Background
There are many reports that obesity could be associated with gastoesophageal refl ux disease (GERD) but the outcomes are controversial and the studies on correlation between endoscopic severity of GERD and obesity are rare. Therefore, we investigated the association between endoscopic severity of GERD and indexes of obesity. Methods: Among the subjects who visited a health promotion center of a general hospital from January 2007 to March 2008, a total of 527 subjects with typical symptoms of GERD who underwent esophagogastroduodenoscopy and analysis of body composition were enrolled. The endoscopic severity of GERD was classifi ed depending on LA grading classifi cation system. Results: Among 527 subjects, 125 subjects were classifi ed with Non-erosive refl ux disease (NERD) while 254, 105, and 43 subjects were classifi ed as LA grade A, B, and C group, respectively. Men and frequent alcohol drinkers (≥ 5 times/week) were likely to be in higher endoscopic severity group (OR, 2.065 and 2.394, respectively; P < 0.05). If the subject was obese by BMI and waist circumference, it showed a higher possibility of belonging to the higher endoscopic severity group (OR, 2.319 and 2.596, respectively; P < 0.001). In the case of %body fat, the obesity group was more likely to be in the higher endoscopic severity group only in men (OR, 1.906; P < 0.001). Conclusion: Indexes of obesity such as BMI, %body fat (only in men), and waist circumference were related with endoscopic severity of GERD and this relationship is more apparent in men and alcohol drinkers (≥ 5 times/week).

Background
It is well known that the metabolic syndrome is associated with visceral adipose tissue (VAT), but several recent studies showed stronger association between the subcutaneous adipose tissue (SAT) and insulin resistance. The purpose of this study was to investigate the clinical significance of deep SAT as a cardiovascular and a metabolic risk factor. Methods: A cross-sectional survey was conducted among fifty-one subjects (21 men and 30 women) who visited an obesity clinic in Yeungnam University Hospital. We performed cross-sectional abdominal CT, and undertook the novel approach of partitioning SAT into the plane superficial to the fascia within SAT (Superficial SAT) and within subcutaneous adipose tissue (deep SAT), as well as the measurement of VAT. Percent body fat was measured by bioimpedance analysis (Inbody 2.0, Biospace). Fasting blood samples were analyzed for total cholesterol, HDL-cholesterol, TG, LDL-cholesterol, FFA, insulin, uric acid and glucose. Resting blood pressure was measured. Results: After adjustment for age, sex, smoking, alchol and exercise, deep SAT was proved to be significantly and positively correlated with fasting insulin, FFA, and uric acid (P＜0.05). VAT was significantly correlated with unfavorable levels of FFA, insulin, HDL-cholesterol, TG and diastolic blood pressure (P＜0.05). In stepwise multiple regression analysis, deep SAT was shown to be the most powerful of the adiposity measures for explaining the variance in fasting insulin and uric acid levels (r2=0.196 and 0.225, respectively; both P＜0.001; including superficial SAT, deep SAT, VAT). Conclusion: Our results suggest that the association exists between deep SAT and fasting insulin, a finding which provides further support to the observation that deep SAT may be involved in insulin sensitivity. (J Korean Acad Fam Med 2007;28:100-105)

Background
: In general, long-term weight loss maintenance is difficult. Thus we have attempted to examine the factors associated with weight loss maintenance after weight reduction to appropriate level in obese people.

Methods : The study subjects were 170 obese adults who visited the Yeung Nam University Medical Center Obesity Clinic from January 2002 to April 2004. Selected individuals for this study were those who have intentionally lost at least 5% of their body weight and have kept it off for at least 1 year and considered to be ; weight loss maintainers ; and the factors that are associated with weight loss maintenance were obsened and assessed by telephone survey.

Results : Among all study subjects, the successful weight loss maintainers were 61 (35.9%) subjects (males: 23, females: 38) and re-gainers were 109 (64.1%) subjects (males: 42, females: 67). The difference between maintainers and re-gainers according to sex, age and basal body weight was not statistically significant. The difference between maintainers and retainers were statistically significant in those with regular exercise more than 3 times per week (P=0.001), no alcohol intake (P= 0.001), physical activity more than moderate level (P＜0.001), TV viewing (internet using) times less than 2 hours (P＜0.001), dietary control (P＜0.001), and no overeating (P＜0.001). According to multiple regression analysis, obesity treatment medication use during the weight loss maintenance period had the greatest influence (R²=0.336, P=0.000), and the following were TV (internet) viewing time, smoking, exercise, and physical activity in order.

Conclusion : By using, medications, reducing TV viewing (internet using) times, smoking cessation, diet control exercise weight loss were maintained significantly.

Background
: In this study we estimated the prevalence of cardiovascular (CV) risk factors according to waist-to- height ratio (W/Ht ratio) in adult obese women to ensure the importance of abdominal obesity and determined the usefulness of W/Ht ratio as a index of abdominal obesity in adult obese women.

Methods : The study subjects were 190 adult obese women who visited an obesity clinic from August, 2001 to January, 2003. They were divided into 4 groups: Group 1; BMI＜30, W/Ht＜0.6, Group 2; BMI＜30, W/Ht≥0.6, Group 3; BMI≥30, W/Ht＜0.6, and Group 4; BMI≥30, W/Ht≥0.6. In each group, we compared the prevalence and odds ratio for CV risk factors.

Results : In obese group, the prevalence of high blood glucose (P＜0.01), hypertriglyceridemia (P＜0.01) were significantly higher in group 2 than group 1. In high obese group, the prevalence of systolic hypertension (P＜0.01), high blood glucose (P＜0.01), hypercholesterolemia (P＜0.01), hypertriglyceridemia (P＜0.05), and high LDL-cholesterol were significantly higher in group 4 than group 3. When odds ratio for each group with reference to group 1 were compared after adjusting for age, high blood glucose (4.48), and hypertriglyceridemia (6.10) in group 2, and systolic hypertension (2.69), high blood glucose (3.02), and hypertriglyceridemia (4.00) in group 4 were significantly higher.

Conclusion : The prevalence of CV risk factors were likely to be increased in higher W/Ht group independently to BMI. W/Ht ratio can be a simple, useful index for abdominal obesity and its related risk factors not only in adult males but also in adult obese women.

Background
: Abdominal obesity is a risk factor for morbidity and mortality associated with cardiovascular disease. It has been reported that metabolically obese is common even in normal weight individuals. In this study, we analysed characteristics of cardiovascular risk factors in normal and overweight men using waist-to-height ratio to find out whether it reflects such risks.

Methods : Study subjects were 516 men.(18.5≤BMI<30.0) According to BMI and waist-to-height ratio(W/Ht), they were divided into four group: Group 1; 18.5≤BMI<25.0, W/Ht<0.5, Group 2;18.5≤BMI<25.0, W/Ht≥0.5, Group 3; 25.0≤BMI<30.0, W/Ht<0.5, Group 4; 25.0≤30.0, W/Ht≥0.5. The prevalence, Odds ratio for cardiovascular risk factors were compared.

Results : In normal weight group, the prevalence of hypertension(P<0.01), high blood glucose(P<0.01), hypercholesterolemia(P<0.05), hypertriglyceridemia(P<0.01) was significantly higher in group 1 than gorup 2. In overweight group, the prevalence of hypercholesterolemia(P<0.01), low HDL(P<0.01) was significantly higher in group 4 than group 3. When compared Odds ratio for each groups with reference to group 1, adjusted for age, smoking status and regular exercise, high blood glucose(4.48), hypertriglyceridemia(5.91) in group 2, hypertension(3.54), hypertriglyceridemia(3.44) in group 3, hypertension(2.90), hypertriglyceridemia(3.81), low HDL(2.60) in group 4 were significantly higher.

Conclusion : Waist-to-height ratio may be a useful method for early detection of abdominal obesity and it's related risk factors in normal and overweight individuals.

Background
: Comprehensive geriatric assessment is identified as a dynamic process responsive to the changes on health status that occurs over time in the context of extremely increasing trend in the numbers of the elderly people, their office visit, and the medical cost universally. We completed the comprehensive geriatric assessment and applied it to the Korean elderly through the multi-center trials.

Methods : We performed studies variables using questionnaires, with interviewing, physical examination to number of total 312 elderly people who visited the department of family medicine or physical medicine and rehabilitation of the 11 university hospital or general hospital in Korea from July 1, 1999 through October 31, 1999. We, the geriatrician, met and discussed 3 times to complete the comprehensive geriatric assessment through the consensus panel.

Results : We found the sex ratio of 312 subjects was 1 to 2 (104 males and 208 females) and the average age was 73.2 years old. The orders of more frequency of self-reported health status of the respondents were hypertension, arthritis, cataract, gastrointestinal disturbance, diabetes mellitus, urinary/fecal incontinence, depression, cerebrovascular accident, anemia, and heart disease. Nearly 15% of those showed depression 41.6% of those were in the status of socially isolation. We found 43.1% of those showed hypertension, 3.7% isolated systolic hypertension, and 20.2% orthostatic hypotension. Of those, cognitive impairment were measured in 37.1%, gait disturbance 13.0%, and the risk of malnutrition 39.6%. Geriatrician spent 21.1 minutes per person during the process of comprehensive geriatric assessmnet.

Conclusion : We realized we could diagnose and intervene effectively certain hidden conditions/ diseases, particularly urinary incontinence, falls, visual impairment, hearing impairment, pain, depression, social isolation, cognitive impairment, and orthostatic hypotension, with using the comprehensive geriatric assessment. These results reflected the fact that the comprehensive geriatric assessment might be necessary for the care of the elderly.

Background
: There are very few cohort studies on the hypertension in family practice. In order to investigate epidemiological characteristics of hypertensive patients and assess the safety and tolerabiliy of newly prescribed antihypertensive monotherapies in Korean patients, a prospective study was carried out.

Methods : A total of 1,181 patients were observed from July 1997 to August 1999. At 2,4,8 and 12 weeks after initiation of antihypertensive monotherapy, the patients were evaluated for whether treatment is continued and development of any adverse reactions.

Results : Calcium channel blockers(CCBs) were the most commonly prescribed initial drug class(44.2%) in family practice, followed by angiotensin converting enzyme inhibitors(ACEI) (21.0%), angiotensin II receptor antagonists(ARA) (11.8%), B-blockers(9.6%), a-blockers(3.9%), and diuretics(3.6%), During the first 12 weeks, the percentage of subjects continuing their initial ACEIs(40.7%) was substantially lower than the percentages that of subjects continuing ARAs(66.2%), a- blockers*(63.0%), CCBs(61.3%), B-blockers(55.8%), and diuretics(53.5%), respectively(P<0.001), The following adverse reactions were detected: cough(7.5%), headache(6.1%), dizziness(3.9%), flushing(3.7%), and impotence(2.4%). The incidence of cough associated with ACEI(27.9%), was higher than those of other classes(P<0.01)

Conclusion : CCBs were the most commonly prescribed initial drug class in family practice, followed by ACEIs, ARAs, B-blockers, a-blockers, and diuretics. The tolerability of antihypertensive medication was the highest in Korean patients treated with ARAs, followed by CCBs, B-blockers, diuretic, a-blocker, and ACEIs.

Background
: Osteoporosis is an important and common medical problem in postmenopausal women. Depression is another major public health concern. Due to the high prevalence of both depression and osteoporosis, even a weak association between them might result in a greater health problem. We have investigated whether depression is associated with bone mineral density (BMD) in peri- and postmenopausal women.

Methods : The study subjects who visited the office of family medicine department and the health screening and diagnosis center in one general hospital from January to May, 2000 were selected. BMD was measured at the lumbar spine using Dual Energy X-ray Absorptiometry. We evaluated the depression scale using the Beck Depression Inventory. The subjects who had disorders known to interfere with bone metabolism or those who had taken medication related to depression were excluded from the study.

Results : Significant positive correlation were noted between BMD and height and weight (P<0.05) but no correlation was found with depression in perimenopausal women. In postmenopausal women, significant negative correlation was noted between BMD and age, and postmenopausal duration and depression. Significant positive correlation was found between BMD and height and weight (P<0.05).

Conclusion : Our results showed that depression was associated with BMD in postmenopausal women which was independent of other factors strongly associated with osteoporosis.

Background
: Overweight and obesity are associated with increased mortality and morbidity. Obesity is influenced by multiple factors, both genetic and environmental factors. We investigated the relationship between socioeconomic, behavioral, dietary, reproductive factors and body mass index(BMI).

Methods : The subjects were 3000 adults who had visited the Health Screening and Diagnosis Center of Yeungnam University School of Medicine from February to June, 1997. We evaluated BMI and occupation, exercise, smoking, alcohol intake, total calorie intake, fat and carbohydrate intake in both gender and reproductive factors in women. Then, we analyzed the association between BMI and such variables as above.

Results : 1629 men and 1371 women were analyzed. The mean BMI was 23.4±2.8kg/M² in men, 22.9±3.1kg/M² in women. In both gender, 9.7% of our population had BMI over 27. Mean BMI increased with age. Those who were active and light smokers(≤20cigarette/day) had the lowest BMI in men. But no relationship was observed between BMI and exercise, smoking in women. Heavy alcohol drinkers(>1cup/day) had higher BMI than other group in both gender. We found significant correlation between BMI and total calorie intake, calorie intake to recommended calorie ratio in both gender. In women, the group whose number of parity was above 3 had significantly higher BMI than the other. And age at first birth was significantly correlated with BMI in a negative direction.

Conclusion : Our results showed that BMI was associated with age, smoking, alcohol, total calorie intake, calorie intake to recommended calorie ratio, parity, age at first birth. Socioeconomic class, exercise and diet composition appeared to have little influence.

Background
: In order to treat obese individuals, control of caloric intake after determination of patient's energy expenditure and recommendation of exercise program with possible use of specific medication is advised. There are many limitations in measuring all individual's energy expenditure by calorimetry, thus estimation is made using many variables such as weight, height, age, and gender. But, commonly used equations to predict resting energy expenditure(REE) are thought to result in overstimation of energy expenditure for use with obese individuals. This study investigated difference between measured and predicted resting energy expenditure in obese individuals..

Methods : Subjects were 133 adults who were admitted either to Internal Medicine Department and ENT Department of Yeung Nam University Hospital and their resting energy expenditure was measured indirest calorimetry between groups was compared. Predicted REE estimated by 6 equations to measured REE was compared in the two groups by body mass index 27 kg/m² under 65 years old individuals.

Results : There was no significant difference of measured REE between groups according to smoking habits(p>0.05). In the older group(≥65 years old), REE was lower compared to the younger groups(<65 years old)(p<0.05). In the obese group(body mass index>27kg/m²) measured REE was higher than the normal weight group(BMI<27kg/m²)(p<0.05). Among 108 indibiduals under 65 years old, other equation except for Fleish equation and Robertson and Ried equation were inaccurate when applied to the obese group.

Conclusion : These commonly used prediction equations tend to overestimate the REE in obese individuals, and the best estimates for the obese seem to be derived from the Fleish and Robertson and Reid equations.

Background
: Marked weight loss is generally viewed as a manifestation of serious disease.
Thus, patients who are experiencing involuntary weight loss(generally defined as more than 5% of usual body weight) can present a perplexing challenge. They may view such weight loss with alarm because of fears of occult malignancy. How does a primary care physician approach the evaluation of involuntary weight loss? An awareness of the most common cause of weight loss and the most efficient diagnostic strategy is essential.

Methods : The study populations were patients who visited the department of Family Practice of Yeungnam university hospital from February 1, 1994 to June 31, 1994. Cases were selected if there were a documented involuntary weight loss more than 5% of their baseline body weight during 6 month period of time, and routine initial laboratory tests were done. The remainder of the diagnostic evaluation was left to the patient's physician. Final diagnoses were made by their personal physicians.

Results : The proportion of involuntary weight loss of the outpatients was 2.38%(105) among 4,409 during the period. The causes were mental disorder, digestive system disorder, uncertain, endocrine system disorder, miscellaneous diseases, infectious diseases, neoplasm and genitourinary system diseases in order of frequency. The sex ratio was 1.26:1, male dominantly. Their chief complaints were epigastric pain, fatigue, weight loss, cough and headache in order of frequency.

Conclusion : Among the patients who visit the department of family practice in university hospital, the main cause of involuntary weight loss is depression. So family physicians should consider this point during patients evaluation.

Background
: Family function and types can influence on family members and may be related to marriage satisfaction degree of couples. The factors related to family function and types have been studied many times, but the study concernng the degree of marriage satisfaction's difference according to family function and types is rare. This study is attempted to see the difference of marriage satisfaction score in family groups according to Family APGAR Score and Family Adaptability Cohesion Evaluationg Scale.

Methods : 67 couples answered the questionaire among 200 couples who registered at Lifelong Health Care Program of Department of Family Medicine of Yeungnam University Medical Center from April 1 to May 31, 1992. The questionnaire is composed of Family APGAR Score, Family Adaptability Cohesion Evaluating Scale an Marriage Satisfaction Score.

Results : We compared into marriage satisfaction mean scores each group. Marriage satisfaction score is increased with high family APGAR score, balanced family type, appropriate adaptability and appropriate cohesion, It is statistically significant.

Conclusion : Families belong to high functional group and balanced type are showed high marriage satisfaction mean scores and marriage satisfaction score was a significant difference according to family function and types.

Background
: In Korea, prevalence rate of pulmonary tuberculosis has been decreasing, but pulmonary tuberculosis is still one of significant public health problem. This study was done for evaluate for therapeutic efficiency of 6-months short course chemotherapy in Family Practice.

Methods : We prescribed 2HERZ/4HER for 68 pulmonary tuberculosis patients from September 1, 1990 to August 31, 1992 at Department of Family Medicine, Yeungnam University Medical Center.
We studied the therapeutic efficiency of 6-months short course chemotherapy-negative conversion, adverse reaction, treatment failure, drop out cause and recurrence rate.

Results : Among 68 patients, bacteriologically positive rate was 14.7% and negative conversion rate was 100%. There was no cases of recurrence, treatment failure and treatment interruption due to drug adverse reaction.

Conclusion : This 6-months regimen (2HERZ/4HER) is effective and can be recommended as a promising regimen for the treatment of pulmonary tuberculosis in Family Practice.

Background
: Because dyslipidemia is a major risk factor of coronary heart disease, it must be screened by sensitive method. Since National Choesterol Education Programm guideline, total cholesterol level has been used for such methods. But now total cholesterol's valididy to dyslipidemia is questionaed bacause of it's limited sensitivity.

Methods : The data were collected from 1,113 subjects who visited yeoung midical center's health center from January 1993 to June 1993. From them fasting lipid profile was tested, and using NCEP guideline we simulated a population based screening programm.

Results : Hypercholesterolemia was the most frequent dyslipidemia, and followed by Low HDL, high LDL, high Triglyceride in order of frequency. Following NCEP process, 48% of those with high LDL concentration and 72.8% of those with low HDL concentration would not be routinely detected. Overall, 66% of those at high risk of CHD would not be promptly evaluated. The sensitivity of the guidelines for promptly idendifying with lipoprotein abnormalities was 34%.

Conclusion : The relatively low sensitivity of total choleterol as a screening tool should be the impetus for rethinking the screening guidelines.

Background
: Chest P-A interpretation is very important because chest P-A is one of the important diagnostic tools in primary care. Primary care physicians often make decision of patient management based on clinical impression and radiologic findings. This study assessed the accuracy of family physicians in interpretationg radiographs taken in the seven family practice offices.

Methods : This study compared the interpretation of family physicians with those of one radiologist on 183 office radiographs using a uniform protocol. Nine family physicians participated in the study along with one radiologist. A total of 183 chest P-Ad were evaluated.

Results : The results were as follows 1) the family physicians' discordancy rate with the radiologist was 19.6% 2) 80% of the discordant films were clinically significant misses of those were read as "normal" by one radiologist 4) only 5% of chest P-As which were read as "normal" by family physicians were read as "abnormal" by radiologist 5) The sensitivity of family physician's interpretation compared with radiologist was 90%, the specificity was 86%, and the positive predictability was 71%.

Conclusion : This result suggest that it is not necessary to consult radiologist for interpretation of Chest PAs which were read as "normal" by family physician, because 95% of Chest PAs which were read as "normal" by family physicians were read as "normal" by radiologist. Radiologically abnormal films may need to be consulted with clinical information. Physicians should take more active role in extending cervical screening corverage.

Background
: Mortality survey for cause of death is very important, but basic statistical results of those are few. This investigation was carried out in a province of Kyonsangpook-do to estimate the mortality rates among Koreans.

Methods : The base population are the beneficiaries of Korea Medical Insurance Corporation(KMIC), Kyonsangpook-do area, among which the 1,767 deaths occurred from January 1, 1991 to December 31, 1991, were reviewed to confirm the death. These were based upon the death certificates and medical utilization records before dying which were available through the computerized database on medical care utility of KMIC. The survey was conducted along three stages. At first, death certificates were existed, as a second step medical utilization records were reviewed, and finally direct contacts to the family members of the deceased were done.

Results : As a result, 1767 persons were died (male 946, female 816 unknown 5). Cause of deaths was accidents, malignant neoplasm, poisoning and injuries among age group 1-39 years. Over age group 40 years, the orders of cause of deaths were malignant neoplasm, cardiovascular disease, hypertensive cardiac disease, and chronic liver disease. Estimated crude rate were stomach cancer, cerebrovascular disease, hepatoma, lung disease in females.
Overall cancer mortality rate in the area was estimated 149.3 per 100,000 person-years in males, and 73.8 in females. Overall standardized mortality rate to the world standard population was estimated 180.1 per 100,000 person-year in males, and 66.2 in females.

Conclusion : This results shows the correct estimated mortality rates and various cause of deaths in a province of Kyonsangpook-do.