Background
This study aimed to investigate trends in the prevalence of current smokers and motivation to quit among Korean male cancer survivors.
Methods
Out of 20,012 men who participated in the Korea National Health and Nutrition Examination Survey V (2010–2012), VI (2013–2015), and VII (2016–2017), 742 cancer survivors were included. A cancer survivor was defined as a person who concurred to the item, “The cancer has been diagnosed by a doctor” in the health questionnaire. Smoking status was classified as current, former, and never smokers. Regarding motivation to quit smoking, we defined those who had a willingness to quit within 6 months as the willing group. Logistic regression analysis was conducted to examine trends in the prevalence of current smokers and the proportion of the willing group among current smokers.
Results
Overall, 3.7% of Korean men who participated in the study were cancer survivors. Current smokers constituted 19.5%, 19.1%, and 15.3% of cancer survivors in phases V, VI, and VII respectively which did not show significant changes (P for trend=0.33). However, the proportion of current smokers in the non-cancer group was significantly reduced to 46.6%, 41.2%, and 38.9% in phases V, VI, and VII, respectively (P for trend <0.001). The proportion of those with a motivation to quit smoking did not show a significant trend in the cancer survivors (P for trend=0.964) and non-cancer group (P for trend=0.884).
Conclusion
Prevalence of current smokers and motivation to quit in Korean male cancer survivors did not show significant trends.

Citations

• Current status of health promotion in Korea
  Soo Young Kim
  Journal of the Korean Medical Association.2022; 65(12): 776.     CrossRef
• Smoking Cessation in Cancer Survivors
  Young Gyu Cho
  Korean Journal of Family Medicine.2021; 42(4): 258.     CrossRef

Background
The worldwide prevalence of obesity and allergic diseases has increased. We aimed to explore the relation of overweight to asthma, atopic dermatitis, allergic rhinitis and conjunctivitis in a sample of Korean adolescents.Methods: We investigated the prevalence of symptoms of asthma and other allergic diseases by using a modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. The survey was conducted among 1,499 high school students in 3 regions of Korea.Results: The lifetime prevalence of wheezing (21.2% vs. 15.7%, P = 0.04), the 12 months-prevalence of wheezing (4.5% vs. 2.0%, P = 0.04), exercise induced wheezing (13.8% vs. 9.3%, P = 0.04), treatment of asthma (3.3% vs. 1.1%, P = 0.01) and the prevalence of symptoms of allergic rhinitis (11.0% vs. 5.1%, P = 0.001) were signifi cantly higher in overweight boys than normal weight boys, but not in girls. However, there were no signifi cant differences of the prevalence of symptoms and past history of atopic dermatitis and allergic conjunctivitis between overweight and normal weight groups. In boys, overweight increased the risk of the lifetime prevalence of wheezing (OR 1.54, 95% CI: 1.05-2.24) and 12 months- prevalence of exercise induced wheezing (OR 1.64, 95% CI: 1.05-2.55) after adjusting for confounding variables.Conclusion: Overweight could be a risk factor for the development of symptoms of asthma and allergic rhinitis in adolescent boys, whereas it was not a signifi cant risk factor for allergic diseases in girls.

Citations

• Factors related to Asthma in Korean Adults: A Secondary Data Analysis of the Korea National Health and Nutrition Examination Survey from 2016
  Mi-Jeong Yun
  Korean Journal of Adult Nursing.2019; 31(3): 259.     CrossRef

Background
The aim of this study was to elucidate the relationship of environmental tobacco smoke (ETS) exposure and the urine cotinine concentrations in Korean adolescents. Methods: Study population was 1st grade adolescents (N=1467, girls 22.2%) recruited from four high schools, two from Seoul, one from Kangleung and one from Woolsan. We obtained information for active smoking and ETS exposure through self-reported questionnaire and urine cotinine concentrations. Results: The prevalence of active smoking was 6.9% in boys and 0.9% in girls. Median urine cotinine concentrations were 19.5 Ռg/L (range, 0-2341 Ռg/L) among smokers, and 0 Ռg/L (range, 0-1359 Ռg/L) among nonsmokers. The positive rate of urine cotinine among nonsmokers exposed to ETS was 2.9%. Boys were exposed to ETS at PC room (79.6%), home (39.4%), school (11.5%), and public places (5.9%); girls were exposed at home (40.9%), PC room (33.2%), public places (28.0%), and school (15.2%). The frequency and duration of ETS exposure were significantly larger and longer in boys than in girls. Boys contacted friends who smoked more than girls did (32.6% vs. 17.1%). Parents'smoking status was similar both in boys and girls. Any information about ETS exposure did not differ according to the detectable urine cotinine among nonsmoking adolescents. Conclusions: Low positive rateof urine cotinine and no association of urine cotinine with various ETS exposure history reflectthat urine cotinine may not a good marker for ETS exposure in Korean adolescents.

Citations

• Association between Second-hand Smoke Exposure and Urinary NNAL Level in Korean Adolescents
  Hyo-Sun You, Jae-woo Lee, Ye-seul Kim, Yonghwan Kim, Hyeong-Cheol Lee, Jin Young Hwang, Woojung Yang, Hee-Taik Kang
  Journal of Korean Medical Science.2021;[Epub]     CrossRef
• Secondhand Smoke Exposure and Dysglycemia
  Su-Jin Bak, Hyo-Jin Sa, Eun-Jung Oh, Hyuk-Jung Kweon, Kyoung-Jin Kim, Jinyoung Shin, Jae-Kyung Choi
  Korean Journal of Family Practice.2021; 11(4): 256.     CrossRef
• Exposure to Hookah and Cigarette Smoke in Children and Adolescents According to Their Socio-Economic Status: The CASPIAN-IV Study
  Roya Kelishadi, Armindokht Shahsanai, Mostafa Qorbani, Gelayol Ardalan, Parinaz Poursafa, Ramin Heshmat, Mohammad Esmaeil Motlagh
  Iranian Journal of Pediatrics.2016;[Epub]     CrossRef
• The Correlation of Different Cotinine Levels With Questionnaire Results
  Myung Bae Park, Eun Woo Nam, Seon Kui Lee, Chun-Bae Kim, Chhabi Ranabhat
  Asia Pacific Journal of Public Health.2015; 27(5): 542.     CrossRef
• Tolerance for and potential indicators of second-hand smoke exposure among nonsmokers: A comparison of self-reported and cotinine verified second-hand smoke exposure based on nationally representative data
  Bo Yoon Jeong, Min Kyung Lim, E Hwa Yun, Jin-Kyoung Oh, Eun Young Park, Do-Hoon Lee
  Preventive Medicine.2014; 67: 280.     CrossRef
• Urine Cotinine for Assessing Tobacco Smoke Exposure in Korean: Analysis of the Korea National Health and Nutrition Examination Survey (KNHANES)
  Sungmo Jung, In Seon Lee, Sae Byol Kim, Chan Soo Moon, Ji Ye Jung, Young Ae Kang, Moo Suk Park, Young Sam Kim, Se Kyu Kim, Joon Chang, Eun Young Kim
  Tuberculosis and Respiratory Diseases.2012; 73(4): 210.     CrossRef
• Association Between Environmental Tobacco Smoke Exposure of Children and Parental Socioeconomic Status: A Cross-Sectional Study in Korea
  O. Yi, H.-J. Kwon, D. Kim, H. Kim, M. Ha, S.-J. Hong, Y.-C. Hong, J.-H. Leem, J. Sakong, C. G. Lee, S.-Y. Kim, D. Kang
  Nicotine & Tobacco Research.2012; 14(5): 607.     CrossRef
• The Biomarkers of Active and Passive Smoke Exposure
  Hye-Young Oh, Yu-Jin Paek
  Journal of the Korean Society for Research on Nicotine and Tobacco.2011; 2(2): 79.     CrossRef
• Effect of environmental exposure to lead and tobacco smoke on inattentive and hyperactive symptoms and neurocognitive performance in children
  Soo‐Churl Cho, Boong‐Nyun Kim, Yun‐Chul Hong, Min‐Sup Shin, Hee Jeong Yoo, Jae‐Won Kim, Soo‐Young Bhang, In Hee Cho, Hyo‐Won Kim
  Journal of Child Psychology and Psychiatry.2010; 51(9): 1050.     CrossRef

Background
The metabolic risks associated with obesity are closely correlated with a central rather than a peripheral fat pattern. These complications of obesity have been attributed to increase in visceral adipose tissue. The aim of this study was to investigate whether the dual- energy X-ray absorptiometry (DEXA) method offers a good alternative to computed tomography (CT) for the prediction of visceral fat in the obese women in correlation of metabolic complication markers. Methods: The design is a cross-sectional analysis. Total body fat and truncal fat amounts were measured by using DEXA, while total abdominal fat area was measured by CT, and divided into visceral abdominal fat area and subcutaneous fat area. Partial correlation after controlling for age and multiple regression analyses after adjusting for age and total percent body fat were performed to relate the metabolic variables to the CT and DEXA body composition variables. Results: For serum uric acid, total abdominal fat area by CT had the largest R² values (R²=0.259). For AST, ALT, total cholesterol and log triglyceride, visceral fat area had the largest R² values (R²= 0.360, 0.407, 0.147, and 0.339), respectively, and for log insulin, truncal fat by DEXA had the largest R² values (R²=0.275). Conclusion: Truncal fat amount measured by DEXA had a strong correlation with visceral fat area measured by CT. Truncal fat amount measured by DEXA and correlated significantly with visceral abdominal fat area measured by CT reflected most of the metabolic complication markers. (J Korean Acad Fam Med 2007; 28:675-681)

Background
: Childhood and adolescent obesity are major health concern impacting on short and long-term health. Prevention programs for obesity through school channel are essential. With the increasing prevalence of obesity and overweight among children and adolescence since 1990's, obesity prevention and management have been pursued in Korea. Schools, where students spend much of their daytime, are in a unique position to play a pivotal role in performing obesity prevention and management programs. The objective of this study was to assess the effectiveness of school-based interventions designed to prevent or manage obesity among elementary, middle, and high school students in Korea.

Methods : Electronic database were searched using the following key words; obesity, obesity prevention, obesity prevention program, child, adolescence, and effectiveness. In this systematic review, school-based programs were evaluated with the assessment items.

Results : Thirteen studies were included in the study. Most programs include at least one of the following components: dietary changes, physical activity, behavioral modifications, and parental participation. Studies that involved multidisciplinary measures including dietary education, increased physical activity, parental involvement and behavioral modification and studies focused on increased physical activity among subjects showed positive results. But the majority of studies were short-term and secondary prevention among children, not adolescents, not randomized, and without control. Few studies used validated questionnaires and process evaluation.

Conclusion : The development and application of evidence-based and feasible strategies in support of communities and families to the school-centered obesity prevention program are needed in the near future.

Background
: Obesity in adolescence is a serious health problem because it may proceed to adulthood, cause metabolic complications, and thereby increase mortality. The main purpose of this study was to investigate the prevalence of obesity and other metabolic complications related to obesity among Korean adolescents.

Methods : The subjects of the study were 3,615 adolescents recruited from 12 middle schools nationwide. We measured their height, weight, obesity indices, fasting blood glucose, serum total cholesterol, triglyceride, HDL- cholesterol, ALT, AST, and uric acid levels. The risk factors of obesity were assessed by self-administered questionnaires.

Results : Obesity was evident in 16.2% of the subjects (20.7% in boys, 11.0% in girls). Adolescent obesity was closely related to parental obesity (Odds Ratio 2.9, 95% CI (Confidence Interval) 1.7∼2.5). Obese adolescents were at higher risk of elevated AST (OR 10.2, 95% CI, 5.2 ∼19.9), elevated ALT (OR 12.9, 95% CI, 6.9∼24.2), hypercholesterolemia (OR 1.5 95% CI, 1.2∼1.8, P＜0.05), hypertriglyceridemia (OR 4.0, 95% CI, 3.1∼5.3), and hyperuricemia (OR 2.2, 95% CI, 1.7∼3.0). More than 70% of obese adolescents had one or more metabolic complications related to obesity.

Conclusion : Adolescent obesity was closely related to parental obesity and metabolic complications related to the obesity were common among both obese boys and girls.

Background
: New educational objectives and evaluation methods in Korean medical schools have been suggested recently to cope with health care related environmental changes. Current status of family medicine clinical clerkships in Korean medical schools is to be known before establishing standards.

Methods : Educational Committee of Korean Academy of Family Medicine surveyed the family medicine clerkship in Korean medical school (about educational environment, subjects and evaluation methods) using structured questionnaires by e-mail and Fax from February through March in 2004.

Results : Family medicine clinical clerkship was run by 25 of 41 medical schools (65.9%). Educational subject areas included communication skill, observation in hospital based ambulatory office, primary care and family medicine, medical recording, diagnosis and treatment of common problems, residential out-hospital ambulatory programs, presentation of hospital based ambulatory programs, procedure skill, lifelong heath management plan, and health promotion, in descending order. Faculties of family medicine were directly in charge of educational subjects. However, educational methods were mainly composed of lectures and indirect observation. It should be noted that concrete and precise evaluation methods in the family medicine clerkship program had been lacking due to insufficient and obscure evaluation strategies.

Conclusion : Clerkship period, educational environment, and number of class were variable among medical schools in Korea. Educational format needs to be standardized in terms of common educational subjects such as communication skill education, patient education, and ambulatory care clerkship. More valid methods are to be introduced for family medicine clerkship evaluation.

Background
: The primary concern of a family physician is the healthcare of patients and their families, with the patient's disease itself being secondary. Family physicians should make efforts to discuss personal issues with their patients. This study examined how many patients were counseled about their private problems, especially family or sexual issues in the private clinics of Cheonan.

Methods : The subjects were the patients who visited a practice-based network from April to June in 2003. The data were collected through simple questionnaire about sociodemographic features of patients and their family and sexual problems.

Results : Eighty eight patients were studied for a total of 107 cases that consisted of 67 cases of family problems (62%) and 40 cases of sexual matters (38%). The common issues about family problems were `the partners' (23 cases, 21%) and `the patients` children' (29 cases, 27 %). The most frequent sexual problems were 'sexually transmitted diseases' (13 cases, 32.5%), `impotence' (7 cases, 17.5%), 'loss of libido, and unsatisfaction' (6 cases, 15.0%). Most physicians were involved in family and sexual issues with medications, and simple counseling with reassurance. Simple counseling was given for 14 cases (21.0%) for family issues and 18 cases (44.0%) for sexual issues. The patients were treated with medications in 47 cases (70.0%) for sexual and 15 cases (38.0%) for family problems.

Conclusion : The most common issue for family problems was their partners and for sexual problems was 'sexually transmitted diseases'. Most family physicians were involved with both simple counseling and medications.

Background
: In modern industrial society, the complexity and diversity of social structure has deeply influenced job stress, and thereby threatens mental health of jobholders more than ever. Therefore, the purpose of this study was to examine the effect of job stress in jobholders on propensity of anxiety.

Methods : Initially, 235 jobholders living in Cheonan, Asan or Seoul, from May to June 2003, were the subjects of this questionnaire. Only 233 jobholders were evaluated due to inadequate responses from two subjects. The questionnaire was made up of three contents: socio-demographic characteristic, Extended Karasek questionnaire for evaluation of job stress, and the Korean version of Goldberg anxiety scale for evaluation of anxiety. The data were analyzed by chi-square test and multiple logistic regression analysis.

Results : Univariate analysis of propensity to anxiety showed a statistical significance on age, monthly income and job characteristics. Moreover, in terms of multivariate analysis, in accordance with age, 40 to 49 (OR: 6.1), showed the highest odds ratio of propensity to anxiety, followed by 30 to 39 (OR: 5.2) and 10 to 29 (OR: 5.4). In job characteristics, high strain group (OR: 3.7) showed highest odds ratio, but neither low strain group nor active group revealed any statistical significance. In monthly income, there was no statistical significance.

Conclusion : Job stress in jobholders and propensity to anxiety was positively associated; especially, the more stress jobholders got, the higher propensity to anxiety was.

Background
: The aim of this study was to investigate the health problems which women feel important and what they want to know from their doctors in the family practice clinics.
Methods
: The subjects were all female patients who visited the family practice clinics at the four hospitals in which some members of the Study Group for Women's Health in Korean Academy of Family Medicine worked from December 10 to 15, 2001. We surveyed by self-administered questionnaire on important health topic, health care services they woud like to receive, what they expected from their doctors, what topics they have difficulty in discussing with, the doctors preference of physician's gender. We analyzed the results by age groups; 19∼44, 45∼64, and 65 years old and over.
Results
: A total of 437 women answered the questionnaires, whose mean age was 49.4 year. Health topics that women felt important were osteoporosis, stress, cervical cancer, arthritis, and stroke, which varied with the age groups and recent health perception. The provision of health care services which they desired were in the order of treatment, prevention and health promotion, and diagnosis, which varied with the age groups and recent health perception. What they expected from their doctors were in the order of giving accurate diagnosis, explaining the treatment plan, and answering their questions. They had difficulty undergoing physical exam undressed, gynecological exam, and discussing on their sexual problems.
Conclusion
: Women who visited the family practice clinics felt differently on important health problems according to the age groups. Overall, they wanted to receive health services on the treatment, prevention and health promotion of osteoporosis, stress, cervical cancer, and arthritis.

Background
: Recently, the number of internet users is rapidly increasing and internet medical counseling for medical information is also becoming frequent. The aim of this study was to assess the responses and accuracy of internet medical counseling, and compare the responses according to years and operating groups.

Methods : The subject websites were 79 websites in August, 2000, and 88 in May, 2002, which operated board-type medical counseling. We questioned a simulated case of an acute dermatologic disease. Then we analysed the response rate, the time taken to reply and the accuracy of reponses.

Results : The number of websites that answered the question was 38 (48.1%) in 2000, and 73 (83.0%) in 2002. The response rate was significantly higher in 2002 than 2000. Time to reply was significantly shorter in 2002 than 2000. The response rate in hospital or clinic groups was higher than in other groups. The rate to make a correct diagnosis was significantly higher in 2002 than 2000. The rate to mention prognosis and necessity of intensive treatment was significantly higher in 2002 than 2000.

Conclusion : The response rate was higher 2002 than 2000. Time to reply and the accuracy of answer improved in 2002. The response rate was higher in hospital or clinic group than in other groups.

Background
: After amendment of the national health insurance law to enforce and reform primary health care, the number of family medicine out-patients was increased. Some patients requested referral. Therefore, this study was made to reveal family medicine residents' perception of attitude towards request for referral.

Methods : The self-administered questionnaires were collected by post mailing (July 1 to July 30, 2002) and by e-mailing (July 25 to August 10, 2002). The questionnaire contained the followings: general characteristics, issues of referral request, influence of referral request in training, and influence in private family clinics.

Results : The overall response rate was 22.2% (93/418). Patients need was the most common cause of referral (62.0%). Among the total, 46.2% of respondents gave answers that increasing number of patients at the family medicine out-patient clinic was beneficial in increasing their experience. Also, 55% of respondents replied that the present state of family medicine out-patient system influenced lowering of motivation in training. Overall, 63.4% of respondents replied that the present state of family medicine out-patient system led a trend of distrust to private family clinics.

Conclusion : Patients request was the most common cause of referral in family medicine out-patient clinic. The present state of referral system in family medicine out- patient clinic influenced lowering of motivation in training and a trend of distrust to private family clinics.

Background
: In spite of harmfulness of smoking, the rate of adult man's smoking is high in Korea and that of young people and women has risen recently. Although the number of hospitals operating smoking-cessation clinic has risen year by year, there is little research on smoking cessation. In this study, we tried to find the factors associated with successful smoking cessation and have attempted to contribute to developing effective smoking cessation strategy and help to continue cessation state.

Methods : Three hundred smokers, who had visited the Dankook Univ. Hospital from May 1999 to December 1999, were consulted. After doing a survey with a basic questionnaire and smoking cessation consultation, we asked them to revisit on the date of appointment with continued use of nicotine patch as much possible. Six months later, we selected 272 people and analyzed the factors of difference between the two group; one is the successful group and the other is the failure group.

Results : The success group included 77 people (28.3%), and the failure group 195 people (71.7%). In view of demographic profiles such as age, sex, marital status, education, and job, there was no significant difference between the two groups. In view of smoking pattern and factors that can influence them such as age of starting to smoke, duration of smoking, motive of smoking, reason of failure to stop smoking, reason of trying to stop smoking, the presence of smoking family member, confidence in smoking cessation, dependence on nicotine and the number of alcohol drinking, there was no significant difference between the two groups. In the results of univariate analysis, daily mean smoking amount, the presence of smoking-associated disease, expiratory CO level at initial visit to hospital, period of using nicotine patch and total times of visiting clinic were significant difference between the two groups. Therefore, the total number of visits to the clinic was the only significant factor according t multivariate analysis.

Conclusion : The results of multivariate analysis has shown that the factor that is most associated with success of smoking cessation is the total number of visits to smoking-cessation clinic. This means that the more people who smoke consult with doctor and the longer the period of utilizing the smoking-cessation clinic is, the more successful they are in smoking cessation.

Background
: Recently, childhood obesity has increased and became a major health concern in Korea. The aim of this study is to measure the prevalence of childhood obesity in rural city and to explore the risk factors of obesity including obesity of parents.

Methods : We made 13 convenience samples of elementary school and attached kindergarten located in Asan-city, ChungNam, in 2001. We surveyed children's height, weight, and risk factors of childhood with a self-recorded questionnaire answered by parents. Children's obesity was evaluated by ideal body weight which is defined as the 50th percentile of weight for Korean children of the same height and sex in 1998. The criteria of parents' obesity was over 25of BMI.

Results : The subjects were 1,558 children among 1870 respondents. The prevalence of childhood obesity was 9.4% and that of male children was 11.0% and that of female children was 7.9%. The older in both male and female, the higher the obesity prevalence was. Mother's age were significantly higher in obese children. Birth weight and family income were also significantly higher in obese children. Birth weight and family income were also significantly higher in obese children. There was a higher family history of obesity in obese children. Risk factors associated with childhood obesity were gender, age of child, mother's age, birth weight, number of siblings, family income, and family history of obesity.

Conclusion : The prevalence of childhood obesity in Asan-city was 9.4%. Children whose father, mother, or parents were obese tended to be obese.

Background
: The harmfulness of cigarette smoking is widely known, as a result the interest of smoking cessation is increasing. Some smoking cessation methods have tried at clinical setting, but with exception of nicotine replacement therapy, the long-term result is not satisfactory. The objective of this study is to determine of smoking cessation effectiveness of aromatherapy, which one of the alternative medicine, attracted public attention recently.

Methods : All participants of this study used nicotine patch, and as a double-blind randomized control study with use of natural herb aroma which is known to have tranquility effect and placebo(artificial lemon perfume). The subjects consist of Dankook University Hospital workers who volunteered as smoking cessation. 6 weeks of smoking cessation program was conducted using nicotine patch and aroma or nicotine patch and placebo, and the result were verified 6 weeks and 6 month after the start of smoking cessation.
Result : Fifty-three male persons(27 in aroma, 26 in placebo) paricipated and three subjects(2 in aroma, one in placebo) were dropped out. In two groups, participants with successful results were 13 persons in aroma group, and 14 persons in placebo group at 6 week later, and 6 persons and 7 persons respective at 6 month later. There was no statistical difference in two groups.

Conclusion : There was no statistical difference between the herb aroma and placebo with smoking cessation effect.

Background
: This study is to investigate on how much the dysmenorrheal and lower abdominal pain(LAP)/back pain are improved by the aromatherapy which is emerging as an alternative therapy.

Methods : In order to get the data by questionnaire, 245 subject was selected from women student class of a high school at rural area from June 2000 to August 2000. 125 subject, aroma was given to 69 subject and placebo was given to 56 subject. The subject was investigated how the dysmenorrhea was improved by using the aroma and placebo.

Results : After the aromatherapy, severities of dysmenorrheal and LAP/back pain improved in aroma group and placebo group. Therefore, there is not statistical difference between both groupts.

Conclusion : The herbal aroma is not effective more than placebo aroma to relieve dysmenorrhea.

Background
: Obesity is a risk factor of hyperlipidemia, DM, hypertension and cardiovascular deseases. In clinical practice the evaluation of obesity has been done indirectly by anthropometric indices such as BMI, waist to hip ratio, waist and hip circumference. This study was attempted to show whetjer waist circumference is better simple anthropometric index of abdominal obesity and has better correlation of metabolic profile than waist to hip ratio which has been commonly used.

Methods : We gathered 286 cases who have taken medical examination from May 1997 to July 1997 at Dankook University Hospital and measured BMI, relative ideal body weight by Modified Broca method, waist circumference, waist to hip ratio, metabolic profiles, fasting blood sugar, systolic and diastolic blood pressure.

Results : Waist to hip ratio and waist circumference showed high correlation with BMI and Modified Broca index. In men, correlation coefficient of waist circumference and waist to hip ratio with BMI was r=0.761, r=0.467, and correlation coefficient of waist circumference and waist to hip ratio with Modified Broca index was r=0.726, r=0.458. In women, correlation coefficient of waist circumference and waist to hip ratio with BMI was r=0.791, r=0.628, and correlation coefficient of waist circumference and waist to hip ratio with Modified Broca index was r=0.769 r=0.660. This finding shows waist to hip ratio and waist circumference are more closely related to BMI and Modified Broca index in women than men and showed higher correlation with waist circumference than waist to hip ratio. There were significant differences of correlation coefficient of obesity indices between waist circumference and waist to hip ratio(p<0.00001). Waist circumference showed relatively significant correlation with metalbolic profiles but we could not notice high correlation coeffience. But there was sighificant difference of distribution between normal group and obese group defined as BMI>25, modified Broca index>120%.

Conclusion : Waist circumference, index of abdominal obesity has better correlation with obesity indices than waist to hip ratio and is more simple method.

Background
: Childhood obesity that has been increasing in Korea in influenced by the environment and life style. The aim of this study is to measure the prevalence of childhood obesity in a rural city and to compare the food habit and life style of obese children with normal children.

Methods : We made 13 conventional samples of primary school and attached kindergarten located in Asan-city, ChungNam, in 1999. We surveyed height, weight, food habits and the life style related to obesity with a self-report questionnaire. The criteria of obese children were over 120% of ideal body weight which is defined as the 50th percentile of weight for Korean children of the same height and sex in 1998, and over 95th percentile of body mass index of Korean children in 1998.

Results : The subjects were 1,449 children smong 2,117 respondents. The prevalence of obese children by relative weight method was 11.3%, and that of male children was 12.4% and that of female children was 10.1%. The prevalence of obese children by body mass index method was 7.1% in male and 8.1% in female. The younger in both male and female, the higher the obesity prevalence was. The food habits that showed significant difference between normal and obese children were eating rapidly and outdoor activity. Obese children has fewer bad habits that normal.

Conclusion : The prevalence of childhood obesity in Asan-city was 11.3%, and lower than that in Seoul. The gravest concern in food habits of obese children was eating rapidly.

Background
: Fasting blood sugar and urine glucose are measured as screening tests of diabetes in the workers' periodic health examination. but of the casual glucose is measured and the basis of the cut-off values of screening tests is not clear. Therefore, we investigated the accuracy of screening test of diabetes in periodic health examination.

Methods : One hundred and eighty two men were selected for this study in 1997-1998. They performed a second confirmatory test for diabetes because their initial screening test results showed 'suspicious diabetes'. The gold standard was a fasting blood glucose for the second test. We analyzed the sensitivity and the specificity of each cut-off values of initial fasting blood glucose and urine glucose, and constructed the receiver operator characteristic (ROC) curve.

Results : The correlation coefficient between initial blood glucose and second fasting glucose was 0.562, and that between initial glucose and 2nd post-prandial glucose was 0.551. The false positive rate of initial screening test was 62.1%. When the cut-off value of initial blood glucose was 144.98mg/dl, the sensitivity was 0.79 and the specificity was 0.97. Using the current cut-off value of 121 mg/dl, the sensitivity was 0.11 and the specificity was 1.0. The best cut-off value of urine glucose test was trace on the basis of ROC curve.

Conclusion : The problem of diabetic screening test was high false positive rate and the low correlation coefficient between screening test and the gold standard. It is necessary to control the test condition and to reset cut-off value up, to make the screening test accurate.

Background
: Electricardiographic variables such as changes in the ST-T segment, and increased QT interval have been found to predict the occurrence of myocardial ischemia, But disadvantages of most of these variables have poor reproducibility and require analysis of all ECG leads. If electrocardiographic T axis properly predicts myocardial ischemia, it can be used as a useful marker for diagnosing myocardial ischemia in primary practice.

Methods : We selected 147 persons, who visited the emergency room or an outpatient clinic because of chest pain, in whom coronary angiography was performed. We reviewed their medical records. Electrocardiographic T axis was classified as normal, borderline and abnormal T axis. We identified the relation between cardiovascular risk factors and electrocardiographic T axis, and also, the relation between ischemic electrocardiographic variables and T axis, We examined the relation between coronary angiographic results and electrocardiographic T axis.

Results : The sensitivity and specificity of electrocardiographic T axis was 26.7% and 86.9%, respectively. The positive predictive value and negative predictive value was 81.8% and 35.1%, respectively. The proportion of hypertension was 41.2% in normal T axis group, 65.5% in borderline T axis group, and 34.4% in abnormal T axis group, which was statistically significant(P=0.032). The relation between coronary angiographic results and electrocardiographic T axis was not statistically significant. The subjects with abnormal T axis were associated with ST depression (P=0.016).

Conclusion : The T axis abnormality was not useful for screening myocardial ischemia, but it was useful to rule out other diseases due to its high specificity.

Background
: It is important to know the contents of health problems in patients in a primary care setting. The aim of this study was to explore the main chief complaints and major diagnoses of patients, who were admitted to a hospital using the ICD-10 and to observe difference according to each department and admission route and how diagnoses were made.

Methods : A total of 18,560 patients who were admitted to a hospital located in Chungnam Province from 1 Jan 1998 to 31 Dec 1998. Mean cheif complaints and major diagnoses made through the admissions departments were chosen as subjects (medical vs. surgical) and by admission route (emergency vc. OPD) were analyzed. How the diagnoses were derived from the most common chief complaints among medical and surgical departments were analyzed by admissions departments and by admission route.

Results : The most common 10 chief complaints revealed no significant difference by admission route in medical departments, but there was some difference in surgical departments. There was some difference in the most common 10 major diagnoses by admission routes in both medical and surgical departments.
Abdominal and pelvic pain, which was the most common chief complaints, became a significantly different diagnosis by admission route in both departments.

Conclusion : Main chief complaints were similar regardless of admission routes, but the diagnoses were different. ICD-10 classification may be useful to classify the diagnoses, but have limitations to classify chief complaints or reasons for encounter. It is necessary to introduce a new classification such as ICPC-2 for reasons for encounter in order to explore the dimension of health problems.

Background
: Overt hyperthyroidism is a well-known cause of secondary hyperlipidemia and atherosclerosis. However, there have been some dissenting report of abnormalities and in serum lipid concentration in patients with subclinical hypothyroidism. We have attempted to analyze serum lipid concentrations to investigate whether they are increased in patients with subclinical hypothyroidism and to see if there is a correlation between serum LDL-C and TSH concentrations.

Methods : Serum lipid profiles(total cholesterol, triglycerides, LDL-C, HDL-C) of patients with subclinical hypothyroidism (M/F=7/119) compared with age, sex and body mass index matched control subject(M/F=14/239) from Jan. 1. 1996. to Dec. 30. 1997.

Results : There were no significant differences of serum total cholesterol, LDL cholesterol, TG, and HDL concentrations in 126 patients with subclinical hypothyroidism and 253 control subjects(178.47±35.76mg/Dl vs. 173.05±35.963mg/Dl ; 113.33±52.89mg/Dl vs.117.64±68.70mg/Dl ; 112.89±33.25mg/dL vs 109.65±29.02mg/Dl ; 48.60±11.34mg/Dl vs 46.51±11.73mg/Dl). There was no correlation between LDL cholesterol and TSH concentrations in subclinical hypothyroidism(r=0.29, p<0.05).

Conclusion : Serum lipid concentration(total cholesterol, LDL cholesterol, and TG, HDL) was not increased in patients with subclinical hypothyroidism. There was no correlation between serum LDL and TSH levels in patients with subclinical hypothyroidism.

Background
: A good doctor-patient relationship should be based on mutual understanding and reliance. Proper conversation and same understanding of the use of this terminology is needed. This study was designed to make a cornerstone to establish appropriate medical terminology by means of investigation of the meaning of 'neurotic' among family' physicians.
Method : A questionnaire was sent to 971 family doctors registered as regular member in the Korean Academy of Family Medicine. We analyzed 184 returned questionnaires. We calculated the percent for each item. Chi-square test used to analyze demographic characteristics and compare whether the word 'neurotic' has been used or not, and whether it was a proper medical terminology or not.
Result:82.6% of responders(152/184) were used to 'neurotic' as a medical terminology. Doctors in their thirties were the least using group(78.7%) and doctors working in university hospitals rarely used them being statistically significant(p<0.000). 82.5% of the doctors in using 'neurotic' responded it is not an appropriate terminology. The most frequent situation in using it was 'patient appealed organic disorders such as functional dyspepsia(64.1%), tension headache(58.5), psychosomatic or somatoform disorder(54.9%). 59% of the patients diagnosed as 'neurotic' gave unsatisfying responses. Family doctors recommended substituting to terminology such as 'functional'(33%), 'psychogenic'(31.8%), and 'stress-induced'(25.0%).

Conclusion : Most family doctors were used to the word 'neurotic' but they did not think it was an appropriate terminology. There fore, other substitute words should be taken into consideration.

Background
: Medical interviewing skills are now recognized as the most important skill to be acquired for the purpose of accurate diagnosis and treatment. Among the several evaluation methods of interviewing skills, audiovisual method has the merit of allowing the fellow residents to have discussion about the interview and of receiving feedback from the teaching faculty by replaying the real interview. In addition, it allows the resident to evaluate his or her interviewing skills. The purpose of this study is to evaluate the reliability and the validity of family residents' self-interviewing skill evaluation protocol.

Methods : A modified Arizona interview rating scale which is an interviewing skill evaluating protocol has been used after Korean version became available. Six interviews with outpatients were recorded and evaluated respectively by 10 residents. The results were compared with that of Golden Standard to assess its validity. Finally, 10 residents were divided into two groups and the results among the groups were compared to evaluate the reliability of the scale.

Results : The evaluation of interviewing skills conducted by the residents showed significant rate of correspondence with the Golden Standard(kappa=0.22), and in the comparison of 17 evaluation items, there appeared significant correspondence in 7 items. The analysis of the rate of correspondence between the two group of residents revealed significant rate of correspondence (kappa=0.43). Lastly, the comparisons between the items showed significant rate of correspondence in 11 items.

Conclusion : The residents' self interviewing skill evaluation protocol showed significant validity and reliability from which it may be concluded that the protocol can be used as an effective evaluating method.

Background
: Although urinary incontinence is a common problem, its prevalence and severity in community is not well established. The main objects of this study were to define the prevalence in adult men and women who came to a primary care office for health care.

Methods : Men and women aged 20 years and over who came to family physician's offices seeking health care for any reason during an 2-week period were the subjects of a survey by anonymous questionnaire. Ten family practice offices in Cheonan Practice-Based Research Network parti-cipated. We defined "current significant urinary incontinence' as over any degree of annoying incontinence in the past 12 months.

Results : Of the 1,130 responders, 46.3% experienced urinary incontinence. Incontinence was experienced by 26.7% of the men and 50.2% of the women. 'Current significant urinary incontinence' was experienced by 3.7% of the men and 10.12% of the women.

Conclusion : Urinary incontinence as a common problem among those seen in primary care settings, and patients hesitate to seek consultation of their problems with physicians. Therefore, family physicians should deal with the symptoms of incontinence more attentively during history taking.(J Korean Acad Fam Med 1999;20:55~61)