Background
: Although childhood obesity is an increasing public health problem in our society and a number of regimens have been developed and distributed for the treatment of adult obesity, few studies have focused on therapeutic programs for obese children. The objective of this study was to develop and measure the effects of an OPD-based childhood obesity control program.

Methods : The OPD-based childhood obesity control program was developed by reviewing the preexisting literature and consulting specialists. It was applied to the 4-6th grade obese(obesity index≥30%) children. The effects of intervention were assessed by the changes in obesity-related behavior, caloric and nutrient intake and exercise amount. The effects in the OPD-based group(group I) were also compared with the school-based group(group II)and the no intervention group(group III).

Results : The OPD-based program was developed based on behavioral modification principles such as self monitoring, stimulus control, positive reinforcement, social support, cognitive change and behavioral contracts and contained diet and exercise therapy. The developed program was applied to 34 pairs(child and mother) in the treatment group of which 21 pairs completed the basic sessions and 17 pairs completed the additional follow up session. Significant changes, decreases in obesity index were observed in the OPD-based group. No significant changes were found in the school-based group whereas increased degrees of obesity were found in the no intervention group. Obesity related behavior scores were significantly increased in both the OPD- and school-based groups. The children in both the OPD-based group showed significant decrease in dietary intake and increase in exercise amount.

Conclusion : Although it was a short-term treatment result, the OPD-based program was more effective than the school-based program in childhood obesity control. We suggest that a control program of comparable intensity and individualization as ours is required, for effective childhood obesity control.

Background
: Ministry of Health and Welfare offered 'Home Doctor Registration Program' to reinforce primary care and to increase the efficiency of national health delivery system. But, it failed because it was not supported by doctors and nations. We designed this study to develope and evaluate a practical version of 'Home Doctor Registration Program'.

Methods : We invited primary care doctors who were concerned with 'Home Doctor Registration Program' via PC-communication and developed a practical version of this program. After 6 months of this program, surveys on participated doctors and patients were done.

Results : 8 primary care doctors and 285 patients have participated in this study. All the 8 doctors have offered the 4 obligatory services and 3 doctors have offered telephone counselling and no doctor has offered visiting examination. After 6 months of this program, CCPQ score was increased significantly and all the health risk factors of participated patients were decreased. Doctors have thought that Family Chart Service, Health Risk Appraisal, Vaccination and Screening Test are more necessary in this program. But, patients have thought that Telephone Counselling and Visiting Examination are more important in this program.

Conclusion : Almost of participated doctors and patients have been satisfied with this practical version of 'Home Doctor Registration Program'. But, subjective feeling about which service was more necessary in this program was different between doctors and patients.

Background
: Hormone replacement therapy(HRT) has an established role in reducing cardiovascular risk and in preventing osteoporosis. But compliance with HRT is not good as expected. Therefore, so we assessed perimenopausal women's knowledge and attitude towards menopause and HRT too.

Methods : Questionnaires were provided to the students' mothers of a high school located in Seoul from June 10th to 15th, 1996. General characteristics and routine breast examination, routine Pap smear, the knowledge and practice of high calcuim diet for preventing osteoporosis, their menstrual pattern, the information source of HRT, in attitude for HRT, and the reasons for refusing.

Results : Among 560 women, 362 women(64.6%) responsed, and the mean age was 45.5 years. For osteoporosis prevention, they knew milk(74.7%) were, anchovy(27.4%), calcium(23.6%). HRT(7.4%) were beneficial. And almost(91.8%) all subjects answered that menopause was a natural course and 40.5% of women answered that physical change after menopause could not prevent. Among 34 postmenopause, 5(14.2%) received HRT and 48(20.3%) answered that they would receive HRT, and 57(24.1%) answered that they would not receive HRT. The reasons for refusing HRT were that menopause was a natural course, therefore devoiding the need for artificial hormone therapy(22.4%), increased incidence of breast cancer(21.8%), and that lack of information for HRT(13.9%). The association was not proven between the attitude for HRT and regular Pap smear, regular breast examination, exercise, oral intake for osteoporosis prevention.

Conclusion : Almost all of the respondents recognized that menopause was a natural course. And the effectiveness of diet and exercise in preventing osteoporosis was more well known compared to HRT.

Background
: In order to provide basic data which are necessary for the standard reference of residency training program in family medicine, we analysed of family practice residency program in Korea(the core curriculum) which has 313 items - diseases and problems - proposed by the Korean Academy of Family Medicine.

Methods : Each item of the core curriculum of family practice residency program in Korea was sorted according to ICD-10. They were the most compared to common 100 diseases and clinical cases in family medicine department of a tertiary hospital in one year. The most common 100 diseases were listed according to ICD-10, also. But some items which were difficult to sort were excluded. Eighty eight types of diseases were sorted. Clinical data of a tertiary hospital included 9138 cases.

Results : Comparing to clinical cases of a tertiary hospital, the core curriculum includes 93.2% cases of family medicine department of a tertiary hospital. Among the 17 fields of the core curriculum, 12 fields were found in about 50% or more among cases of the clinic and 5 fields were in less than 50%.
Among 88 diseases, the core curriculum includes 78 diseases. 10 diseases were excluded. In the most common 100 diseases, 12 diseases were related to trauma and the core curriculum did not include them.

Conclusion : Generally the core curriculum included highly prevalent diseases, but did not include some diseases which is important. Revision to make up for the weak points in the current core curriculum may be necessary.

Background
: The goals of this study are to investigate the propensity to depression and anxiety in children, and also, to investigate its relationship to the family structure, their life events, and school achievement. We have attempted to aid the continuous and comprehensive management of children with depression and anxiety in a field of family practice.

Methods : A group of 797 boys and girls in 5th and 6th were selected grades a elementary school in their, in the area of II-san and In-cheon city in August, 1997. Making use of the Kovacs' Children's Depression Inventory(CDI, 1977) and the Spielberger's State-Trait Anxiety Inventory for Children(STAIC, 1973), we investigated the propensity to depression and anxiety by self-rating. At the same time, the general characteristics(gender, age, residence, family structure), life events(death single parent, divorced family, death of a sibling, family discord between husband), and school achievement were investigated and assessed their relationship.

Results : The Children's Depression Inventory score was 11.69, the State Anxiety Inventory score was 31.51, and the Trait Anxiety Inventory score was 31.49. The CDI score were significantly higher in females, sixth year students, residents except for those living in an apartment or villa, and low school achievement group(P<0.01, P<0.05). There was no significance between CDI score and age, whether or not a dual-income family, death of a sib, hospitalization within 6 months, and family discord between husband and wife. The STAIC score was significantly higher for old age, female, sixth year students, and low school achievement group(p<0.01), and there was no significance between the STAIC score and residence, whether or not a dual-income family, death of a sibling, hospitalization within 6 months, and family discord between husband and wife.

Conclusion : According to our results, there was a significant correlation between gender, school years, school achievement and a propensity to depression and anxiety. Therefore, family physician should be more involved in family intervention and anticipatory guidance upon medical examination and treatment, if he or she has symptoms of anxiety and depression.

Background
: With the rapid increase in the number of the aged population, curable or controlled diseases were treated as aging process because of the difficulty of early detection and treatment of disease and specificity of elderly patients. We help manage elderly patients by studying their frequency of common known disease and hidden disease that would enable the curable diseases to be detected early, and noncurable disease to be controlled.

Methods : The subjects included 128 patients over 60 years old who had completed structured questionnaires and we reviewed chart records among 208 patients registered from January 1997 to July at the Health Screening Center of a general hospital in Kyonggi-do. Known diseases were based on charts recorded through structured questionnaires and hidden diseases were based on health screening results and overall geriatric assessment data.

Results : The number of patients was 128 in which male was 47 and female was 81. The ratio between male and female was 1:1.72 and the average age was 66.0 years. In the order of frequency, the most common known diseases were hypertension, arthritis, G-I disturbance, diabetes mellitus, chronic obstructive pulmonary disease, heart disease, depression and the hidden diseases they were arthritis, G-I disease, depressive mood, malnutrition, hypertension, osteoporosis, hearing loss, hypercholesterolemia, hypomagnesemia, incontinence, anemia, decreased cognitive function.

Conclusion : We assessed the characteristics of multiple pathology in geriatric patients and realized that it was important to manage aggressively those with a hidden disease that can be treatable after early detection through overall geriatric assessement.

Background
: Blood pressure is normally lower during night times than in day times. But in some people, this nocturnal blood pressure drop is decreased or absent. In essential hypertensives, absence of nocturnal blood pressure drop(the 'nondipping' pattern) has been associated with increased target organ damage and cardiovascular morbidity. Present study was intended to describe the proportion of 'nondippers' among untreated essential hypertensives in Korea and to investigate the influences of independent clinical factors on the nocturnal fall of blood pressure.

Methods : We studied 50 untreated Korean essential hypertensives who underwent 24-hour ambulatory blood pressure monitoring. Subjects with a nocturnal drop in systolic or diastolic blood pressure, or both, 10% were defined as 'dippers', the others as 'nondippers'. Their demographic and clinical characteristics were obtained through medical record and questionnaire. Above characteristics were considered to be independent variables and the dipping status, dependent.

Results : Thirty four percent of essential hypertensives were 'nondippers'. Nocturnal blood pressure drop decreased with reporting of family history of hypertension and higher 24-hour ambulatory mean blood pressure. Previous studies insisted on the influence of age on the dipping status, but in our study, age showed no impact on nocturnal blood pressure drop.

Conclusion : About one third of untreated subjects with essential hypertension were observed to be nondippers. Family history of hypertension and high 24-hour ambulatory mean blood pressure significantly decreased nocturnal blood pressure drop in our study. According to previous studies, above factors might work through affecting the normally decreased sympathetic activity during sleep time. Longitudinal studies of the influence of nondipping on the long term prognosis of hypertension and large scale studies to establish the factors influencing nocturnal blood pressure drop and their mechanisms are further needed.

Background
: Alcohol use is a major source of health problem. The social and economic costs related to alcohol use are enormous. Thus, alcohol use is a public health issue. Previous studies on alcohol use were based on hospitalized patients(especially alcoholics) or community subjects, but national survey is lacking. In this study, we describe alcohol use among the Koreans.

Methods : Household telephone survey was carried out using multistage stratified random sampling methods from April to May, 1997. Fifteen to sixty-nine year old subjects were randomly selected from household and asked to report type, quantity and frequency of alcoholic beverage consumption.

Results : The prevalences of alcohol drinking during the last month were 64.0% for men, 37.8% for women, and 64.7% for those in their twenties, and it decreased with increasing age. In multivariate logistic regression model, men, the unmarried, those in their twenties, administrative and professional personnel were associated with higher prevalence of alcohol drinking. Proportions of nearly daily drinker were 16.5% for men, 2.2% for women, and more than 20% for those in their forties and over and increased with increasing age. Mean alcohol consumption was 56 grams for men, 12 grams for women. Heavy drinkers, defined as average intake of 30 grams or more per day, were found in 23.4% of men and 2.4% of women. The most widely consumed beverages were soju, beer and makuli. In multivariate logistic regression model, men, the unmarried, those in their twenties, and administrative and professional personnel were highly associated with heavy drinking.

Conclusion : The prevalences of alcohol drinking during the last month was 49.0%. The proportion of heavy drinker was 11.4%. Men, the unmarried, those in their twenties, and administrative and professional personnel were highly associated with heavy drinking. Therefore, efforts should be made to reduce heavy alcohol drinking among the risk groups.

Background
: Although adult immunization is as important as childhood immunization, is being inadequately performed. However, previous studies concerning adult immunization could not be sufficiently evaluated because studies were restricted to the residents in rural area or those who have visited a doctor.

Methods : We conducted a study by telephone interview which included 201 households(375 adult family members)selected by systematic sampling from the yellow pages of Kangnam-gu and Sungbuk-gu districts of Seoul. The types of immunization covered in this study were immunizations against hepatitis B, influenza, pneumococcus, and hemorrhagic fever with renal syndrome(HFRS). Immunization status of all adult household members, cognition of the need for immunization and of interviewees were surveyed. Sex, age, area of residency, education, medical history of study subjects were considered as factors related to the cognition of the need for immunization and immunization performance.

Results : The cognition rates of immunization were as follows : hepatitis B 85.1%, influenza 45.8%, pneumonia 38.3%, and HFRS 33.8%. In the people over 65 years old, the cognition rate against influenza and pneumococcus were 6.25%, 6.25% respectively and for those who have chronic disease. 80.0%, 20.0%, respectively. The cognition rates of immunization was significantly higher among those subjects who were young, well educated, and those residing in Kangnam-gu district.
The immunization performance rate of hepatitis B was 62.5%, influenza 5.6%, pneumonia 0.8%, and HFRS 1.1%. 75.8% of subjects vaccinated against hepatitis B had received at least three times. The immunization performance rate of influenza and pneumococcus by the immunization indication are as follows : 8.0%, 0.0%, respectively in the subjects over 65 years old, and 11.1%, 0.0% respectively in the people who have chronic diseases. The immunization performance rate of hepatitis B was higher among young, well educated subjects living in Kangnam-gu district. But age, education, area of residency played no apparent role in the case of other types of immunization.
The immunization performance rate of those who felt the need for immunization as significantly higher than that of those who did not. To assess the factors which relate to the correct cognition for immunization necessity, we used a multiple logistic regression test. For all types of immunization surveyed, sex(females) and age(young) seemed to be significantly related to the correct necessity cognition. Medical history of chronic disease was also related to the correct necessity cognition for immunization against hepatitis B and influenza.

Conclusion : This study reveals that among living in urban area the immunization performance rate and the correct cognition rate concerning the necessity for adult immunization was generally very low. Therefore, an active publicity and public education will be needed to increase the level of correct necessity cognition for immunization in which the disease status, sex, and age of vaccinee are considered. And more active effort to increase the cognition for immunization necessity performance is required.

Background
: Cardiovascular risk factors have been divided into 2 categories, modifiable risk factors, and nonmodifiable risk factors. Clustering of risk factors may increase the risk of CAD more than any of the factors alone and often related to each other. We conducted this study to examine clustering of modifiable risk factors, to analyse associated factors with the clustering of metabolic risk factors, and to evaluate the risk of CAD according to the number of cardiovascular risk factors.

Methods : The case series comprised of 166 patients with angiographically confirmed coronary artery disease, who were admitted to the Division of Cardiology of a Medical Center in Seoul. The controls were 137 persons composed of patients with normal coronary arteriogram or patients with normal myocardial SPECT for chest pain. We surveyed their life style habits, measured anthropometric variables, and analyzed biochemical markers among CAD patients and controls.

Results : Modifiable risk factors, smoking, hypertension, diabetes, hypercholesterolemia, and low HDL-C were clustering each others among middle-aged Korean. Clustering of metabolic risk factors, hypertension, diabetes, hyperchesterolemia, and low HDL-C were associated with white-collar group, low physical activity, non-exercise, high BMI(body mass index) and high WHR(waist-hip ratio). The odds ratios for CAD in men with 3, 4, more than 5 risk factors were 2.0(95% CI:0.9-4.5), 2.9(95% CI:1.2-6.7), and 12.2(95% CI:3.5-42.0) respectively, compared with men with less than 2 risk factors. The corresponding odds ratios in women were 3.4(95% CI:1.3-9.0), 4.1(95% CI:1.2-13.5), and 4.5(95% CI:1.0-21.5) respectively.

Conclusion : There findings show that modifiable cordiovascular risk factors cluster among middle-aged Korean. The more the cardivascular risk factors, the higher the CAD risk in men and not only for clustering cardiovascular risk factors but also for CAD risk.