Background
: The accuracy and efficiency of a job performed by hospital employee can be linked directly with patients' health and life. It is considered that their irregular work and stress are relatively high as compared with other workplaces. In this article we tried to look into how job stress, working environment and factors of life- style influence sleep problems in hospital employees.

Methods : This research was conducted among 248 workers of a hospital in Busan on April, 2002. Sleep problems were categorized into insomnia, sleep deprivation, daytime sleepiness and snoring on the basis of the factor analysis of 11-item questions. The job stress was proposed by Karasek, etc., and measured by 14-item modified questions. The statistical analysis was conducted using Chi-square test and multiple logistic regression analysis.

Results : Statistically insomnia, sleep deprivation and daytime sleepiness showed a significant increase in women (OR:2.1/2.69/3.16) and shift workers (OR:4.67/ 3.28/1.98) and snoring showed a significant increase in obesity (OR:5.0) and smokers (OR:2.34).

Conclusion : This research showed that many hospital employees perceive sleep disorders as critical. Especially, work shift seemed to be an important risk factor for sleep disorders.

Background
: The age-related increase in fat mass seems related to decrease in hormone level. Few studies have been done in Korea concerning the association between testosterone, GH (growth hormone) and fat mass. This study was undertaken to evaluate the relationship among testosterone, IGF-1 and fat mass.

Methods : The study was performed from February to October 2001 in the Health Screening Center of Pundang CHA Hospital with 243 men as subjects. Fat intake was measured through interview with diet therapist and other data were obtained by self-questionnaire. Fat mass was measured using Inbody 3.0 and the level of total testosterone, SHBG and IGF-1 in serum were measured.

Results : Smoking was negatively correlated with fat mass and WHR (waist to hip ratio) (P＜0.05) and fat intake was positively correlated with fat mass (P＜0.05). Fat mass was negatively correlated with total testosterone, calculated free testosterone, and SHBG (r=-0.26; P＜0.01, r=-0.15; P＜0.05, r=-0.31; P＜0.01). WHR was positively correlated with age (r=0.26; P＜0.01) and negatively correlated with total testosterone, calculated free testosterone, and IGF-1 (r=-0.24; P＜0.01, r=-0.20; P＜0.01, r=-0.16; P＜0.05). After adjustment for age, body mass index, smoking, and fat intake, the calculated free testosterone and IGF-1 were independently negatively correlated with fat mass (β=-0.072; P＜0.01, β=-0.0035; P＜0.05) and WHR (β=-6.9E-04; P＜0.05, β=-4.0E-05; P＜0.05) but, total testosterone and SHBG were not independently correlated with fat mass and WHR.

Conclusion : The results indicate that the calculated free testosterone and IGF-1 can be independent determinants of fat mass and WHR in middle-aged men.

Background
: After amendment of the national health insurance law to enforce and reform primary health care, the number of family medicine out-patients was increased. Some patients requested referral. Therefore, this study was made to reveal family medicine residents' perception of attitude towards request for referral.

Methods : The self-administered questionnaires were collected by post mailing (July 1 to July 30, 2002) and by e-mailing (July 25 to August 10, 2002). The questionnaire contained the followings: general characteristics, issues of referral request, influence of referral request in training, and influence in private family clinics.

Results : The overall response rate was 22.2% (93/418). Patients need was the most common cause of referral (62.0%). Among the total, 46.2% of respondents gave answers that increasing number of patients at the family medicine out-patient clinic was beneficial in increasing their experience. Also, 55% of respondents replied that the present state of family medicine out-patient system influenced lowering of motivation in training. Overall, 63.4% of respondents replied that the present state of family medicine out-patient system led a trend of distrust to private family clinics.

Conclusion : Patients request was the most common cause of referral in family medicine out-patient clinic. The present state of referral system in family medicine out- patient clinic influenced lowering of motivation in training and a trend of distrust to private family clinics.

Background
: The purpose of this study was to evaluate the efficacy of caudal epidural steroid injection with local anesthetic for chronic lower back pain patients.

Methods : The 152 patients with lower back pain were selected for the study. The patients were treated with the caudal injections of steroid (triamcinolone acetate 40 mg) and local anesthetics (1% lidocaine 17 ml). The efficacy of caudal injections was assessed with the visual analogue scale (VAS) before procedure and at 8 weeks following procedure.

Results : The VAS scores of 'Before procedure' group and '8 weeks after procedure' group were 62±23 and 31±15, respectively. The caudal steroid injections provided effectiveness in treating various lower back pain diseases except postlaminectomy syndrome.

Conclusion : We consider that caudal epidural injections of steroid and local anesthetics are effective for patients with chronic lower back pain in the short term.

Background
: In modern society, thin appearance is treated as ideal, making the majority of the normal weight group think that they are fat. Therefore, exercise and diet, numerous unhealthy methods were frequently chosen by normal weight group for weight control. The authors gave a definition of Ideal Body Weight and attempted to propose a new classification of obesity to the normal weight group who do not view themselves as they should.

Methods : The test subjects were 261 adults, who visited the IJUH Health Promotion Center between May 15, 2002 and June 30, 2002. After the subjects were measured anthropometric values such as height and weight, the self-recorded questionnaires including 12 questions were collected. The grades of somatotype drawing were 1∼9 by BMI. The subjects chose 1 somatotype drawing that was thought to be obese man and woman.

Results : The data were collected from 261 subjects. For female somatotype drawing, 81.7% of the men and 49.1% of the women thought the drawings of normal weight were obese (P＜0.001). For male somatotype drawing, 47.7% of the men and 29.3% of the women thought the drawings of normal weight were obese (P＜0.01). For women's weights, 81.7% of the men and 82.1% of the women thought the normal weight was obese. For men's weights, 20.3% of the men and 23.6% of the women thought the normal weight was obese. Women thought the normal weight was obese more than in men.

Conclusion : Women thought the normal weight was obese more than in men. Many men and women thought below the BMI 25 was obese.

Background
: Physical fitness is defined as the ability to carry out work necessary for muscle exercise satisfactorily. Generally, obese person have been considered to have low physical performance. In addition, obesity has been known to be a risk factor of cardiovascular disease such as hyperlipidemia, hypertension, and coronary arterial disease. Based on previous epidemiologic studies, abdominal obesity, especially, visceral obesity, is thought to be more important risk factor for cardiovascular disease rather than obesity itself. Therefore, the interest on assessment of abdominal visceral fat has been increasing. The aim of this study was to see the difference in physical fitness and blood pressure according to obesity degree assessed by BMI, and compare the anthropometric obesity indices with abdominal visceral fat accumulation measured by abdominal CT (Computed Tomogram).

Methods : Four hundred thirty-two subjects, who participated in the exercise program for more than one month duration at the 'Clinic for Obesity' in St. Mary's Hospital from November 1998 to June 2000, were included in the analysis. They were categorized into 4 groups [severe obesity group (BMI≥30), obesity group (25≤BMI＜30), overweight group (23≤BMI＜25), normal group (BMI＜23)] according to their BMI. Blood pressure, anthropometric obesity indices and physical fitness (V0₂ max, back muscle strength, sit up, forward bending, vertical jump, side step, balance) were measured by one skillful exercise trainer. Among them, one hundred thirty-one subjects performed abdominal CT to assess visceral fatness. We compared anthropometric indices (waist to hip ratio, body mass index, abdominal circumference, skin foldness) with abdominal visceral fat accumulation measured by CT.

Results : Blood pressure, cardiovascular endurance, muscular endurance, muscle strength, speed and balance were significantly different among the four groups categorized by BMI in both sexes, but flexibility and agility were not significant. In women, the correlation coefficients between visceral fat area measured by abdominal CT and each of waist to hip ratio, BMI, abdominal circumference, and skin foldness adjusted for age were 0.487, 0.479, 0.464, 0.31, respectively (P＜0.01). However in men, there were no significant correlations.

Conclusion : Obesity tended to increase blood pressure, and reduce physical performance. Only in women, obesity related indices reflected the abdominal visceral fat accumulation.