Background
After referral system had been established, patients wishing to consult with a specialist with 'self- referral' in mind is increasing in university hospital family medicine clinics. This study was conducted to know whether those by self-referral to a specialist in a university hospital could benefit from family physician's consultation or not. Methods: Three hundred and sixty patients were serially assigned to either 'simple referral' group provided with a referral note without consultation or 'referral after consultation' group with consultation from a family physician. Patient satisfaction was rated by using questionnaires with 5-point Likert scale. Results: Patients in the 'simple referral' group were more satisfied with the whole process of family physicians' consultation compared to the 'referral after practice' group in both the appropriateness and patient satisfaction of the consultation (both, P＜0.001). Males, longer encounter time, and shorter waiting time were significantly influenced patient satisfaction compared to each counterpart. Conclusion: Patients who want only a referral note from a family physician in a university hospital may received some benefit from the coordination and comprehensive care by a family physician. Health delivery system should be rectified according to the consideration of the role of the primary care physician such as a family physician. (J Korean Acad Fam Med 2008;29:325-329)

Background
It has been reported that cardiovascular factors such as hypertension, smoking, diabetes and obesity are related to decrease in heart rate variability (HRV). This study purposed to examinate the association of HRV with Framingham risk score in non-obese males and the affecting factors of HRV. Methods: The study was carried out in 323 males who visited a health care center from June to August, 2004, None had previous cardiovascular and cerebral diseases, diabetes, or obesity (BMI≥25 kg/m²). The subjects were divided into three groups by Framingham risk score and we compared the means of HRV parameters including the Mean Heart Rate (MHR), Standard Deviation of NN interval (SDNN), the Square Root of the Mean Squared Differences of successive NN intervals (RMSSD), Total Power (TP), Very Low Frequency (VLF), Low Frequency (LF), High Frequency (HF), and LF/HF ratio in these three groups. Results: There were significant differences among the groups by age. Among HRV parameters, SDNN (P＜ 0.001), RMSSD (P=0.001), TP (P=0.008), LF (P=0.024), and HF (P=0.003) are inversely associated with the risk score group. Multiple regression analysis revealed age, systolic blood pressure and C-reactive protein as independent explanatory variables of HRV. Conclusion: SDNN, RMSSD, TP, LF and HF were decreased in the higher risk group, we can suggest that autonomic function is impaired as the cardiovascular risk increases. (J Korean Acad Fam Med 2008;29:330-335)

Background
The purpose of this study was to examine the association between the change of parental weight status and the change of their child's weight status over 2 years. Methods: A total of 379 children ages 11-13 years were measured their height and weight in 2001 and 2003. Their parents completed a questionnaire including self-reported parental weight and height during the same period. Parental weight status was classified as overweight (BMI≥25 kg/m²) and non-overweight (BMI＜25 kg/m²). Children's weight status was classified as overweight and non-overweight using the age and gender-specific BMI established by the Korean Academy of Pediatrics. The weight status over 2 years was categorized as a group of persistent overweight, persistent non-overweight, shifting overweight to non-overweight, and shifting non-overweight to overweight. Results: After adjusting for the child's gender and the father's weight status, the odds ratio for being persistently overweight over 2 years in a child having a mother with persistent overweight was 2.8 (95% CI: 0.9-8.5) compared to a child having a mother with persistent non-overweight. Likewise, the odds ratio for being persistently overweight over 2 years in a child having a father with persistent overweight was 2.9 (95% CI: 1.4-6.1) compared to the child having a father with persistent non-overweight. Conclusion: Parental weight status over 2 years was associated with the 2-year weight status in children. The parents- and family-based intervention are needed to prevent and manage childhood obesity. (J Korean Acad Fam Med 2008;29:336-341)

Background
This study was designed to evaluate the effectiveness of brief group education on improvement of readiness to change in heavy drinkers. Methods: We selected 37 heavy drinkers categoriged in the state of precontemplation and contemplation stage according to readiness to change questionnaire (RTCQ). The readiness to change was re-evaluated after 4 sessions of drinking education. Results: The mean (±SD) frequency of participation in group education was 3.5 (±0.6). According to the stage of readiness to change, the subjects were distributed into 11 (29.7%) in the stage of precontemplation and 26 (70.3%) in contemplation before participation in the program. After completion of educational program, the readiness to change in the subjects was significantly (P＜0.001) changed into 1 drinker (2.7%) in the stage of precontemplation, 16 (43.2%) in contemplation and 20 (54.1%) in action. The influential factors associated with the improvement of the status of readiness to change was family APGAR score (odd ratio 1.75, 95% CI 1.02-3.03). Conclusion: Above results suggested that the readiness to change in heavy drinkers can be improved by brief group education program. (J Korean Acad Fam Med 2008;29: 342-348)

Background
Most patients feel uneasy about visiting a clinic and thus the trust on their physicians can be affected by the physicians´ attire, attitude and greeting. We aimed to investigate the difference between patients´ and physicians´ preferences to attires and greetings in clinics. Methods: We conducted a questionnaire survey on 394 outpatients in a university hospital and on 169 doctors from five university hospitals. We questioned to the outpatients about their preference for physicians´ dress style, how to address them and the method of greeting. We also questioned to the doctors about their own attire, attitude and etiquette. Results: The patients preferred to be called 'OOO Nim' (54.0%), 'OOO Ssi' (29.2%), 'Hwanjabun' (16.2%) and 'Sunsaengnim' (2.5%). However, the physicians were used to calling patients 'Hwanjabun' (39.2%), 'OOO Nim' (29.6%), 'OOO Ssi' (24.5%) and 'Sunsaengnim' (1.2%) (P＜0.001). Both the patients and the physicians preferred physicians′to wear white-gown (70.3% vs 78.7%) in a medical office. Inside the gown, a shirt and a necktie (66.2% vs 71.6%) were favored in both groups. Compared to the patients, the physicians thought that their attitude (23.1% vs 45.6%) and their attire (49.7% vs 55.6%) had a great effect on their professionalism. Conclusion: We found that the patients wanted to be called 'OOO Nim', but 'Hwanjabun' was most commonly used by the physicians. Both the patients and the physicians preferred white-gown. We also found that the physicians′ attire and attitude were strongly associated with their professionalism. (J Korean Acad Fam Med 2008;29:349-353)

Background
This study was performed to evaluate the validity of triage of non-urgent ambulatory patients using Triage Tool, the Emergency Severity Index-4 by a family medicine resident in the emergency room (ER). Methods: A total of 790 ambulatory patients who visited an urban ER between March and April 2007 were enrolled. A family medicine (FM) resident and emergency medicine (EM) residents independently evaluated the severity of patients with ESI-4, and reviewed the basic characteristics and disposition of the patients. Concurrent validity and predictive validity were measured using weighted kappa analysis and chi-square analysis. Results: Concurrent validity was good. The weighted kappa value was 0.910 between an FM resident and EM residents. The hospitalization rate was 75% in catergory 2 and 19.6%, 2.5%, 0.05% in category 3 through 5, respectively. More severe category patients of ESI-4 had higher rate of hospitalization rate. Conclusion: Triage by a family medicine resident, using the Emergency Severity Index-4 in ambulatory patients of emergency room (ER) is a useful screening tool for non-urgent patients. (J Korean Acad Fam Med 2008; 29:354-359)