stroke: A review
  190. NRXN1-related disorders, attempt to better define clinical assessment
  191. Lidocaine infusion for the treatment of complex regional pain syndrome: Case series and literature review
  192. Trends and future directions of autophagy in osteosarcoma: A bibliometric analysis
  193. Iron in ventricular remodeling and aneurysms post-myocardial infarction
  194. Case Reports
  195. Sirolimus potentiated angioedema: A case report and review of the literature
  196. Identification of mixed anaerobic infections after inguinal hernia repair based on metagenomic next-generation sequencing: A case report
  197. Successful treatment with bortezomib in combination with dexamethasone in a middle-aged male with idiopathic multicentric Castleman’s disease: A case report
  198. Complete heart block associated with hepatitis A infection in a female child with fatal outcome
  199. Elevation of D-dimer in eosinophilic gastrointestinal diseases in the absence of venous thrombosis: A case series and literature review
  200. Four years of natural progressive course: A rare case report of juvenile Xp11.2 translocations renal cell carcinoma with TFE3 gene fusion
  201. Advancing prenatal diagnosis: Echocardiographic detection of Scimitar syndrome in China – A case series
  202. Outcomes and complications of hemodialysis in patients with renal cancer following bilateral nephrectomy
  203. Anti-HMGCR myopathy mimicking facioscapulohumeral muscular dystrophy
  204. Recurrent opportunistic infections in a HIV-negative patient with combined C6 and NFKB1 mutations: A case report, pedigree analysis, and literature review
  205. Letter to the Editor
  206. Letter to the Editor: Total parenteral nutrition-induced Wernicke’s encephalopathy after oncologic gastrointestinal surgery
  207. Erratum
  208. Erratum to “Bladder-embedded ectopic intrauterine device with calculus”
  209. Retraction
  210. Retraction of “XRCC1 and hOGG1 polymorphisms and endometrial carcinoma: A meta-analysis”
  211. Corrigendum
  212. Corrigendum to “Investigating hormesis, aging, and neurodegeneration: From bench to clinics”
  213. Corrigendum to “Frankincense: A neuronutrient to approach Parkinson’s disease treatment”
  214. Special Issue The evolving saga of RNAs from bench to bedside - Part II
  215. Machine-learning-based prediction of a diagnostic model using autophagy-related genes based on RNA sequencing for patients with papillary thyroid carcinoma
  216. Unlocking the future of hepatocellular carcinoma treatment: A comprehensive analysis of disulfidptosis-related lncRNAs for prognosis and drug screening
  217. Elevated mRNA level indicates FSIP1 promotes EMT and gastric cancer progression by regulating fibroblasts in tumor microenvironment
  218. Special Issue Advancements in oncology: bridging clinical and experimental research - Part I
  219. Ultrasound-guided transperineal vs transrectal prostate biopsy: A meta-analysis of diagnostic accuracy and complication rates
  220. Assessment of diagnostic value of unilateral systematic biopsy combined with targeted biopsy in detecting clinically significant prostate cancer
  221. SENP7 inhibits glioblastoma metastasis and invasion by dissociating SUMO2/3 binding to specific target proteins
  222. MARK1 suppress malignant progression of hepatocellular carcinoma and improves sorafenib resistance through negatively regulating POTEE
  223. Analysis of postoperative complications in bladder cancer patients
  224. Carboplatin combined with arsenic trioxide versus carboplatin combined with docetaxel treatment for LACC: A randomized, open-label, phase II clinical study
  225. Special Issue Exploring the biological mechanism of human diseases based on MultiOmics Technology - Part I
  226. Comprehensive pan-cancer investigation of carnosine dipeptidase 1 and its prospective prognostic significance in hepatocellular carcinoma
  227. Identification of signatures associated with microsatellite instability and immune characteristics to predict the prognostic risk of colon cancer
  228. Single-cell analysis identified key macrophage subpopulations associated with atherosclerosis
https://doi.org/10.1515/med-2024-0978
Keywords for this article
adolescents; COVID-19; depression; mental health; physical activity; stress
Creative Commons
BY 4.0

Articles in the same Issue

  1. Research Articles
  2. EDNRB inhibits the growth and migration of prostate cancer cells by activating the cGMP-PKG pathway
  3. STK11 (LKB1) mutation suppresses ferroptosis in lung adenocarcinoma by facilitating monounsaturated fatty acid synthesis
  4. Association of SOX6 gene polymorphisms with Kashin-Beck disease risk in the Chinese Han population
  5. The pyroptosis-related signature predicts prognosis and influences the tumor immune microenvironment in dedifferentiated liposarcoma
  6. METTL3 attenuates ferroptosis sensitivity in lung cancer via modulating TFRC
  7. Identification and validation of molecular subtypes and prognostic signature for stage I and stage II gastric cancer based on neutrophil extracellular traps
  8. Novel lumbar plexus block versus femoral nerve block for analgesia and motor recovery after total knee arthroplasty
  9. Correlation between ABCB1 and OLIG2 polymorphisms and the severity and prognosis of patients with cerebral infarction
  10. Study on the radiotherapy effect and serum neutral granulocyte lymphocyte ratio and inflammatory factor expression of nasopharyngeal carcinoma
  11. Transcriptome analysis of effects of Tecrl deficiency on cardiometabolic and calcium regulation in cardiac tissue
  12. Aflatoxin B1 induces infertility, fetal deformities, and potential therapies
  13. Serum levels of HMW adiponectin and its receptors are associated with cytokine levels and clinical characteristics in chronic obstructive pulmonary disease
  14. METTL3-mediated methylation of CYP2C19 mRNA may aggravate clopidogrel resistance in ischemic stroke patients
  15. Understand how machine learning impact lung cancer research from 2010 to 2021: A bibliometric analysis
  16. Pressure ulcers in German hospitals: Analysis of reimbursement and length of stay
  17. Metformin plus L-carnitine enhances brown/beige adipose tissue activity via Nrf2/HO-1 signaling to reduce lipid accumulation and inflammation in murine obesity
  18. Downregulation of carbonic anhydrase IX expression in mouse xenograft nasopharyngeal carcinoma model via doxorubicin nanobubble combined with ultrasound
  19. Feasibility of 3-dimensional printed models in simulated training and teaching of transcatheter aortic valve replacement
  20. miR-335-3p improves type II diabetes mellitus by IGF-1 regulating macrophage polarization
  21. The analyses of human MCPH1 DNA repair machinery and genetic variations
  22. Activation of Piezo1 increases the sensitivity of breast cancer to hyperthermia therapy
  23. Comprehensive analysis based on the disulfidptosis-related genes identifies hub genes and immune infiltration for pancreatic adenocarcinoma
  24. Changes of serum CA125 and PGE2 before and after high-intensity focused ultrasound combined with GnRH-a in treatment of patients with adenomyosis
  25. The clinical value of the hepatic venous pressure gradient in patients undergoing hepatic resection for hepatocellular carcinoma with or without liver cirrhosis
  26. Development and validation of a novel model to predict pulmonary embolism in cardiology suspected patients: A 10-year retrospective analysis
  27. Downregulation of lncRNA XLOC_032768 in diabetic patients predicts the occurrence of diabetic nephropathy
  28. Circ_0051428 targeting miR-885-3p/MMP2 axis enhances the malignancy of cervical cancer
  29. Effectiveness of ginkgo diterpene lactone meglumine on cognitive function in patients with acute ischemic stroke
  30. The construction of a novel prognostic prediction model for glioma based on GWAS-identified prognostic-related risk loci
  31. Evaluating the impact of childhood BMI on the risk of coronavirus disease 2019: A Mendelian randomization study
  32. Lactate dehydrogenase to albumin ratio is associated with in-hospital mortality in patients with acute heart failure: Data from the MIMIC-III database
  33. CD36-mediated podocyte lipotoxicity promotes foot process effacement
  34. Efficacy of etonogestrel subcutaneous implants versus the levonorgestrel-releasing intrauterine system in the conservative treatment of adenomyosis
  35. FLRT2 mediates chondrogenesis of nasal septal cartilage and mandibular condyle cartilage
  36. Challenges in treating primary immune thrombocytopenia patients undergoing COVID-19 vaccination: A retrospective study
  37. Let-7 family regulates HaCaT cell proliferation and apoptosis via the ΔNp63/PI3K/AKT pathway
  38. Phospholipid transfer protein ameliorates sepsis-induced cardiac dysfunction through NLRP3 inflammasome inhibition
  39. Postoperative cognitive dysfunction in elderly patients with colorectal cancer: A randomized controlled study comparing goal-directed and conventional fluid therapy
  40. Long-pulsed ultrasound-mediated microbubble thrombolysis in a rat model of microvascular obstruction
  41. High SEC61A1 expression predicts poor outcome of acute myeloid leukemia
  42. Comparison of polymerase chain reaction and next-generation sequencing with conventional urine culture for the diagnosis of urinary tract infections: A meta-analysis
  43. Secreted frizzled-related protein 5 protects against renal fibrosis by inhibiting Wnt/β-catenin pathway
  44. Pan-cancer and single-cell analysis of actin cytoskeleton genes related to disulfidptosis
  45. Overexpression of miR-532-5p restrains oxidative stress response of chondrocytes in nontraumatic osteonecrosis of the femoral head by inhibiting ABL1
  46. Autologous liver transplantation for unresectable hepatobiliary malignancies in enhanced recovery after surgery model
  47. Clinical analysis of incomplete rupture of the uterus secondary to previous cesarean section
  48. Abnormal sleep duration is associated with sarcopenia in older Chinese people: A large retrospective cross-sectional study
  49. No genetic causality between obesity and benign paroxysmal vertigo: A two-sample Mendelian randomization study
  50. Identification and validation of autophagy-related genes in SSc
  51. Long non-coding RNA SRA1 suppresses radiotherapy resistance in esophageal squamous cell carcinoma by modulating glycolytic reprogramming
  52. Evaluation of quality of life in patients with schizophrenia: An inpatient social welfare institution-based cross-sectional study
  53. The possible role of oxidative stress marker glutathione in the assessment of cognitive impairment in multiple sclerosis
  54. Compilation of a self-management assessment scale for postoperative patients with aortic dissection
  55. Left atrial appendage closure in conjunction with radiofrequency ablation: Effects on left atrial functioning in patients with paroxysmal atrial fibrillation
  56. Effect of anterior femoral cortical notch grade on postoperative function and complications during TKA surgery: A multicenter, retrospective study
  57. Clinical characteristics and assessment of risk factors in patients with influenza A-induced severe pneumonia after the prevalence of SARS-CoV-2
  58. Analgesia nociception index is an indicator of laparoscopic trocar insertion-induced transient nociceptive stimuli
  59. High STAT4 expression correlates with poor prognosis in acute myeloid leukemia and facilitates disease progression by upregulating VEGFA expression
  60. Factors influencing cardiovascular system-related post-COVID-19 sequelae: A single-center cohort study
  61. HOXD10 regulates intestinal permeability and inhibits inflammation of dextran sulfate sodium-induced ulcerative colitis through the inactivation of the Rho/ROCK/MMPs axis
  62. Mesenchymal stem cell-derived exosomal miR-26a induces ferroptosis, suppresses hepatic stellate cell activation, and ameliorates liver fibrosis by modulating SLC7A11
  63. Endovascular thrombectomy versus intravenous thrombolysis for primary distal, medium vessel occlusion in acute ischemic stroke
  64. ANO6 (TMEM16F) inhibits gastrointestinal stromal tumor growth and induces ferroptosis
  65. Prognostic value of EIF5A2 in solid tumors: A meta-analysis and bioinformatics analysis
  66. The role of enhanced expression of Cx43 in patients with ulcerative colitis
  67. Choosing a COVID-19 vaccination site might be driven by anxiety and body vigilance
  68. Role of ICAM-1 in triple-negative breast cancer
  69. Cost-effectiveness of ambroxol in the treatment of Gaucher disease type 2
  70. HLA-DRB5 promotes immune thrombocytopenia via activating CD8+ T cells
  71. Efficacy and factors of myofascial release therapy combined with electrical and magnetic stimulation in the treatment of chronic pelvic pain syndrome
  72. Efficacy of tacrolimus monotherapy in primary membranous nephropathy
  73. Mechanisms of Tripterygium wilfordii Hook F on treating rheumatoid arthritis explored by network pharmacology analysis and molecular docking
  74. FBXO45 levels regulated ferroptosis renal tubular epithelial cells in a model of diabetic nephropathy by PLK1
  75. Optimizing anesthesia strategies to NSCLC patients in VATS procedures: Insights from drug requirements and patient recovery patterns
  76. Alpha-lipoic acid upregulates the PPARγ/NRF2/GPX4 signal pathway to inhibit ferroptosis in the pathogenesis of unexplained recurrent pregnancy loss
  77. Correlation between fat-soluble vitamin levels and inflammatory factors in paediatric community-acquired pneumonia: A prospective study
  78. CD1d affects the proliferation, migration, and apoptosis of human papillary thyroid carcinoma TPC-1 cells via regulating MAPK/NF-κB signaling pathway
  79. miR-let-7a inhibits sympathetic nerve remodeling after myocardial infarction by downregulating the expression of nerve growth factor
  80. Immune response analysis of solid organ transplantation recipients inoculated with inactivated COVID-19 vaccine: A retrospective analysis
  81. The H2Valdien derivatives regulate the epithelial–mesenchymal transition of hepatoma carcinoma cells through the Hedgehog signaling pathway
  82. Clinical efficacy of dexamethasone combined with isoniazid in the treatment of tuberculous meningitis and its effect on peripheral blood T cell subsets
  83. Comparison of short-segment and long-segment fixation in treatment of degenerative scoliosis and analysis of factors associated with adjacent spondylolisthesis
  84. Lycopene inhibits pyroptosis of endothelial progenitor cells induced by ox-LDL through the AMPK/mTOR/NLRP3 pathway
  85. Methylation regulation for FUNDC1 stability in childhood leukemia was up-regulated and facilitates metastasis and reduces ferroptosis of leukemia through mitochondrial damage by FBXL2
  86. Correlation of single-fiber electromyography studies and functional status in patients with amyotrophic lateral sclerosis
  87. Risk factors of postoperative airway obstruction complications in children with oral floor mass
  88. Expression levels and clinical significance of serum miR-19a/CCL20 in patients with acute cerebral infarction
  89. Physical activity and mental health trends in Korean adolescents: Analyzing the impact of the COVID-19 pandemic from 2018 to 2022
  90. Evaluating anemia in HIV-infected patients using chest CT
  91. Ponticulus posticus and skeletal malocclusion: A pilot study in a Southern Italian pre-orthodontic court
  92. Causal association of circulating immune cells and lymphoma: A Mendelian randomization study
  93. Assessment of the renal function and fibrosis indexes of conventional western medicine with Chinese medicine for dredging collaterals on treating renal fibrosis: A systematic review and meta-analysis
  94. Comprehensive landscape of integrator complex subunits and their association with prognosis and tumor microenvironment in gastric cancer
  95. New target-HMGCR inhibitors for the treatment of primary sclerosing cholangitis: A drug Mendelian randomization study
  96. Population pharmacokinetics of meropenem in critically ill patients
  97. Comparison of the ability of newly inflammatory markers to predict complicated appendicitis
  98. Comparative morphology of the cruciate ligaments: A radiological study
  99. Immune landscape of hepatocellular carcinoma: The central role of TP53-inducible glycolysis and apoptosis regulator
  100. Serum SIRT3 levels in epilepsy patients and its association with clinical outcomes and severity: A prospective observational study
  101. SHP-1 mediates cigarette smoke extract-induced epithelial–mesenchymal transformation and inflammation in 16HBE cells
  102. Acute hyper-hypoxia accelerates the development of depression in mice via the IL-6/PGC1α/MFN2 signaling pathway
  103. The GJB3 correlates with the prognosis, immune cell infiltration, and therapeutic responses in lung adenocarcinoma
  104. Physical fitness and blood parameters outcomes of breast cancer survivor in a low-intensity circuit resistance exercise program
  105. Exploring anesthetic-induced gene expression changes and immune cell dynamics in atrial tissue post-coronary artery bypass graft surgery
  106. Empagliflozin improves aortic injury in obese mice by regulating fatty acid metabolism
  107. Analysis of the risk factors of the radiation-induced encephalopathy in nasopharyngeal carcinoma: A retrospective cohort study
  108. Reproductive outcomes in women with BRCA 1/2 germline mutations: A retrospective observational study and literature review
  109. Evaluation of upper airway ultrasonographic measurements in predicting difficult intubation: A cross-section of the Turkish population
  110. Prognostic and diagnostic value of circulating IGFBP2 in pancreatic cancer
  111. Postural stability after operative reconstruction of the AFTL in chronic ankle instability comparing three different surgical techniques
  112. Research trends related to emergence agitation in the post-anaesthesia care unit from 2001 to 2023: A bibliometric analysis
  113. Frequency and clinicopathological correlation of gastrointestinal polyps: A six-year single center experience
  114. ACSL4 mediates inflammatory bowel disease and contributes to LPS-induced intestinal epithelial cell dysfunction by activating ferroptosis and inflammation
  115. Affibody-based molecular probe 99mTc-(HE)3ZHER2:V2 for non-invasive HER2 detection in ovarian and breast cancer xenografts
  116. Effectiveness of nutritional support for clinical outcomes in gastric cancer patients: A meta-analysis of randomized controlled trials
  117. The relationship between IFN-γ, IL-10, IL-6 cytokines, and severity of the condition with serum zinc and Fe in children infected with Mycoplasma pneumoniae
  118. Paraquat disrupts the blood–brain barrier by increasing IL-6 expression and oxidative stress through the activation of PI3K/AKT signaling pathway
  119. Sleep quality associate with the increased prevalence of cognitive impairment in coronary artery disease patients: A retrospective case–control study
  120. Dioscin protects against chronic prostatitis through the TLR4/NF-κB pathway
  121. Association of polymorphisms in FBN1, MYH11, and TGF-β signaling-related genes with susceptibility of sporadic thoracic aortic aneurysm and dissection in the Zhejiang Han population
  122. Application value of multi-parameter magnetic resonance image-transrectal ultrasound cognitive fusion in prostate biopsy
  123. Laboratory variables‐based artificial neural network models for predicting fatty liver disease: A retrospective study
  124. Decreased BIRC5-206 promotes epithelial–mesenchymal transition in nasopharyngeal carcinoma through sponging miR-145-5p
  125. Sepsis induces the cardiomyocyte apoptosis and cardiac dysfunction through activation of YAP1/Serpine1/caspase-3 pathway
  126. Assessment of iron metabolism and iron deficiency in incident patients on incident continuous ambulatory peritoneal dialysis
  127. Tibial periosteum flap combined with autologous bone grafting in the treatment of Gustilo-IIIB/IIIC open tibial fractures
  128. The application of intravenous general anesthesia under nasopharyngeal airway assisted ventilation undergoing ureteroscopic holmium laser lithotripsy: A prospective, single-center, controlled trial
  129. Long intergenic noncoding RNA for IGF2BP2 stability suppresses gastric cancer cell apoptosis by inhibiting the maturation of microRNA-34a
  130. Role of FOXM1 and AURKB in regulating keratinocyte function in psoriasis
  131. Parental control attitudes over their pre-school children’s diet
  132. The role of auto-HSCT in extranodal natural killer/T cell lymphoma
  133. Significance of negative cervical cytology and positive HPV in the diagnosis of cervical lesions by colposcopy
  134. Echinacoside inhibits PASMCs calcium overload to prevent hypoxic pulmonary artery remodeling by regulating TRPC1/4/6 and calmodulin
  135. ADAR1 plays a protective role in proximal tubular cells under high glucose conditions by attenuating the PI3K/AKT/mTOR signaling pathway
  136. The risk of cancer among insulin glargine users in Lithuania: A retrospective population-based study
  137. The unusual location of primary hydatid cyst: A case series study
  138. Intraoperative changes in electrophysiological monitoring can be used to predict clinical outcomes in patients with spinal cavernous malformation
  139. Obesity and risk of placenta accreta spectrum: A meta-analysis
  140. Shikonin alleviates asthma phenotypes in mice via an airway epithelial STAT3-dependent mechanism
  141. NSUN6 and HTR7 disturbed the stability of carotid atherosclerotic plaques by regulating the immune responses of macrophages
  142. The effect of COVID-19 lockdown on admission rates in Maternity Hospital
  143. Temporal muscle thickness is not a prognostic predictor in patients with high-grade glioma, an experience at two centers in China
  144. Luteolin alleviates cerebral ischemia/reperfusion injury by regulating cell pyroptosis
  145. Therapeutic role of respiratory exercise in patients with tuberculous pleurisy
  146. Effects of CFTR-ENaC on spinal cord edema after spinal cord injury
  147. Irisin-regulated lncRNAs and their potential regulatory functions in chondrogenic differentiation of human mesenchymal stem cells
  148. DMD mutations in pediatric patients with phenotypes of Duchenne/Becker muscular dystrophy
  149. Combination of C-reactive protein and fibrinogen-to-albumin ratio as a novel predictor of all-cause mortality in heart failure patients
  150. Significant role and the underly mechanism of cullin-1 in chronic obstructive pulmonary disease
  151. Ferroptosis-related prognostic model of mantle cell lymphoma
  152. Observation of choking reaction and other related indexes in elderly painless fiberoptic bronchoscopy with transnasal high-flow humidification oxygen therapy
  153. A bibliometric analysis of Prader-Willi syndrome from 2002 to 2022
  154. The causal effects of childhood sunburn occasions on melanoma: A univariable and multivariable Mendelian randomization study
  155. Oxidative stress regulates glycogen synthase kinase-3 in lymphocytes of diabetes mellitus patients complicated with cerebral infarction
  156. Role of COX6C and NDUFB3 in septic shock and stroke
  157. Trends in disease burden of type 2 diabetes, stroke, and hypertensive heart disease attributable to high BMI in China: 1990–2019
  158. Purinergic P2X7 receptor mediates hyperoxia-induced injury in pulmonary microvascular endothelial cells via NLRP3-mediated pyroptotic pathway
  159. Investigating the role of oviductal mucosa–endometrial co-culture in modulating factors relevant to embryo implantation
  160. Analgesic effect of external oblique intercostal block in laparoscopic cholecystectomy: A retrospective study
  161. Elevated serum miR-142-5p correlates with ischemic lesions and both NSE and S100β in ischemic stroke patients
  162. Correlation between the mechanism of arteriopathy in IgA nephropathy and blood stasis syndrome: A cohort study
  163. Risk factors for progressive kyphosis after percutaneous kyphoplasty in osteoporotic vertebral compression fracture
  164. Predictive role of neuron-specific enolase and S100-β in early neurological deterioration and unfavorable prognosis in patients with ischemic stroke
  165. The potential risk factors of postoperative cognitive dysfunction for endovascular therapy in acute ischemic stroke with general anesthesia
  166. Fluoxetine inhibited RANKL-induced osteoclastic differentiation in vitro
  167. Detection of serum FOXM1 and IGF2 in patients with ARDS and their correlation with disease and prognosis
  168. Rhein promotes skin wound healing by activating the PI3K/AKT signaling pathway
  169. Differences in mortality risk by levels of physical activity among persons with disabilities in South Korea
  170. Review Articles
  171. Cutaneous signs of selected cardiovascular disorders: A narrative review
  172. XRCC1 and hOGG1 polymorphisms and endometrial carcinoma: A meta-analysis
  173. A narrative review on adverse drug reactions of COVID-19 treatments on the kidney
  174. Emerging role and function of SPDL1 in human health and diseases
  175. Adverse reactions of piperacillin: A literature review of case reports
  176. Molecular mechanism and intervention measures of microvascular complications in diabetes
  177. Regulation of mesenchymal stem cell differentiation by autophagy
  178. Molecular landscape of borderline ovarian tumours: A systematic review
  179. Advances in synthetic lethality modalities for glioblastoma multiforme
  180. Investigating hormesis, aging, and neurodegeneration: From bench to clinics
  181. Frankincense: A neuronutrient to approach Parkinson’s disease treatment
  182. Sox9: A potential regulator of cancer stem cells in osteosarcoma
  183. Early detection of cardiovascular risk markers through non-invasive ultrasound methodologies in periodontitis patients
  184. Advanced neuroimaging and criminal interrogation in lie detection
  185. Maternal factors for neural tube defects in offspring: An umbrella review
  186. The chemoprotective hormetic effects of rosmarinic acid
  187. CBD’s potential impact on Parkinson’s disease: An updated overview
  188. Progress in cytokine research for ARDS: A comprehensive review
  189. Utilizing reactive oxygen species-scavenging nanoparticles for targeting oxidative stress in the treatment of ischemic stroke: A review
  190. NRXN1-related disorders, attempt to better define clinical assessment
  191. Lidocaine infusion for the treatment of complex regional pain syndrome: Case series and literature review
  192. Trends and future directions of autophagy in osteosarcoma: A bibliometric analysis
  193. Iron in ventricular remodeling and aneurysms post-myocardial infarction
  194. Case Reports
  195. Sirolimus potentiated angioedema: A case report and review of the literature
  196. Identification of mixed anaerobic infections after inguinal hernia repair based on metagenomic next-generation sequencing: A case report
  197. Successful treatment with bortezomib in combination with dexamethasone in a middle-aged male with idiopathic multicentric Castleman’s disease: A case report
  198. Complete heart block associated with hepatitis A infection in a female child with fatal outcome
  199. Elevation of D-dimer in eosinophilic gastrointestinal diseases in the absence of venous thrombosis: A case series and literature review
  200. Four years of natural progressive course: A rare case report of juvenile Xp11.2 translocations renal cell carcinoma with TFE3 gene fusion
  201. Advancing prenatal diagnosis: Echocardiographic detection of Scimitar syndrome in China – A case series
  202. Outcomes and complications of hemodialysis in patients with renal cancer following bilateral nephrectomy
  203. Anti-HMGCR myopathy mimicking facioscapulohumeral muscular dystrophy
  204. Recurrent opportunistic infections in a HIV-negative patient with combined C6 and NFKB1 mutations: A case report, pedigree analysis, and literature review
  205. Letter to the Editor
  206. Letter to the Editor: Total parenteral nutrition-induced Wernicke’s encephalopathy after oncologic gastrointestinal surgery
  207. Erratum
  208. Erratum to “Bladder-embedded ectopic intrauterine device with calculus”
  209. Retraction
  210. Retraction of “XRCC1 and hOGG1 polymorphisms and endometrial carcinoma: A meta-analysis”
  211. Corrigendum
  212. Corrigendum to “Investigating hormesis, aging, and neurodegeneration: From bench to clinics”
  213. Corrigendum to “Frankincense: A neuronutrient to approach Parkinson’s disease treatment”
  214. Special Issue The evolving saga of RNAs from bench to bedside - Part II
  215. Machine-learning-based prediction of a diagnostic model using autophagy-related genes based on RNA sequencing for patients with papillary thyroid carcinoma
  216. Unlocking the future of hepatocellular carcinoma treatment: A comprehensive analysis of disulfidptosis-related lncRNAs for prognosis and drug screening
  217. Elevated mRNA level indicates FSIP1 promotes EMT and gastric cancer progression by regulating fibroblasts in tumor microenvironment
  218. Special Issue Advancements in oncology: bridging clinical and experimental research - Part I
  219. Ultrasound-guided transperineal vs transrectal prostate biopsy: A meta-analysis of diagnostic accuracy and complication rates
  220. Assessment of diagnostic value of unilateral systematic biopsy combined with targeted biopsy in detecting clinically significant prostate cancer
  221. SENP7 inhibits glioblastoma metastasis and invasion by dissociating SUMO2/3 binding to specific target proteins
  222. MARK1 suppress malignant progression of hepatocellular carcinoma and improves sorafenib resistance through negatively regulating POTEE
  223. Analysis of postoperative complications in bladder cancer patients
  224. Carboplatin combined with arsenic trioxide versus carboplatin combined with docetaxel treatment for LACC: A randomized, open-label, phase II clinical study
  225. Special Issue Exploring the biological mechanism of human diseases based on MultiOmics Technology - Part I
  226. Comprehensive pan-cancer investigation of carnosine dipeptidase 1 and its prospective prognostic significance in hepatocellular carcinoma
  227. Identification of signatures associated with microsatellite instability and immune characteristics to predict the prognostic risk of colon cancer
  228. Single-cell analysis identified key macrophage subpopulations associated with atherosclerosis
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