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This study investigates the relationship between perceptions of inequality, feelings of loneliness, and societal fragmentation in South Korea, focusing on their interconnected dynamics. The research emphasizes the social contexts in which loneliness emerges and exerts its influence. In the first phase, path analysis is employed to examine how perceived inequality contributes to societal fragmentation-manifested through disbelief, exploitation, and indifference-with loneliness serving as a mediating factor. The findings reveal a significant link between perceived inequality and loneliness, which, in turn, undermines social cohesion. The second phase delves deeper into this relationship by analyzing each regression model, further substantiating the connection between perceived inequality and loneliness and its role in shaping perceptions of societal fragmentation. In an era marked by rising economic inequality and democratic erosion, loneliness extends beyond an individual concern, posing broader implications for societal emotional health. The study underscores the urgent need for interventions aimed at reducing economic inequality and addressing loneliness to promote more cohesive societies., (© 2024. The Author(s).)

Background: Modification of health-related behaviors may improve clinical outcomes after acute myocardial infarction (AMI), but the need for systematic efforts to modify such behaviors and the estimated effect have not been investigated, especially in Asian populations. The aim of the study was to investigate changes in smoking and physical activity after AMI and their associations with death and recurrent revascularization., Methods and results: Using the Korean National Insurance Health Service database, we included 13,452 patients with AMI in 2011, who were stable until 1.5 years on average after onset. Patients were grouped according to their smoking status and physical activity before and after AMI. After AMI, 44.6% of smokers continued smoking and only 11.0% of inactive patients increased their physical activity to a sufficient level. The 'smoker/smoker' group and 'non-smoker/smoker' group showed higher mortality (hazard ratio (HR): 1.566, 95% confidence interval (CI): 1.192-2.035; HR: 1.785, 95% CI: 1.061-2.815, respectively). On the other hand, the 'active/active' group and 'inactive/active' group showed less mortality (HR: 0.625, 95% CI: 0.460-0.832; HR: 0.681, 95% CI: 0.438-1.009, respectively) and the 'inactive/active' group showed less recurrent revascularization (HR: 0.761, 95% CI: 0.599-0.952)., Conclusions: Smoking cessation and maintaining sufficient physical activity after AMI remain challenging for many Korean patients, and are associated with higher rates of mortality and recurrent revascularization. Systematic nationwide efforts such as cardiac rehabilitation (CR) to change health-related behaviors after AMI are required in Korea.