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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.

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&ndash, 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 &lt, 0.05) and high level exercise showed the lowest HRQoL (p &lt, 0.05). In menopause status, the participants under menopause status showed lower HRQoL (p &lt, 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&ndash, 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.

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.

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 (pl0.001), household size (pl0.001), education (pl0.001), personal income (p=0.003), and household income (pl0.001) 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 (pl0.001). Conclusions The developed social contact survey instrument demonstrated high validity and feasibility, suggesting that it is viable for implementation.

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.

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. Electronic supplementary material The online version of this article (10.1186/s12889-018-5669-1) contains supplementary material, which is available to authorized users.

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.

This study examined associations between changes in lifestyle risks and disability in late life.A national sample of Koreans aged ≥ 65 years was surveyed at baseline (2006) and 2-year follow-up (n=3511). Disability transition was categorized as disability-free, improved, maintained, and declined, based on activities of daily living (ADL) and instrumental ADL (IADL) scales. Lifestyle risk factors included current smoking, heavy alcohol consumption, low physical activity, and unhealthy weight. Changes in lifestyle risks were categorized as risk-free, positive (decreased risk), stable, and negative (increased risk). Multinomial logistic regression models examined the influence of changes in lifestyle risks on disability transition.A higher percentage (82.9%) of respondents who were risk-free remained disability-free than those who exhibited positive (71.8%), stable (64.9%), or negative (63.8%) change (p0.001). Sustaining no lifestyle risks, compared with negative change, was associated with a higher likelihood of remaining disability-free than decline (odds ratio=2.68, 95% confidence interval (CI): 1.32-5.42), adjusting for covariates. Among individual lifestyle factors, physical activity was predictive of not only functional independence but also improvement and maintenance.Older adults adopting more healthy lifestyles are more likely to maintain functional independence than decline. Making healthy lifestyle choices may delay disability progression in later life.

Accumulating evidence suggests that physical activity may be beneficial in preserving cognition in late life. This study examined the association between baseline and changes in physical activity and cognitive decline in community-dwelling older people. Data were from the Korean Longitudinal Study of Aging, with 2605 aged 65 years and older subjects interviewed in 2006 and followed up for 2 years. Cognitive decline was defined by calculating the Reliable Change Index using the Mini-Mental State Examination. Physical activity levels were categorized as sedentary, low, or high. Changes in physical activity were classified as inactive, decreaser, increaser, or active. Logistic regression analysis of baseline and changes in physical activity with cognitive decline was performed. Compared with the sedentary group at baseline, both the low and high activity groups were less likely to experience cognitive decline. The active (odds ratio [OR] = 0.40, 95 % confidence interval [CI] 0.23–0.68) and increaser (OR = 0.45, 95 % CI 0.27–0.74) group, compared with the inactive counterpart, demonstrated a significantly lower likelihood of cognitive decline. Older adults who remained active or increased activity over time had a reduced risk of cognitive decline. Engagement in physical activity in late life may have cognitive health benefits.

Background: Frailty and body mass index (BMI) are known to be predictive of late life mortality, but little is known about the combined effects of frailty and BMI on mortality. Objective: This study investigated the influence of frailty status and BMI category on mortality in older adults. Methods: Data were from the Living Profiles of Older People Survey, a national survey of community-dwelling older people in Korea, with a baseline study of 11,844 Koreans aged 65 years and older in 2008 and a 3-year follow-up for mortality. Frailty was categorized as not frail, prefrail, and frail, based on five indicators (weight loss, exhaustion, physical activity, walking speed, and grip strength). BMI (kg/m2) was classified as underweight (Results: Adjusting for covariates, compared with the normal-weight nonfrail counterpart, the underweight or normal-weight prefrail/frail status demonstrated significantly increased rates of death. The obese frail respondents showed a significantly higher mortality risk (hazard ratio, 3.89; 95% confidence interval, 1.14-13.28). The overweight prefrail/frail group, however, exhibited no significant association with mortality. Conclusion: Among older people who were of normal weight or underweight, greater frailty was associated with poorer survival. Whereas being overweight tended to be neutral of the influence of frailty on mortality, the obese frail exhibited a significantly elevated rate of death.

Objective: this study examined the association of physical activity with sarcopenia and sarcopenic obesity among the community-dwelling Korean elderly. Methods: subjects consisted of 2,264 aged 65 years or older in the 2008–09 Korea National Health and Nutrition Examination Survey. Sarcopenia was defined as 2 SD below the mean of the appendicular skeletal muscle/weight for healthy young adults. Obesity was defined as waist circumference ≥90 cm for men and ≥85 cm for women. Levels of physical activity were classified using the metabolic equivalent task method. Results: the prevalence of sarcopenia was 12.1% in men and 11.9% in women. Among those with sarcopenia, obesity was prevalent in 68.3% of men and 65.0% of women. Adjusting for all covariates, compared with those with low physical activity, men who engaged in moderate and high activity were 38% and 74%, respectively, less likely to have sarcopenia (Ptrend < 0.001). In women, the relationship between physical activity and sarcopenia was not significant. For sarcopenic obesity, men participating in moderate [odds ratio (OR) = 0.47; 95% confidence interval (CI) 0.26–0.87] and high (OR = 0.27; 95% CI: 0.12–0.60) physical activity, compared with low activity, had significantly lower risk (Ptrend = 0.001). In women, high physical activity was associated with a lower risk of sarcopenic obesity (OR = 0.43; 95% CI: 0.22–0.86). Conclusion: physical activity is associated with a reduced risk of sarcopenia and sarcopenic obesity in older Korean adults. There were gender differences in the relationship, with stronger associations observed in men than in women.

Despite the predictive value of combined healthy lifestyles in maintaining physical and cognitive functioning in late life, little is known about the clustering patterns of healthy lifestyle behaviors in older people. The aim of the present study was to examine the prevalence, clustering and population characteristics of adherence to multiple health behaviors in community-dwelling older Korean adults.The study population consisted of a nationally representative sample of 4165 Korean adults aged 65 years and older in 2006. Healthy lifestyles, defined as adherence to recommended guidelines, included non-smoking, no heavy drinking, physical activity and healthy weight. Combinations of behavioral patterns and prevalence odds ratios for pairwise clusters were analyzed. Multinomial logistic regression was used to identify demographic and health-related characteristics associated with the number of adherence to guideline recommendations.Those who adhered to all four guideline recommendations constituted the minority (11.7%). More women than men engaged in a higher number of healthy lifestyles. Clustering was more pronounced in men for whom no heavy alcohol drinking and physical activity centered around non-smoking. In women, clustering patterns were less obvious. Men, those with low levels of education, income and wealth, and the functionally impaired were less likely to adhere to multiple healthy lifestyles.Clustering of healthy lifestyles, especially among older men, supports the potential benefit of a multiple behavior change approach. Health promotion efforts should target the socially disadvantaged and functionally compromised segment of the older population presenting low adherence to recommended behaviors.