Addressing Digital Literacy in Telehealth Interventions for Persons with Dementia.

As telehealth reshapes healthcare, the landscape for persons with dementia and their caregivers is rapidly evolving. Our scoping review examines how digital health equity was addressed or examined in the context of telehealth interventions among PwD and their family caregivers. We conducted a scoping review and used four electronic databases, PubMed, CINHAL, Embase, and Scopus, using combinations of keywords including "digital literacy," "caregivers," and "dementia." We analyzed 8 studies that met the inclusion criteria. Almost half of the studies were descriptive studies and have emphasized the importance of educating digital inclusiveness to all stakeholders including nurses.

Resilience and coping: a qualitative analysis of cognitive and behavioral factors in adults with osteogenesis Imperfecta.

PURPOSE: The aim of this qualitative study was to investigate resilience among adults with Osteogenesis Imperfecta (OI). MATERIALS AND METHODS: Semi-structured interviews were conducted with 15 adults with OI. Transcripts were coded and subsequently abstracted, yielding themes specific to resilience and coping. Interview guides covered broad topics including pain challenges specific to OI, mental health issues related to OI, and priorities for future interventions for individuals with OI. RESULTS: Participants described resilience in the context of OI as the ability to grow from adversity, adapt to challenges resulting from OI-related injuries, and find identities apart from their condition. Psychological coping strategies included acceptance, self-efficacy, cognitive reframing, perspective-taking, and positivity. Behavioral factors that helped participants develop resilience included developing new skills, pursuing meaningful goals, practicing spirituality, and seeking external resources such as psychotherapy, education, and connection with community. CONCLUSION: Having identified how adults with OI define resilience and the strategies they use to cope, we can now develop interventions and guide healthcare providers in improving psychological wellbeing in this population.

Adults with Osteogenesis Imperfecta (OI) employ resilience factors to combat mobility and pain-related issues.Adults with OI report developing adaptive skills to cope with their disease, including forming one's identity outside of OI, growing through adversity, overcoming challenges resulting from OI-related injury, employing psychological adaptations, and practicing behavioral coping strategies.Resiliency factors such as behavioral and psychological coping (e.g., exercise, breathing strategies, acceptance) may buffer against OI-related challenges, and treatment modalities that foster these activities may be beneficial for adults with OI.

Survival and Risk Factors for Mortality in Infants With Congenital Heart Disease in South Korea.

BACKGROUND/AIM: The survival of patients with congenital heart disease (CHD) has dramatically improved over recent decades. However, a disparity exists depending on the country and medical system. This study aimed to analyze the survival of infants with CHD until the age of 18 years using large-scale population data in South Korea and investigate the effect of neonatal conditions at birth. PATIENTS AND METHODS: We retrospectively extracted the Korean National Health Insurance Service claims data from January 2002 to December 2020. We included patients diagnosed with CHD who were less than one year of age. The follow-up duration was until their death or until they were censored before the age of 18 years. The CHD lesions were classified hierarchically (conotruncal, severe non-conotruncal, coarctation of the aorta, ventricular septal defect, atrial septal defect, and others). Several neonatal conditions were adopted as risk factors. RESULTS: Overall, 127,958 infants had been diagnosed with CHD and 2,275 died before the age of 18 years. The survival rate of infants with CHD during childhood was 97.9%. The highest childhood mortality rate was associated with non-conotruncal defects (19.7%), followed by conotruncal defects (10.2%). The significant risk factors for childhood mortality were complex CHD, pulmonary hypertension, birth asphyxia, small for gestational age, respiratory distress, pulmonary hemorrhage, bronchopulmonary dysplasia, and convulsions. CONCLUSION: The survival of infants with CHD has been favorable in South Korea. Several neonatal conditions are risk factors for childhood mortality. Individualized risk assessment and optimal treatment strategies may help improve their survival rate.

Risk factors and outcomes of vitamin D deficiency in very preterm infants.

BACKGROUND: Vitamin D is essential for bone health and immune system. Vitamin D deficiency (VDD) poses a high-risk to very preterm (VP) infants. This study aimed to evaluate the risk factors associated with VDD in VP infants and its potential clinical outcomes. METHODS: A retrospective cohort study was conducted on VP infants admitted to the neonatal intensive care unit of a specialized tertiary hospital in Seoul, Republic of Korea, between January 2018 and June 2022. Serum 25-hydroxyvitamin D (25(OH)D) levels and other biochemical parameters were measured between 4 and 6 weeks of age. VDD was defined as a serum 25(OH)D level <20 ng/mL. Prenatal and postnatal risk factors and clinical outcomes were compared between the VDD and non-VDD groups. RESULTS: Of the 82 VP infants analyzed, 27 (32.9%) were diagnosed with VDD. The VDD group exhibited a significantly longer duration of parenteral nutrition (PN) compared to the non-VDD group (adjusted odds ratio [OR] = 1.12; 95% confidence interval [CI]: 1.008-1.245). Breast milk intake was lower in the VDD group than in the non-VDD group (adjusted OR = 0.976, 95% CI, 0.955-0.999). Notably, calcium levels were significantly lower in the VDD group, while parathyroid hormone levels were significantly higher, compared with the non-VDD group. Additionally, the rickets severity score was higher in the VDD group than in the non-VDD, although the difference was not statistically significant. CONCLUSIONS: Prolonged PN duration and low breast milk intake significantly increased the risk of VDD in VP infants.

Psychosocial Outcomes of Pain and Pain Management in Adults with Osteogenesis Imperfecta: A Qualitative Study.

Osteogenesis imperfecta (OI) is a genetic disorder characterized by bone fragility and fractures, short stature, dental abnormalities, hearing loss, scoliosis, and chronic pain. Despite a growing literature on the functional outcomes of OI, limited research has explicitly examined the psychosocial outcomes of pain within OI. Adults with OI (N = 15) were interviewed to understand pain-related experiences through a thematic analysis of semi-structured interview data. Research team members, genetic research experts, and OI clinicians developed an interview guide focused on topics related to pain and mental health challenges. Participants' transcripts were coded by two independent coders; codes were then merged across coders and quotation outputs were subsequently abstracted (paraphrased then thematically classified) to identify common themes. Themes related to pain management variability regarding pain type, pain risk management and accessibility, pain outcomes (e.g., behavior, cognitive, affective), and pain exacerbating factors (e.g., individual, contextual) were identified. Participants reported chronic and acute pain, and despite the inaccessibility and stigmatization of pain medications (e.g., opioids), pharmacological treatments were the most common pain management approach. Participants reported negative pain outcomes, such as limited daily functioning and activity participation, fear, anger, anxiety, depression, and difficulty concentrating. Lastly, participants suggested that lack of physician and community knowledge on chronic pain in OI indirectly exacerbates both subjective pain intensity and outcomes. Although limited by a small, nondiverse sample, the current study provides valuable exploration of the unique pain experiences of adults with OI that may have implications for proactive management, treatment development, and clinician training.

Characteristics of Telehealth Interventions for Adult Patients with Chronic Pain and Family Care Partners.

Objectives: This review aimed to assess characteristics of telehealth in pain management for adult patients with chronic pain and their family care partners and review current evidence of the effectiveness of telehealth for pain management. Based on the Revised Symptom Management model, this review identified types of chronic pain management strategies and symptom management outcomes delivered by telehealth. Methods: We conducted a systematic review of four electronic databases, PubMed, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and Embase, using combinations of keywords, including "telehealth," "caregivers," and "pain." Only interventions delivered online, including websites, mobile applications, phone calls, and videoconferencing, were included. To accurately characterize the features of each telehealth pain intervention, we employed a standardized checklist. Additionally, a summary table of the evidence was created. Results: We analyzed 17 studies that met the inclusion criteria, of which 14 were randomized controlled trials, 1 was a cohort study, and 2 were qualitative cohort studies. We grouped interventions based on content of the intervention for pain management (education, psychotherapy, reporting and consultation, and multicomponent intervention). The quality rating of studies was mostly moderately strong. Findings of interventions' effectiveness were showing heterogenous effects on variables, possibly due to different pain measurements and varying follow-up times. Significance of Results: Telehealth interventions can potentially increase access to care for patients with chronic pain and their families in a limited resource area. Telehealth technology is a feasible tool that may enhance clinicians' pain management efforts for patients with chronic pain and their family care partners. The results of this review can be used to guide telehealth pain assessment and evaluation for care partners, clinicians, and researchers and inform the design of future telehealth systems.

A qualitative exploration of patient perspectives on psychosocial burdens and positive factors in adults with osteogenesis imperfecta.

Osteogenesis imperfecta (OI) is a pleiotropic, heritable connective tissue disorder associated with a wide range of health implications, including frequent bone fracture. While progress has been made to understand the spectrum of these physical health implications, the impact of OI on psychosocial well-being, as well as protective factors that buffer against adverse psychosocial outcomes, remain understudied. This present study relies on a qualitative approach to assess patient perspectives on both protective and adverse psychosocial factors specific to OI in 15 adults with varying disease status. Semi-structured interviews were conducted, subsequently coded, and themes extracted. Themes concerning psychosocial burdens (i.e., negative affective and behavioral impacts of disease status) and protective factors were identified from cooperatively-coded transcripts (two coders per transcript). Participants reported experiencing an increase in negative affect and disease-related distress after fracturing a bone and during recovery. Fear and concern specific to the uncertainty of future bone fractures and negative self-image was common. In contrast to these negative impacts, participants additionally described positive orientations toward their disease and attributed positive traits to their lived experience with a chronic disease. While limited due to small sample size and lack of ethno-racial diversity, findings highlight a need for continued research on the relationship between OI disease status and psychosocial outcomes, as well as the development of psychological interventions designed for OI populations. Findings have relevant clinical applications for healthcare providers working with those diagnosed with OI.

Machine learning-based risk factor analysis of necrotizing enterocolitis in very low birth weight infants.

This study used machine learning and a national prospective cohort registry database to analyze the major risk factors of necrotizing enterocolitis (NEC) in very low birth weight (VLBW) infants, including environmental factors. The data consisted of 10,353 VLBW infants from the Korean Neonatal Network database from January 2013 to December 2017. The dependent variable was NEC. Seventy-four predictors, including ambient temperature and particulate matter, were included. An artificial neural network, decision tree, logistic regression, naïve Bayes, random forest, and support vector machine were used to evaluate the major predictors of NEC. Among the six prediction models, logistic regression and random forest had the best performance (accuracy: 0.93 and 0.93, area under the receiver-operating-characteristic curve: 0.73 and 0.72, respectively). According to random forest variable importance, major predictors of NEC were birth weight, birth weight Z-score, maternal age, gestational age, average birth year temperature, birth year, minimum birth year temperature, maximum birth year temperature, sepsis, and male sex. To the best of our knowledge, the performance of random forest in this study was among the highest in this line of research. NEC is strongly associated with ambient birth year temperature, as well as maternal and neonatal predictors.

Machine learning-based risk factor analysis of adverse birth outcomes in very low birth weight infants.

This study aimed to analyze major predictors of adverse birth outcomes in very low birth weight (VLBW) infants including particulate matter concentration (PM10), using machine learning and the national prospective cohort. Data consisted of 10,423 VLBW infants from the Korean Neonatal Network database during January 2013-December 2017. Five adverse birth outcomes were considered as the dependent variables, i.e., gestational age less than 28 weeks, gestational age less than 26 weeks, birth weight less than 1000 g, birth weight less than 750 g and small-for-gestational age. Thirty-three predictors were included and the artificial neural network, the decision tree, the logistic regression, the Naïve Bayes, the random forest and the support vector machine were used for predicting the dependent variables. Among the six prediction models, the random forest had the best performance (accuracy 0.79, area under the receiver-operating-characteristic curve 0.72). According to the random forest variable importance, major predictors of adverse birth outcomes were maternal age (0.2131), birth-month (0.0767), PM10 month (0.0656), sex (0.0428), number of fetuses (0.0424), primipara (0.0395), maternal education (0.0352), pregnancy-induced hypertension (0.0347), chorioamnionitis (0.0336) and antenatal steroid (0.0318). In conclusion, adverse birth outcomes had strong associations with PM10 month as well as maternal and fetal factors.

Direct swallowing training and oral sensorimotor stimulation in preterm infants: a randomised controlled trial.

OBJECTIVE: To evaluate the effects of direct swallowing training (DST) alone and combined with oral sensorimotor stimulation (OSMS) on oral feeding ability in very preterm infants. DESIGN: Blinded, parallel group, randomised controlled trial (1:1:1). SETTING: Neonatal intensive care unit of a South Korean tertiary hospital. PARTICIPANTS: Preterm infants born at <32 weeks of gestation who achieved full tube feeding. INTERVENTIONS: Two sessions per day were provided according to the randomly assigned groups (control: two times per day sham intervention; DST: DST and sham interventions, each once a day; DST+OSMS: DST and OSMS interventions, each once a day). PRIMARY OUTCOME: Time from start to independent oral feeding (IOF). RESULTS: Analyses were conducted in 186 participants based on modified intention-to-treat (63 control; 63 DST; 60 DST+OSMS). The mean time from start to IOF differed significantly between the control, DST and DST+OSMS groups (21.1, 17.2 and 14.8 days, respectively, p=0.02). Compared with non-intervention, DST+OSMS significantly shortened the time from start to IOF (effect size: -0.49; 95% CI: -0.86 to -0.14; p=0.02), whereas DST did not. The proportion of feeding volume taken during the initial 5 min, an index of infants' actual feeding ability when fatigue is minimal, increased earlier in the DST+OSMS than in the DST. CONCLUSIONS: In very preterm infants, DST+OSMS led to the accelerated attainment of IOF compared with non-intervention, whereas DST alone did not. The effect of DST+OSMS on oral feeding ability appeared earlier than that of DST alone. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT02508571).

Head growth during neonatal intensive care unit stay is related to the neurodevelopmental outcomes of preterm small for gestational age infants.

BACKGROUND: To investigate postnatal growth patterns and their relationship with the neurodevelopment of preterm infants born small for gestational age (SGA). METHODS: This retrospective cohort study analyzed 90 infants born SGA with a birthweight <1500 g or gestational age <32 weeks. Length, weight, and head circumference (HC) were recorded at birth, 35 weeks postmenstrual age (PMA), 40 weeks PMA, and 4, 9, and 18 months corrected age (CA). Neurodevelopmental outcomes were assessed using the Bayley-III scales at 18 months CA. RESULTS: The Z-score of HC in SGA infants increased from birth to 40 weeks PMA. Failure of head growth catch-up to the 10th percentile by four months CA and all three parameters by nine months CA were associated with worse neurodevelopmental outcomes. Z-score changes in head growth between birth and 35 weeks PMA were significantly associated with neurodevelopmental outcomes (p = 0.006; adjusted odds ratio, 6.964; 95% confidence interval: 1.763-27.506). CONCLUSION: Head growth trajectory during neonatal intensive care unit stay is associated with neurodevelopmental outcomes in preterm SGA infants. If head growth catch-up is achieved by four months CA and length and weight catch-up by nine months CA, preterm SGA infants are predicted to have optimal neurodevelopment at 18 months CA.

A multicenter comparison of [18F]flortaucipir, [18F]RO948, and [18F]MK6240 tau PET tracers to detect a common target ROI for differential diagnosis.

PURPOSE: This study aims to determine whether comparable target regions of interest (ROIs) and cut-offs can be used across [18F]flortaucipir, [18F]RO948, and [18F]MK6240 tau positron emission tomography (PET) tracers for differential diagnosis of Alzheimer's disease (AD) dementia vs either cognitively unimpaired (CU) individuals or non-AD neurodegenerative diseases. METHODS: A total of 1755 participants underwent tau PET using either [18F]flortaucipir (n = 975), [18F]RO948 (n = 493), or [18F]MK6240 (n = 287). SUVR values were calculated across four theory-driven ROIs and several tracer-specific data-driven (hierarchical clustering) regions of interest (ROIs). Diagnostic performance and cut-offs for ROIs were determined using receiver operating characteristic analyses and the Youden index, respectively. RESULTS: Comparable diagnostic performance (area under the receiver operating characteristic curve [AUC]) was observed between theory- and data-driven ROIs. The theory-defined temporal meta-ROI generally performed very well for all three tracers (AUCs: 0.926-0.996). An SUVR value of approximately 1.35 was a common threshold when using this ROI. CONCLUSION: The temporal meta-ROI can be used for differential diagnosis of dementia patients with [18F]flortaucipir, [18F]RO948, and [18F]MK6240 tau PET with high accuracy, and that using very similar cut-offs of around 1.35 SUVR. This ROI/SUVR cut-off can also be applied across tracers to define tau positivity.

Antenatal magnesium sulfate and intestinal morbidities in preterm infants with extremely low gestational age.

BACKGROUND: Antenatal magnesium sulfate is widely used as a tocolytic, for maternal seizures, and for seizure prophylaxis in preeclampsia. Recent studies have suggested that antenatal magnesium sulfate use is associated with favorable neurodevelopmental outcomes in preterm infants. However, there are concerns regarding the effects of antenatal magnesium sulfate on neonates, especially regarding gastrointestinal morbidities. This study aims to explore the effects of antenatal magnesium sulfate on intestinal morbidities requiring surgery in preterm infants. METHODS: This was a retrospective cohort study of 181 preterm infants who were born at less than 28 weeks of gestational age. Subjects were categorized as infants exposed to antenatal magnesium sulfate and those not exposed to antenatal magnesium sulfate. RESULTS: Antenatal magnesium sulfate was associated with a decreased risk of surgical conditions of the intestine (OR 0.393, 95% CI 0.170-0.905). The multivariate analysis showed that the duration of antenatal magnesium sulfate use was associated with surgical conditions of the intestine (adjusted OR 0.766, 95% CI 0.589-0.997). In the <26 weeks of gestational age subgroup, the use of antenatal magnesium sulfate was significantly associated with decreased intestinal morbidities requiring surgery (adjusted OR 0.234, 95% CI 0.060-0.922). CONCLUSION: Antenatal magnesium sulfate use appears to have a protective effect on intestinal morbidities requiring surgery in preterm infants in a duration-dependent manner. Association of antenatal magnesium sulfate use and decreased intestinal morbidities requiring surgery was more distinct in preterm infants <26 weeks of gestational age.

Extrauterine growth restriction in extremely preterm infants based on the Intergrowth-21st Project Preterm Postnatal Follow-up Study growth charts and the Fenton growth charts.

Growth charts are essential for monitoring the postnatal growth of preterm infants. The preterm postnatal follow-up study (PPFS) of the Intergrowth-21st Project provides new growth standards based on a longitudinal study. This study was conducted to investigate the prevalence of extrautrine growth restriction (EUGR) and the associated factors of EUGR in preterm infants, using the PPFS charts and the Fenton charts. Data of 1,356 infants with gestational age (GA) less than 28 weeks from the Korean Neonatal Network were analysed. The prevalence of small for gestational age (SGA) of weight and length was higher with the Intergrowth charts than with the Fenton charts. EUGR in weight and length was more prevalent when using the Fenton charts. Multivariate analysis showed that low GA, high birthweight z score, male, treated patent ductus arteriosus (PDA), necrotizing enterocolitis, intraventricular haemorrhage and duration of parenteral nutrition (PN) were associated with EUGR in weight by the Intergrowth charts. High birthweight z score, treated PDA and PN duration were associated with EUGR defined by the Fenton charts.Conclusion: Compared to the Fenton charts, SGA was more defined and EUGR was less prevalent in extremely low gestational infants, while EUGR defined by the Intergrowth charts categorized infants with adverse clinical courses more elaborately. What is Known: • Preterm infants are at risk of postnatal growth restriction (PGR), although optimal postnatal growth is important for the long-term outcomes. • Growth charts are essential tools to monitor the postnatal growth of preterm infants. What is New: • PGR of weight and length were less defined with the Intergrowth charts than the Fenton charts. • PGR defined by the Intergrowth preterm postnatal follow-up study (PPFS) chart categorized preterm infants with morbidities more elaborately than the Fenton charts.

The ubiquitin ligase Cullin-1 associates with chromatin and regulates transcription of specific c-MYC target genes.

Transcription is regulated through a dynamic interplay of DNA-associated proteins, and the composition of gene-regulatory complexes is subject to continuous adjustments. Protein alterations include post-translational modifications and elimination of individual polypeptides. Spatially and temporally controlled protein removal is, therefore, essential for gene regulation and accounts for the short half-life of many transcription factors. The ubiquitin-proteasome system is responsible for site- and target-specific ubiquitination and protein degradation. Specificity of ubiquitination is conferred by ubiquitin ligases. Cullin-RING complexes, the largest family of ligases, require multi-unit assembly around one of seven cullin proteins. To investigate the direct role of cullins in ubiquitination of DNA-bound proteins and in gene regulation, we analyzed their subcellular locations and DNA-affinities. We found CUL4A and CUL7 to be largely excluded from the nucleus, whereas CUL4B was primarily nuclear. CUL1,2,3, and 5 showed mixed cytosolic and nuclear expression. When analyzing chromatin affinity of individual cullins, we discovered that CUL1 preferentially associated with active promoter sequences and co-localized with 23% of all DNA-associated protein degradation sites. CUL1 co-distributed with c-MYC and specifically repressed nuclear-encoded mitochondrial and splicing-associated genes. These studies underscore the relevance of spatial control in chromatin-associated protein ubiquitination and define a novel role for CUL1 in gene repression.

Differential Effect of Growth on Development between AGA and SGA Preterm Infants.

Predicting developmental outcomes with growth measurement would be beneficial for primary healthcare or in developing countries with low medical resources. This study aimed to identify physical growth measures that indicate neurodevelopment in very preterm infants. Preterm infants, born at <32 weeks' gestation or weighing <1500 g, were included. We calculated the changes in z-score of weight, length, and head circumference (HC) at different time points: birth, postmenstrual age (PMA) 35 weeks, and 4 and 18 months corrected age (CA). We examined the relationship between growth and Bayley-III scores using linear regression. Among 122 infants, HC at 4 months CA and HC growth between PMA 35 weeks and 4 months CA showed a positive correlation with Bayley-III scores in appropriate-for-gestational-age infants (AGAs). Weight and length increases between birth and 18 months CA were also associated with AGAs' development. In small-for-gestational-age infants (SGAs), only birthweight's z-score was associated with improved neurodevelopmental outcomes. HC at 4 months CA was an important indicator of favorable neurodevelopmental outcomes, and head growth spurt between PMA 35 weeks and 4 months CA contributed to this benefit in preterm AGAs. The period and indices should be monitored differently for SGAs and AGAs.

The Association of Pregnancy-induced Hypertension with Bronchopulmonary Dysplasia - A Retrospective Study Based on the Korean Neonatal Network database.

The prevalence of pregnancy-induced hypertension (PIH) and preeclampsia (PE) are 5-10% and 2-4%, respectively. PIH might affect angiogenesis in preterm neonates, but its association with bronchopulmonary dysplasia (BPD) remains controversial. This study evaluated the association between PIH and BPD in very low-birth weight infants. We retrospectively analysed the maternal, perinatal, and neonatal data of preterm infants born before 30 weeks of gestation, selected from the nationwide registry of very low-birth weight infants, between January 2013 and December 2014. As a result, 1,624 infants without maternal PIH (gestational age: 27.3 ± 1.8 weeks) and 203 infants with maternal PIH (28.0 ± 1.4 weeks, p < 0.001) were included. Birth weight was higher in the non-PIH group, compared with the PIH group (1027.4 ± 250.2 vs. 876.4 ± 261.5 g, p < 0.001). Multivariate logistic regression showed that PIH was associated with BPD (adjusted OR 1.474, 95% confidence interval 1.025-2.121), after adjusting for confounders, including small-for-gestation age (SGA). The result of present study is consistent with the current concept of BPD as an early form of pulmonary vascular disease, for both PIH and BPD are attributed by abnormal vascular formation.

Youth Suicide in Korea Across the Educational Stages.

Background: Youth suicides have diverse characteristics according to the young people's developmental stages. Warning signs and communication of suicidal intent can be vague among early adolescents, while mental health problems may be more evidently related to suicidal ideation in older adolescents. Understanding the developmental characteristics of youth suicide is necessary for effective suicide prevention. Aims: We explored the differences between children and adolescents who died by suicide and the characteristics of these young people as observed by their school teachers. Method: We analyzed teachers' mandatory postmortem reports of suicides among 308 Korean students. We compared: suicide-related information including personal, familial, and school factors; stressful life events; and participation in interventions among elementary, middle, and high school students who died by suicide. We also assessed the distribution of student suicides per month. Results: Suicide among elementary school students increased during school vacations, and suicide among middle and high school students increased during the school semester. According to the teachers' reports, elementary school students who died by suicide were more extroverted and had better academic achievements than their high school peers, and had significantly lower levels of substance/tobacco use. Elementary school students who died by suicide showed significantly less academic stress and use of external professional help than did other groups. Limitations: Because this research is based on mandatory teacher reports, the subjective opinions of teachers may have affected the reliability of the data. Suicide by out-of-school youth was not included. Conclusion: School-based suicide prevention should be implemented in accordance with young people's developmental characteristics.