Background
: According to recent studies of smoking rates among adolescents, the age at which young people begin to smoke is decreasing. The present study reports the results of a survey, conducted by the Korean National Tuberculosis Association (KNTA) in 2002, of the smoking status of Korean middle school students.

Methods : From April to November 2002, the KNTA surveyed the present smoking status of middle school students (total 14,296: boys-8,697, girls-5,599) according to sex and grade in 125 schools in 12 provinces during a smoking cessation education program.

Results : The survey showed that 18.4% of the males (7th grade-15.8%, 8th grade-17.6%, 9th grade-21.8%) and 8.3% of the females (7th grade-6.2%, 8th grade-9.3%, 9th grade-9.5%) had smoking experience. Approximately 2.5% of the males (7th grade-1.2%, 8th grade-1.8%, 9th grade-4.6%) and 1.0% of the females (7th grade- 0.3%, 8th grade-1.2%, 9th grade-1.5%) smoked regularly. The boys' smoking rate was higher than that of the girls in all grades. Smoking rates varied among the provinces, with Chungbuk having the highest rate (2.8%) and Jeonbuk having the lowest (0.9%). The time when most smokers began to smoke was in 6th grade of elementary school for the boys (15.9%) and 7th grade of middle school for the girls (28.6%). Approximately 69.4% of smokers answered that "curiosity" was the most important motivational factor. Statistical analysis indicated that smoking rates were positively correlated with alcohol use and height of students, but were negatively correlated with parents' level of education. At the end of the smoking cessation education program, the number of smokers had reduced for the boys (from 2.6% to 2.2%), but had increased for the girls (from 1.8% to 2.0%). The pre- program survey on the trans-theoretical stage of smoking cessation revealed that 34.2% fell into a pre- contemplation stage, 34.2% into a contemplation stage, and 31.6% into a preparation stage. The post-education survey showed remarkable changes: 24.0% were in the pre-contemplations stage, 40.0% in the contemplation stage, and 36.0% were in the preparation stage.

Conclusion : This study reports the results of a survey, conducted by the KNTA in 2002, concerning the national smoking status of middle school students, relating factors, and levels of motivation for quitting smoking. The smoking cessation education program run by the KNTA had an impact on the motivational stage of smoking cessation.

Background
: Although expert panels and guidelines recommend that 5∼10% weight reductions of initial body weight have beneficial effects for decreasing obesity-related complications, obese persons tend to desire greater weight losses. Little is known about the patients' expectations and the disparity of goal weight between physicians and patients. The aim of this study was to evaluate the patients' weight loss expectation, and the association between the degree of desired weight losses and treatment outcomes.

Methods : A total of 283 obese subjects (84 men, 199 women), aged ≥20 years with body mass index (BMI) over 25 kg/m² from 19 obesity clinics were included. Patients' desired weight as evaluated using modified GRWQ (Goals and Relative Weight Questionnaire) which included goal weight, ideal weight, satisfactory weight, acceptable weight, and disappointed weight. After 12 weeks, subsequent weight changes and treatment adherence were investigated.

Results : Mean BMI of men and women were 30.9±4.2 kg/m² and 29.1±3.8 kg/m², respectively. Men expected 13.2 kg (14.0%) mean weight reductions and women expected 10.8 kg (15.7%) mean reductions during the 3 months. The heavier the patient's weight, the greater the reduction amount was desired in both men and women. During the 3 months, the dropout rates of men and women were 40.1% and 46.2%, respectively. In women, the amount of desired weight reduction as significantly higher in the dropout group compared to the non-dropout group. Those who attained pre-determined goal weight after 3 months were 6% for men and 4% for women. After 3 months, 81% of male subjects and 80% of female subjects had not achieved even their predefined disappointed weight.

Conclusion : Obese patients seeking treatment expected average of 15% weight reduction, greater than 'medically reasonable or successful' weight reductions. The disparities between patients' expectations and physicians' recommendations could influence treatment adherence.

Background
: Most recent studies have suggested that beer is associated with high risk of mortality and morbidity. The purpose of this study was to investigate how beverage types affected high risk drinking for chronic harm.

Methods : We analyzed data from 1997 Korea's Behavioral Risk Factor Surveillance System Survey collected through telephone interview based on the multi-stage stratified random sampling (N=1,045). According to the WHOs guidelines, we categorized alcohol consumption per day into three risk levels for chronic harm and employed logistic regression analyses by adjusting for confounding factors including the number of beverages consumed, smoking, BMI, stress, and subjective health.

Results : Those who preferred soju were almost three to four times as likely to involve medium or high risk as those who preferred beer. In addition, compared to the beer-preferring drinkers, those who preferred spirits had more than five times of possibility in high risk drinking. However, both of those who preferred makkolli or wine and of those who preferred beer were exposed to high risk drinking to a similar degree.

Conclusion : In Korea, preferred types of alcoholic beverage turned out to be very important factor of high risk drinking behavior. Therefore, we need to encourage drinkers to switch high alcohol to low alcohol content beverages.

Background
: An increasing number of people undergo periodic health examination but due to its lack of a standardized method of examination and failure meet individual's specific, it has led to a huge wasting of resources. Thus, electrolyte tests performed during a routine health examination were reviewed to determine their significance and usefulness in mass screening.

Methods : We gathered 6,514 healthy cases who had received a periodic health examination at Asan Medical Center in August and December 2002. We reviewed the charts of the people who had abnormal results in electrolyte tests.

Results : The mean age of the subjects was 46 years (range 14∼82). Abnormal electrolyte results were relatively common. Four hundred and sixty one cases out of 26,056 (1.76%) had abnormal results. Abnormal results in sodium, potassium, calcium, and phosphorus were detected in 1.76%, 0.56%, 1.44%, and 3.53%, respectively. Only 16 of the 461 (0.06%) patients with abnormal results were recommended to visit a physician and only one of these cases revealed to have a new disease.

Conclusion : These results suggest that an electrolyte test is unnecessary as a screening test since only one case was revealed to be beneficial from it. Most of the cases involving abnormal electrolyte results did not need any treatment. Considering the cost benefit effect, a potential increase in false positive rate, and false negative rate, electrolyte tests should be reconsidered as a screening tests in periodic health examination.

Background
: Because the sensitivity of mammography (MAM) is lower in young women than in old and in women with dense breast than those without, many physicians utilize breast ultrasonography (US) with MAM. But the addictive value of US is unclear. This study compared the diagnostic value between MAM and MAM+US.

Methods : Between September, 2002, and February, 2003, there were 89 cases of breast disease confirmed by surgery, that had both MAM and US results. The results of MAM and US were classifed by Breast Imaging Reporting and Data System (BI-RADS) and were categorized as positive or negative. Among the positive results, BI-RADS Category 0 and Category 3 with recommendation of other test were regarded as an intermediate result.

Results : Among all 89 cases, 38 cases were malignancies. The receiver operating characteristic curves showed non-significant increase in diagnostic value by adding US to MAM. The sensitivity of MAM was non-significantly higher in above-50-years women than in below- 49-years women and in women with dense breast than in women with non-dense breast. Among positive results of MAM, 21 cases were 'intermediate results'. US correctly regraded 8 benign lesions from 19 cases of false-positive MAM and 1 extra malignancy with palpable lump from 4 false-negative MAM.

Conclusion : MAM is a valuable test in diagnosing breast cancer. US is a valuable complementary test to MAM in evaluating palpable lump with negative MAM and intermediate result of MAM.

Background
: Since March 1, 1989, a new health care system has been introduced. But the departments of ENT, ophthalmology, dermatology and PMR (rehabilitation medicine) in tertiary health care hospitals were exempted from the new system and were allowed to see patients directly. Thereafter, the Ministry of Health revised the National Health Insurance regulation, and required the above departments to see patients only with referral. This study was done to analyze whether the revision has contributed to providing adequate specialized medical services and to know what role family physicians can assume under revision by analyzing the referred patients.

Methods : From November 1998 to June 2000 and from July 2000 to February 2002, both 20 months, we reviewed the charts of 331 patients who were referred from family medicine department of KHMC (Kyung Hee Medical Center) to the above four departments and analysis has done.

Results : During both periods, the number of cases increased from 94 to 237, and the patients group had no significant difference in age and sex. Reviewing the number of referred cases, before revision, cases were concentrated to the department of ENT and to PMR. After revision, cases were evenly distributed in three departments. except for PMR. Reviewing referral contents, the three departments except for dermatology showed no significant difference.

Conclusion : The sum of cases increased by 2.5 times, but the three departments except for dermatology showed no significant difference in referral and diagnosis content. In dermatology, the majority of the patients wanted a referral with the objective of obtaining a referral paper. Therefore, we can consider that the revision didnot contribute to specialized medical services. But after revision, referral cases to ophthalmology and dermatology increased by 4 and 6 times. We recommend that family physicians know and experience more about these.