Experience and perspectives of end-of-life care discussion and physician orders for life-sustaining treatment of Korea (POLST-K): a cross-sectional study.

BACKGROUND: This study aimed to identify the healthcare providers' experience and perspectives toward end-of-life care decisions focusing on end-of-life discussion and physician's order of life-sustaining treatment documentation in Korea which are major parts of the Life-Sustaining Treatment Act. METHODS: A cross-sectional survey was conducted using a questionnaire developed by the authors. A total of 474 subjects-94 attending physicians, 87 resident physicians, and 293 nurses-participated in the survey, and the data analysis was performed in terms of frequency, percentage, mean and standard deviation using the SPSS 24.0 program. RESULTS: Study results showed that respondents were aware of terminal illness and physician's order of life-sustaining treatment in Korea well enough except for some details. Physicians reported uncertainty in terminal state diagnosis and disease trajectory as the most challenging. Study participants regarded factors (related to relationships and communications) on the healthcare providers' side as the major impediment to end-of-life discussion. Study respondents suggested that simplification of the process and more staff are required to facilitate end-of-life discussion and documentation. CONCLUSION: Based on the study results, adequate education and training for better end-of-life discussion are required for future practice. Also, a simple and clear procedure for completing a physician's order of life-sustaining treatment in Korea should be prepared and legal and ethical advice would be required. Since the enactment of the Life-Sustaining Treatment Act, several revisions already have been made including disease categories, thus continuous education to update and support clinicians is also called for.

Psychometric properties of the end-of-life care decision inventory (EOL-CDI): a mixed-methods study.

BACKGROUND: End-of-life care decision-making has become important to support dignity and quality of life for patients who are facing death in Korea, along with the enactment of the Life-Sustaining Treatment Act in 2018. However, it seems that the concepts and policies related to the law are not yet familiar to health care providers or the general public. This unfamiliarity can hinder efficient end-of-life care discussions. Therefore, the purpose of this study was to propose a valid and reliable tool to explore the level of understanding of concepts and attributes related to end-of-life care decisions. METHODS: This is a mixed-methods study design. A relevant law and literature analysis, expert consultation, cognitive interviews of 10 adults, and cross-sectional survey for psychometric tests using data from 238 clinical nurses were performed to update a tool developed before the life-sustaining treatment Act was enacted in Korea. RESULTS: 29 items of the draft version were polished in terms of literacy, total length, and scoring method via cognitive interviews and finalized into 21 items through psychometric tests and expert consultations. The 21 items conformed to the Rasch unidimensional paramenters. CONCLUSION: A tool to identify the level of understanding of concepts related to end-of-life care decisions was proposed through a rather rigorous process to ensure feasibility and validity/reliability. We recommend the proposed tool to apply to the adult population and nurses for evaluation and educational purposes.

Nursing leaders' perceptions of the state of nursing leadership and the need for nursing leadership education reform: A qualitative content analysis from South Korea.

AIM: This study aimed to clarify nursing leaders' perceptions of nursing leadership education and practice. BACKGROUND: Leadership is an essential competency that is required in nursing practice. It is also necessary to pay more attention to the development of nurses' leadership to improve patient safety and outcomes. METHODS: Participants were 15 nursing leaders. We adopted qualitative content analysis for data collected through individual and/or focus group interviews and analysed using the process of coding, condensing and categorizing. RESULTS: The results revealed the following five major themes with categories: (1) nursing leadership-commitment to nurses, the nursing profession and the organisation; (2) nursing leadership abilities-competency and compatibility, personality and traits; (3) importance of nursing leadership education to enhance educational efficiency and to nurture next-generation nursing leaders; (4) difficulties in nursing leadership education: lack of perception and difficulty of implementation; and (5) strategies for nursing leadership education: contents and methods. CONCLUSIONS: Nursing leaders' perception of nursing leadership was extended to nurses, organisations and nursing professions. Competency, capability, innate personality and traits are required nursing abilities that are acquired through education. IMPLICATIONS FOR NURSING MANAGEMENT: Experience and theoretical-based nursing leadership education should be introduced gradually and systematically from the beginning of nurses' careers.

Emphysema Quantification Using Ultra-Low-Dose Chest CT: Efficacy of Deep Learning-Based Image Reconstruction.

Background and Objectives: Although reducing the radiation dose level is important during diagnostic computed tomography (CT) applications, effective image quality enhancement strategies are crucial to compensate for the degradation that is caused by a dose reduction. We performed this prospective study to quantify emphysema on ultra-low-dose CT images that were reconstructed using deep learning-based image reconstruction (DLIR) algorithms, and compared and evaluated the accuracies of DLIR algorithms versus standard-dose CT. Materials and Methods: A total of 32 patients were prospectively enrolled, and all underwent standard-dose and ultra-low-dose (120 kVp; CTDIvol < 0.7 mGy) chest CT scans at the same time in a single examination. A total of six image datasets (filtered back projection (FBP) for standard-dose CT, and FBP, adaptive statistical iterative reconstruction (ASIR-V) 50%, DLIR-low, DLIR-medium, DLIR-high for ultra-low-dose CT) were reconstructed for each patient. Image noise values, emphysema indices, total lung volumes, and mean lung attenuations were measured in the six image datasets and compared (one-way repeated measures ANOVA). Results: The mean effective doses for standard-dose and ultra-low-dose CT scans were 3.43 ± 0.57 mSv and 0.39 ± 0.03 mSv, respectively (p < 0.001). The total lung volume and mean lung attenuation of five image datasets of ultra-low-dose CT scans, emphysema indices of ultra-low-dose CT scans reconstructed using ASIR-V 50 or DLIR-low, and the image noise of ultra-low-dose CT scans that were reconstructed using DLIR-low were not different from those of standard-dose CT scans. Conclusions: Ultra-low-dose CT images that were reconstructed using DLIR-low were found to be useful for emphysema quantification at a radiation dose of only 11% of that required for standard-dose CT.

Imaging Characterization of Non-Rheumatoid Retro-Odontoid Pseudotumors: Comparison with Atlantoaxial Manifestation of Rheumatoid Arthritis.

Backgroundand Objectives: To date, imaging characterization of non-rheumatic retro-odontoid pseudotumors (NRROPs) has been lacking; therefore, NRROPs have been confused with atlantoaxial joint involvement of rheumatoid arthritis (RA). It is important to differentiate these two disease because the treatment strategies may differ. The purpose of this study is to characterize imaging findings of NRROPs and compare them with those of RA. Material and Methods: From January 2015 to December 2019, 27 patients (14 women and 13 men) with NRROPs and 19 patients (15 women and 4 men) with RA were enrolled in this study. We evaluated various imaging findings, including atlantoaxial instability (AAI), and measured the maximum diameter of preodontoid and retro-odontoid spaces with magnetic resonance imaging (MRI) and computed tomography (CT). Results: Statistical significance was considered for p < 0.05. AAI was detected in eight patients with NRROPs and in all patients with RA (p < 0.0001). Seventeen patients with NRROPs and six patients with RA showed spinal cord compression (p = 0.047). Compressive myelopathy was observed in 14 patients with NRROPs and in 4 patients with RA (p = 0.048). Subaxial degeneration was observed in 25 patients with NRROPs and in 9 patients with RA (p = 0.001). Moreover, C2-3 disc abnormalities were observed in 11 patients with NRROPs and in 2 patients with RA (p = 0.02). Axial and longitudinal diameter of retro-odontoid soft tissue and preodontoid and retro-odontoid spaces showed significant differences between NRROP and RA patients (p < 0.0001). Furthermore, CT AAI measurements were differed significantly between NRROP and RA patients (p < 0.05). Conclusions: NRROPs showed prominent retro-odontoid soft tissue thickening, causing compressive myelopathy and a high frequency of subaxial and C2-3 degeneration without AAI.

Effect of upflow and downflow baffle configuration on particulate matter removal in a mirror-symmetrical multi-compartment scrubber.

Control over particulate matter (PM) emission from grilling is required for improving public health and air quality. The performance of mirror-symmetrical multi-compartment scrubbers with an upflow (U-type) and downflow baffle (D-type) configuration was evaluated for PM emission control from grilling at a flow rate of 30 m3 min-1. The PM removal efficiency of the U-type scrubber was the highest when the water level was 8 cm (95.6%), and the pressure drops recorded at the water levels of 6, 8 and 10 cm were 103, 122 and 153 mmH2O, respectively. Although PM removal efficiency of the D-type scrubber was over 91.0% at the water levels of 8, 10 and 12 cm, the pressure drops were 124, 142 and 185 mmH2O, respectively. A comprehensive evaluation of the water volume, pressure drop and PM removal performance, as well as device size, revealed that the U-type scrubber with a PM removal efficiency of 92% or higher and a pressure drop of 122 mmH2O or lower at the water levels of 6-8 cm was more economical for removing PM from grilling gas than the D-type scrubber.

Risk Factors for Obesity Among Children Aged 24 to 80 months in Korea: A Decision Tree Analysis.

PURPOSE: The purpose of this study was to examine the multiple intergenerational risk factors of obesity among children aged 24 to 80 months using national cohort data. DESIGN AND METHODS: This is a retrospective longitudinal cohort study using the Korean National Health Insurance (KNHI) database, and the number of study participants was 1,001,775 families. Social-Economic Status (SES), parental and child-related factors were examined. Descriptive statistics and Chi-squared Automatic Interaction Detection (CHAID) for a decision tree analysis were conducted. RESULTS: The prevalence of obesity was 6.57%, and that of overweight was 11.31% among the entire study population. The 17 groups with a prevalence of childhood obesity higher than the mean prevalence rate were classified as high-risk groups for childhood obesity; there were 6 groups with a prevalence of childhood obesity twice as high as the mean prevalence rate from this study. The best predictors were as follows: mothers being obese prior to conception, fathers being obese, non- medical aid beneficiaries, and mothers with hypertension during gestation. CONCLUSIONS: The best predictors of children obesity were parental obesity history and SES. Other parental predictors of outcomes were gestational hypertension and diabetes, older pregnancy, drinking during gestation, and depression after delivery. Child-related outcome predictors were noncompliance with exclusive breastfeeding, a sugar-sweetened beverage intake ≥200 ml per day, and irregular breakfast consumption. PRACTICE IMPLICATIONS: These findings could help community health nurses assess high-risk groups for early childhood obesity and develop or provide effective interventions in the early stages of life.

Overweight or obesity in children aged 0 to 6 and the risk of adult metabolic syndrome: A systematic review and meta-analysis.

AIMS AND OBJECTIVES: To identify an association between overweight or obesity in early childhood and metabolic syndrome in adults. BACKGROUND: Early childhood overweight or obesity is important because it can predict metabolic syndrome in adulthood. A longer period of overweight or obesity leads to the accumulation of more risk factors. However, there are insufficient and inconsistent studies on this issue. DESIGN: A systematic review and meta-analysis. METHODS: We followed the Meta-Analysis of Observational Studies in Epidemiology guideline, MEDLINE, EMBASE, Cochrane library and CINAHL electronic databases as well as reference lists of included studies were searched, without published date restriction. We used the Newcastle-Ottawa Scale to assess the quality of the observational studies in the systematic review, and the meta-analysis was performed using random-effects models. RESULTS: All of the included studies were published from 2008-2014, and the participants of this study were only Asians or Europeans. A total of 12 results from five studies were included in the meta-analysis. Overweight or obesity in early childhood was associated with a higher risk of adult metabolic syndrome compared with the controls. When confirmed in each age group (at birth, 0-2 and 2-6 years), there was a statistically significant difference before and after the age of 2 years. As a result of the meta-regression, when the age of the children increased, the effect size of adult metabolic syndrome for overweight or obesity also increased. CONCLUSIONS: The results confirm that the aetiology of metabolic syndrome includes long-term impacts from the early stage of life and indicate that early intervention for overweight or obesity is needed. RELEVANCE TO CLINICAL PRACTICE: these findings could help community and clinical health nurses recognize the risk of overweight or obesity in early life, and provide evidence to develop and implement the preventive intervention for early childhood.

(E)-3-(3-methoxyphenyl)-1-(2-pyrrolyl)-2-propenone displays suppression of inflammatory responses via inhibition of Src, Syk, and NF-κB.

(E)-3-(3-methoxyphenyl)-1-(2-pyrrolyl)-2-propenone (MPP) is an aldol condensation product resulting from pyrrole-2-carbaldehyde and m- and p- substituted acetophenones. However, its biological activity has not yet been evaluated. Since it has been reported that some propenone-type compounds display anti-inflammatory activity, we investigated whether MPP could negatively modulate inflammatory responses. To do this, we employed lipopolysaccharide (LPS)-stimulated macrophage-like RAW264.7 cells and examined the inhibitory levels of nitric oxide (NO) production and transcriptional activation, as well as the target proteins involved in the inflammatory signaling cascade. Interestingly, MPP was found to reduce the production of NO in LPS-treated RAW264.7 cells, without causing cytotoxicity. Moreover, this compound suppressed the mRNA levels of inflammatory genes, such as inducible NO synthase (iNOS) and tumor necrosis factor (TNF)-α. Using luciferase reporter gene assays performed in HEK293 cells and immunoblotting analysis with nuclear protein fractions, we determined that MPP reduced the transcriptional activation of nuclear factor (NF)-κB. Furthermore, the activation of a series of upstream signals for NF-κB activation, composed of Src, Syk, Akt, and IκBα, were also blocked by this compound. It was confirmed that MPP was able to suppress autophosphorylation of overexpressed Src and Syk in HEK293 cells. Therefore, these results suggest that MPP can function as an anti-inflammatory drug with NF-κB inhibitory properties via the suppression of Src and Syk.

Risk stratification model in elderly patients with multiple myeloma: clinical role of magnetic resonance imaging combined with international staging system and cytogenetic abnormalities.

The International Staging System (ISS) does not take into consideration the clinical role of imaging modalities in multiple myeloma (MM), even though these are important. Some studies have indicated a lack of impact of ISS in MM patients who receive novel agents. Therefore, accessible novel risk stratification might be needed in elderly MM patients receiving conventional therapy or novel agents. We analyzed 198 newly diagnosed and symptomatic MM patients who were not eligible for transplantation. The initial treatment regimen was therapy with melphalan-prednisone (MP, n = 44), thalidomide-cyclophosphamide-dexamethasone (n = 89) or bortezomib-MP (VMP, n = 65). The magnetic resonance imaging (MRI) pattern was normal in 34 patients, focal in 30 and diffuse/variegated in 134. High-risk cytogenetic abnormalities were not associated with the diffuse/variegated MRI pattern (p = 0.182). ISS stage III [progression-free survival (PFS) p = 0.005; overall survival (OS) p = 0.027], high-risk cytogenetic abnormalities (PFS p = 0.001; OS p < 0.001) and diffuse/variegated MRI pattern (PFS p < 0.001; OS p < 0.001) were independently associated with poorer PFS and OS. Patients were further stratified according to the 3 prognostic factors. The PFS and OS of the 3 groups differed significantly. The addition of the diffuse/variegated MRI pattern may improve the prognostic potential of the current staging system which includes ISS and cytogenetic abnormalities.

Magnetic resonance imaging pattern of bone marrow involvement as a new predictive parameter of disease progression in newly diagnosed patients with multiple myeloma eligible for autologous stem cell transplantation.

We investigated the prognostic value of the magnetic resonance imaging (MRI) pattern of bone marrow involvement in patients with multiple myeloma (MM) eligible for autologous stem cell transplantation (ASCT). 126 patients with untreated MM indicated for ASCT underwent spine MRI and cytogenetic analysis at diagnosis. All patients received ASCT after induction therapy of VAD (vincristine, doxorubicin, dexamethasone; n = 55) or a thalidomide-based regimen (TCD; n = 71). Thalidomide maintenance therapy was performed in 68 patients. The MRI pattern was normal in 27, focal in 47, and diffuse/variegated in 52 patients. Patients with the diffuse/variegated pattern showed significantly higher stage (P = 0·038), higher ß-2 microglobulin level (P = 0·001) and severe anaemia (P = 0·015). However, the cytogenetics were not different among the MRI patterns (P = 0·890). Progression-free survival (PFS) was lower in the diffuse/variegated pattern (P = 0·002) than other patterns, but not overall survival (OS) (P = 0·058). Thalidomide maintenance therapy was correlated only with PFS (P = 0·001). High-risk cytogenetics were associated with both poorer PFS (P < 0·001) and OS (P = 0·003). In a multivariate analysis, the diffuse/variegated MRI pattern was an independent predictor of disease progression (Hazard Ratio, 1·922; 95% confidence interval, 1·185-3·118; P = 0·008). The diffuse/variegated MRI pattern is a novel prognostic factor for disease progression in MM patients eligible for ASCT.

Factors influencing children's emotional and behavioral problems perceived by North Korean refugee mothers: a descriptive study.

PURPOSE: The study investigated the relationships between key variables, including the level of parenting knowledge, acculturative stress, depression, and the strengths and difficulties associated with their children's emotions and behavior, among North Korean refugee mothers who faced the challenging task of adapting to Korean society while raising their children. METHODS: A descriptive study design was used. Data were collected from 130 North Korean refugee mothers between September and November 2023. RESULTS: The participants had very limited parenting knowledge, and 82.3% of them scored 21 or higher on the depression scale used in community epidemiological studies. Higher levels of parenting knowledge and lower levels of depression were associated with lower levels of acculturative stress. Moreover, higher levels of depression were associated with more emotional and behavioral difficulties in children. Maternal depression, age, and employment status were identified as factors that influenced emotional and behavioral problems in preschool-aged children. CONCLUSION: These findings underscore the importance of providing parent education and mental health support programs for North Korean refugee families in order to improve parents' parenting skills and emotional well-being.

Sexual Knowledge, Sexual Attitudes, and the Need for Sex Education Among Adolescent Defectors From North Korea.

INTRODUCTION: Adolescent North Korean defectors are vulnerable due to harmful environments during defection, limited access to sex education in North Korea, and exposure to different sexual norms in South Korea. The purpose of this study was to investigate the sexual knowledge, attitudes, and sex education needs of North Korean refugee adolescents. METHODS: A cross-sectional, descriptive survey was administered to 102 North Korean refugee adolescents. RESULTS: The correct answer rate for questions on genital anatomy, physiology, masturbation, and contraception was less than 20%. The participants exhibited conservative attitudes toward female contraception, masturbation, and having friends of the opposite sex. A significant positive correlation was found between knowledge and the need for sex education. DISCUSSION: These results highlight the importance of tailored sex education in providing accurate information, improving sexual knowledge, fostering positive attitudes, and enabling healthy behaviors among adolescent North Korean defectors.

Knowledge, confidence, and educational needs of newborn care among North Korean refugee women: a descriptive study.

PURPOSE: North Korean refugee women struggle with the double burden of adaptation and parenting as mothers in a new environment. This study aimed to identify the knowledge, confidence, and educational needs regarding newborn care among North Korean refugees, and to determine differences between these variables according to participants' characteristics. METHODS: Data were collected from September to October 2022, and 150 North Korean refugee women recruited using convenience sampling participated in the study. Descriptive statistics, the t-test, analysis of variance, and Pearson correlation analysis were used for data analysis. RESULTS: The mean scores were as follows: parenting knowledge, 14.97 out of 25; infection prevention knowledge and confidence, 20.09 out of 33 and 51.37 out of 80, respectively; and educational needs, 245.86 out of 310. Significant differences were observed in newborn care, knowledge, and confidence according to maternal age, educational level, family structure, and pregnancy history. Significant positive correlations were observed between the participants' newborn care knowledge, confidence, and educational needs. CONCLUSION: Personalized educational programs should be implemented to enhance North Korean refugee women's confidence in newborn care, focusing on areas with low knowledge levels and high educational needs and enabling women to achieve healthy pregnancy and childbirth, and to parent well.

Knowledge of atopic dermatitis and food allergies, as well as health information literacy, among North Korean refugee mothers: a descriptive survey study.

PURPOSE: This study investigated knowledge of atopic dermatitis and food allergies, as well as health information literacy, among North Korean refugee mothers with preschool-age children and explored how these variables were related to participants' characteristics. METHODS: A descriptive study design was used. Data from 130 North Korean refugee mothers were collected between January and March 2023. RESULTS: The mean scores were 14.48 of 30 for atopic dermatitis knowledge; 2.77 of 10 for food allergy knowledge, and 56.95 of 80 for health information literacy. Significant differences were observed in knowledge of atopic dermatitis based on breastfeeding duration (F=4.12, p=.009), and in knowledge of food allergies based on mixed feeding (F=3.11, p=.049). Health information literacy showed significant relationships with education level (F=3.76, p=.026), occupation (F=3.99, p=.021), checking nutritional information (t=2.91, p=.004), mixed feeding (F=4.50, p=.014), and atopic dermatitis diagnosis (t=6.86, p=.001). Significant positive correlations were observed between atopic dermatitis knowledge, food allergy knowledge, and health information literacy. CONCLUSION: Personalized educational programs should be implemented to improve awareness of allergies and health information literacy among North Korean refugee mothers, which would help them find, evaluate, and understand health-related information. These programs should focus on providing nutrition and dietary education to promote healthy growth in children and prevent diseases.

The mediating effects of social support on the influencing relationship between grit and academic burnout of the nursing students.

AIM(S): This study aimed to examine the social supports' mediating effects on the relationship between grit and academic burnout in nursing students. DESIGN: This was a descriptive study. METHODS: This study was conducted in two nursing departments in Korea, utilizing a convenience sample of 158 nursing students. Data were analysed using hierarchical multiple regression analysis and bootstrapping to verify the mediation effect. RESULTS: The grit's direct effect on academic burnout and indirect effect with social support on academic burnout were statistically significant. Social support mediated the relationship between grit and academic burnout. Social support can improve grit and reduce academic burnout. Social support programs for nursing students should be implemented to prevent/reduce academic burnout.

Factors influencing suicidal tendencies during COVID-19 pandemic in Korean multicultural adolescents: a cross-sectional study.

BACKGROUND: There is concern that the COVID-19 pandemic has had a negative impact on the psychological wellbeing of many populations, including increase of fear, anxiety, and uncertainty. Since the start of the COVID-19 pandemic, adolescents specifically have experienced direct and indirect impacts on their mentally, resulting in severe depression, self-harm and suicide. This study aimed to identify factors influencing suicidal tendencies and the mental health status of multicultural adolescents in Korea during the COVID-19 pandemic. METHODS: This cross-sectional study was conducted with 784 multicultural adolescents (Korean fathers and foreign mothers) who participated in the 16th national Korean Youth Risk Behaviour online survey. Research variables were measured using self-reported questionnaires for mental health and suicidal tendencies. Data was analysed using SPSS 26.0 program. RESULTS: The factors influencing suicidal tendencies (contemplating suicide, suicidal plans, and suicide attempts) were sexual intercourse experience (adjusted odds ratio [aOR], 7.67, 5.04, 7.10), depressive mood (aOR 1.03, 0.98, 0.97, 0.90), and unhappiness (aOR 13.00, 7.28, 5.56). CONCLUSIONS: In conclusion, the factors that affect suicidal tendencies showed sexual intercourse experience, depressive mood and unhappiness. Screening for suicidal tendencies and suicide prevention programs that consider the significant factors that affect suicidal tendencies should be developed for multicultural adolescents. School health professions and mental health counselors at schools need to emphasize the mental health and psychosocial support needs of senior high school students.

Effects of parenting education programs for refugee and migrant parents: a systematic review and meta-analysis.

PURPOSE: This systematic review and meta-analysis investigated the effects of parenting education programs (PEPs) for refugee and migrant parents. METHODS: A systematic review was conducted according to PRISMA guidelines. Relevant studies published from 2000 to 2020 were identified through a systematic search of six electronic databases (PubMed, Embase, Cochrane Library, CINAHL, RISS, KMBASE). A meta-analysis of the studies was then undertaken. RESULTS: Of the 14,996 published works identified, 23 studies satisfied the inclusion criteria, and 19 studies were analyzed to estimate the effect sizes (standardized mean differences) of the PEPs using random-effect models. PEPs were effective for parenting efficacy (effect size [ES]=1.40; 95% confidence interval [CI]: 1.14-1.66), positive parenting behaviors (ES=0.51; 95% CI: 0.30-0.73), parent-child relationships (ES=0.38; 95% CI: 0.22-0.53), and parenting stress (ES=0.64; 95% CI: 0.50-0.79). There were statistically significant differences in the effect sizes of PEPs that included mothers only (ES=0.93), included children under 7 years of age(ES=0.91), did not include child participation (0.77), continued for 19 or more sessions (ES=0.80), and were analyzed in quasi-experimental studies (ES=0.86). The overall effect of publication bias was robust. CONCLUSION: PEPs were found to be effective at improving parenting efficacy, positive parenting behaviors, parent-child relationships, and parenting stress.

The multiple mediating effects of grit and learning agility on academic burnout and learning engagement among Korean university students: a cross-sectional study.

INTRODUCTION: This article reports the results of a study conducted to assess the mediating effects of grit and learning agility on the relationship between academic burnout and learning engagement among undergraduate students. METHODS: A cross-sectional survey was conducted using a self-report questionnaire. Undergraduate students (N = 344) were recruited from one university in South Korea (58.0% female; average age 21.43) to complete assessments of academic burnout, grit, learning agility, and learning engagement. Data were analysed using descriptive statistics, Pearson's correlation coefficient, hierarchical regression and bootstrapping to verify the multiple parallel mediation effect. RESULTS: We found that the direct effect of academic burnout on learning engagement (B= -0.26, p<.001) and the indirect effect of academic burnout as mediated by learning agility (B= -0.13; 95% CI, -0.20∼-0.06) were significant. This finding confirmed that 33.3% of the total effect of academic burnout on learning engagement was the result of indirect effects via learning agility. CONCLUSION: These results indicate the necessity of developing an educational programme that focuses not only on reducing academic burnout but also on improving learning agility to increase undergraduate students' learning engagement. This study contributes to the development of a curriculum aimed at increasing the effectiveness of university education, promoting learning engagement, and reducing academic burnout.KEY MESSAGEOur study reports that academic burnout has both a direct effect on learning engagement and an indirect effect via learning agility. Learning agility mediates the relationship between academic burnout and learning engagement among undergraduate students.Although grit has been reported by many previous studies to mediate the relationship between the tendency to pursue happiness and the willingness to continue learning and effectively improving one's academic achievement and ability, our study did not find any mediating effect via grit in this context.