Background
PAP smear has been highly appraised for screening cervical cancer. Generally regarded is that women physicians regularly screen for PAP would promote patients' early detection and treatment rate by their strong recommendation. Hereby we investigated PAP-screening in primary care women physicians, recommending proportion and associated factors. Methods: Questionnaires were sent to 981 members of the Korean Academy of Family Medicine, Korean Association of Family Practitioners, Korean Medical Women's Association, and Songpa-gu and Kangdong-gu family practitioners. a total of 193 respondents was analyzed. Results: Among the total 55.4% of the respondents screened for PAP smear regularly, either annually (23.9%), or from their treating gynecologists (61.6%) or through routine check-up (81.1%). Common reasons for not screening were lack of time (40.7%) and forgetfulness (38.4%). Recommending proportion for PAP to patients was 49.2%. Reasons for not recommending were lack of equipment, forgetfulness (18.8% each). Confidence of PAP as a screening test was very high (71.5%); significantly related to PAP-screening and to recommending proportion (P=0.033, P=0.005, respectively). Many of the respondents thought physician's own PAP-screening affected its recommendation (45.3%), whereas significant relation to their actual PAP-screening was not found (P=0.845). PAP-screening in physicians showed no significant relationship with recommending proportion (P=0.053). Internal disease history had meaningful relation only with recommending proportion (P=0.001). Conclusion: Though physicians show strong confidence in PAP and undergo more than the general public, most do not screen for it regularly and the recommending proportion was low. To improve physician's PAP-screening and recommending proportion, re-education of physicians and provision of proper clinical equipment are required. (J Korean Acad Fam Med 2007;28:589-598)

Background
Nationwide evaluation of physicians' smoking rate may be helpful to predict future trend of smoking in a general population. Thus, we investigated physicians' smoking rate and their habits in Korea. Methods: Ten percent of physicians among the registered members of the Korean Medical Association were chosen by stratified random sampling and a mail questionnaire survey was conducted in 2000. Of the 2,977 physicians to whom the questionnaires were delivered, 1,248 (41.9%) responded. Results: Overall smoking rate among Korean doctors was 29.9%. Smoking rate of males was 34.9% and that of females was 2.3%. In the current smokers, the most frequently reported age when they had begun smoking were 15∼20 years (60.3%), the majority of daily smoking amount was less than or equal to 1 pack (92.5%), and those who were planning to quit smoking within 1 month were 11.9%. In the ex-smokers, the most frequently reported age when they had begun smoking were in their 20s (67.7%) and the most frequently reported age when they had stopped smoking were in their 30s (38.0%). Conclusion: The smoking rate of Korean physicians was estimated to be less than that of the general Korean population, but higher than that of physicians in major developed countries. More efforts to lower smoking rate of physicians and regular follow up is needed. (J Korean Acad Fam Med 2007;28:599-603)

Background
This study investigated the relationship between stress and nicotine dependence, dividing stress into external stress and internal response. Methods: The subjects were 263 male adults who had visited the General Health Promotion Center at Chungnam National University Hospital in Korea between April and June 2005. Nicotine dependence, external stress and internal response were measured by the Fagerstrom test for nicotine dependence, life change unit of the social readjustment rating scale and the brief encounter psychosocial instrument. Results: The mean (±SD) score of external stress in smokers (n=107) was 150.79 (±109.02), which was significantly (P<0.001) higher than 92.96 (±126.27) in non- smokers, and the mean (±SD) score of internal response in smokers was 10.30 (±3.16), which was also significantly (P<0.001) higher than 8.71 (±3.33) in non- smokers. The smokers' nicotine dependence showed positive correlation with the score of external stress (r=0.436, P<0.001) and the score of internal response (r=0.579, P<0.001). The stepwise multiple regression analysis showed that nicotine dependence was related to the score of internal response, the score of external stress, the duration of education, the age of first smoking (overall R²=0.433, P=0.040), and most closely to the score of internal response (partial R²=0.335, P<0.001). Conclusion: In order to develop an effective strategy for quitting smoking, the internal response to stress needs to be considered as one of evaluation items. (J Korean Acad Fam Med 2007;28:604-609)

Background
Diabetic neuropathy is a common complication of diabetes. Since neuropathy leads to ulceration and amputation, efforts to detect early and to elucidate its risk factors are ongoing. The goal of this study was to check the validity of Michigan neuropathy screening instrument (MNSI) as a screening test and its risk factors for diabetic neuropathy. Methods: A total of 75 subjects with type II diabetes mellitus, who visited a university hospital, were investigated. We measured their duration of diabetes, height, weight, systolic blood pressure, diastolic blood pressure, fasting glucose, glycosylated hemoglobin, triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, total cholesterol, serum creatinine, and 24-h urine albumin. MNSI tested and electrophysiological test were performed. Results: The sensitivity, specificity, positive predictive value, and negative predictive value of MNSI was 63.5%, 78.3%, 86.8%, and 48.6%, respectively. Statistically significant relationships were found between neuropathy and the duration of diabetes and total cholesterol. Conclusion: MNSI seemed to be an appropriate screening test for diabetic neuropathy. More attention must be paid to the duration of diabetes and the total cholesterol of type 2 diabetic patients with peripheral neuropathy. (J Korean Acad Fam Med 2007;28:610-615)

Background
The educational assessment of residents is very important in order to check their knowledge and to improve their ability. In case of family practice, the residents spend most of their training time in outside rotations with other specialities. Therefore, they are requested to be evaluated by each specialist after each rotation. To give more accurate assessment, we surveyed directly our family practice residents and family practice faculties. Methods: A questionnaire was sent to family practice residents and family practice faculties in 116 hospitals from May to June 2006. The response rate was 29% and 78%, respectively. Results: Among the total, 70.2% of family practice residents thought an assessment is necessary, but only 51.7% were evaluated. Overall, 90.4% of family practice faculties knew about the assessment of residents made by other specialists, and only 56.7% of faculties requested other specialists to assess their family practice residents. Conclusion: Most of the family practice residents and their faculties knew the need for assessment, but they complained there were no objectivity and the assessment tool was lacking. In order to solve this problem, it is urgent to develop a unified form and guidelines of assesment. (J Korean Acad Fam Med 2007;28:616-625)

Idiopathic intracranial hypertension, or Pseudotumor cerebri is a disorder characterized by symptoms and signs of a space-occupying intracranial mass without any evidence of mass or ventricular obstruction. We experienced a 28 years old obese woman who was presented with headache and progressive visual disturbance for one month. She presented bilateral papilledema with visual field defect. On MRI investigation no intracranial abnomality were observed. Lumbar puncture showed increased intracranial pressure and normal biochemical and cellular findings. The patient was diagnosed idiopathic intracranial hypertension and treated with therapeutic lumbar puncture, acetazolamide, furosemide, weight control and symptoms resolved gradually. We conclude that weight reduction is difficult to accomplish but always needed in idiopathic intracranial hypertension. (J Korean Acad Fam Med 2007;28:626-630)