Vulnerable populations may be more vulnerable to mental health problems posed by the coronavirus disease 2019 (COVID-19) pandemic. A systematic review was performed to compare the mental health impact of COVID-19 between vulnerable and non-vulnerable groups. Five electronic databases were searched for observational studies reporting the psychological outcomes of both vulnerable populations and healthy controls during the COVID-19 era. The primary outcomes are the severity of depression and anxiety, and secondary outcomes include other aspects of mental health such as stress or sleep disturbance. Meta-analysis was performed for the severity of mental health symptoms, and the results were presented as standardized mean difference and 95% confidence intervals. A total of 25 studies were included. According to the findings, the elderly generally experienced significantly lower levels of psychological symptoms including depression, anxiety, and perceived stress. Pregnant women, patients with chronic diseases, and patients with pre-existing severe mental disorders showed mixed results according to each mental health outcome. The results indicate that vulnerable groups have been affected differently in the COVID-19 era. Though the insufficient number and heterogeneity of included studies leave the results inconclusive, our findings may contribute to identifying priorities of mental health needs among various vulnerable populations and allocating health resources with efficiency.

Objective This cross-sectional study aimed to 1) explore the relationships among work-life balance (WLB), burnout, and empathy and 2) investigate the roles of the subtypes of burnout relating to WLB and empathy.Methods A total of 105 health care professionals from a general hospital in Seoul were assessed using the Maslach Burnout Inventory, Jefferson Scale of Physician Empathy, and a one-sentence-question on subjective WLB. Multiple questions on psychiatric problems, including sleep problems, anxiety, depressive symptom, and alcohol problems, were also included.Results In the mediation analyses, personal achievement was considered as a potential mediating variable between WLB and empathy. The direct effect (β=3.93, 95% CI: 1.21–6.64) and the indirect effect (β=1.95, 95% CI: 0.52–3.76) of WLB on empathy were also significant.Conclusion Interventions encouraging personal achievement may help mitigate burnout of health professionals.

Background: The purpose of this study was to evaluate the effects a cognitive behavioral intervention on perceived stress, somatic symptoms, automatic negative thoughts and dysfunctional attitudes in college students. Methods: This was a quasi-experimental study with a nonequivalent control group design. Students who agreed to participate in the study and had a total score of 7 or greater on the Patient Health Questionnaire-15 were asked to choose one of the two groups to attend: Experimental and control groups. Students in the experimental group (N=17) received 5-weekly group sessions of the intervention, each of which lasted 60 minutes. The interventions were not provided to the control group (N=15). Students in both groups were asked to complete a set of questionnaires at baseline and five weeks. Descriptive statistics were calculated, and t-test, Mann-Whitney U test and repeated measures ANOVA were performed. Results: There was a significant interaction between time and group for perceived stress, somatic symptoms and automatic negative thoughts. Dysfunctional attitudes, on the other hand, were not significantly different by group. Conclusions: The findings showed that the intervention was effective for college students suffering from perceived stress and somatic symptoms. In particular, the significant decrease in automatic negative thoughts among students in the intervention group suggests that the effect of the cognitivebehavioral intervention was mediated by the cognitive factors of somatic symptoms.

This study aimed to investigate the serial mediating effects of the time mothers spend with their adolescent children and the adolescents' self-esteem on the relationship between mothers' and adolescents' problematic smartphone use. Patients and Methods: This study was a secondary analysis of data extracted from the Korean Children and Youth Panel Survey (KCYPS) in 2018, which comprised data on first-year middle school students. Mediation analysis was conducted using Model 6 of the Hayes' PROCESS macro for SPSS. Results: The mediating effect of the time mothers spent with adolescents on the relationship between mothers' and adolescents' problematic smartphone use was significant, but the mediating effect of adolescents' self-esteem was not significant. Mothers' problematic smartphone use was found to significantly affect adolescents' problematic smartphone use by sequentially mediating the time mothers spent with adolescent children and adolescents' self-esteem. Conclusion:It was concluded that, to lower adolescents' problematic smartphone use due to mothers' problematic smartphone use, appropriate interventions should be formulated to help adolescents develop higher self-esteem through sufficient mother-child interaction time.

This study aims to examine how work-to-life negative spillover is associated with depressive symptoms among working women and to explore moderating effect of social activities satisfaction on the relationship between work-to-life spillover and depression. This was a secondary data analysis from a sample of 2869 employed women from the 7th Korean Longitudinal Survey of Women and Families. The results showed that work-to-life negative spillover was positively associated with depressive symptoms. Additionally, there was a significant moderating effect of social activities satisfaction on the relationship between work-to-life negative spillover and depressive symptoms (β = 0.176, p < 0.05). It was found that the low social activity group showed fewer depressive symptoms induced by the negative work-to-life spillover than the high social activity group. Based on the results of our study, effective strategies and policies for work-family compatibility and interventions aimed at reducing the work induced stress and depressive symptoms are recommended.

Background: Intraoperative hypercapnia and hypocapnia are common during pediatric anesthesia, and the cerebral blood flow and intracranial pressure may be affected by the partial pressure of arterial carbon dioxide. Transorbital ultrasound measurement of the optic nerve sheath diameter is a simple and non-invasive method for intracranial pressure assessment. The objective of this study was to evaluate the effect of end-tidal carbon dioxide (E T CO 2 ) on optic nerve sheath diameter in a healthy anesthetized pediatric population. Methods: Pediatric patients scheduled for elective surgery under general anesthesia and mechanical ventilation in the supine position were enrolled and divided into four subgroups; age <2 years, 2-6 years, 6-12 years, and 12-18 years. Mechanical ventilation was adjusted to achieve target E T CO 2 levels in a randomized sequence (40-35-45-40 mmHg or 40-45-35-40 mmHg). Three minutes after reaching each target E T CO 2 level, transorbital ultrasound images of optic nerve sheath diameter were obtained and analyzed.The primary outcome was the optic nerve sheath diameter at each E T CO 2 level.Results: Sixty-four pediatric patients were enrolled and analyzed. At E T CO 2 = 40 mmHg, the optic nerve sheath diameter was 5.6 ± 0.6 mm, 6.4 ± 0.5 mm, 6.8 ± 0.6 mm, and 7.1 ± 0.5 mm in children aged <2 years, 2-6 years, 6-12 years, and 12-18 years, respectively. The overall percent decreases in the optic nerve sheath diameter was −5.6 ± −4.3% (95% CI; −6.7 to −4.5%) at E T CO 2 = 35 mmHg while the overall percent increases of optic nerve sheath diameter (ONSD) was 4.9 ± 5.1% (95% CI; 3.6 to 6.1%) at E T CO 2 = 45 mmHg compared with those at E T CO 2 = 40 mmHg. Spearman rank correlation analysis indicated that there were weak to moderate correlation between E T CO 2 and the optic nerve sheath diameter (correlation coefficient [p-value] = .355 [.004], .318 [.014], .373 [<.001], and .420 [<.001] in children aged <2 years, 2-6 years, 6-12 years, and 12-18 years, respectively). Conclusions: The optic nerve sheath diameter measured by transorbital ultrasound showed rapid reactivity from E T CO 2 35 to 45 mmHg in healthy pediatric patients under inhalation general anesthesia. How to cite this article: Jang Y-E, Nam SP, Ji S-H, et al. Effect of end-tidal carbon dioxide level on the optic nerve sheath diameter measured by transorbital ultrasonography in anesthetized pediatric patients: A randomized trial. Pediatr

Background: This study investigates the serial mediation of self-esteem and smartphone dependency in the relationship between negative parenting style and adolescents’ aggression.Methods: We conducted a secondary data analysis of the 2018 Korean Children and Youth Panel Survey (KCYPS) and used the data of first-year middle school students. A mediation analysis was conducted using Hayes’ SPSS PROCESS Macro (Model 6).Results: The mediation of smartphone dependency was significant in the relationship between parents’ negative parenting style and aggression, but the mediation of self-esteem was not. Negative parenting style significantly affected adolescents’ aggression through the sequential mediation of self-esteem and smartphone dependency.Conclusions: Appropriate interventions should be prepared to help adolescents increase their self-esteem and reduce smartphone dependency, thus reducing the aggression that a negative parenting style induces.

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