Background
: We evaluated physician's management of hypercholesterolemia on the basis of the third Adult Treatment Panel (ATP III) report of the National Cholesterol Education Program.

Methods : The subjects were 85 adult patients. The inclusion criteria were as follows: outpatients with an initial total cholesterol level of ≥200 mg/dL or HDL-cholesterol ＜40 mg/dL from October to November in 2002, and those visiting the clinic at least three times for the 12 weeks after the baseline test. We reviewed the patients' cardiovascular risk factors (age, low and high HDL, hypertension, history of coronary heart disease (CHD), and diabetes) and the use of LDL-lowering drugs using hospital records. Smoking status and family history of premature CHD were obtained from 19 patients out of 36 patients without CHD or diabetes by telephone. On the whole, cardiovascular risk in 68 patients was identified. Among the total, 52 patients responded to telephone interview concerning education of therapeutic lifestyle change (TLC) provided by a physician.

Results : Forty nine (72.1%) of 68 patients were diagnosed as CHD or diabetes. Fifty three (77.9%) showed undesirable LDL that was categorized by the number of cardiovascular risk factors (≥160 mg/dL for patients with risk factor＜2; ≥130 mg/dL for patients with risk factors ≥2; ≥100 mg/dL for patients with CHD or diabetes). In 59.5% of patients with undesirable LDL reported that they did not provide education about TLC and in 40.0% of patients with desirable LDL were provided prescription of LDL-lowering drugs from physicians. Physicians were more likely to prescribe if the patients had more risk factors (P=0.001) and educated patients when they prescribed them (P=0.049). However, physicians did not educate on TLC and did not recheck lipid profile prior to first prescription.

Conclusion : The physicians did not follow the ATP III guideline for management of hypercholesterolemia. Barriers to comply with these guidelines and ways to eliminate barriers should be found.

Background
: The results of previous epidemiologic studies showed that dietary and life style factors are associated with colon polyps. Despite the high prevalence of colon polyps, little is known about its risk factors in Korean adults. The aim of this study was to assess the relationship between physical activity and the presence of colorectal polyps.

Methods : In 859 subjects, rectosigmoidoscopy was performed at Ulsan University Hospital Health Promotion Center from January 2002 to October 2002. Drinking, smoking and other confounding factors were assessed by self-administered questionnaire in 161 subjects with colon polyps and 698 controls.

Results : Among the total of 859 cases the prevalence of colorectal adenomatous polyps was 18.7%. After adjusting for age, sex, physical activity, obesity, calcium and total energy intake, using multiple logistic regression, decreasing risk of colorectal polyps were observed with increasing level of physical activities. The odds ratio for 3 to 4 hours per week exercise group was 0.460 (CI=0.262∼0.809). The frequency and intensity of exercise also had an inverse association with colon polyps (4∼5 times/ week group: OR=0.428, CI=0.220∼0.832; vigorous exercise group: OR=0.454, CI=0.298∼0.693).

Conclusion : Physical activities were inversely associated with colorectal polyps in Korean adults.

Background
: Two representative groups of family physicians and oncologists were surveyed concerning their knowledge and attitudes toward cancer pain management (CPM).

Methods : A questionnaire, designed to assess knowledge (13 items) and attitudes (6 items) toward CPM, was sent to 2,200 members of Korean Association of Family Medicine and 800 members of Korean Cancer Association.

Results : Three hundred and eighty eight family physicians (17.6%) and one hundred and forty seven oncologists (18.4%) responded and completed the questionnaire. They had inadequate knowledge toward CPM, especially, chance of respiratory depression, tolerance to adverse effect, ceiling effect, risk of addiction, and use of adjuvants. Most of the physicians had positive attitude toward importance of CPM, best judge of pain severity, and priority of CPM but had negative attitude toward concerns about potential problem of addiction and earlier prescription of maximum dose of opioid. Family physicians displayed more lack of knowledge about CPM in 9 of 13 items and more negative attitudes toward 4 of 6 items. Adjustment for demographic characteristics and experiences in cancer patients with pain showed that while family physicians had poor knowledge of tolerance to confusion, they had more adequate knowledge on the effect of antidepressant and had positive attitude towards best judge of pain severity and priority of CPM. Poor knowledge about CPM was rated by 66.3% of physicians as the most important barrier to adequate CPM.

Conclusion : These findings that most of the physicians had poor knowledge and negative view toward CPM suggest a continuous need for comprehensive education program focused on CPM for physicians.

Background
: The purpose of this study was to assess the quality of primary care by patient-completed questionnaire, and to investigate whether the results of the assessment were different among the specialties of doctors (especially family medicine) and according to the existence of a family doctor.

Methods : The questionnaire, which covers 7 components of primary care (accessibility, continuity, accountability, comprehensiveness, integration, sustained partnership with patients, whole person orientation), was administered to the applicants of health screening center of a university hospital, and factory workers in Cheonan, and residents living in Seoul. Statistical analysis was performed through the collected samples.

Results : Total of 574 subjects were analyzed. The mean score (%) of each component of the total sample was as follows; accessibility 45.8, continuity 47.8, comprehensiveness 22.5, accountability 55.5, integration 41.8, sustained partnership with patients 48.9, and whole person orientation 31.8. The mean score (%) of all components were 42.0. Doctors were classified into internists, general surgeons, family physicians, general physicians, and others. Family physicians had the best score in accessibility (P=0.01). The mean score of all components of family physicians was better than that of internists and the other specialties (P＜0.05). The number of respondents who had family doctors was 129 (22.5%). The mean score of each component was higher than those without a family doctor (P＜0.05).

Conclusion : Family physicians are providing high quality primary care compared to internists and other specialists. Patients who have a family doctor are provided with higher quality primary care than those who do not. Especially, comprehensiveness and whole person orientation need to be improved.