Background
: Hypertension is one of the common diseases which family physicians encounter to manage. Various research proved that appropriate aerobic exercise had effect on lowering blood pressure efficiently. This study was to find out the status of exercise, the change of exercise according to time and its predicting factors in hypertensive patients.

Methods : A total of 193 of the followed-up hypertensive patients of family physicians in Seoul and Kyoungkido from May 11, 2001 to June 10, 2001 were interviewed by doctor according to the previously designed structured questionnaire.

Results : Eighty two patients (42.5%) were male and mean age was 57.4±9.9 years. Using Kaplan-Meier's method, 8% of non-exercise group (N=115) in diagnosing hypertension started exercise after 1 year and 40%, after 5 years. Otherwise, 5% of exercise group(N=78) stopped exercise after 1 year and 30%, after 5 years. The characteristics of 5 exercise groups according to sex, age, level of education and adequacy of exercise showed significant difference. In average blood pressure, lately started group showed the lowest (137/84 mmHg) and non-exercise group, the highest (146/91mmHg). In the degree of recommendation, sporadic group showed the highest and non-exercise group, the lowest which showed significant difference(p=0.0024).

Conclusion : I conclude that lately started group among non-exercise group and continuous exercise group were mainly affected by recommendation to exercise of physician. As well as exercise, other nonpharmacologic treatment should be promoted by physician as an important strategy for treatment of hypertension.

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
: Ideal Body Weight(IBW) is commonly used to determine obesity levels because of its usefulness as target weight. This study was attempted to evaluate the comparative consistency between standards of determining obesity levels using the BMI and IBW. And the authors here provide a definition of IBW and attempt to suggest a new classification of obesity by IBW.

Methods : The test subjects for the research were 24,816 patients who received treatment at the such Health Promotion Center between May 1, 1996 and December 31, 1999. The comparative consistency between standards of determining obesity levels using the BMI and IBW were analyzed calculating the kappa value.

Results : The IBW from the Broca methods produced a kappa value of 0.668(p<0.001), while the calculation method for IBW recommended by the Japan Obesity Institute produced a kappa value of 0.664(p<0.001). On the other hand, an IBW calculated as 21(kg/m2)X[height(m)]2 (kg) produced the highest value of consistency at a kappa value of 0.911(p<0.001). After calculating IBW as 21(kg/m2)X[height(m)]2 (kg) and comparing the kappa values while adjusting the boundary zone standards, it was found that defining underweight as below 88% IBW and obesity as above 145% produced the highest value of concurrence at a kappa value of 0.935(p<0.001).

Conclusion : The validity and confidence with respect to the definition of IBW and the determination method for obesity as proposed by the authors may be confirmed through the methods high level of consistency [kappa value = 0.935(p<0.001)] with determination methods using the BMI.

Background
: In retrospective studies relating body weight to disease, the source of information on the past body weight and height as often based on recall. Several studies examined the accuracy of recalled body weight and height, and factors that might affect the accuracy of recall but data on the accuracy of the recalled weight and height are scare. This study examined the accuracy of recalled body weight and height, over a 5year period.

Methods : Participants was two hundred and two men and women visiting Health Promotion Center of medical colleage hospital, from 1th Jan. to 30th Jun.1996. We compared of measured weight and height with recalled weight and height 5 year later and examined of the influence of sex, occupation, education, chronic disease on recall.

Results : When we defined recall error as measured body weight and height minus recalled body weight and height, the mean of weight error were 0.02±3.22 kg, and the measured body weight was significantly correlated with recalled body weight(r=0.96). The mean of height errors were-0.80 1.95 cm, the correlation was 0.97. Weight errors were negatively correlated to weight gain over 5 year period(r=-0.49). The accuracy of recall was not influenced by sex, education, occupation, chronic disease.

Conclusion : Middle aged men and women recalled their previous 5year weight and height well in this study. The recalled past body weight and height are feasible information in retrospective study relating body weight to disease.

Background
: The research is to find out the object of Medical Phone Counsel rational and satisfactory by investigating in local clinic the actual state of Medical Phone Counsel, which is a form of medical care between doctor and patient, and by grasping the difference of expectation and recognition between doctor and patient on Medical Phone Counsel which is one of the service items of Attending Physician Registration System which is to be put into effect in near future.

Methods : This research conducted a self-administered questionnaire targeting all practitioners to the number of forty four who gave primary care in Kangnung city from August to September in 1999, and each twenty patients per practitioner. This research compared and analyzed the difference of recognition between doctor and patient on the following contents of Medical Phone Counsel; General Characteristic, Frequency, Contents, Time, Satisfiability, For or Against the Medical Phone Counsel to be executed under Attending Physician Registration System and Expectations.

Results : The questionnaire for doctor had a 70.5% of response rate, and the one for patient 17.2%. The 40.7% of the practitioners took a Phone Counsel actively, the 55.6% took part in Phone Counsel passively and the rest 3.7% did not participate in it. The 74.2% of them took this counsel for less than three minutes. Regarding recognition on Phone Counsel, the 48.1% of them answered that they executed it as it is their duty and the 48.4% responded that they took it reluctantly in spite of their busy business. The 3.2% answered that it is not their duty. Among those in favor of Phone Counsel under Attending Physician (or Prime Doctor) Registration System, the 28.6% agreed as it is their own duty and the 71.4% was for it subject to economic compensation. While, the 62.9% of the patients answered that they had never experienced the Phone Counsel, and the 34.4% responded that they had experienced it one or two times in a year. Among those who had experienced Phone Counsel, the 46.4% was satisfied with it. As far as the difference of expectation and recognition between doctor and patient on Medical Phone Counsel is concerned, only 45.2% of the practitioners were in favor of Medical Phone Counsel under the Attending Physician Registration System. While, the 70.1% among the patients was in favor of its execution. These two values showed a significant difference between doctor and patient (P<0.05), And the 83.9% of the practitioners insisted that the charge should be paid against Phone Counsel, and only 56.2% of the patients insisted the same. There was also a significant difference between two values.(P<0.05).

Conclusion : The practitioners were taking part in Medical Phone Counsel at any form. To the contrary, most of the patients were not. As far as the systematization of Phone Counsel is concerned, most of the practitioners had mental reluctance if there is no economic compensation. On the other hand, most of the patients and high expectation regardless of economic matters. If Medical Phone Counsel becomes systematized, it is expected that there will be a great trouble between its supply and demand.

Background
: Cervical cancer is the second most commonly diagnosed cancers in women and is responsible for about 14 percent of all female cancer found in Korean women. Early detection is very important because the likelihood of a complete cure is greater, and among the early screening tools to detect cervical cancers, a Pap smear is most widely used. It has the clinical significance to follow-up patients whose results are classified a class II in their Pap smear. Therefore we tried to find the factors associated with follow-up in class II patients.

Methods : On Pap smear practiced from Jan. 1, 2000 to Dec. 31 in a university Hospital, 159 patients Pap smear results were categorized as class II, and among the 159 patients, we were able to collect data from 107 patients who voluntarily answered a phone survey. The categories in the survey were the followings: follow-up for the Pap smear, age, age of marriage, presence of menopause, age of menopause, occupation, family history of chronic diseases or cancers, educational level, presence of concomittant diseases, income, average hospital visit frequency in a year, belief of general health, and reason for doing follow-up and reason for not doing it.

Results : Among 107 patients, only 62 patients(57.9 percent) did follow-up for their Pap smear results. The reason were doctors follow-up recommendation for Pap smear results and regular health check-up, and the two main reasons not doing follow-up were nonexistence of further symptom and financial distress. In a single variable analysis, the higher educational level, individual income, and hospital visit frequency, the more people had follow-up. But in multiple logistic analysis, only individual income was statistically significant.

Conclusion : The follow-up rate was as low as 57.9 percent, and the reasons why they did not follow up were mainly the lack of understanding about the clinical significance II result on the Pap smear. Therefore, an advertisement and public education programs to general public about cervical cancer will make more patients follow up their result on the Pap smear, especially to the low income and low education class people.

Background
: Patients diagnosed as an advanced cancer and families need accurate information about the length of survival in order to plan for and to make the best use of the time that remains. The health care of that patient can then be redirected toward palliation and mobilizing resources to ensure a comfortable life. The purposes of this study were to evaluate the prognostic value of performance status plus some physical symptoms and some biological indices and therefore to assist in planning appropriate palliative care.

Methods : This study was performed on 151 patients, who had been diagnosed as advanced cancer in Korean University Guro Hospital from July 1999 to July 2000.: We requested Karnofsky performance status scale, mental status, jaundice, severity of pain, anorexia, voiding difficulty, dyspnea and dry mouth. We assessed the biological indices by leukocyte count, plasma albumin, proteinuria.

Results : We could confirm 82 patients' death(54.3%) of 151 patients. Univariate analysis showed that Karnofsky status scales mental status, jaundice, severity of pain, anorexia, voiding difficulty, dyspnea, dry mouth, leukocyte count, albumin and proteinuria demonstrated a statistically significant predictive prognosis. Multivariate analysis using Cox's proportional hazard model showed that age, performance status, albumin, proteinuria were independent predictors of survival and severity of pain had the borderline value.

Conclusion : Age, performance status, albumin and proteinuria were the independent prognostic factors for patients with advanced cancer.

Background
: Obligatory continuing medical education was applied by medical law for lifelong education to physicians in Korea. A new method of continuing medical education was needed because of wide-spread and easy access to internet which resulted in improved public knowledge of medicine, and appearance of a new internet site for doctors's continuing medical education.

Methods : A questionnaire was sent twice by mil and fax to randomly selected 256 office based family physicians in Seoul and Kyonggi Province in May 2001 and 124 available responses were received.

Results : The response rate to the questionnaire was 50.7%. Median studying time per week for the past one year of the responders was 3 hours and there was no significant correlation in studying time per week with duration in practice, age, sex, or internet accessibility at clinic. The group with more than or equal to 6 years in duration of practice was significantly more than the group of participating academic conferences(P=0.027), number of participating lectures for office based physicians(P=0.001) and points of formal continuing medical education(P=0.002). The practice pattern change after attendance was 51.3% in 5years or less in duration of practice, 42.7% in 6years on more. Main causes of being reluctant to attend continuing medical education activities were 'no practical content' and 'long distance'.

Conclusion : For the improvement of quality of care by continuing medical education, practical program applicable to the clinical practices should be developed and continuing medical education activities be carried out in various areas.

Background
: This research has been performed to recognize their current attention on the purpose of further improvement and management of health understanding co-relation between working and stress through the survey of smoking and alcohol drinking as an object of salary men and women.

Methods : The questionnaire toward the their general situation and interest of health status (smoking, alcohol drinking, stress, joy and sadness) was distributed and surveyed as an object of full members of hospital which is located at Suwon in 1999. The form of the questionnaire was comfortable answer, multiple choice which was composed of 125 question. The object of survey was all members of hospital (about 1940 person). However, finally 483 person was recommended amon collected 492 pieces out of distributed 600 pieces.

Results : The age range of objects was 21-54 years old. Average age was 31 yrs old, male was 175 persons(36.2%) and female was 308 persons (63.8%). Smoking rate per sex was that female was 2 persons (0.7%) among 299 persons and male was 118 person (68.2%) among 173 persons. Thirties of age group was the most majorities as 78 person among 120 smokers. The reason for smoking is that habit was 79 persons (52.0%) next to relief of stress was 51 persons (33.6%). There was significant differences (p<0.05) whether present health due to smoking future health. Alcohol drinking rate is 75.93% (344 persons). There is no sexual differences. (M:76.3%, F:75.7%) Dining together as a primary reason of alcohol drinking is 222 persons (65.1%), next to stress is 92 persons (27.0%). 146 persons considered that alcohol drinking is helpful for life. However 63 persons (19.6%) was concerned that alcohol drinking affected health and 197 persons (61.6%) agreed that alcohol drinking affected health not now for the future. It is proved that there is significant differences whether present status of health effects future one of those. 355 patients (78.5%) answered that they are stressed at present showed especially significant high rate to female (p<0.01). 287 patients (64.3%) considered that there is an abnormal symptoms due to stress. There is significant relation between stress and health(r=0.46, p<0.01). 279 persons answered that company is an object of stress whether 48 persons is family as that. 322 persons (74.4%) considered that stress of working (family) affects family (working) showed that there is significant differences (p<0.01). 353 persons (83.5%) answered that stress is worst to health among stress, smoking, alcohol drinking. However, it is not significant differences statistically that there is relation between stress, smoking, alcohol drinking by sex and age.

Conclusion : Stress was no relation to smoking and alcohol drinking. It might be considered that stress is worst to health than smoking and alcohol drinking. It affects health abnormally.

Background
: Early detection is the most effective strategy for reducing mortality by cervical cancer among women. Many factors associated with attendance for cervical smear test have been reported. The aim of this study was to describe the extent of cervical cancer screening practices among women in Seoul, Korea and to identify the social and behavioral characteristics associated with these activites. We also want to identify the reason for not participating in cervical cancer screening among Korean women.

Methods : This study was cross-sectional study. From April, 1995 to August, 1995 a sample of 738 women were surveyed by direct interview at family practice clinic. They were all first encountered patients over 18 years old and were asked question about attendance for cervical cancer screening, utilization of other women cancer screening methods, certain social and behavioral factors. Data were analyzed with χ2 analysis and logistic regression using SAS 6.12, and EGRET program.

Results : Approximately 54.1% of the women had had a Papanicolaou(Pap) smear test once or more and 48.2% of them had had it regularly. The most frequent reason given for non-attendance for Pap smear test was "Not necessary at my age"(50.3%) among women in the twenties, was "Never thought about Pap smear test" among women in the thirties and forties. The prevalence of women undergoing a Pap smear test regularly once in a year was 20.5% of analyzed population and was higher among those women who were married(OR=15.1, 95% CI 3.1-73.2, p<0.01), who had higher family income(OR=7.3, 95% CI 2.4-22.2, p<0.01), who had last Pap smear test in the last year(OR=18.2, 95% CI 7.0-47.2, p<0.01), who had mammography regularly (OR=9.2, 95% CI 2.0-42.3, p<0.01), who had hepatitis B vaccination(OR=4.7 95% CI 2.0-11.2, p<0.01).

Conclusion : These results showed that the predictive factors of utilization of Pap smear test among study population, even though this study was not national survey, were similar to hose factors reported by other researches. We recognized that women who were poor, who had not spouse, who had a Pap smear test more than 1 year ago, and who had not mammography regularly had lower prevalence of undergoing Pap smear test regularly once in a year. These factors could, especially as barriers, affect the utilization of Pap smear test as an effective method for early detection of cervical cancer. So, family physicians must consider these factors. These results may be useful in planning screening strategies and educational programs to improve attendance in primary care field.