Background
: Hypertension is a common, chronic disease that poses as a main risk factor of coronary artery disease. Therefore, it requires accurate diagnosis. This study attempted to examine the problem of misclassification and accurate diagnosis of hypertension in primary care settings and to consider the relationship between variability of blood pressure and number of measurements.

Methods : Among the 158 patients with initially high blood pressure who visited health screening center of one university hospital from May to November, 199,97 persons who corresponded to the following conditions were chosen for this study. We classified hypertension as stage 1 and 2. The subjects were not previously diagnosed as hypertensive and had no past history of use of antihypertensive medication. Blood pressure was measured according to 1999 WHO/ISH Hypertension Guideline, and two or more measures were performed at each visit on five separate occasions at one week intervals.

Results : The mean of initial blood pressure was 159.6 mmHg in systole, 95.3 mmHg in diastole. The mean of subsequent blood pressure was 155.6 mmHg, 146.1 mmHg, 143.4 mmHg, 138.7 mmHg in systole and 92.5 mmHg, 88.4mmHg, 87 mmHg, 85.1 mmHg in diastole, which showed the tendency to be lower. In both systole and diastole, the mean differences between first and second measurements, second and third measurements were significant, but insignificant between third and forth measurements, and forth and fifth measurements.
We divided systolic and diastolic pressures ito two subgroups according to stage 1, 2 classification of hypertension. In stage 1 subgroup, the means of blood pressures were lower from 151.3 mmHg to 135.4 mmHg in systole, from 95.1 mmHg to 85.3 mmHg in diastole, but there were not significant. In stage 2 subgroup, the mean blood pressure was lower from 169.7 mmHg to 142.5 mmHg in systole, form 105.4 mmHg to 87.8 mmHg in diastole, and the mean differences between first and second measurements, second and third measurements were significant, but not significant between third and forth measurements, and forth and fifth measurements.

Conclusion : Blood pressure tends to be checked significantly lower until subsequent third measurements, but not thereafter. We think that more studies to find out how many blood pressure measurements are needed for diagnosing hypertension in consideration of patient's blood pressure level and risk factors.

Background
: Despite the development of medical knowledge and technology, it has long been pointed out that the treatment guidelines are not sufficiently based on evidence. It has not been yet studied how evidence based medicine if implemented when physicians make their therapeutic decision. The purpose of this study was to determine the degree of evidence based interventions in a university based family medicine outpatient clinic.

Methods : The degree of evidence based practice was evaluated using Ellis and Gills' method developed by the Evidence-Based Medicine Center in Oxford. The patients' records of an outpatient clinic of a university hospital were reviewed on the primary diagnosis - intervention. The evidence based guidelines were defined as traditional textbooks and the results of randomized controlled trials found on databases such as Medicine, Clinical evidence, Best evidence, and Cochrane. In case where there were no guidelines, consultation with the specialists was done. The degree of the evidence based therapeutic interventions was assessed by three levels.

Results : There were 179 primary diagnosis - intervention pairs, among them, 125 pairs (69.8%) of interventions were based on randomized controlled trial evidence and 19 pairs (10.6%) based on convincing non-experimental evidence. No evidence was found for 35 pairs (19.6%). As a result, 80.4% of the total 144 pairs were regarded as evidence-based medicine.

Conclusion : The result showed that considerable portion of the total cases were evaluated as based on clinical evidence, which is similar to the conclusions of the previous studies in other countries. We hope that future similar studies will be conducted in other institutions as well as in other specialities.

Background
: The decisive factors influencing the eradication of H.pylori still remain unclear. It was our aim to assess H.pylori eradication rte with proton pump inhibitor based triple therapy and investigate the clinical characteristics and endoscopic factors.

Methods : We investigated 106 male patients with H.pylori-positive peptic ulcer. The patients were treated with a 1-week regimen composed of omeprazole, amoxicillin and clarithromycin. The success of the treatment was evaluated by histology at least 4 weeks after completion of therapy. Endoscopic factor and clinical factors influencing H.pylori eradication were assessed.

Results : The overall eradication of H.pylori was successful in 87 of 106 patients (82%). The eradication rate was higher in those who drink or smoke, with gastric ulcer, less than 50 years old but these factors did not significantly influence the outcome of treatment.

Conclusion : H.pylori eradication rate with omeprazole, amoxicillin, and clarithromycin did not differ from other studies. These results suggest that factors such as smoking, drinking, age and ulcer site did not influence the eradication rate of H.pylori.

Background
: It has been found that parental role is essential for obesity management in childhood. However, there are few studies concerning parental on childhood obesity in Korea. Parental perception on childhood obesity according to weight status in elementary school children was examined.

Methods : The subjects were 3,996 elementary school children and their parents in Busan. The surveys which included socioeconomic characteristics, children's eating habits and activities, parental weight and height, parental perception on childhood obesity, were filled out by parents. Children's body mass index(BMI) were calculated using the height and weight measured in school. Children were classified into the obese group (BMI≥95 percentile), the high risk group (85 percentile≤BMI<95 percentile) and the normal weight group (<85 percentile) according to BMI gender and age. The analyses were done using x²-test and ANOVA.

Results : Parental BMI in the obese group was higher than the normal weight group in boys and girls (P<0.001). Participation in regular exercise was higher among the obese group compared to the normal weight group regardless of sex, but daily exercise time was lesser among the obese group only in boys (P<0.001). Daily TV watching time was not different according to weight status in both sex. The parents with obese children perceived their children's weight as an appearance problem or a health problem about 7-18 times more likely than the parents of children with normal weight. 70% of obese children have tried weight control. The proportion of parental understanding on childhood obesity as a disease was not different among boys, but different among girls (P<0.001). Eighty five percents of the parents perceived childhood obesity as a disease or a risk factor. But, their perception for the association of hypertension, fatty liver, sleep apnea syndrome with obesity was relatively low.

Conclusion : Most parents with obese children perceived childhood obesity as an appearance problem, a health problem and as a disease or a risk factor.

Background
: The hemoglobin is a basic tool in diagnosing anemia. Not many studies compared hemoglobin between non-smokers and smokers in Korea and they did not differentiate hemoglobin between males and females. This study was conducted to show the difference of hemoglobin between non-smokers and smokers in male population and factors affecting hemoglobin.

Methods : We gathered 313 men who underwent periodic health examination from May to July 2001 in a general hospital. The relationship between cigarette smoking and hemoglobin concentration was examined by comparing the means of hemoglobin between two groups and through multiple regression analysis.

Results : The mean of hemoglobin was significantly higher in smokers than in non-smokers, especially in smokers with more than 1 pack per day. The factors that influence the hemoglobin level were age, the amount per day, and the total amount they smoked in the past(pack-year). Daily cigarette smoking seemed to cause a general upward shift of hemoglobin distribution curve, while age and pack-year on the opposite.

Conclusion : The study suggests that hemoglobin cutoff values should be adjusted for smokers and one must consider the patient's age to compensate for masking effect of smoking and aging on detection of anemia.

Background
: In korea, tsutsugamushi disease is one of the common diseases which occurs in more than 40% among acute febrile diseases during Autumn. The diagnosis is confirmed with Rickettsia tsutsugamushi antibody, and is characterised by fever, chill, headache, myalgia, skin rash, escha and lymphadenopathy.

Methods : We have conducted a survey on 16 clinically and serologically confirmed cases of Tsutsugamushi disease occurring during the period of October-November, 2000.

Results : Of 16 cases, 7 were males and 9 were females with an average age of 57.75. Most patients had fever, chill, headache, myalgia, sore throat, conjunctival injection, cough, abdominal, pain, nausea, vomiting, hematuria in order of frequency. The physical findings were eschar (81.25%) and skin rash(62.5%). Serologically 7 cases (43.75%) of 16 cases were confirmed positively R. tsutsugamushi antibody. General hematologic findings were decreased platelet count (37.5%), increased or decreased WBC (31.25% and 25% each other), and anemia (25%). Test for liver function included elevated AST, ALT (68.75%), alkaline phosphatase (62.5%), hypoalbuminemia (12.5%), and hyperbilirubinemia (6.25). Urinanalysis showed hematuria (50%), proteinuria (50%), and pyuria (12.5%). Doxycycline therapy decreased fever in 2.85 days and after 5-6 days patients were discharged with improvement of almost all symptoms.

Conclusion : Primary care physician in a community should always consider tsutsugamushi disease when he encounters patients with acute febrile disease in late Autumn and early winter and expect good prognosis with early diagnosis and treatment.

Background
: There are several reports on the association between hypothyroidism and coronary heart disease. But, it is not convincing whether the subclinical hypothyroidism is associated with the coronary heart disease or not. We have attempted to investigate the association between subclinical hypothyroidism and several coronary risk factors, and the difference of Framingham risk score between subclinical hypothyroidism and normal control subjects in women above 55 years old, who have higher prevalence in subclinical hypothyroidism.

Methods : This study involved th subjects above age 55, who visited the health promotion center in a university hospital from 1995 to 2000. Subclinical hypothyroidism was defined as a TSH level greater than 4.1 uIU/mL in the presence of a normal T3 (87-184 ng/dL) and T4 (5.6-13.1ug/dL) level. We measured thyroid function test(TSH, T3, T4) and the coronary risk factors (systolic and diastolic blood pressure, total cholesterol, LDL cholesterol, HDL cholesterol, triglyceride, fasting glucose, uric acid, C-reactive protein, and body mass index). Also, we calculated the Framingham risk score from their sum.

Results : There were no significant differences between the subclinical hypothyroidism patients and normal control subjects with coronary risk assessment in women above 55-years-old.

Background
: Little information exists concerning the amount of information patients espects from physicians as to the risk for an adverse reaction of medication. The present study was designed to determine such opinions in a population sample and to determine whether patients believe physicians should use discretion in the amount of such information given.

Methods : Five hundred fifty sequential adults visiting outpatient clinics filled out a 9-item questionaire. The percentage of subjects desiring information about varying degrees of risk and those believing physicians should and should not use discretion in the amount of such information provided were recorded. The results were correlated with demographic variables and previous experience of adverse effects.
Result: Among the respondents, 56.6% desired to be told of all possible adverse effects; 13.8% only if an adverse effect occurred in 1 out of 100,000; and 26.3% only if such occurrence was 1 in 100; 3.3% were not interested in any information. The percentages were closely similar to those for the same question that restricted opinion to serious adverse effects. The opinion that physicians should give the same information to all patients comprised 41.8% of the sample, and 83.4% opinioned that physicians were never justified in withholding any information.

Conclusion : Many individuals desire all information concerning possible adverse effects of prescribed medication from physicians and agree that the physician use judgement on the amount of information given but do not consider the physician to be justified in withholding information.

Background
: This study was done to investigate the clinical risk factors of delirium in general hospital's elderly inpatients.

Methods : A case-control study design was used. Forty cases and age-sex matched 120 controls were identified using hospital discharge data from June 1995 to May 2001. The controls were selected during the same period. The clinical records of each subject were reviewed using discharged disease code to select cases. Subsequently, the data were recorded from clinical records.

Results : The subjects admitted with delirium with delirium tended to have increased age (P=0.007), hypoxia (P=0.018), low hemoglobin(P=0.011), sleep disturbance(P=0.001), more ADL total dependence(P=0.018), diagnoses with infections (P=0.006), diabetes (P=0.046), and hypertension (P=0.041). Above risk factors seemed to be clinically associated with delirium.

Conclusion : These findings indicate that rapid infection control, maintenance of good sleep hygiene, well-controlled diabetes and hypertension, and correction of hypoxia may help to prevent delirium in general hospital's elderly inpatients.