Generalized anxiety disorder (GAD) is highly prevalent psychiatric disorder in primary care population and is a source of major morbidity. However, the underawareness and undertreatment of GAD, which is due to insufficient knowledge about the disorder, often hinder the proper management of this chronic condition. Other characteristic features such as chronic course of GAD, frequent comorbidity with other anxiety and depressive disorders, and the controversy regarding the best diagnostic criteria should be fully discussed. First of all, proper and accurate diagnosis is crucial for an appropriate management. Primary care management of GAD and associated comorbidities includes education about the nature of GAD and counseling about treatment alternatives and coping strategies is an important first step. The most effective treatment of GAD is combined psychotherapeutic and pharmacotherapeutic approach. The major psychotherapeutic approaches to GAD are cognitive-behavioral therapy with relaxation techniques. Pharmacological treatment for GAD includes benzodiazepine, buspirone, and antidepressants. In this review, these combined treatment at the view point of primary practitioners was described.

Background
: Obesity has been proposed as a risk factor for cardiovascular diseases. CRP has been proposed as an independent risk factor for cardiovascular diseases, and has been associated with body weight and body fatness. It has been known that weight reduction reduces CRP. We examined the hypothesis that weight loss can reduce plasma CRP levels in Korean, obese premenopausal women.

Methods : In a sample of 36 Korean obese (BMI 25.00 ∼47.02 kg/m²), premenopausal (22∼48 years) women, we measured hsCRP, plasma lipid profiles, blood glucose, body weight, body mass indexes, body fatness and intraabdominal body fat area. A 12-week weight reduction program was conducted in 36 obese women. When the program was finished, fat distribution, hsCRP and lipid profile test was repeated. The effects of weight loss on CRP levels were tested by means of paired t-test and nonparametric Wilcoxon signed rank test.

Results : We found that plasma CRP level was positively associated with body weight, body mass index, body fatness, CT-measured abdominal visceral and subcutaneous fat area. After a 12-week weight loss protocol, the average weight loss was 7.97±3.46 kg (P＜0.0001) with loss of fat mass 5.29±0.59 kg, and 1.98±1.20 kg lean body mass. Plasma CRP levels were both positively associated with plasma CRP level reductions (P=0.0437).

Conclusion : Obesity and adiposity influenced significantly on plasma CRP in Korean premenopausal women on cross sectional basis. Moreover, 12-week caloric restriction induced weight loss decreased plasma CRP levels. Weight loss represents an intervention to reduce plasma CRP and can mediate to reduce cardiovascular disease risk in Korean obese premenopausal women.

Background
: Family environment has an important effect on the development of children. During childhood and adolescence, depression and anxiety are common forms of psychopathology. Therefore, the relationship between family function and depression·anxiety in children was investigated in this study. This research was intended to aid management of children in the field of primary care.

Methods : This study was based on the survey administered to 193, 4th grade students of two elementary schools in the area of Sung-buk in Seoul, Korea, in May, 2003. We investigated family function, depression and anxiety by self-rating using the Smilkstein's Family APGAR, the Kovacs's CDI and the Reynolds's RCMAS. At the same time, home environment characteristics (Family Structure, Parental Religion, Parental Education and Monthly Household Income) were investigated.

Results : There were no significant differences in home environment characteristics between Family APGAR groups (P＞0.05). CDI scores were significantly higher for children whose parents had education levels of middle school or lower (P＜0.05). However, there was no significant difference in RCMAS scores between home environment characteristics (P＞0.05). CDI score was significantly different between Family APGAR groups (P ＜0.05). And, RCMAS scores was significantly higher in poor family function groups than good family function groups according to Family APGAR groups (P＜0.01). Both CDI and RCMAS scores was negatively correlated with Family APGAR scores (r=-0.376, P＜0.01) (r=-0.266, P＜0.01) and CDI score was positively correlated with RCMAS scores (r=0.711, P＜0.01).

Conclusion : In groups where the Family APGAR score was lower, both CDI and RCMAS scores were significantly lower. Accordingly, when caring for children, family physicians should need to their family function and know that it has an effect on children's emotions.

Background
: Although smoking hazards are acknowledged worldwide, recent study of Korean teenage smokers shows that students' first smoking experiences are occurring at younger ages. Therefore, we have developed an internet-based smoking prevention program, and assessed the effectiveness of the self-administered internet program by comparing with traditional lecture.

Methods : Between April and June of 2004, 463 female eighth-grade students at a middle school were divided into two groups. One group (n=252) received the lecture-based smoking prevention education by an expert, while the other group (n=212) learned themselves via the internet program. Prior to both smoking prevention programs, the students filled out questionnaires about their basic information. One month after their education, the students were tested on the information included in the programs without prior notice and filled out another questionnaire on the level of comprehension, satisfaction and other factors.

Results : According to the pre-education questionnaire, the percentage of current smoking rate was 2.8%, and the first smoking experience was largely between the sixth and seventh grades. When comparing the scores of self-administered internet education with that of the lecture, the mean scores were 56.7 and 57.8, respectively, which was not significantly different (P=.267). The survey on comprehension, satisfaction, and other factors did not show any significant difference between the two groups.

Conclusion : There was no significant difference between the internet-based program and the lecture-based one, in terms of effectiveness as well as comprehension, satisfaction, and other factors. Considering that the internet-based program is not restricted by time or location, it will no doubt be an effective tool in teenage smoking prevention programs.

Background
: The purpose of this study was to examine the sensitivity and specificity of ECG as a tool for detecting echocardiographically defined LVH in a population-based sample and to examine the impact of a variety of factors that affect the sensitivity and specificity of ECG for detection of LVH.

Methods : A total of 1,130 subjects who received a thorough medical checkup for cardiologic department voluntarily were selected. The subjects were examined using M-mode echocardiography and standard 12-lead ECG. The x² test was used to test for differences in sensitivity and specificity of ECG for echocardiographically defined LVH. Cochran-Mantel-Haenszel statistic was used to adjust for sex, age, and obesity and to test the association between cigarette smoking, amount of alcohol, exercise, hypertension, diabetes mellitus (DM) and sensitivity and specificity of ECG.

Results : Echocardiographic LVH was detected in 434 (38.4%) and electrocardiographic features of LVH were present in 146 (12.9%). ECG for diagnosis of LVH showed sensitivity of 20.0%, specificity of 91.5%, and diagnostic accuracy of 64.1%. Sensitivity of ECG for LVH was higher in persons with obesity (P=.04) or hypertension (P=.04). Specificity of ECG for LVH was lower in persons with hypertension (P=.003).

Conclusion : ECG has a low sensitivity and a high specificity for echocardiographically defined LVH. Attention must be paid to carefully interpret ECG for diagnosis of LVH in persons with obesity or hypertension, because the rate of false positives and negatives can be increased.

Background
: This study was conducted to find out the difference of heart rate variability between practicing Tai Chi and walking at 6 km/hr.

Methods : Twelve healthy volunteers aged 25 to 35 were recruited through advertisement. All the subjects gave their informed consent, and the study was approved by the Institutional Review Board of the Catholic Medical Center Research Foundation. The subjects either practised Tai Chi or walked at 6 km/ hr on a treadmill machine, maintaining 5-minute rest, 20-minute exercise, and 30-minute rest. After 1 week, they switched and performed the other form of exercise. During the exercise, beat-to-beat HRV data was recorded by Polar S-810. We calculated HRV indices using Matlab software program and analyzed the mean value of HRV indices.

Results : The differences of the mean value of HRV indices of pre-exercise resting period were not significant. However, repeated ANOVA revealed that there were significant differences of change in the mean of SDNN (-14.27±13.03 ms, -33.67±20.23 ms; P=0.023), RMSSD (-10.17±9.59 ms, -21.90±12.60 ms; P=0.087), and STIDX (171.60±196.84, 1003.49±812.56; P=0.003) between practising Tai Chi and walking. The differences of change in mean heat rate, LF/HF ratio, LF, HF and TP were not significant. The differences of the mean value of HRV indices of the post-exercise resting period were not significant compared to the pre-exercise period.

Conclusion : The result of this study suggest that exertional intensity of practising Tai Chi is similar to that of walking. Moreover, practising Tai Chi may be more profitable than walking in the aspect of HRV.