Background
: This study aimed at finding out how much the rate of the JNC-7 guideline was carried out, and assessed the degree of evidence based clinical practice patterns and the validity of the new guideline by comparatively analyzing primary care practice patterns in hypertensive patients.

Methods : A questionnaire regarding the management of hypertension was conducted by mail between May 15 and July 15, 2005, to 1,008 of the Korean Association of Family Medicine listed in the address book. There were 195 respondents with a response rate of 19.4%.

Results : Among the total respondents, 91.1% were aware of the new guideline and had received information mainly through training lectures and seminars. They said that the biggest difference between the new guideline from the previous one was the inclusion of prehypertension (62.3%), and 61.1% were using the new term prehypertension in their practice. The most frequency advice given to patients related to lifestyle modification were in the order of smoking cessation (44.8%), exercise (41.7%) and weight reduction (38.0%). Calcium channel blocker was the most commonly used (60.9%) as the first-line agent. When physicians failed to control blood pressure with the first medication in cases of stage 1 hypertension, 67.7% added other agents. In treating stage 2 hypertension, 59.9% started with a single agent and gradually added other agents.

Conclusion : Family physicians in primary care clinics had a good understanding of the JNC-7 guideline. However, the rate at which they applied it in treatment was low. To effectively apply the guideline in actual treatments, aggressive education of practitioners and improvement on medical system and treatment guidelines are needed.

Background
: It is well known that heavy alcohol consumption may result in various lesions on multiple organs and tissue, especially liver. The aim of this study was to measure prevalence of raised liver-derived enzymes in healthy men and possible association with alcohol consumption, smoking and body mass index.

Methods : All subjects were 450 men who received Adult Health Examination at Seoul Hospital of Konkuk medical center from May, 1998 to October, 1998. We carried out telephone survey and analyzed 360 men, excluding men with HBs Ag(+), hepatic problems within 6 months, medication drug that could change serum activity of hepatic enzyme or joints, muscles, cardiac problem and non-responder to telephone survey. We examined prevalence of raise liver enzymes and its possible association with alcohol consumption, smoking, and body mass index, applying logistic regression analysis.

Results : In 20.3% of study subjects, we found raised levels of liver-derived enzymes. If the alcohol consumption was higher than 270 g/week, the odds ratio(OR) for raised liver enzymes, adjusted for body mass index and smoking, increased ; serum gamma glutamyltransferase(r GTP) (OR: 9.48), serum aspartate aminotransferase(AST) (OR: 13.09), and serum alanine aminotransferase(ALT) (OR: 7.40). Smoking was not associated with the risk of raised liver enzymes and obesity(body mass index 25 kg/㎡) showed a positive association with two enzymes ; rGTP(OR: 1.92) and ALT(OR: 2.08).

Conclusion : If alcohol consumption was higher than 270 g/week, the risk of raised liver enzymes increased dramatically and rGTP, AST were shown more sensitive than ALT in alcoholic liver disease.

Background
: Cerebral infarction is one of the common cause of death in Korea. There are many studies about risk factors of cerebral infarction in the world and Korea. and there are some studies about risk factors of mortality and recurrence after first cerebral infarction in the world. but there are no reliable epidemiologic studies about risk factors of mortality and recurrence after first cerebral infarction in Korea. So this study was designed to investigate the risk factors of mortality and recurrence after first cerebral infarction in Korea.

Methods : A cohort of 257 patients with diagnosing first cerebral infarction at our hospital were selected and followed for at least 5 years. 30 days, 1 year, 5 year cumulative mortality and recurrence was calculated. Risk Factors classified at the time of first cerebral infarction. and then entered into a Cox proportional harzards model for mortality and for recurrence.

Results : The cumulative risk of mortality after first cerebral infarction was 13%, at 30days, 21%, at 1year, 49% at 5years. The cumulative risk of recurrence after first cerebral infarction was 4% at 30days, 11% at 1year, 24% 5years. The significant risk factors of mortality after first cerebral infarction were age(≥65), heavy alcohol drinking history, heart, failure, untreated diabetes mellitus history, untreated hypertension history, high admission Hct(≥50%), high admission glucose(≥200), atrial fibrillation at admission, under drowsy mental state at admission, embolic infarction type, high admission systolic bolld pressure(≥160), high admission diastolic blood pressure(≥100). The significant risk factors of recurrence were age(<65), men, heavy alcohol drink-ing history, ischemic heart disease, untreated DM history, high admission glucose(≥200).

Conclusion : Diabetes mellitus, hypertension, heavy alcohol drinking, cardiovascular disease were important factor of cerebral infarction prognosis on our study. So primary care physicians focus on these factors when treating cerebral infarction patient.

Background
: Urinary tract infection is one of the most common diseases in primary practice. Although quantitative urine culture is the standard for diagnosis, a rapid screening test is needed for effective management. But numerous studies in the past were controversial. We evaluated the utility of dipstick urine analysis as a screening test for urinary tract infection.

Methods : A retrospective analysis of 311 patients who were admitted between May 1997, and April 1998 were chosen as subject. Patients had a complete urine analysis, such as microscopic analysis, chemical analysis by dipstick and urine culture was performed as part of an evaluation for urinary tract infection or suspicious febrile illness.
We compared dipstick analysis with microscopic examination and urine culture. The results of the dipstick urinalysis were compared with the results of the urine culture, sensitivity, specificity, positive predictive value and negative predictive value.

Results : A total of 311 cases were included in the study among which 122 cases were true pos-itive in urine culture. For dipstick urine analysis 92 of 122 cases were leukocyte esterase positive and 39 of 122 were nitrite positive. On microscopic examination 44 of 122 cases were leukocyte positive and 40 of 122 were microorganism positive.

Conclusion : The sensitivity of the dipstick urinalysis seems higher than the microscopic exami-nation in urinary tract infection. We conclude that the dipstick urinalysis is a useful screening test for urinary tract infection for those above 2 years old.

Background
: Papanicolaou smear adequacy is directly related to endocervical edll discovery, and therefore can improve the value of the Papanicolaou smear as a cancer screening test. One of the pruposes of this study is to assess capture rate of endocervical element of the current Pap smear method in Korea which is performed by using only dry cotton swab. The other purpose is to compare effectiveness of cytobrush cell collector when performing Pap smear.

Methods : This study was performed for 333 patients visiting Family medicine outpatient department at Konkuk University Medical College Hospital to take Pap smear test from March 3, 1994 to July 12, 1994. The both dry cotton swab and cytobrush cell collector were used to collect specimen for each of total 333 patients.

Results : The endocervical cell capture rate was 37.2% for dry cotton swab, 73.0% for cytobrush. The difference of endocervical cell capture rates among two methods was significant statistically. A significant higher number of atypical epithelial changes was found in smears with endocervical cells than in smears without endocervical epithelial changes was found in smears with endocervical cells than in smears without endocervical columnar cells. Thus, the chance of missing an abnormal epithelial change is increased in smears without endocervical columnar cells irrespective of instruments. The use of the cytobrush incresased the number of smears that contained endocervical cells for reproductive age and postmenopausal women.

Conclusion : The use of cytobrush is considered as a more effective method for collection of endocervical cells compared with dry cotton swab, and the chance of detecting an abnormal epithelial change is increased in smears with endocervical cells.

Background
: Glaucoma is one of the main causes of blindness throughout the world and the prevalence of glaucoma increases with the increasing numbers of elderly in our population. Typically, glaucoma occurs without any subjective symptoms until the late stage of the disease. Early detection of glaucoma by screening and therapeutic intervention are therfore of the highest importance for the prevention of blindness by glaucoma. The purpose of this study was to demonstrate the importance of glaucoma screening in family practice.

Methods : We conducted glaucoma screenings by tonometry and direct opthalmoscopy in the health examination center of university hospital in Chungjoo. A total of 283 subjects were screened and patients with suspected abnormalities were referred to opthalmologist.

Results : The mean intraocular pressure obtained with Shiotz tonometry was 14.73mmHg and there was no sexual or age-related differences. Of 17 patients referred to opthalmologist 9 patients (3.18%) were confirmed as having glaucoma. The most common type of glaucoma was low tension glaucoma.

Conclusion : Glaucoma is the preventable cause of blindness and one of the objectvies of family medicine is early diagnosis and disease prevention. Therefore, we support the view that it is prerequisite to adopt glaucoma screening in health examination.

Background
: The Role of Family Medicine have been important scince the establishment of new health care delivery system, which came into effect on July, 1989. It is very important for family physician to manage hopitalized patients in the aspect of continuing care. And inpatient care is one of the main role of department of family medicine in general hospital. Therefore we analysed the hospitalized patients to help in establishing the orientation of in-patient care and the role of family medicine in general hospital.

Methods : We examined the medical records of the patients who had hospitalzed in department of family medicine of college of medicine, Kon-kuk university in Chungju from July, 1, 1989 to June, 30, 1993.

Results : A total of 453 patients were hospitalized during study periods. The sex ratio was 1.4:1. Mean age was 40.8 years old. The patient admitted via emergency room was 63.5% in the first year. But The last two years, the most patients was admitted via O.P.D. of Family Medicine. The most common symptoms with the patients complained at the time of admission was fever(17.0%), headache(7.5%), abdominal pain(5.7%). The common diagnosis at discharge was multiple contusion(9.5%), neurosis(6.6%), chronic hepatitis(6.4%). But the 98% patient of multiple contusion was in the first years. The most common diagnosis was acute gastroenteritis(13.0%) in the second year, chronic hepatitis(13.0%) in the third year, gastroduodenitis(18.5%) in the last year. The injury and intoxication was the most common disease in the first year, parasitic and infectious disease in the second year and digestive diseases in the last two years. Total 236 cases of special study was done and the common special study was abdominal ultrasonography(27.9%). The total 24 cases of operative procedure was done and all operative procedure was done in the first years. Total 179 cases were consulted. Total 23 patients were transferred to other departments.

Conclusion : The content of hospitalized patients in family Medicine was varied and it was changed by the characteristics and situation of the hospital to support the general function of hospital. The comprehensive practice and the unique field of family medinice was enforced to develop the role of family medicine in general hospital.

To know the knowledge, attitude and behavior about family medicine among the people living in certain apartment in Seoul, a questionnaire survey was carried out.
Among 500 persons setected randomly, 206 persons answered the questionnaire.
The results of this survey were as follows:
1. Among 296 persons, male was in 41.6%, and female was in 58.4%.
2. The rate of knowledge of family medicine was 70.9% and most of them heard of it via mass media.
3. 87.5% of the subject answered that the family medicine is really necessary for the health delivery system in Korea.
4. 6.8% of the subjects were registered at family medicine department and 78.7% of 196 answers were interested in participating family practice program whenever it is available.

For a baseline survey on the knowledge, attitude and parctice of family medicine among patients admitted in Seoul Christian Hospital, a questionnaire survey was carried out during the period of April 1 through May 31, 1990. Among 300 patients, 224 patients responded the questionnaires. The results of this survey were as follows:
1. Total number of samples were 224. Among them male population was 134(59.8%) and female population was 90(40.2%).
2. The rate of respondents who have ever heard about family medicine was 71.9% and most of them it from the mass media.
3. The rate of respondents who thought that family medicine is necessary for the Korean medical system was 90.6%.
4. The rate of respondents who will register to family physician for their medical care was 83.5%.

A clinical observation was made on 102 cases of drug intoxication admitted to the Seoul Christian Hospital via emergency room during one year from March 1989 to February 1990.
The observed results were as follows;
1. The ratio of drug intoxicated patients to total patients of emergency room was 1.6%.
2. Female was slightly more than male(1.2:1) and the age group of the third decade was of the largest proportion.
3. The motives of most intoxication(97.0%) were suicidal attempts.
4. In monthly distribution, July had the largest proportion(14.7%). The largest proportion of the time interval on arrival at emergeney room and of presumed time of poisoning was night(8 pm-12 pm).
5. The most common drug of intoxication was rodenticides(28.4%), the remainders were insecticides(21.6%) and sedatives(19.6%).
6. The chief complaints of the patients on admission were mental change(40.5%), nausea and vomiting(19.1%), abdominal pain(10.0%), but asymptomatic cases were as 18.1%.
The observed abnormal vital signs were tachypnea, hypertension, tachycardia and elevated body temperature in order of frequency.
7. The observed abnormal laboratory findings on admission were leukocytosis(57.4%), elevated transaminase(20.0%), elevated blood sugar(16.0%), anemia(13.8%) and elevated serum creatinine(5.3%).
8. The outcomes of the patients were recovery(64.7%), discharge against medical advice and transfer to other hospital(26.5%) and death(8.8%).