Ten-year trends of antibiotics used for patients with pneumonia at long-term care hospitals in the Republic of Korea: An analysis based on national health insurance claims data.

Aim: To determine the trends in the usage of antimicrobial drugs by patients with pneumonia with prescriptions from long-term care (LTC) hospitals in the Republic of Korea. Method: This retrospective study was conducted from 2011 to 2022 using the National Health Insurance Review and Assessment Service claim data in Korea. We calculated antibiotic usage expressed as a daily defined dose (DDD) per 1000 patients per day (DID). Results: The number of patients with pneumonia in LTC hospitals increased by 2.7 times, from 30,000 in 2011 to 79,000 in 2022. Furthermore, antibiotic consumption per episode by patients with pneumonia in LTC hospitals increased from 17.14 DDD in 2011 to 18.11 DDD in 2022. Among the Access, Watch, and Reserve classification groups, the Watch group showed the highest usage; further, the Access group showed a decreasing trend, whereas the Watch and Reserve groups showed an increasing trend (p < 0.01). In the Watch group, the most commonly used antibiotic was J01CR05 (piperacillin and beta-lactamase inhibitor), followed in order by J01DD04 (ceftriaxone), J01MA12 (levofloxacin), and J01DH02 (meropenem). In the Reserve group, J01XB01 (colistin) and J01AA12 (tigecycline) were commonly used. Conclusion: The antibiotics prescribed for pneumonia in LTC hospitals have continuously increased the use of broad-spectrum antibiotics. Accordingly, appropriate use of antibiotics in LTC hospital settings and assessment of antibiotics used are warranted.

Physical Leisure Activities in Adolescents with Disabilities: Data from National Survey of Disabled Persons.

The impact of activities of daily living (ADLs) on the life satisfaction of adolescents with disabilities and the potential role of physical leisure activities as a moderator in this context have received attention. However, little is known about the influence of physical leisure activities on the relationship between ADLs and life satisfaction in adolescents with disabilities. This cross-sectional study aimed to investigate the moderating effect of physical leisure activities on the relationship between ADLs and life satisfaction among adolescents with disabilities. Secondary data analysis was conducted by extracting data from 5364 adolescents aged 12-18 years with disabilities from the 2020 National Survey of Disabled Persons of Korea. The potential moderating effect of physical leisure activities on the relationship between ADLs and life satisfaction was investigated using Pearson's correlation analysis and hierarchical multiple regression. Significant positive correlations were found for living, life satisfaction, and physical leisure activities. Physical leisure activities were found to play a moderating role in the relationship between ADLs and life satisfaction. This study concluded that increasing physical leisure activities, even with dependent ADLs, promotes life satisfaction, especially if ADLs are low, highlighting the necessity of increasing leisure activities in adolescents with disabilities.

Sleep-related problems as a mediator in the association between depression and work-family conflict in middle-aged female workers: A population-based study.

AIM: To investigate the mediating effect of sleep-related problems on the relationship between depression and work-family conflicts (WFCs) among middle-aged female workers. DESIGN: Secondary analysis of cross-sectional study. METHODS: Overall, 15,718 female workers aged 40-65 years from the Sixth Korean Working Conditions Survey (KWCS) were included. Depression was assessed using the WHO-5 wellbeing index; sleep-related problems and WFCs were measured with five items on a Likert scale. The mediating effect of sleep-related problems between depression and WFCs was analysed using model 4 of Hayes PROCESS macro for SPSS. RESULTS: There was a significant positive correlation between depression and both sleep-related problems (r = 0.225, p < 0.001) and WFCs (r = 0.124, p < 0.001). Depression also had a significant effect on sleep-related problems (ß = 0.221, p < 0.001) and WFCs (ß=0.061, p < 0.001). Sleep-related problems had a significant effect on WFCs (ß = 0.282, p < 0.001). The indirect effect of depression on WFCs by mediating sleep-related problems was ß = 0.062 (95% bootstrap confidence interval = 0.057-0.068). The study also confirmed the significance of the mediating effect of sleep-related problems in the relationship between depression and WFCs.

Mediators of the Effect of Obesity on Stroke and Heart Disease Risk: Decomposing Direct and Indirect Effects.

BACKGROUND: The prevalence of overweight and obesity are well known risk factors of atherosclerotic cardiovascular disease (ASCVD). We aimed to examine the association between body mass index (BMI) and ASCVD over a 23-year follow-up in young adults. We also qualified how much of the effects of obesity on ASCVD were mediated through blood pressure, cholesterol, and glucose. METHODS: Data are from the Korean Life Course Health Study, a cohort study of 226,955 Korean young adults aged 20-39. At baseline, the participants undertook routine health assessments where their BMI was measured in 1992-1994; and the metabolic mediators including systolic blood pressure (SBP), fasting serum glucose (FSG), and total cholesterol (TC) were re-measured in 2002-2004. The main outcomes of the study include incident events of ischemic heart disease (IHD), stroke, and ASCVD between 2005 and 2015. Cox proportional model was used to calculate adjusted hazard ratios (HRs) for ASCVD. RESULTS: In both men and women, the direct effect of BMI on ASCVD was greater than the indirect effect. The percentage of excess HR of BMI mediated by all of the metabolic mediators, including SBP, FSG, and TC, was 45.7% for stroke and 18.7% for IHD in men and 27.5% for stroke and 17.6% for IHD in women. CONCLUSION: High BMI in young adults increases the risk of metabolic mediators in their middle age, and metabolic mediators explain the adverse effects of high BMI on stroke risk than IHD risk.

Hand-to-Face Contact of Preschoolers during Indoor Activities in Childcare Facilities in the Republic of Korea.

PURPOSE: This study aimed to characterize hand-to-face contact (HFC) in children and analyze the factors that affect HFC behaviors of preschoolers in childcare facilities in Korea. METHODS: Thirty preschoolers aged between 13 and 84 months were enrolled with parents' voluntary participation. Videotaping (10 children/childcare center/2 h) and video reading was performed from 23 November 2018 to 7 January 2019. RESULTS: A total of 2719 cases of HFC were observed in 30 participants within 2 h. The average contact with the facial mucosa (frequency/person/2 h) was 55.6 ± 42.2, of which the mouth (25.4 ± 23.9), the nose (20.4 ± 24.5), and the eye (9.8 ± 11.7) were the most frequent contacts, in that order. The average contact duration (sec/person/2 h) with the facial mucosa was 232.6 ± 169.7, of which the mouth (145.2 ± 150), the nose (57.6 ± 62.2), and the eyes (29.7 ± 42.3) were the longest in that order. The density distribution of the frequency and duration of mucosal contact was wider in boys than in girls. The mucosal and non-mucosal contact frequencies were significantly higher in boys (p = 0.027 and p = 0.030, respectively). CONCLUSION: Children's HFC frequency and duration were highest for the mouth, nose, and eyes. Boys tended to have a higher contact frequency than girls for both mucous and non-mucous HFC.

An observational study of hand-to-face contact via videotaping of Korean older people in daily life settings.

OBJECTIVES: This study aimed to quantify hand-to-face contact (HFC) and identify the related factors that influence HFC in the daily life of Korean older people. METHODS: From November 20-December 4, 2018, 30 older people were enrolled and were each videotaped for their daily activities for two hours in total. The videotaped HFC data were classified by frequency, duration, site of contact, and as self-contact with membranes (eye, nose and mouth) or non-membranes (head, forehead, chin, cheek and ear). RESULTS: Of the 4826 self-contacts, 1311 HFC (560 membrane contacts [42.7%], 751 non-membrane contacts [57.3%]) were observed in 60 person-hours. The mean contact frequency (mean/person) of membrane and non-membrane contact was 18.7 times (nose, 9.3; mouth, 5.7; and eye, 3.6) and 24.6 (highest with the chin, 8.5), respectively. The mean contact duration (seconds/contact) for membrane and non-membrane contacts was 3.4 s (nose, 3.1; mouth, 3.7; and eye, 3.0) and 6.3 s (highest with the chin, 8.2), respectively. Contact exposure (frequency-duration/second/person) of the membrane and non-membrane was 3510.7 (nose, 1002.3; mouth, 639.3; and eye, 92.3) and 11,727.1 (highest with the chin, 2,965.6), respectively. The frequency and duration of HFC differed by age, economic activity and household income. CONCLUSIONS: HFC was highest at the nose in Korean older people, followed by the mouth. Consequently, education about avoiding HFC of the nose and hygienic care of the nose should be a nursing priority. Awareness of the risks of HFC and the prophylactic effects of vigorous hand hygiene should be strengthened among the elderly to prevent the spread of infectious diseases via hand contact.

Characteristics of hand-to-environment contact during indoor activities in daily life among Korean adults using a video-based observation method.

OBJECTIVE: The aim of this study was to describe the characteristics of hand-to-environmental contact (HEC) and to identify the factors influencing HEC behavior in Korean adults' indoor daily life. METHODS: Thirty participants were enrolled from January 14 to February 12, 2018 after providing informed consent for being videotaped. Data were collected by recording their indoor daily lives for 2 hours, resulting in 4,732 HEC cases. To ensure the accuracy and reliability of the HEC readings, 3 training sessions were conducted for the videotape readers. Rereading and verifying randomly selected data ensured the validity of intra- and inter-reader readings. RESULTS: The most frequent contact items were phones, papers, computer accessories, and furniture surfaces. The contact density (frequency-duration/min) was highest for category II (items occasionally shared by others, 56.8), followed in descending order by category I (items for individual use, 35.9), and category III (public use items, 3.4). Significant differences in contact density were found according to participants' demographic characteristics. CONCLUSION: As mobile phones were the most frequent contact item, regular and strict mobile phone cleansing or disinfection strategies are needed, in addition to preventative measures taken for category II and III items. Avoiding sharing personal items with others, refraining from unnecessary HEC, and maintaining strict hand hygiene are recommended.

Hand-to-face contact behaviors during indoor activities in daily life among Korean adults: an observational pilot study using videotaping.

OBJECTIVES: Hand-to-face contact (HFC) is the major route for the self-inoculation of pathogens. This study aimed to describe the characteristics of HFC behaviors among Korean adults during indoor activities. METHODS: Thirty participants were enrolled in the study, and 2 hours of videotaped data were collected from each participant. Contact data were recorded by examining the frequency and duration of HFC on the videos. Three training sessions were conducted for 2 readers to ensure the accuracy and reliability of videotape reading. Re-reading and verification of selected video data were performed to confirm intrapersonal and interpersonal validity. Contact exposure (CE) was determined by multiplying the contact frequency (CF) by the contact duration (CD) to quantify the intensity of contact during the observation time (2 hours). RESULTS: A total of 3,007 HFCs (1,305 mucous membrane contacts and 1,702 non-mucous membrane contacts) were observed for 60 person-hours. The median CF (person/2 hr) of the mucous membranes (eye; 4.0, nose; 15.5, mouth; 16.5) was 39.5/person and the median total CD was 177.0 sec/person. The median CE (frequency-duration/sec/person) was 5,795.0 (mouth: 1,356.0, nose: 600.0, eye: 57.5). CONCLUSIONS: This study showed that the mouth and nose were the most frequent exposure sites for HFC. Avoiding habitual HFC, awareness of self-inoculation by HFC, and vigorous hand hygiene should be strengthened to prevent the spread of infections.

Association of the Risk of Osteoarthritis and Hypertension in the Korean Adult Population Aged 40-59 in Pre- and Postmenopausal Women: Using Korea National Health and Nutrition Examination Survey 2012-2016 Data.

PURPOSE: Previous studies reported the relation of osteoarthritis (OA) and hypertension (HTN) mostly in postmenopausal women. This study aimed to identify the association between OA and HTN in pre- and postmenopausal women. METHODS: We used data of 4,627 middle-aged (40-59 years) women from the Korea National Health and Nutrition Examination Survey (KNHANES) from 2012 to 2016. Chi-square and t-test compared the characteristics of the participants. Binomial logistic regression was used to identify an association between OA and HTN under controlling covariates such as age, tobacco smoking, alcohol consumption, and obesity. RESULTS: There were 1,859 participants with non-OA and menopause, 104 with OA and nonmenopause, and 375 with OA and menopause, respectively. The number of women with OA and HTN was 129. OA was significantly associated with HTN diagnosis in postmenopausal women under controlling covariates (odds ratio: 1.408, 95% CI: 1.092-1.815, p=0.008). However, this relationship was weakened in premenopausal women (odds ratio: 1.651, 95% CI: 0.950-2.869, p=0.075). CONCLUSION: In conclusion, women with HTN showed a distinct association with OA than the normotensives, and this relationship was more apparent among postmenopausal women. Further research is needed for a preventive approach.

Hand-to-Environment Contact During Indoor Activities in Senior Welfare Centers Among Korean Older Adults: A Pilot Study.

(1) Background: This study aimed to describe the characteristics of hand-to-environment contact (HEC) and identify the influencing factors of HEC behavior during the indoor daily life of Korean older adults in senior welfare centers. (2) Methods: A cross-sectional observational study was used with 30 participants over 65 years of age attending programs in senior welfare centers. Video recordings of the 30 participants were collected for two hours a day for participants selected from 20 November to 4 December 2018. Contact frequency, density, and duration were measured. (3) Results: Video recordings of 3,930 HEC cases were analyzed. Furniture surface (25.0%), tableware and cooking utensils (5.4%), phones (5.3%), and door handles (0.1%) were found to be the items with the most frequent contact, in this order. The average contact frequency and contact density (frequency-duration/min/person) of HEC for two hours were highest for the Category I equipment (personally used, accounting for 70.4%), and the average contact duration of HEC was highest in the Category III equipment (commonly used, 47.7 s/contact/person). Contact density was as high as 266.5 (frequency-duration/min/person). Participants above 75 years of age and the unemployed showed high HEC with Category III. (4) Conclusions: Older adults need to be educated to avoid unnecessary hand contact with items in Category III. In particular, hand hygiene and sanitization through the regular and thorough disinfection of furniture surfaces and shared equipment are very important to prevent the spread of pathogens.

National hospital quality measures for surgical site infections in South Korea: a survey among 20 expert physicians.

BACKGROUND: Surgical site infection (SSI) is recognized as an important quality indicator for patient safety. In Korea, the use of prophylactic antibiotics for surgery is conducted as a national quality measures related to SSI prevention. The objective of the present study was to investigate physicians' perceptions of hospital quality measures for SSI as well as identify obstacles that might hinder its implementation in South Korea. METHOD: Online-based questionnaires were administered twice. Twenty physician experts who were members of the Healthcare Review and Assessment Committee that was constituted for the "Assessment of prophylactic use of antibiotics for surgery" participated in the study. The first survey comprised open-ended questions that were designed to elicit the physician who could hinder the implementation of SSI indicators. The second survey, which was developed on the basis of the initial survey's results, consisted of 10 closed-ended questions about the feasibility of objective perception and the need for subjectivity, with regard to SSI. RESULTS: From among the 20 physicians, we collected data from 16 respondents in the first survey (response rate of 80%) and 15 respondents in the second survey (response rate of 75%).Thirty-one percent of the respondents supported hospital SSI evaluations, and 69% expressed objections. The obstacles that were perceived as being able to hinder hospital SSI evaluations pertained to difficulties in collecting data, unavailability of information, possibility of underreporting, and redundancy of the inquiry undertaken by the Korean National Healthcare-associated Infections Surveillance System-SSI. Physician experts provide significantly higher ratings for the clinical indicator, rate of readmission due to SSI, both in terms of feasibility and need, when evaluating the results of SSI prevention in hospitals. CONCLUSION: The results of this study show that physicians perceive the need for QI development of hospital SSI measurements to prevent nation-wide SSIs in Korea. However, the feasibility of hospital SSI measurements is low. To develop QIs of hospital SSIs using health insurance claims data, it is necessary to develop a methodology for claims data-based surveillance systems and a data collection system in order to increase the sensitivity and validity of post-operative SSI detection.

Development of a Social Contact Survey Instrument Relevant to the Spread of Infectious Disease and Its Application in a Pilot Study Among Korean Adults.

OBJECTIVES: This study aimed to develop a valid social contact survey instrument and to verify its feasibility for use among Korean adults. METHODS: The Delphi technique was used to develop an instrument to assess social contacts, which was then applied in a cross-sectional pilot study. A panel of 15 medical professionals reviewed the feasibility and validity of each item. The minimum content validity ratio was 0.49. Thirty participants used the developed measure to record contacts during a 24-hour period. RESULTS: After a systematic review, the survey instrument (parts I and II) was developed. Part I assessed social contact patterns over a 24-hour period, and part II assessed perceptions of contacts in daily life and preventive behaviors (hand hygiene and coughing etiquette). High validity and feasibility were found. In the pilot study, the 30 participants had a combined total of 198 contacts (mean, 6.6 daily contacts per person). The participants' age (p=0.012), occupation (p<0.001), household size (p<0.001), education (p<0.001), personal income (p=0.003), and household income (p<0.001) were significantly associated with the number of contacts. Contacts at home, of long duration, and of daily frequency were relatively likely to be physical. Assortative mixing was observed between individuals in their 20s and 50s. Contact type differed by location, duration, and frequency (p<0.001). CONCLUSIONS: The developed social contact survey instrument demonstrated high validity and feasibility, suggesting that it is viable for implementation.

Analysis of Association of Occupational Physical Activity, Leisure-Time Physical Activity, and Sedentary Lifestyle with Hypertension according to the Adherence with Aerobic Activity in Women Using Korea National Health and Nutrition Examination Survey 2016-2017 Data.

PURPOSE: We investigated the association between occupational physical activity, leisure-time physical activity, and sedentary lifestyle with hypertension by adherence with aerobic exercise in middle-aged and elderly women. METHODS: A cross-sectional analysis was performed using Korea National Health and Nutrition Examination Survey (KNHANES), a nationally representative data between 2016 and 2017. A total of 4,241 women aged 40 years or older were included. Hypertension diagnosed by physician and exercise status was asked by questionnaires. RESULTS: Mean age of the participants was 58.4 (±11.4, range: 40∼80 years). There were 1,681 (39.6%) women in the aerobic activity adherence group. In the logistic regression analysis with adjustment for confounding factors, frequency of occupational physical activity (OPA) level (OR 1.931; p=0.048, in ≤4 per week group), walking frequency (OR 0.436; p=0.048, in ≤4 per week group), walking frequency (OR 0.436; p=0.048, in ≤4 per week group), walking frequency (OR 0.436; p=0.048, in ≤4 per week group), walking frequency (OR 0.436. CONCLUSIONS: In the aerobic activity adherence group, further research is needed to identify the influence of occupational physical activity. In the aerobic activity nonadherence group, decreasing sitting hours and increasing endurance exercise may be helpful.

Effect of Aerobic Physical Activity on Health-Related Quality of Life in Middle Aged Women with Osteoarthritis: Korea National Health and Nutrition Examination Survey (2016-2017).

:Background: There have been few studies reporting the association between health-related quality of life (HRQoL) and osteoarthritis (OA) in female subjects performing aerobic exercise or not. The aim of this study is to compare HRQoL between OA patients and non-OA subjects in middle aged Korean women (40-59 y) with/without aerobic physical activity, and also to identify an association between EQ-5D instrument based HRQoL and OA controlling for aerobic exercise. Methods: This study used the cross-sectional data, the Korea National Health and Nutrition Examination Survey (KNANES) from 2016 to 2017. We only selected those who had completed the evaluations of aerobic physical activity and osteoarthritis diagnosis. In total, 2445 middle aged women were finally selected for this study. The European quality of life-5 dimensions (EQ-5D) was used for the evaluation of HRQoL as a dependent variable. In socio-demographic factors, age, sex, income level, education level, marital status, economic activity, type of insurance and private insurance and behaviour-related factors were included. One-way analysis of variance was conducted to compare the EQ-5D index and multiple linear regression analysis was employed to identify associated factors with the EQ-5D index. Results: In total, 2445 middle aged women were included in this study, in which 2209 participants were normal (90.0%) with aerobic physical activity (no: 55.0%, yes: 45.0%) and 246 participants were diagnosed with osteoarthritis (10.0%) with aerobic physical activity (no: 56.1%, yes: 43.9%). In group 2-2 (OA with aerobic), the moderate level of muscle exercise (less than 5 days per week) showed the highest HRQoL (p < 0.05) and high level exercise showed the lowest HRQoL (p < 0.05). In menopause status, the participants under menopause status showed lower HRQoL (p < 0.05) than those not under menopause status in group 2-2 (OA with aerobic) only. Conclusion: The HRQoL of OA patients was significantly lower than that of normal participants in middle aged Korean women (40-59 y). Especially, OA patients with maintained aerobic physical activity showed significantly higher HRQoL than those without that under controlling covariates such as age, income level, education level, marital status, economic activity, type of insurance, etc.

Prospective diary survey of preschool children's social contact patterns: A pilot study.

PURPOSE: This pilot study aimed to describe children's social contact patterns and to analyze factors related to their social contacts. METHODS: The participants were 30 children aged ≥13 months to <7 years, whose teachers at childcare centers and parents at home were asked to maintain diaries of their social contacts prospectively for 24 hours. Data were collected from November 30, 2018, to January 7, 2019. RESULTS: The 30 participating children were in contact with 363 persons in a 24-hours period (mean, 12.1±9.1). The number of contacts showed significant relationships with day of the week (p<.001), number of family members/cohabitants (p=.015), area of residence (p=.003), and type of housing (p=.002). A multiple regression model showed significantly higher numbers of contacts on weekdays (B=10.64, p=.010). Physical versus non-physical types of contact showed significant differences in terms of duration, location, and frequency (p<.001). The duration of contacts showed significant relationships with their location and frequency (p<.001), while the frequency of contacts was significantly related to their location (p<.001). CONCLUSION: This is the first survey describing the characteristics of Korean preschool children's social contacts. Further large-scale social contact studies of children should be conducted.

Association between Relative Handgrip Strength and Osteoporosis in Older Women: The Korea National Health and Nutrition Examination Survey 2014-2018.

BACKGROUND: While handgrip strength is associated with osteoporosis (OS) in the older population and muscle weakness is related to a reduction in bone mineral density, no study has yet assessed the association between relative hand grip strength (RHGS) and OS in the older Korean population. This study assessed the associations between RHGS and OS in Korean older women aged over 60 years. METHODS: We used data of 4,179 older women from the Korea National Health and Nutrition Examination Survey (KNHANES) from 2014 to 2018. We applied binomial logistic regression to identify an association between RHGS and OS while controlling for other covariates such as age; socioeconomic status; smoking behavior; alcohol consumption, laboratory test results; and the prevalence of hypertension, diabetes mellitus, thyroid disease, and obesity. RESULTS: RHGS was significantly associated with OS of the left hand in older Korean women. RHGS levels 2 and 4 of the left hand showed an inverse association with the prevalence of OS in female participants aged 60-69 years (odds ratio [OR]=0.637; 95% confidence interval [CI], 0.452-0.898; p=0.010; and OR=0.496; 95% CI, 0.258-0.956; p=0.036, respectively) but not in those aged over 70 years and in the right hand. CONCLUSION: OS was significantly associated with left-hand RHGS in 60-69-year-old women, and the OS risks decreased by approximately 36.3% and 50.4% in women with RHGS levels 2 and 4, respectively. RHGS may be used to predict OS in pre-clinical settings such as public health care institutes.

Trajectory of Smoking and Incidence of Atherosclerotic Cardiovascular Disease among Korean Young Adult Men.

Introduction: Smoking among young adults is associated with atherosclerotic cardiovascular disease (ASCVD) in middle age. Our aim was to analyze the trajectory of smoking in young adults and analyze the effects of the trajectory group on incident ASCVD. Methods: This study was conducted among 60,709 young adult men aged 20-29 years who received health screening every two years from 1992-2004. Trajectory analysis was performed through smoking survey data measured 7 times during this period. ASCVD, including ischemic heart disease (IHD) and stroke events were confirmed from 2005-2015. The association between the trajectory group and ASCVD risk was analyzed using Cox proportional hazard models, controlling for covariates and mediators. Results: Trajectory analysis showed that smoking categorized into five groups as follows: Group 1 (28.3%), low steady; Group 2 (14.7%), lowering; Group 3 (17.3%), high steady; Group 4 (15.6%), rise and fall; and Group 5 (24.2%), very high steady. The model performance of the trajectory model (Akaike information criterion; AIC = 51,670.78) with mediators was better than the model (AIC = 51,847.85) without mediators. Group 5 showed a 49% higher risk of ASCVD than Group 1. The risk of IHD was 1.63-times higher for Group 5 and 1.31-times higher for Group 4, compared to Group 1. Compared to Group 1, Group 5 had a 1.36- and 1.58-times higher risk for total stroke and ischemic stroke, respectively. Conclusions: In young adult men, the multiple measured trajectory model with mediators was far more informative than one-time smoking for explaining the association with cardiovascular disease.

Cancer site differences in the health-related quality of life of Korean cancer survivors: Results from a Population-based Survey.

OBJECTIVES: We investigated cancer site differences in the health-related quality of life (HRQOL) of cancer survivors. DESIGN AND SAMPLE: A secondary data analysis was conducted using the sixth Korea National Health and Nutrition Examination Survey (2013-2015). Participants were 15,461 adults (664 cancer survivors) with available EuroQol-5 Dimensions (EQ5D) information. MEASUREMENTS: Constructs from the revised Wilson and Cleary's model were examined. HRQOL status was measured using the EQ5D. EQ5D dimensional problems and indices were compared across cancer sites using multiple linear and quantile regression analyses. RESULTS: The most common problems across cancer sites were pain/discomfort and mobility. There were differences in EQ5D dimensional problems by cancer site: problems of usual activities in the cervix-cancer group and anxiety/depression in the thyroid cancer group were prevalent. Those with cervix cancer (vs. stomach) had higher EQ5D index scores; however, no significant differences were observed between other site subgroups. Subjective health perception and socioeconomic factors were significant determinants affecting HRQOL among cancer survivors with low EQ5D index scores. CONCLUSIONS: Subjective health status and socioeconomic characteristics are predicted to have a greater impact on survivors with low (vs. high) HRQOL. Socioeconomic and psychological support is essential to increase cancer survivors' HRQOL, regardless of cancer site.

Exercise and cancer mortality in Korean men and women: a prospective cohort study.

BACKGROUND: Little is known about longitudinal associations of exercise with different types of cancer, particularly in Asian populations. The purpose of this research was to estimate the association between the duration of exercise and all-cause and cancer-specific mortality. METHOD: Data were obtained from the Korean Metabolic Syndrome Mortality Study (KMSMS), a prospective cohort study of 303,428 Korean adults aged 20 years or older at baseline between 1994 and 2004 after exclusion of individuals with missing variables on smoking and exercise. Death certificate-linked data until 31 December 2015 were provided by the Korean National Statistical Office. Cox regression models were constructed to evaluate the associations of exercise with cancer mortality after adjusting for potential confounders such as age, alcohol consumption and smoking status. RESULTS: During the follow-up period of 15.3 years (4,638,863 person-years), a total of 16,884 participants died. Both men and women who exercised showed approximately 30% decreased hazards of mortality, compared to those who did no exercise (hazard ratio (HR) 0.70, 95% confidence interval (CI)=0.68-0.73 for men, HR=0.71, CI : 0.67-0.75). A notable observation of this study is the curvilinear associations between the total duration of exercise per week and cancer mortality, with the lowest risk being observed at the low-to-medium levels of exercise; this trend of associations was found for esophagus, liver, lung, and colorectal cancer mortality in men, and all-cause, all-cancer and lung cancer mortality in women. CONCLUSIONS: Individuals who exercised showed considerably lower all-cause and cancer mortality risks compared with those who did no exercise. Policies and clinical trials aimed at promoting minimal or moderate participation in exercise may minimize cancer mortality risk.

Perception and attitude of Korean physicians towards generic drugs.

BACKGROUND: In 2012, a new pharmaceutical policy was introduced in Korea. According to the new policy, off-patent brand-name drugs (original drugs) and generic drugs must be priced the same. METHODS: This study aims to investigate the perception and attitude of Korean physicians towards generic drugs before and after the policy reform. Surveys were conducted with registered doctors at the Health Insurance Review Agency (HIRA) twice, in 2011 and 2013, by means of email and HIRA online survey systems. RESULTS: In the 2011 survey, 82% knew about the bioequivalent (BE) guideline, whereas only 25.7% trusted BE testing results. More than half preferred original drugs to generic drugs because of clinical experience and generic drugs confidence limits. 64.2% pointed out that the Korean generic drugs prices are more expensive than in other counties. In the 2013 survey, 73% preferred original drugs to generic drugs because of believed difference in drug effectiveness. After the pricing policy reform, 35.5% stated that they didn't change their prescribing pattern, whereas 29.7% stated that they began prescribing generic drugs. CONCLUSIONS: The Korean government has revised and strengthen the guideline on BE test to improve the quality and confidence of generic drugs. Although generic drugs prescription was increased slightly more than the 2011 survey, 2013 survey showed that around 70% of respondents still preferred original drugs.