Background
Children of obese parents are more likely to be obese themselves. Parental lifestyle habits could induce or aggravate children's obesity. This study was conducted to assess the relationship between parental lifestyle habits and children's overweight. Methods: Children who were enrolled in this study were first grade students from elementary schools in Gwacheon and Seoul. A total of 121 children (50 overweight children and 71 normal weight children) and their parents underwent anthropometric measurements and also were surveyed by a questionnaire. Results: The children of obese parents were more likely to be diagnosed as overweight compared to the children whose parents were normal weight (Father: P=0.037, Mother: P=0.001). Among the paternal lifestyle habits, hours of watching TV or computer usage (adjusted odd ratio =2.08, 95% CI=0.90∼4.80) and eating frequency of soda, ice cream, cake and chips (adjusted OR=5.77, 95% CI=1.65∼20.22) were found to be related to their children being overweight. Among the maternal lifestyle habits, hours of watching TV or computer usage (adjusted OR=2.35, 95% CI=0.99∼5.58), the frequency of eating breakfast (adjusted OR: 2.48, 95% CI=1.07∼5.75) and the frequency of overeating (adjusted OR: 2.15, 95% CI=0.91∼5.11) were found to be related to their children being overweight. Additive adjustment of children's lifestyle habits made the relationship between maternal lifestyle habits and children's overweight reduced. However, the odds ratio of paternal lifestyle habits was not reduced. Conclusion: Parental obesigenic lifestyle habits were related to children's overweight. Maternal lifestyle habits could affect her children's weight via an effect on her children's lifestyle habits. (J Korean Acad Fam Med 2008; 29:395-404)

Background
The Fagerstrom Test for Nicotine Dependence (FTND) is a widely used six-item questionnaire. Its completion require a few minutes, but such time may be too much for busy clinicians and large epidemiologic surveys. The goals of this study was to compare the sensitivity and the specificity of Heavy Smoking Index (HSI) of high nicotine dependence. Methods: The FTND was administered to 943 current smokers from a smoking-cessation clinic in Gwangjin-gu, Seoul. The HSI which combines two items of the FTND (the number of cigarettes per day and the time of the first cigarette of the day) was compared to the FTND. We measured cigarette per day, duration of smoking, and age of smoking initiation. Results: A cutoff score equal or greater than 4 on the HSI detected a similar rate of nicotine dependence as a cutoff score equal or greater than 6 on the FTND. The HSI showed a sensitivity of 88.0% and a specificity of 86.5%. The concordance between the two instruments was high (kappa= 0.74). Conclusion: The HSI was proven to be very useful. If HSI had a proper validity, the HSI can be a good standard of high nicotine dependence for busy clinician and epidemiologists. (J Korean Acad Fam Med 2008;29:405-411)

Background
The present study purposed to evaluate the clinical usefulness of biological indicators in identifying Korean female heavy drinkers. Methods: Fifty five drinking women were selected among those who visited the Department of Family Medicine of Chungnam National University Hospital during the period from January to December 2006. We surveyed the alcohol intake during the recent one month. The correlation of alcohol intake with %CDT (carbohydrate- deficient transferrin), mean corpuscular volume (MCV), gamma glutamyl transferase (ՃGT), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) was examined. The sensitivity, specificity, positive predictive value, negative predictive value and ROC (receiver operating characteristic) curve of the biomarkers for heavy drinking (more than 7 drinks per week, one drink= 14 g of alcohol) were also investigated. Results: The mean weekly alcohol intake showed a significant positive correlation with %CDT (r=0.583, P＜ 0.01), MCV (r=0.290, P＜0.05) and AST (r=0.423, P＜0.01). The sensitivity of %CDT, MCV, ՃGT, AST and ALT to heavy drinking were 66.7%, 13.3%, 40.0%, 26.7% and 26.7%, respectively, and the specificity 80.0%, 97.4%, 71.1%, 90.0% and 85.0%, respectively, and positive predictive values 55.6%, 66.6%, 35.3%, 50.0% and 40.0%, respectively, and negative predictive values 86.5%, 74.5%, 75.0%, 76.6% and 75.6%, respectively. The areas under the ROC curve (95% confidence interval) of %CDT, MCV, ՃGT, AST and ALT were 0.873 (0.780∼0.966), 0.806 (0.668∼0.944), 0.549 (0.372∼0.725), 0.519 (0.328∼0.710) and 0.479 (0.293∼0.666), respectively. Conclusion: %CDT is considered as the most useful marker for identifying Korean female heavy drinkers.(J Korean Acad Fam Med 2008;29:412-417)

Background
In spite of its high prevalence and social impact, pain in the elderly has not been managed appropriately. Understanding the multidimensional aspect of pain is crucial in its effective management. Patients with chronic pain are known to be more profoundly affected by psychological and social factors. We, therefore, classified chronic pain patients and especially focused on the relationship between pain and stress. Methods: The subjects were 149 persons older than 60 years attending a certain geriatric college. A survey was peformed employing the Korean version of Geriatric Pain Measure (GPM-K), the Korean Version of Brief Pain Inventory (BPI-K), the Elderly Life Stress Inventory (ELSI), the Perceived Stress Scale (PSS), the Geriatric Depression Scale Short Form-Korea Version (GDSSF-K), and the Revised Chalder's Fatigue Scale (Fatigue). Results: A total of 103 people, who completed both the questionnaires on pain and stress were enrolled. There was a significant correlation between GPM-K and ELSI (ELSI: r=.38, P＜ 0.01). In chronic pain patients, not only ELSI, but also PSS was correlated with GPM-K (ELSI: r=.37, P＜0.01, PSS: r=.25, P=0.04). Conclusion: There was a significant correlation between GPM-K and ELSI in the elderly. In chronic pain patients, it was more closely associated with GPM-K. We, therefore, believe that stress management can be useful in the management of pain, especially in the management of chronic pain patients. (J Korean Acad Fam Med 2008;29: 418-423)

Background
Body image, a personal perception of the body shape, is known to influence motive to control body weight. This study aimed to evaluate perception of body image according to the weight status in children. Methods: The study participants were 442 Korean boys and girls enrolled in 2nd or 6th grade of a primary school. Heights and weights were measured by standardized method. Each child was asked to fill in a questionnaire asking about the factors which might be probably related to body image and to select a figure reflecting their current and ideal images among 7 drawings grading the extent of fatness. Weight status was classified using the age- and gender-specific cut-off points of the International Obesity Task Force based on the body mass index calculated. Chi-square test and multiple linear logistic regression test were performed. Results: Among the subjects, 17% of the children were overweight, and 4.3% were obese. Among the overweight or obesity group, the children who chose figures corresponding to fatty body image were 4% and 32%, respectively, and the children who wanted to be thinner were 27% and 47%, respectively. Only the previous trial for weight reduction was independently associated with body image distortion defined as being satisfied with current body image in overweight or obese children. Conclusion: Safe and systematic efforts providing children with adequate body image perception would be needed to prevent and manage the obesity problem, especially for overweight or obese children who think their body images as normal or who were satisfied with their current body images. (J Korean Acad Fam Med 2008;29:424-430)

Background
Despite the use of antibiotics and cardiac surgery, infective endocarditis, remains a life-threatening disease. Unfortunately, diagnosis and treatment may be delayed. This is due, in part, to the vague and, at times, baffling clinical picture of this disease and to the frequency with which antibiotics were administered prior to obtaining a microbiological diagnosis. We conducted this study to improve the suspicion index from difficult diagnostic process of this serious disease. Methods: We retrospectively reviewed the medical records of 39 patients admitted to the Gangneung Asan Hospital in Gangwon-do with infective endocarditis from December 1996 to July 2004. We evaluated initial chief complaints and presumed diagnosis on first visit to medical care facilities, duration of referral from primary care to our hospital, the time period to confirm the diagnosis, treatment modality, and survival rate. Results: Among the total, 23 out of 39 patients fulfilled the criteria for definite infective endocarditis, whereas the others (16 patients) were for possible group in Duke criteria. In 79.5%, infective endocarditis was the first clinical presentation without medical history of any cardiac disease. Most frequent initial presenting symptoms and signs were fever and chills (56.4%), abnormal neurologic deficit (12.8%), and myalgia (7.6%). The most common initial diagnosis at first medical facilities was common cold. The mean duration of referral from primary care to our hospital was 9.5 days. The mean duration of symptoms before the definite diagnosis was 20.3 days. The most frequent etiologic microorganisms were streptococcus and staphylococcus. Blood culture negative infective endocarditis was found in 35.9% of cases. Almost all patients were treated with 3rd generation cephalosporins. Among the total, 71.6% patients were treated with medical treatment only, and 28.2% patients required surgical intervention. The mortality rate was 20.5% with the major cause of death being sepsis. Conclusion: Since the symptoms and signs of infective endocarditis are nonspecific, it is difficult to suspect and reach to correct diagnosis of infective endocarditis in primary care, requiring prolonged duration of 3 weeks to reach diagnosis. The consequences can result in higher rate of systemic complications and mortality. (J Korean Acad Fam Med 2008;29:431-437)