Korean Journal of Family Medicine

"Prevention"

Original Articles

Association between changes in systolic blood pressure and the incidence of diabetes mellitus: a retrospective study based on the Korean National Health Screening Cohort: Hyo-Sun You, Jeong Sook Kim, Joungyoun Kim, Hee-Taik Kang; Received April 11, 2025 Accepted June 27, 2025 Published online November 18, 2025; DOI: https://doi.org/10.4082/kjfm.25.0101 [Epub ahead of print]

Background
As the global prevalence of diabetes mellitus continues to increase, it is important to identify its risk factors and implement preventive approaches. This study aimed to investigate the association between changes in systolic blood pressure (SBP) and the incidence of diabetes.
Methods
Data from 152,547 participants, who underwent two consecutive health checkups between 2002 and 2003, and 2004 and 2005, and included in the Korean National Health Insurance Service Health Screening Database, were reviewed. Participants were divided into three groups according to change in SBP: decrease (≥10 mm Hg); no change (<10 mm Hg); and increase (≥10 mm Hg). Cox proportional hazard regression models for diabetes incidence were constructed to evaluate adjusted hazard ratio (HR) with corresponding 95% confidence interval (CI).
Results
The median follow-up was 14.3 years, and 26,352 patients with diabetes were identified. Compared to those with no change in SBP, the adjusted HRs for decrease and increase among males were 1.06 (95% CI, 1.02–1.10) and 1.10 (95% CI, 1.06–1.14), and 1.06 (95% CI, 1.00–1.12) and 1.08 (95% CI, 1.02–1.13) for females, respectively. After stratifying data according to SBP at baseline, the HRs for decrease in males and females were as follows: normotensive group, 1.16 (95% CI, 1.08–1.24) and 1.11 (95% CI, 1.02–1.21); and prehypertensive group, 1.14 (95% CI, 1.09–1.20) and 1.19 (95% CI, 1.10–1.29), respectively.
Conclusion
Changes in SBP were associated with a risk for diabetes.

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The effectiveness of online smoking prevention program for adolescents in South Korea: a comparative analysis with traditional education: HyoRim Ju, EunKyo Kang, Cheol Min Lee, Yooseock Cheong; Received February 6, 2025 Accepted May 2, 2025 Published online October 31, 2025; DOI: https://doi.org/10.4082/kjfm.25.0030 [Epub ahead of print]

Abstract
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Background
This study aimed to evaluate the effectiveness and engagement of an interactive simulation-based online smoking prevention program compared to a traditional offline program for Korean adolescents.
Methods
A total of 1,008 adolescents from elementary, middle, high, and alternative schools in Chungcheongnam-do Province, South Korea participated in this study from October 1 to 31, 2021. The offline program consisted of 2-hour lectures by teachers, whereas the online program included six interactive peer-oriented video modules. The evaluation compared and analyzed the survey results measuring changes in smoking-related knowledge and attitudes before and after each program, as well as the level of interest in and satisfaction with education.
Results
When comparing the pre- and post-intervention scores between the two groups, no statistically significant differences were found except for a decreased belief that smoking helps relieve stress (F=12.125, P=0.001). However, withingroup comparisons revealed that the online smoking prevention program led to positive changes in most smokingrelated knowledge and attitude items, including reduced beliefs about smoking as a stress reliever (P<0.001) and lower misconceptions about the harm of e-cigarettes (P<0.001). In terms of engagement and satisfaction, the online program received significantly higher scores for interest (P<0.001), knowledge improvement (P<0.001), and program recommendations (P=0.021).
Conclusion
The online smoking prevention program was as effective as the traditional offline approach in enhancing smoking-related knowledge and attitudes. Moreover, its superior engagement and time efficiency highlight its strong potential as an effective alternative or complementary strategy to conventional school-based programs.

Citations

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Adapting and Implementing a School-Based “Implementation Intentions” Program Within FRESHAIR4Life to Prevent Smoking Initiation Among Adolescents in Greece: A Study Protocol
Izolde Bouloukaki, Antonios Christodoulakis, Sevasti Peraki, Floor A. Van Den Brand, Faraz Siddiqui, Theodoros Krasanakis, Antonia Aravantinou-Karlatou, Purva Abhyankar, Siân Williams, Julia van Koeveringe, Rianne MJJ van der Kleij, Ioanna Tsiligianni
Healthcare.2026; 14(7): 938. CrossRef

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Association of lipoprotein(a) with progression of coronary artery calcification: retrospective longitudinal study: Anna Lee, Hyun-Min Koh, Ji-Yong Jang, Hye-Rang Bak, Hye-Jin Jang, Jun-Young Huh, Nak-Gyeong Ko; Korean J Fam Med 2025;46(3):176-184. Published online May 22, 2024; DOI: https://doi.org/10.4082/kjfm.23.0108

Abstract
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Background
Atherosclerotic cardiovascular disease (ASCVD) is a major health concern, and lipoprotein(a) (Lp(a)) is an independent risk factor. However, there is limited evidence regarding Lp(a) and the risk of ASCVD in Asian populations. This study aimed to assess the predictive value of changes in coronary artery calcification (CAC) for ASCVD risk associated with Lp(a) level.
Methods
Participants (n=2,750) were grouped according to their Lp(a) levels, and the association between Lp(a) and CAC progression was examined. CAC progression was defined as the occurrence of incident CAC or a difference ≥2.5 between the square root (√) of baseline and follow-up coronary artery calcium scores (CACSs) (Δ√transformed CACS). To adjust for differences in follow-up periods, Δ√transformed CACS was divided by the follow- up period (in years).
Results
Over an average follow-up of 3.07 years, 18.98% of participants experienced CAC progression. Those with disease progression had notably higher Lp(a) levels. Higher Lp(a) tertiles correlated with increased baseline and follow-up CACS, CAC progression (%), and Δ√transformed CACS. Even after adjustment, higher Lp(a) levels were associated with CAC progression. However, annualized Δ√transformed CACS analysis yielded no significant results.
Conclusion
This study demonstrated an association between elevated Lp(a) levels and CAC progression in a general population without ASCVD. However, longer-term follow-up studies are needed to obtain meaningful results regarding CAC progression. Further research is necessary to utilize Lp(a) level as a predictor of cardiovascular disease and to establish clinically relevant thresholds specific to the Korean population.

Citations

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A Position Paper on Lipoprotein(a) From the Lipoprotein(a) Task Force of the Korean Society of Lipid and Atherosclerosis: Current Evidence, Clinical Applications, and Future Directions
Youngwoo Jang, Jang Hoon Lee, Sang-Guk Lee, Hun Jee Choe, Sang Min Park, In-Kyung Jeong, Byung Jin Kim
Korean Circulation Journal.2026; 56(1): 9. CrossRef
A Position Paper on Lipoprotein(a) From the Lipoprotein(a) Task Force of the Korean Society of Lipid and Atherosclerosis: Current Evidence, Clinical Applications, and Future Directions
Youngwoo Jang, Jang Hoon Lee, Sang-Guk Lee, Hun Jee Choe, Sang Min Park, In-Kyung Jeong, Byung Jin Kim
Journal of Lipid and Atherosclerosis.2026; 15(1): 2. CrossRef

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Review Articles

Family Involvement to Stop the Conversion of Prediabetes to Diabetes: Denny Anggoro Prakoso, Yodi Mahendradhata, Wahyudi Istiono; Korean J Fam Med 2023;44(6):303-310. Published online August 14, 2023; DOI: https://doi.org/10.4082/kjfm.23.0019

Abstract
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Prediabetes is a condition associated with an increased risk of developing diabetes, in which blood glucose levels are high but not high enough to be diagnosed as diabetes. The rapid increase in the prevalence of prediabetes is a major global health challenge. The incidence of prediabetes has increased to pandemic levels and can lead to serious consequences. Unfortunately, nearly 90% of prediabetic individuals are unaware of their ailment. A quarter of prediabetic individuals develop type 2 diabetes mellitus (T2DM) within 3–5 years. Although prediabetes is a reversible condition, the prevention of diabetes has received little attention. It is essential for prediabetic individuals to implement new health-improvement techniques. Focusing on family systems is one strategy to promote health, which is determined by health patterns that are often taught, established, and adjusted within family contexts. For disease prevention, a family-based approach may be beneficial. Family support is essential for the metabolic control of the disease. This study aimed to show several strategies for involving the patient’s family members in preventing the conversion of prediabetes to T2DM and to emphasize that the patient’s family members are a valuable resource to reduce the incidence of diabetes.

Citations

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The Natural History of Prediabetes and Cardiovascular Disease in the Pediatric Population
Siham Accacha, Julia Barillas-Cerritos, Liana Gabriel, Ankita Srivastava, Shelly Gulkarov, Jennifer A. Apsan, Joshua De Leon, Allison B. Reiss
Biomedicines.2026; 14(1): 198. CrossRef
Plan, Track, and Live Mindfully: Insights from the Eat Smart, Move More, Prevent Diabetes Program
Erin McCallum, Kelly Nordby, Surabhi Aggarwal, Christine Lavelle, Cathy Thomas, Carolyn Dunn
Diabetology.2025; 6(5): 42. CrossRef
Facilitators and barriers affecting the implementation of diabetes prevention programs in primary care settings: A qualitative meta-synthesis from a multi-stakeholder perspective
Jiali Chen, Zheng Lin, Yang Lei, Qingyu Wang, Lichen Tang, Hantian Cheng
International Journal of Nursing Studies.2025; 170: 105156. CrossRef
A critical realist exploration of health professionals’ perspectives on prediabetes diagnosis, management and type 2 diabetes prevention programs in a rural setting
Britney McMullen, Kerith Duncanson, David Schmidt, Clare Collins, Lesley MacDonald-Wicks
Australian Journal of Primary Health.2025;[Epub] CrossRef
Classification of self-care patterns in Korean adults with prediabetes using unsupervised machine learning: a secondary data analysis
Mi-Kyoung Cho, Myoung-Lyun Heo
Journal of Korean Biological Nursing Science.2025; 27(4): 586. CrossRef
Addressing gaps in pre-diabetes care: health professionals’ knowledge, attitudes, and counseling practices
Kashif Shafique, Nadia Shah, Saba Mughal, Iqra Ansari, Rija Siddiqui, Muhammad Fareed Uddin, Riasat Ali Khan, Asima Khan Niazi, Shabeen Naz
BMC Research Notes.2025;[Epub] CrossRef
Assessment of burden of prediabetes and diabetes with oral glucose tolerance test in community-based settings of Bengaluru rural district
Gokul Sarveswaran, Vaitheeswaran Kulothungan, Sukanya Rangamani, Deepadarshan Huliyappa, Pruthvish Sreekantaiah
Journal of Family Medicine and Primary Care.2024; 13(9): 3806. CrossRef

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Risk-Reducing Measures for Cancer Prevention: Israel Oluwasegun Ayenigbara; Korean J Fam Med 2023;44(2):76-86. Published online March 20, 2023; DOI: https://doi.org/10.4082/kjfm.22.0167

Abstract
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Cancer, or malignancy, continues to be one of the most serious health problems in the world, leading to death and disability. Unlike in previous years, where new cases of cancer were predominant in developed nations, the number of cases of cancer and the resultant deaths are increasing in low- and middle-income countries. This is partially attributable to the current trend of adopting a Western lifestyle, substantial urbanization, and the rise in infections, such as the human papillomavirus (HPV) and hepatitis B virus (HBV), which together account for over 30% of cancer cases in underdeveloped and developing nations. The deleterious impact of cancer, as cases multiply worldwide, is multi-dimensional. Cancer exerts serious physical, psychological, and monetary burdens, not only on cancer patients but also on their family members, close friends, health care systems, and society at large. Importantly, over half of all cancer types can be prevented globally by mitigating the risk and causative factors as well as prompt adherence to scientifically recommended prevention measures. This review provides various scientifically based and people-centered strategies that every individual could adopt to reduce their risk of developing cancer in the future. It is recommended that, for these cancer prevention strategies to be effective, there should be a strong political will from the governments of individual countries to enact specific laws and implement policies that will significantly reduce sedentary lifestyles and unhealthy eating among the general public. Likewise, HPV and HBV vaccines, as well as cancer screenings, should be made available, affordable, and accessible on a timely basis for those who are eligible to take them. Finally, intensified campaigns and numerous informative and educational programs that promote cancer prevention should be initiated globally.

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Application of Machine Learning and Deep Learning Models in Prostate Cancer Diagnosis Using Medical Images: A Systematic Review
Olusola Olabanjo, Ashiribo Wusu, Mauton Asokere, Oseni Afisi, Basheerat Okugbesan, Olufemi Olabanjo, Olusegun Folorunso, Manuel Mazzara
Analytics.2023; 2(3): 708. CrossRef

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Diabetes Prevention and Measures to Ensuring a Healthy Lifestyle during COVID-19 Pandemic and after: Israel Oluwasegun Ayenigbara; Korean J Fam Med 2023;44(1):11-20. Published online January 19, 2023; DOI: https://doi.org/10.4082/kjfm.21.0216

Abstract
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The incidence of diabetes mellitus (DM) is increasing exponentially globally, with 90% of the confirmed cases being type 2 DM. The global incidence of DM is expected to increase by 48% during 2017–2045. The coronavirus disease 2019 (COVID-19) pandemic continues to have a massive impact on human health, causing sudden lifestyle changes through quarantine measures, such as lockdown, social distancing, various curfews, and isolation at home. This in turn might increase the risk of developing numerous chronic diseases, such as DM, obesity, and cardiovascular diseases, which increase the severity of COVID-19. To this end, we performed a comprehensive review to determine viable measures for the prevention of DM and its subsequent upsurge globally. Additionally, we have determined strategies that should be adopted globally to ensure a healthy lifestyle during the COVID-19 pandemic and later.

Citations

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Post-COVID Metabolic Fallout: A Growing Threat of New-Onset and Exacerbated Diabetes
Shaghayegh Hemat Jouy, Harry Tonchev, Sarah M. Mostafa, Abeer M. Mahmoud
Biomedicines.2025; 13(6): 1482. CrossRef
Intertwined pathways of SARS-CoV-2 infection and its clinical repercussions on glucose homeostasis: Exploring the rise of new-onset diabetes
Vertika Awasthi, Rupinder Kaur, Chirag Pasricha, Pratima Kumari, Suruchi Chaubey, Sarita Jangra, Sanjana Mehta, Ravinder Singh
Obesity Medicine.2025; 56: 100624. CrossRef
Lifestyle prescriptions for diabetes management in primary care: a narrative review
Hye Jun Lee, Jung-Ha Kim
Ewha Medical Journal.2025; 48(4): e55. CrossRef
Insulin therapy adherence and associated factors among diabetes mellitus patients in Southern Ethiopia
Mulualem Gete Feleke, Tadele Lankrew Ayalew, Kidist Ashager, Bizuayehu Atinafu Ataro, Hailu Asmare Beyene
Diabetes Epidemiology and Management.2025; 19-20: 100284. CrossRef
Enhancement of Virtues: Key to a Healthy Lifestyle against Chronic Diseases and Future Health Crisis
Dalmacito A. Cordero Jr.
Korean Journal of Family Medicine.2023; 44(4): 244. CrossRef

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Preventive Measures against the Development of Dementia in Old Age: Israel Oluwasegun Ayenigbara; Korean J Fam Med 2022;43(3):157-167. Published online May 20, 2022; DOI: https://doi.org/10.4082/kjfm.21.0030

Abstract
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Dementia is a neurological condition characterized by numerous types of central nervous system diseases, which gradually deteriorates an individual’s reasoning, rational thinking, and judgment abilities. As a serious public health concern that currently affects more than 50 million older adults, dementia is one of the most significant causes of incapacity, disability, and dependency among older adults. As new cases are expected to increase exponentially in the next three decades, dementia, which is not a normal feature of healthy aging despite the fact that it generally affects older adults disproportionately, requires enormous management and care efforts due to its associated socioeconomic, psychological, and physical burdens that involve the patient, their caregivers, guardians, family members, and society at large. Presently, there is no cure for dementia; however, this condition could be prevented. This narrative review aimed to provide a broad overview of studies detailing the alternative lifestyle modification-centered preventive measures against dementia. A comprehensive search of key databases to find articles related to this topic revealed that participating in regular physical activities, healthy eating and dieting, avoiding all forms of smoking, avoiding air pollutants, halting or reducing alcohol consumption, exercising the mind and being socially dynamic, getting enough rest and establishing good sleeping habits, infection prevention, stress prevention, avoidance of injuries, preventing the effects of social isolation and lockdowns, continuing education, and depression prevention are protective measures against the development of dementia.

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Neurología.2026; 41(2): 501939. CrossRef
Protective effect of adult vaccination on the development of dementias: A systematic review
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Neurología (English Edition).2026; 41(2): 501939. CrossRef
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Mabel Ho, Esme Fuller-Thomson, Isaac Akintoyese Oyekola
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Guidelines for nutrition counseling in primary healthcare clinics
Gyeongsil Lee, Seung-Won Oh
Journal of the Korean Medical Association.2024; 67(4): 278. CrossRef
A Genome-Wide Association Study of Dementia Using the Electronic Medical Record
Xiaowen Cao, Yao Dong, Li Xing, Xuekui Zhang
BioMedInformatics.2023; 3(1): 141. CrossRef
Health promotion: the essence of primary healthcare
Sung Sunwoo
Journal of the Korean Medical Association.2022; 65(12): 772. CrossRef

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Can Nutritional Supports Beneficial in Other Viral Diseases Be Favorable for COVID-19?: Fatmanur Zehra Zelka, Rümeysa Rabia Kocatürk, Öznur Özge Özcan, Mesut Karahan; Korean J Fam Med 2022;43(1):3-15. Published online January 20, 2022; DOI: https://doi.org/10.4082/kjfm.20.0134

Abstract
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The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus-2 (SARS-COV-2), has rapidly spread worldwide, causing many deaths, the number of which continues to increase. Global public health organizations and governments have advised on the adoption of various handwashing and hygiene guidelines, use of masks, and social distancing, along with isolation or lockdown protocols to prevent SARS-COV-2 spread. There are vaccines and drugs that are confirmed but still many human suffer from this disease. Important risk factors for SARS-COV-2 infection are similar to other viral infectious diseases as including influenza, hepatitis B, acquired immunodeficiency syndrome, and other lung infections. These diseases might be related to poor nutritional support, affecting the patient outcomes against COVID-19. In this review, we discuss some of the nutritional therapies currently being investigated for infectious diseases. Studies have shown that nutrition has the potential to prevent and mitigate viral infections. Micronutrients (vitamins A, B6, B12, C, D, and E, B9, and trace elements, such as iron, zinc, copper, selenium, magnesium, and polyphenols) and macronutrients (carbohydrates, prebiotics, probiotics, protein [amino acids], and lipids [fatty acids]) affect the whole body, including the immune system, preventing viral entry and modulating clinical symptoms. This review discusses the importance of nutrition as a strategy to understand food groups and key nutrients that may affect the clinical outcomes of COVID-19 patients during the ongoing pandemic. Scientists believe that the likelihood of another pandemic is imminent. COVID-19 remains important and scientists believe it will continue will in the future. We emphasize the lack of studies on the nutritional impact of COVID-19 in terms of nutrition, even though nutritional interventions has been shown to have many advantages during the treatment of viral infections.

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Guidelines for nutrition counseling in primary healthcare clinics
Gyeongsil Lee, Seung-Won Oh
Journal of the Korean Medical Association.2024; 67(4): 278. CrossRef
Vitamin-mineral complexes to help adult patients frequently suffering with acute respiratory viral infections: A review
Dmitry I. Trukhan, Natalya V. Bagisheva
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Binshan Jiang, Qiangru Huang, Mengmeng Jia, Xinai Xue, Qing Wang, Weizhong Yang, Luzhao Feng
Chinese Medical Journal.2022; 135(19): 2282. CrossRef

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Original Article

Effect of Education on Promoting Healthy Lifestyle Behaviors That Prevent Breast Cancer in Middle-Aged Women: Application of Protection Motivation Theory: Zakieh Sadat Hoseini, Hamid Tavakoli Ghouchani, Hamidreza Mohaddes Hakak, Hossein Lashkardoost, Ali Mehri, Mehdi Khankolabi, Elahe Salari; Korean J Fam Med 2021;42(2):166-171. Published online June 29, 2020; DOI: https://doi.org/10.4082/kjfm.19.0164

Abstract
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Background
In recent years, an increased incidence of breast cancer has made this disease the most common malignancy among Iranian women. Since education plays an important role in the implementation of preventive behaviors in breast cancer treatment, this study investigates the effect of educational interventions on the promotion of lifestyle-related behaviors that prevent breast cancer in middle-aged women.
Methods
In this randomized control study, 120 women referred to Neyshabur Health Services Centers were randomly selected and divided into two groups: an intervention group (60 subjects) and a control group (60 subjects). An educational intervention was carried out over five sessions, based on protective motivation theory constructs. Participants completed a researcher-designed questionnaire immediately and again 2 months after the intervention. The data were analyzed using IBM SPSS ver. 19.0 software (IBM Corp., Armonk, NY, USA).
Results
The results revealed a significant difference between the mean scores of participants exposed to protective motivation theory, awareness, and physical activities immediately and also 2 months after the intervention (P<0.05). Although the healthy diet scores of the two groups differed significantly immediately after the educational intervention (P<0.05), there was no significant difference between the groups 2 months after the intervention (P<0.05).
Conclusion
Given the effective role of education in protective motivation theory and the physical activity levels of the women who participated in this research, it seems clear that the women’s financial status shaped their ability to consume more fruits and vegetables. As this social element impacts the health of individuals, training programs alone cannot succeed.

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The effect of educational intervention based on protection motivation theory in improving reproductive health protective behaviors: a quasi-experimental study
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BMC Women's Health.2025;[Epub] CrossRef
Increasing Knowledge about Breast Cancer in Young Women with Word Square Model Education
Putri Nofia Marta Wulandari, Sri Wahyuni Adriani, Siti Kholifah
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Elaha Jafari, Mahnaz Zarshenas, Monireh Toosi, Azar Nematollahi, Mehrab Sayadi
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Protection Motivation Theory and Prevention of Breast Cancer: A Systematic Review
Fatemeh Estebsari, Zahra Rahimi Khalifehkandi, Marzieh Latifi, Abdollah Farhadinasab, Parvaneh Vasli, Davoud Mostafaie
Clinical Breast Cancer.2023; 23(4): e239. CrossRef
Predictors of breast self‐examination behavior among adult females in Najran city, Saudi Arabia
Awad M. Al‐Qahtani, Heba A. Ibrahim, Wafaa T. Elgzar
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Review Article

Psoriasis and Cardiovascular Disease: A Narrative Review: Adrian Martinez-Moreno, Jorge Ocampo-Candiani, Veronica Garza-Rodriguez; Korean J Fam Med 2021;42(5):345-355. Published online June 9, 2020; DOI: https://doi.org/10.4082/kjfm.20.0053

Abstract
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Psoriasis is a chronic, autoimmune, and inflammatory disease that affects 2% of the world’s population. In recent years, it has been demonstrated that psoriasis confers a 25% increase in relative risk of cardiovascular disease, independent of factors such as hyperlipidemia, smoking, and obesity. The objective of this review was to analyze and describe the association between psoriasis and cardiovascular disease. In this review, we describe the epidemiological association of psoriasis and cardiovascular disease, pathophysiology, mechanisms, and its association with the well-known cardiovascular risk calculators. In addition, we describe diagnostic tools, such as imaging techniques and novel biomarkers, that are useful in the evaluation of atherosclerotic cardiovascular disease. Finally, we present different systemic therapies that are used in patients with psoriasis and their effect on atherosclerotic cardiovascular disease. This article provides an overview of the current literature on psoriasis and cardiovascular risk, which can be useful for primary care physicians in their daily clinical practice.

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Olga A. Kuzmina, Olga Iu. Mironova, Anfisa A. Lepekhova, Karinat S. Tregub, Artem I. Demin, Victor V. Fomin, Olga Yu. Olisova
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Cardiovascular comorbidities in psoriasis (Review)
Daciana Branisteanu, Alin Nicolescu, Daniel Branisteanu, Catalina Branisteanu, Andreea Dragoi, Camelia Bogdanici, Mihaela Toader, Andreea Tucaliuc, Andreea Dimitriu, Doru Daogaru, Ruxandra Pirvulescu, Elena Porumb
Experimental and Therapeutic Medicine.2021;[Epub] CrossRef

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Original Articles

Unintentional Injuries among the Elderly in Rural Areas and Their Related Behaviors: Forouzan Rezapur-Shahkolai, Nasrin Sayfian, Babak Moeini, Ghodratollah Roshanaei; Korean J Fam Med 2019;40(2):80-86. Published online February 28, 2019; DOI: https://doi.org/10.4082/kjfm.17.0124

Abstract
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Background
Although the role of unintentional injuries as a cause of death in adults is known, there is limited knowledge about such adults’ behaviors. This study aims to investigate the frequency of and factors affecting unintentional injuries among the elderly living in rural areas and their related behaviors.
Methods
A cross-sectional study was carried out in the rural areas of Hamadan County, Iran, in 2016. The sample consists of randomly selected 445 adults aged 60–75 years. Data collection was conducted through face-to-face interviews, using questionnaires.
Results
One hundred and forty-three participants (34.7%) experienced 166 injury occurrences. The injuries occurred more in females than in males. There were more mild and severe injuries (48.2% and 31.3%, respectively) than moderate ones (20.5%). The most frequent mechanism of injuries was accidental falls (64.5%). There was a significant relationship between using aid devices and injuries (P=0.001). Among the most applied injury preventive measures as reported by the elderly, crossing streets safely and the use of proper lighting at night had the highest percentages (81.5% and 69.7%, respectively). However, the use of protective handles and plastic flooring in bathrooms in order to prevent slipping had the lowest percentages (less than 1.0%).
Conclusion
The injuries among the elderly in this study were important health concerns. Injury-related factors should be considered in the development of injury prevention programs.

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Prevalence and Risk Factors of Unintentional In-Home Injuries in Older Adults
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Delphi Survey for Designing a Intervention Research Study on Childhood Obesity Prevention: Min Jeong Kim, Eunju Sung, Eun Young Choi, Young-Su Ju, Eal-Whan Park, Yoo-Seock Cheong, Sunmi Yoo, Kyung Hee Park, Hyung Jin Choi, Seolhye Kim; Korean J Fam Med 2017;38(5):284-290. Published online September 22, 2017; DOI: https://doi.org/10.4082/kjfm.2017.38.5.284

Abstract
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Background

The prevalence of childhood obesity in South Korea has increased owing to economic improvement and the prevailing Westernized dietary pattern. As the incidence of chronic diseases caused by obesity is also expected to increase, effective interventions to prevent childhood obesity are needed. Therefore, we conducted a Delphi study to determine the priorities of a potential intervention research on childhood obesity prevention and its adequacy and feasibility.

Methods

The two-round Delphi technique was used with a panel of 10 childhood obesity experts. The panelists were asked to rate “priority populations,” “methods of intervention,” “measurement of outcomes,” “future intervention settings,” and “duration of intervention” by using a structured questionnaire. Finally, a portfolio analysis was performed with the adequacy and feasibility indexes as the two axes.

Results

For priority populations, the panel favored “elementary,” “preschool,” and “middle and high school” students in this order. Regarding intervention settings, the panelists assigned high adequacy and feasibility to “childcare centers” and “home” for preschool children, “school” and “home” for elementary school children, and “school” for adolescents in middle and high school. As the age of the target population increased, the panelists scored increasing numbers of anthropometric, clinical, and intermediate outcomes as highly adequate and feasible for assessing the effectiveness of the intervention.

Conclusion

According to the results of the Delphi survey, the highest-priority population for the research on childhood obesity prevention was that of elementary school students. Various settings, methods, outcome measures, and durations for the different age groups were also suggested.

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Review Article

Preventing a Mass Disease: The Case of Gallstones Disease: Role and Competence for Family Physicians: Piero Portincasa, Agostino Di Ciaula, Ignazio Grattagliano; Korean J Fam Med 2016;37(4):205-213. Published online July 21, 2016; DOI: https://doi.org/10.4082/kjfm.2016.37.4.205

Abstract
PDF

Gallstone formation is the result of a complex interaction between genetic and nongenetic factors. We searched and reviewed the available literature to define how the primary prevention of gallstones (cholesterol gallstones in particular) could be applied in general practice. Electronic bibliographical databases were searched. Prospective and retrospective cohort studies and case–controlled studies were analyzed and graded for evidence quality. The epidemiological data confirmed that genetic factors are estimated to account for only approximately 25% of the overall risk of gallstones, while metabolic/environmental factors are at least partially modifiable in stone-free risk groups, and are thus modifiable by primary prevention measures related to diet, lifestyle, and environmental factors (i.e., rapid weight loss, bariatric surgery, somatostatin or analogues therapy, transient gallbladder stasis, and hormone therapy). There is no specific recommendation for the secondary prevention of recurrent gallstones. Family physicians can contribute to preventing gallstones due to their capability to identify and effectively manage several risk factors discussed in this study. Although further studies are needed to better elucidate the involvement of epigenetic factors that may regulate the effect of environment and lifestyle on gene expression in the primary prevention of gallstone formation, preventive interventions are feasible and advisable in the general practice setting.

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FaisalA Alsaif, FahadS Alabdullatif, MohammedK Aldegaither, KhalidA Alnaeem, AbdulrahmanF Alzamil, NoufH Alabdulkarim, AbdullahD Aldohayan
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Cholesterol cholelithiasis: part of a systemic metabolic disease, prone to primary prevention
Agostino Di Ciaula, David Q-H Wang, Piero Portincasa
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Original Article

The Effect of Exercise on Prevention of the Common Cold: A Meta-Analysis of Randomized Controlled Trial Studies: Hyun Kun Lee, In Hong Hwang, Soo Young Kim, Se Young Pyo; Korean J Fam Med 2014;35(3):119-126. Published online May 22, 2014; DOI: https://doi.org/10.4082/kjfm.2014.35.3.119

Abstract
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Background

Because there is no specific treatment for the common cold, many previous studies have focused on prevention of the common cold. There were some studies reporting that regular, moderate-intensity exercise increases immunity and prevents the common cold. We conducted a meta-analysis to determine the effects of exercise on prevention of the common cold.

Methods

We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL for studies released through June 2013. We manually searched the references. Two authors independently extracted the data. To assess the risk of bias of included literature, Cochrane Collaboration's tool for assessing risk of bias was used. Review Manager ver. 5.2 (RevMan, Cochrane Collaboration) was used for statistical analysis.

Results

Four randomized controlled trials were identified. A total of 281 participants, 134 in the exercise group and 147 in the control group, were included. The effect of exercise on the prevention of the common cold had a relative risk (RR) of 0.73 (95% confidence interval [CI], 0.56 to 0.95; I² = 7%). The mean difference of mean illness days between exercise group and control group was -3.50 (95% CI, -6.06 to -0.94; I² = 93%). In the subgroup analysis, the RR of under 16 weeks exercise was 0.79 (95% CI, 0.58 to 1.08).

Conclusion

In this meta-analysis, regular, moderate-intensity exercise may have an effect on the prevention of the common cold. But numbers of included studies and participants were too small and quality of included studies was relatively poor. Subsequent well-designed studies with larger sample size are needed to clarify the association.

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Antonio Jose Grande, Justin Keogh, Valter Silva, Anna M Scott
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The Clinical Evaluation between Overtraining Syndrome and Exercise-related Immunity
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Brief Communication

The Association Chronic Liver Diseases with Health Related Behaviors in South Korea.: Juwon Lim, Soyeun Kim, Soshin Ke, Belong Cho; Korean J Fam Med 2010;31(4):302-307. Published online April 20, 2010; DOI: https://doi.org/10.4082/kjfm.2010.31.4.302

Abstract
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Background
The chronic liver disease is a relatively common health problem in primary care in Korea. But there are few studies of the prevalence and management status of chronic liver disease in Korea. The aim of this study is to estimate the ratio of health relative behavior among the patients of chronic liver disease, and analyse the association of chronic liver disease with health related behaviors such as private insurance, liver cancer screening examination, smoking, drinking, and exercise.Methods: We analyzed data from the third Korea National Health and Nutrition Examination Survey (KNANES III) 2005. The subjects of this study included the persons over 40 years. We used data about demographics, chronic liver disease, and health behavior data. Results: The prevalence of chronic liver disease was 2.4%. The ratios of private insurance, liver cancer screening examination among the patients of chronic liver disease were 72.6%, 44.2% respectively. The ratios of no smoking, abstinence from drinking, and exercise were 70.0%, 52.6%, and 33.8% respectively. After adjusted with demographic data, the odds ratio of liver cancer screening among the patients of chronic liver disease was 8.4 (P < 0.001), that of abstinence from drinking was 1.2 (P = 0.434). Adjusted odds ratio of private insurance, no smoking and exercise were 1.3 (P = 0.425), 1.2 (P = 0.578), 0.6 (P < 0.05).Conclusion: The primary prevention is less satisfactory than secondary prevention among the patients with chronic liver disease in Korea. In primary care, it is necessary for them not only to check liver cancer screening examination but also encourage no smoking, abstinence from drinking, and exercise.

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Review

Aspirin Usage Based on Evidence for the Prevention of Cardio-Cerebrovascular Disease.: Young Sang Kim, Kyoung Kon Kim, In Cheol Hwang; Korean J Fam Med 2009;30(4):249-260. Published online April 20, 2009; DOI: https://doi.org/10.4082/kjfm.2009.30.4.249

Abstract
PDF

Aspirin is well known for its central role in preventing cardio cerebrovascular diseases as an antiplatelet agent. However besides its favorable effects, one must also be fully aware of its side effects such as gastrointestinal complications or cerebral hemorrhage. Particularly when prescribing to Koreans, one must be highly cautious, considering the higher prevalence of helicobacter pylori infection and the contribution of hemorrhagic stroke as a major part of cerebral disease in Korean. Currently the guideline for secondary prevention of cardio cerebrovascular diseases is relatively well established, while the consensus for primary prevention is still controversial. The purpose of this paper would be to summarize the evidence of aspirin usage in preventing cardio cerebrovascular diseases, examine the additional factors one must consider, and help primary physician prescribing aspirin appropriately.

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Original Articles

Body Mass Index Change during and after the Childhood Obesity Prevention Program.: Wook Je Cho, Kayoung Lee, Tae Jin Park; J Korean Acad Fam Med 2008;29(8):572-578. Published online August 10, 2008

Abstract
PDF

Background
This study was designed to find out the effect of school based obesity prevention intervention by considering the changes of BMI during both at the time of intervention and post-intervention. Methods: The research was conducted at an elementary school located in Busan metropolitan city, where we measured the height and weight of 260 students at baseline, 6 months after the initiation, and 6 months after the intervention. The students were classified into three weight groups of normal, overweight and obesity according to the age and sex-specific BMI. Results: The BMI decreased or maintained in 60% of the boys and 65% of the girls after the initial six months of the intervention, while after six months from the end of the intervention, BMI increased in 91% of the boys and 83% of the girls. The children's BMI significantly decreased during the intervention (P＜0.01), whereas it significantly increased post intervention (P＜0.05). In the logistic regression model including age, sex, initial BMI, and the follow-up status after the intervention, the increase of BMI by 1 unit was associated with 11% lower odds (95% CI 0.83∼0.98) for BMI decrease and maintenance. Likewise, the increase of age by 1 year was associated with 24% lower odds (95% CI 0.59∼0.98) for BMI decrease and maintenance. However, there was no significant predictors for BMI decrease and maintenance after the intervention. Conclusion: As the positive effect of this intervention for children is not consistent, the research should be more focused in finding out the effective method for prevention of obesity among elementary school children, as a better solution in the longrun. (J Korean Acad Fam Med 2008;29:572-578)

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Level of Understanding of Importance of Preventing and Treating Dermatophytoses in Diabetic Patients.: Bong Wu Wu, Sung Kyung Je, Kyoung Kon Kim, Hee Cheol Kang, Bang Bu Youn; J Korean Acad Fam Med 2007;28(5):359-366. Published online May 10, 2007

Abstract
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Background
Dermatophytoses tend to have a poorer outcome in diabetic patients than in non-diabetic patients. Therefore, diabetic patients need to pay a closer attention to the prevention and treatment of dermatophytoses. The aim of this study was to determine the level of understanding of the dermatophytoses in diabetic patients and to clarify the factors associated with the level of understanding. Methods: A questionnaire survey was carried out from June to July, 2005, targeting 200 patients who had visited two hospitals in Seoul for the management of diabetes. There were 163 respondents (response rate 50.9%). The degree of understanding was calculated by giving 1 point to each question, with a maximum of 12 points. Results: The average degree of understanding of dermatophytoses was 6.68 points (SD 1.79). Younger age (P= 0.0002), high education level (P=0.0035), and high income (P=0.0013) were the factors related to a better understanding of dermatophytoses. The patients who had obtained the information on dermatophytoses from the websites, broadcasts, newspapers, or magazines showed higher recognition points than others (P=0.0377). The body mass index, the duration of diabetes, the complications associated with diabetes did not affect the understanding of dermatophytoses. Conclusion: There are many diabetes patients who do not know enough about dermatophytoses. Diabetes itself is not related to the level of understanding of dermatophytoses. However, diabetic patients who are older, have a lower level of education, and a low income will need to be informed about prevention and treatment of dermatophytoses. (J Korean Acad Fam Med 2007;28: 359-366)

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Evaluation of School-based Obesity Prevention and Management Program in Korean Children.: Kyung Hee Park, Sun Mi Yoo; J Korean Acad Fam Med 2006;27(6):471-480. Published online June 10, 2006

Abstract
PDF

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.

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Review

Factors to be Considered for a Choice of Antiplatelet Agents.: Soo Jin Cho; J Korean Acad Fam Med 2006;27(1):1-6. Published online January 10, 2006

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Original Articles

Smoking Behavior Following Diagnosis of the Coronary Artery Disease and Factors Influencing Smoking Cessation.: Hyun Mi Kim, Chang Jin Choi, Ki Bae Seung, Wook Sung Chung, Hahn Byoll Kahng; J Korean Acad Fam Med 2005;26(10):629-635. Published online October 10, 2005

Abstract
PDF

Background
: The success rate of smoking cessation by patients with coronary artery disease is lower than expected and reportedly this rate increases once doctors intervene. The purpose of this study is to help doctors mediate their patients to quit smoking by investigating of smoking behavior following the diagnosis of coronary artery disease and promoting methods of smoking cessation with knowledge of factors influencing smoking cessation.

Methods : A total of 245 male coronary artery disease patients confirmed by coronary angiography in two university hospitals located in Seoul participated in the survey.

Results : The smoking cessation rate among the subjects for more than one year was 39.6%. More than 90% of the subjects were aware of the doctors warning about smoking, but no more than 6% of them heard how to actually stop smoking from their doctors. In the smoking cessation group the stress score was lower and the exercise performance rate was higher than the smoking group. Logistic regression analysis revealed the abstinence group succeeded in smoking cessation at higher rate than the drinking group (odds ratio 0.30; 95% confidence interval 0.14 to 0.65).

Conclusion : In recommending that a patient quit smoking, doctors should inform patients that drinking could be a detrimental factor and should promote a smoking cessation program including exercise and stress control. Doctors should educate patients that smoking cessation program will be more effective than sheer will power.

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The Effectiveness and Satisfaction of Personal Computer Based Smoking Cessation Program for Adolescents.: Eun Kyung Kim, Yoo Seock Cheong, Eal Whan Park, Eun Young Choi, Jae Hun Kim, Ran Lee, Sung Ook Jo; J Korean Acad Fam Med 2005;26(9):544-550. Published online September 10, 2005

Abstract
PDF

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.

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Cardiovascular risk and lifestyle advice from physician: rates recalled by patients and predicting factors.: Ho Cheol Shin; J Korean Acad Fam Med 2001;22(11):1656-1669. Published online November 1, 2001

Abstract
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Background
: The relation between lifestyle and chronic diseases in now well established. For example, smoking, high dietary fat intake, lack of exercise have been identified as independent risk factors for the development of cardiovascular disease. So changing risk factors related to lifestyle is very important to minimize the burden of many kinds of chronic diseases including cardiovascular disease and cancer. Patients who are at increased risk of developing chronic diseases should be identified and if this increased risk is modifiable unhealthy behavior, appropriate advice should be given to encourage behavioral change. That is one of the most important role of primary care physician. However, we do not know how often patients with varying risk factors receive lifestyle advice from their physician in Korea. This study is to know how often patients having cardiovasculr risk factors receive lifestyle advice from their physician and what is the predicting factor of that.

Methods : Cross-sectional study was done by direct interview. Subjects were 3151 people aged 19-61 years who had consulted a physician at leat once during 12 months before interview and who were employee of the national company which had branches nationwide. Possible cardiovascular risk factors were identified from the result of health check. Subjects were asked whether they had received lifestyle advice for each of identified risk factors from physician. The data about sociodemographic characteristics also were collected during interview. We used x2 test for trend to establish whether increasing risk levels were associated with a change in the likelihood of receiving advice about modifying risky behaviors.

Results : The proportion of smokers who received advice about smoking was just 29.3%, but smoking was unhealthy behavior most likely to receive advice from physician. The proportion of subjects receiving advice about exercise was only 8.6% and was significantly higher among those who were diabetic (27.6%), hypertensive (22.7%), or who had a history of cardiovascular disease (36.4%). The proportion of subjects receiving advice about low dietary fat intake was only 6.8%. The proportion was higher among obese subjects (13.7%) and rose with increasing serum cholesterol level (x2 trend=9.46, df=1; p<0.01). The proportion of subjects receiving advice about alcohol consumption was 18.1%. Women were significantly less likely than men to receive advice about smoking, exercise, alcohol consumption except about dietary intake and weight control. Age was significantly associated with the likelihood of receiving lifestyle advice.

Conclusion : Patients reported a low rate of receiving lifestyle advice from physician. This results suggest that more preventive advice about healthy lifestyle should be given in primary care.

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Assessment of risk factors of coronary heart disease in a university hospital using the Framingham risk score.: Young Hee Choi, Jung Hee Yang, Hyuk joon Choi, Kyung Hee Lee, Belong Cho, Bong Yul Huh; J Korean Acad Fam Med 2001;22(3):324-335. Published online March 1, 2001

Abstract
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Background
: Ischemic heart diseases have increased by more than 80% in the past 10 years among Korean and the global risk assessment of coronary heart disease(CHD) based on the relative risk factors to the probability of developing CHD became widely used for western populations. In this study we hope to provide information on the distribution and characteristics of the relative risks of CHD using the Framingham risk score.

Methods : This study involved the subjects who visited a university hospital for health promotion from 1995 to 2000 without CHD. We surveyed medical history of the subjects, and measured their blood pressure, serum glucose, total cholesterol(total-C) and HDL-cholesterol(HDL-C). Risk points from the Framingham chart were given to age, systolic BP, total-C, HDL-C, smoking, diabetes, and the global risk score was calculated from their sum. We analyzed the global risk scores and each risk points of the high risk groups.

Results : For younger and older men in the high risk group, the factors smoking and high blood pressure had the highest score assigned respectively. With younger women total-C had the highest score assigned, and with older women diabetes took over but HDL-C and high blood pressure still had a higher score.

Conclusion : For primary prevention of CHD, younger men need active education to quit smoking and for older aggressive blood pressure control is desperately needed. For women, concern about low HDL-C is highly needed and after menopause aggressive treatment for diabetes, high blood pressure, low HDL-C is needed.