Korean Journal of Family Medicine

"management"

Review Articles

Metformin-Induced Vitamin B12 Deficiency in Patients with Type 2 Diabetes: A Narrative Review with a Practical Approach for Screening, Diagnosing, and Managing Vitamin B12 Deficiency: Meriem Yazidi, Elyes Kammoun, Ibtissem Oueslati, Melika Chihaoui; Korean J Fam Med 2024;45(4):189-198. Published online July 18, 2024; DOI: https://doi.org/10.4082/kjfm.24.0090

Abstract
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Metformin is the most widely used antihyperglycemic drug in patients with type 2 diabetes (T2D). Over the past 2 decades, several studies have highlighted a substantial increase in the risk of vitamin B12 deficiency in patients with T2D on metformin therapy. This can lead to several complications and induce or exacerbate peripheral neuropathy. Despite these data, there are no definite guidelines for screening, diagnosing, and treating vitamin B12 deficiency in patients with T2D on metformin therapy. Therefore, in this narrative review, we aimed to suggest a practical diagnostic and therapeutic strategy to address vitamin B12 deficiency in patients with T2D receiving metformin treatment. Clinical evidence supporting an increased risk of vitamin B12 deficiency in patients with T2D on metformin therapy and its risk factors and potential complications are also discussed.

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Correlation between vitamin B12 deficiency and hemoglobin A1c in patients with diabetes mellitus
Yahya Madkhali, Sami G. Almalki
Journal of King Saud University – Science.2025; 37: 3542024. CrossRef
Rethinking about Metformin: Promising Potentials
Kyunam Kim
Korean Journal of Family Medicine.2024; 45(5): 258. CrossRef
Prevalence of Vitamin B12 Deficiency in Patients With Type 2 Diabetes Mellitus on Metformin Therapy: A Cross-Sectional Study
Shoaib Asghar, Haider Tanvir, Asad Riaz, Muhammad Hamza Ejaz, Mamuna Akram, Al Muktadir Chowdhury Evan, Salman Shahid
Cureus.2024;[Epub] CrossRef

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Management of Sarcopenia in Primary Care Settings: Chang Won Won; Korean J Fam Med 2023;44(2):71-75. Published online March 20, 2023; DOI: https://doi.org/10.4082/kjfm.22.0224

Abstract
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With aging, loss of skeletal muscle mass and muscle function increases, resulting in an increased risk of falls, fractures, long-term institutional care, cardiovascular and metabolic diseases, and even death. Sarcopenia, which is derived from the Greek words “sarx” or flesh+“penia” or loss, is defined as a condition characterized by low muscle mass and low muscle strength and performance. In 2019, the Asian Working Group for Sarcopenia (AWGS) published a consensus paper on the diagnosis and treatment of sarcopenia. The AWGS 2019 guideline, specifically, presented strategies for case-finding and assessment to help diagnose “possible sarcopenia” in primary care settings. For case finding, the AWGS 2019 guideline proposed an algorithm that recommends calf circumference measurement (cut-off <34 cm in men, <33 cm in women) or the SARC-F (strength, assistance with walking, rising from a chair, climbing stairs, and falls) questionnaire (cut-off ≥4). If this case finding is confirmed, handgrip strength (cutoff <28 kg in men, <18 kg in women) or the 5-time chair stand test (≥12 seconds) should be performed to diagnose “possible sarcopenia.” If an individual is diagnosed as “possible sarcopenia,” AWGS 2019 recommends that the individual should start lifestyle interventions and related health education for primary healthcare users. Because no medication is available to treat sarcopenia, exercise and nutrition is essential for sarcopenia management. Many guidelines, recommend physical activity, with a focus on progressive resistance (strength) training, as a first-line therapy for the management of sarcopenia. It is essential to educate older adults with sarcopenia on the need to increase protein intake. Many guidelines recommended that older people should consume at least 1.2 g of proteins/kg/d. This minimum threshold can be increased in the presence of catabolic or muscle wasting. Previous studies reported that leucine, a branched-chain amino acid, is essential for protein synthesis in muscle, and a stimulator for skeletal muscle synthesis. A guideline conditionally recommends that diet or nutritional supplements should be combined with exercise intervention for older adults with sarcopenia.

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Evaluating sarcopenia and nutritional status in outpatients with liver cirrhosis: concordance of diagnostic methods
Marina Demas Rezende Gischewski, Fernanda Lívia Cavalcante Araujo, Aryana Isabelle De Almeida Neves Siqueira, Alina Joana da Silva Wallraf, João Araújo Barros Neto, Nassib Bezerra Bueno Nassib, Juliana Célia de Farias Santos, Fabiana Andréa Moura
Nutrición Hospitalaria.2025;[Epub] CrossRef
Update on the Complications and Management of Liver Cirrhosis
Hiba Fadlallah, Diala El Masri, Hisham F. Bahmad, Wassim Abou-Kheir, Jad El Masri
Medical Sciences.2025; 13(1): 13. CrossRef
Diabetes and Sarcopenia: Intersection of Co Morbid Conditions
Byron J. Hoogwerf
OBM Geriatrics.2025; 09(01): 1. CrossRef
Prevalence and Associated Factors of Dynapenia, Pre-Sarcopenia, and Sarcopenia in Korean Adults: A Cross-Sectional Epidemiological Study
Do-Youn Lee
Medicina.2025; 61(4): 575. CrossRef
The Prognostic Significance of Handgrip Strength in Cirrhosis: Simplicity Is the Ultimate Sophistication
Binxin Cui, Ziyi Yang, Chao Sun
Portal Hypertension & Cirrhosis.2025; 4(2): 100. CrossRef
Guidelines for obesity clinic consultations in primary healthcare clinics
Jee-Hyun Kang, Kyoung-Kon Kim
Journal of the Korean Medical Association.2024; 67(4): 240. CrossRef
Guidelines for physical activity counseling in primary healthcare clinics
Yun Jun Yang
Journal of the Korean Medical Association.2024; 67(4): 265. CrossRef
Whole Genome Linkage and Association Analyses Identify DLG Associated Protein-1 as a Novel Positional and Biological Candidate Gene for Muscle Strength: The Long Life Family Study
Adam J Santanasto, Sandeep Acharya, Mary K Wojczynski, Ryan K Cvejkus, Shiow Lin, Michael R Brent, Jason A Anema, Lihua Wang, Bharat Thyagarajan, Kaare Christensen, E Warwick Daw, Joseph M Zmuda, Lewis A Lipsitz
The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences.2024;[Epub] CrossRef
Predictors of hip fracture in 15 European countries: a longitudinal study of 48,533 geriatric adults using SHARE dataset
M. Azhar Hussain, Rizwan Qaisar, Asima Karim, Firdos Ahmad, Fabio Franzese, Atif Awad, Abeer A. Al-Masri, Mohammed Alsaeed, Shaea A. Alkahtani
Archives of Osteoporosis.2024;[Epub] CrossRef
Open, Active-Controlled Clinical Study to Evaluate the Correlation between Whole Body DEXA and BIA Muscle Measurements
Yong-Chan Ha, Shinjune Kim, Jun-Il Yoo
Journal of Bone Metabolism.2024; 31(3): 219. CrossRef
Doctor and patient perceptions of sarcopenia in community-based primary care clinics: a questionnaire survey
Jungha Park, Daehyun Lee, Jae Young Jang, Jung-Ha Kim, Jae Uk Baek, Myungkwan Jeong, Sungwouk Kim, Moonbae Kyoung, Miji Kim, Chang Won Won
European Geriatric Medicine.2024; 15(6): 1827. CrossRef
Frequency of clinical signs in patients with Cushing's syndrome and mild autonomous cortisol secretion: overlap is common
Leah T Braun, Frederick Vogel, Elisabeth Nowak, German Rubinstein, Stephanie Zopp, Katrin Ritzel, Felix Beuschlein, Martin Reincke
European Journal of Endocrinology.2024; 191(4): 473. CrossRef
Efficacy of a combined exercise and nutrition intervention study for outpatients with possible sarcopenia in community-based primary care clinics (ENdSarC): study protocol for a multicenter single-blinded randomized controlled trial
Woohyuk Ji, Daehyun Lee, Minjin Kim, Nahyun Lim, Jae-Young Lim, Jae Uk Baek, Sungwouk Kim, Choong Hyung Lee, Miji Kim, Chang Won Won
BMC Geriatrics.2024;[Epub] CrossRef
Age-related increase in the excitability of mouse layer V pyramidal neurons in the primary motor cortex is accompanied by an increased persistent inward current
Jose A. Viteri, Nikolaus Bueschke, Joseph M. Santin, W. David Arnold
GeroScience.2024; 47(2): 2199. CrossRef
The Effect of Long Chain n-3 Fatty Acid Supplementation on Muscle Strength in Older Adults: A Systematic Review and Meta-Analysis
Maha Timraz, Ahmad Binmahfoz, Terry J. Quinn, Emilie Combet, Stuart R. Gray
Nutrients.2023; 15(16): 3579. 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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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

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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
Consilium Medicum.2024; 26(3): 164. CrossRef
Association between influenza vaccination and SARS-CoV-2 infection and its outcomes: systematic review and meta-analysis
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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Malaysia Healthcare Early Response in Combatting COVID-19 Pandemic in 2020: Safiya Amaran, Ahmad Zulfahmi Mohd Kamaruzaman, Nurul Yaqeen Mohd Esa, Zaharah Sulaiman; Korean J Fam Med 2021;42(6):425-437. Published online November 20, 2021; DOI: https://doi.org/10.4082/kjfm.20.0117

Abstract
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The year 2020 saw the emergence of a novel coronavirus—the severe acute respiratory syndrome coronavirus 2— which has led to an unprecedented pandemic that has shaken the entire world. The pandemic has been a new experience for Malaysia, especially during the implementation of large-scale public health and social measures called the Movement Control Order (MCO). This paper seeks to describe the experiences of the Malaysian healthcare system thus far in combatting the pandemic. The Malaysian healthcare system comprises two main arms: public health and medicine. The public health arm focuses on early disease detection, contact tracing, quarantines, the MCO, and risk stratification strategies in the community. The medical arm focuses on the clinical management of coronavirus disease 2019 (COVID-19) patients; it encompasses laboratory services, the devising of clinical setting adjustments, and hospital management for COVID-19 and non-COVID-19 patients. Malaysia experienced intense emotions at the beginning of the pandemic, with great uncertainty regarding the pandemic’s outcome, as the world saw a frighteningly high COVID-19 mortality. As of writing (May 30, 2020), Malaysia has passed the peak of its second wave of infections. The experience thus far has helped in preparing the country’s healthcare system to be vigilant and more prepared for future COVID-19 waves. To date, the pandemic has changed many aspects of Malaysia’s life, and people are still learning to adapt to new norms in their lives.

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Speech-language Telepractice Services During the COVID-19 Lockdown: Perspectives from Parents in Malaysia
Jing Feng, Xiao P. Choong, Pui J. Woi, Siaw C. Chai, Tian K. Quar, Jaehoon Lee, Shin Y. Chu
International Journal of Telerehabilitation.2025;[Epub] CrossRef
Geographical Debate on COVID-19’s Impact on Healthcare Access and Utilization in Vulnerable Malaysian Communities
Lay Im Lim, Mohammad Javad Maghsoodi Tilaki, Sharifah R. S. Dawood, Su Jinxia
Societies.2025; 15(7): 172. CrossRef
Unveiling the Nexus Between Intellectual Capital Efficiency and Financial Performance in Malaysia's Healthcare Sector Amidst the Covid-19 Crisis
Noor Sharida Badri Shah, Roslan Ja’afar
Information Management and Business Review.2024; 16(1(I)): 262. CrossRef
An Online Survey of the Perceptions of Clinical and Non-Clinical Professionals on Healthcare for Non-Communicable Diseases and COVID-19 Measures During the Pandemic in Malaysia
Sugitha Sureshkumar, Feisul Mustapha, Haironi Yusoff, Kibachio Joseph Mwangi, Kailing Marcus, Bogomil Kohlbrenner, David Issom, Mohamed-Rida Benissa, Sigiriya Aebischer-Perone, Nirit Braha, Egidio Candela, Kumar Gaurav Chhabra, B. R. Desikachari, Arianna
International Journal of Public Health.2023;[Epub] CrossRef

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Diagnosis and Management of Frailty in Primary Health Care: Chang Won Won; Korean J Fam Med 2020;41(4):207-213. Published online July 20, 2020; DOI: https://doi.org/10.4082/kjfm.20.0122

Abstract
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Disability in older adults has become a significant burden, both individually and socially, due to the rapidly aging population in Korea. It is important to manage both frailty and chronic diseases to delay disability. Frailty, which is considered to be a transition phase between healthy status and disability, is defined as a significant decline in functional reserves of multiple organ systems and the resultant extreme vulnerability to stressors, leading to a higher risk of adverse health-related outcomes. The frailty phenotype and frailty index are the most commonly used methods to diagnose frailty. Frailty is related to physical, psychological, cognitive, and social dysfunction, and is sometimes caused by chronic disease. Therefore, primary care providers are ideally situated to incorporate the concept of frailty into their practice, as they are champions in comprehensive care. Although the identification and treatment of frailty is not yet standard practice in primary care, primary care physicians must use the electronic frailty index to identify frailty in all the patients aged ≥65 years in the United Kingdom. In Canada, some insurance companies and governments are using a similar program, which is called the Community Actions and Resources Empowering Seniors model. The clinical practice guidelines of the International Conference of Frailty and Sarcopenia Research, as well as some additional references, will be introduced. Here, we review the current literature on how to diagnose and manage frailty in primary care.

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Comparison of Frailty Rates in Aged Patients Using Updated Clinical Guidelines
Julia A. Safonova, Daria S. Dyachkova-Gertseva, Ekaterina S. Lapteva
Russian Family Doctor.2025; 29(2): 77. CrossRef
Frailty and nutrition
Neil Wilson, William Mullaney
British Journal of Community Nursing.2024; 29(3): 118. CrossRef
The Chinese translation and cross-cultural adaptation of PRISMA-7 questionnaire: an observational study to establish the accuracy, reliability and validity
Meredith T. Yeung, Yen Gan, Shu Qi Teo, Kai Quan Lim, Hui Xuan Leow, Myriam Jbabdi, Michel Raiche, Mingxing Yang
BMC Geriatrics.2024;[Epub] CrossRef
Frailty and Cognitive Function in Middle-Aged and Older Adults With Congenital Heart Disease
Bo Daelman, Liesbet Van Bulck, Koen Luyckx, Adrienne H. Kovacs, Alexander Van De Bruaene, Magalie Ladouceur, Hsiao-Ling Yang, Ju Ryoung Moon, André Schmidt, Birgitte Lykkeberg, Edward Callus, Michèle de Hosson, Camilla Sandberg, Bengt Johansson, Joanna Hl
Journal of the American College of Cardiology.2024; 83(12): 1149. CrossRef
Looking out across the front yard: aboriginal peoples’ views of frailty in the community – A qualitative study
Ebony T. Lewis, Leanne Howard, Uncle Robert Carroll, Adam Howie, Gail Kenning, Adrienne Withall, Kenneth Rockwood, Magnolia Cardona, Kylie Radford, Katherine Schreyenberg, Ruth Peters
Ethnicity & Health.2024; 29(8): 987. CrossRef
Physical activity and nutrient intake levels according to grip strength among single-household elderly in Korea: data from 2014 and 2019 Korea National Health and Nutrition Examination Survey (KNHANES)
Mi-Young Park, Nana Chung
Physical Activity and Nutrition.2024; 28(3): 027. CrossRef
The challenge of home and community older adult care in China: a survey of the capability of primary care physicians in providing geriatric healthcare services
Xiufang Chen, Kun Xie, Yahui Li, Dan Hu, Yong Chen, Jiaying Chen
Frontiers in Public Health.2024;[Epub] CrossRef
Patient-reported outcomes in the aging population of adults with congenital heart disease: results from APPROACH-IS
Philip Moons, Koen Luyckx, Corina Thomet, Werner Budts, Junko Enomoto, Maayke A Sluman, Hsiao-Ling Yang, Jamie L Jackson, Paul Khairy, Stephen C Cook, Shanthi Chidambarathanu, Luis Alday, Erwin Oechslin, Katrine Eriksen, Mikael Dellborg, Malin Berghammer,
European Journal of Cardiovascular Nursing.2023; 22(4): 339. CrossRef
Nutritional and physical activity issues in frailty syndrome during the COVID-19 pandemic
Maria Chiara Massari, Viviana Maria Bimonte, Lavinia Falcioni, Antimo Moretti, Carlo Baldari, Giovanni Iolascon, Silvia Migliaccio
Therapeutic Advances in Musculoskeletal Disease.2023;[Epub] CrossRef
Receiver Operating Characteristic Analysis of Posture and Gait Parameters to Prevent Frailty Condition and Fall Risk in the Elderly
Valentina Presta, Laura Galuppo, Giancarlo Condello, Francesca Rodà, Prisco Mirandola, Marco Vitale, Mauro Vaccarezza, Giuliana Gobbi
Applied Sciences.2023; 13(6): 3387. CrossRef
Building resilience and reversing frailty: a randomised controlled trial of a primary care intervention for older adults
John Travers, Roman Romero-Ortuno, John Langan, Fergal MacNamara, Darren McCormack, Christopher McDermott, Jude McEntire, Joanne McKiernan, Seán Lacey, Peter Doran, Dermot Power, Marie-Therese Cooney
Age and Ageing.2023;[Epub] CrossRef
Management of Sarcopenia in Primary Care Settings
Chang Won Won
Korean Journal of Family Medicine.2023; 44(2): 71. CrossRef
Utilizing multimodal approach to identify candidate pathways and biomarkers and predicting frailty syndrome in individuals from UK Biobank
Watson Hua-Sheng Tseng, Amrita Chattopadhyay, Nam Nhut Phan, Eric Y. Chuang, Oscar K. Lee
GeroScience.2023; 46(1): 1211. CrossRef
Biological Age in Congenital Heart Disease—Exploring the Ticking Clock
Tijs K. Tournoy, Philip Moons, Bo Daelman, Julie De Backer
Journal of Cardiovascular Development and Disease.2023; 10(12): 492. CrossRef
Unsupervised Home-based Exercise for Rural Frail Elderly: An Evidence-based Case-report
Gilbert Lazarus, Czeresna Heriawan Soejono
Activities, Adaptation & Aging.2022; 46(3): 218. CrossRef
Up-to-date knowledge of frailty
Chang Won Won
Journal of the Korean Medical Association.2022; 65(2): 108. CrossRef
Born to Age: When Adult Congenital Heart Disease Converges With Geroscience
Philip Moons, Ariane Marelli
JACC: Advances.2022; 1(1): 100012. CrossRef
Fragilidade e funcionalidade familiar de idosos da Atenção Domiciliar: estudo transversal analítico
Gilmara Ramos, Mariane Lurdes Predebon, Fernanda Laís Fengler Dal Pizzol, Naiana Oliveira dos Santos, Lisiane Manganelli Girardi Paskulin, Ana Karina Silva da Rocha Tanaka, Idiane Rosset
Acta Paulista de Enfermagem.2022;[Epub] CrossRef
Predictive Ability of the Three-Time Stand and Walk Test to Determine Frailty and its Associations with Fear of Falling and Cognitive Function in Community-Dwelling Older Adults
Sirintip Kumfu, Puttipong Poncumhak
Annals of Geriatric Medicine and Research.2022; 26(4): 316. CrossRef
Current status of nutrient intake in Korea: focused on macronutrients
Seung-Won Oh
Journal of the Korean Medical Association.2022; 65(12): 801. CrossRef
World Health Organization Integrated Care for Older People (ICOPE) and the Integrated Care of Older Patients with Frailty in Primary Care (ICOOP_Frail) Study in Korea
Chang Won Won, Eunmi Ha, Eunjin Jeong, Miji Kim, Juhyun Park, Ja Euk Baek, Sungouk Kim, Sung Bae Kim, Jihun Roh, Jee Hye Choi, Seung Youn Jeon, Heeeun Jung, Daehyun Lee, Yuri Seo, Hyungeun Shin, Heesun Kim
Annals of Geriatric Medicine and Research.2021; 25(1): 10. CrossRef
Clinical Practice Guidelines for Managing Frailty in Community-Dwelling Korean Elderly Adults in Primary Care Settings
Hyo-Sun You, Yu-Jin Kwon, Sunyoung Kim, Yang-Hyun Kim, Ye-seul Kim, Yonghwan Kim, Yong-kyun Roh, Byoungjin Park, Young Kyu Park, Chang-Hae Park, Joung Sik Son, Jinyoung Shin, Hyun-Young Shin, Bumjo Oh, Jae-woo Lee, Jae Yong Shim, Chang Won Won, Ji Won Yoo
Korean Journal of Family Medicine.2021; 42(6): 413. CrossRef
Implications of frailty interventions from Korean frailty and aging cohort study
Chang Won Won
AGING MEDICINE.2021; 4(4): 247. CrossRef
Perceived Recovery Time from Common Cold as a Possible Indicator of Physical Resilience
Yoonki Kim, Chang Won Won, Sunyoung Kim, ByungSung Kim, Miji Kim, Eunjin Jeong, Jisoo Yang, Hyona Lee
Annals of Geriatric Medicine and Research.2021; 25(3): 204. CrossRef
Grip Strength as a Cardiometabolic Marker
Jungun Lee
Korean Journal of Family Medicine.2020; 41(5): 271. CrossRef

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Chronic Constipation in the Elderly Patient: Updates in Evaluation and Management: Amir Mari, Mahmud Mahamid, Hana Amara, Fadi Abu Baker, Afif Yaccob; Korean J Fam Med 2020;41(3):139-145. Published online February 17, 2020; DOI: https://doi.org/10.4082/kjfm.18.0182

Abstract
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Chronic constipation (CC) is a common disorder in the elderly population globally and is associated with comorbidities and negative implications on the quality of life. Constipation prevalence varies in different studies, primarily owing to the nonuniformity of the diagnostic criteria. However, 15%–30% of individuals aged >60 years are diagnosed with CC. Primary care physicians are the main healthcare providers that manage constipation in elderly patients in parallel with increased population aging and increased prevalence of constipation. Physical inactivity, polypharmacy, chronic medical conditions, rectal hyposensitivity, and defecatory disorders all play a role in the pathogenesis of CC in elderly patients. Detailed anamnesis, particularly history related to chronic medication use, with digital rectal examination may assist in identifying constipation causes. Additionally, blood tests and colonoscopy may identify organic causes of CC. Physiologic tests (i.e., anorectal manometry, colonic transit time with radiopaque markers, and defecography) can evaluate the physiologic function of the colon, rectum, and anus. However, generally, there are several causes of constipation in older patients, and an individualized approach is recommended. Treatment of chronic idiopathic constipation is empiric, based on the stepwise approach. Lifestyle advice, adjustment of chronic medications, and prescription of laxatives are the first steps of management. Several laxatives are available, and the treatment is evolving in the last decade. Biofeedback is an effective therapy especially for defecatory disorders. This review aimed to summarize the most updated knowledge for primary care physicians in the approach and management of CC in elderly patients.

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Rehabilitation for Chronic Constipation: Integrative Approaches to Diagnosis and Treatment
Luana Alexandrescu, Ionut Eduard Iordache, Alina Mihaela Stanigut, Laura Maria Condur, Doina Ecaterina Tofolean, Razvan Catalin Popescu, Andreea Nelson Twakor, Eugen Dumitru, Andrei Dumitru, Cristina Tocia, Alexandra Herlo, Ionut Tiberiu Tofolean
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Life’s Simple 7 and its impact on chronic bowel disorders: a study on constipation and diarrhea in the U.S. adult population
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Frontiers in Medicine.2025;[Epub] CrossRef
Attenuation of intestinal peristalsis with age is attributed to decreased sensitivity of receptors in the enteric nervous system
Tsukasa Kobayashi, Yuko Takeba, Masanori Ootaki, Yuki Ohta, Keisuke Kida, Taroh Iiri, Naoki Matsumoto
Cell and Tissue Research.2025; 400(3): 303. CrossRef
Health multidimensional evaluation of institutionalized older adults according to cognitive performance
Beatriz Cintra Martins, Lilian Barbosa Ramos, Anna Karla Carneiro Roriz, Henrique Salmazo da Silva
Dementia & Neuropsychologia.2025;[Epub] CrossRef
Advancements in the application of botulinum toxin type a in the treatment of anorectal disorders
Xiaojuan Chen
Toxicon.2025; 260: 108346. CrossRef
Probiotics and prebiotics in the treatment of functional constipation in the elderly individuals
Li Xu, Jian-Tang Guo, Jing Zhao, Ming-He Liu, Chen Mo
World Journal of Gastrointestinal Pharmacology and Therapeutics.2025;[Epub] CrossRef
Evaluation of nutritional and functional characteristics of noodles formulated with chickpea flour and moringa leaf powder
Tanjum Kabir Khuku, Sanaullah Mazumdar, Borhan Uddin, Md. Syduzzaman
Applied Food Research.2025; 5(1): 101062. CrossRef
The role of constipation in the development of dyslipidemia in the elderly
A. V. Martynenko, S. P. Nunes
Fundamental and Clinical Medicine.2025; 10(2): 118. CrossRef
A Low FODMAP Diet Supplemented with L-Tryptophan Reduces the Symptoms of Functional Constipation in Elderly Patients
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Nutrients.2024; 16(7): 1027. CrossRef
Predictors of inadequate bowel preparation in older patients undergoing colonoscopy: A systematic review and meta-analysis
Yuanyuan Zhang, Lining Wang, Wenbi Wu, Shi Zhang, Min Zhang, Wenjing She, Qianqian Cheng, Nana Chen, Pengxia Fan, Yuxin Du, Haiyan Song, Xianyu Hu, Jiajie Zhang, Caiyan Ding
International Journal of Nursing Studies.2024; 149: 104631. CrossRef
Laxatives in Geriatric Practice: From Preoperative Bowel Preparation to Correction of Chronic Constipation
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Russian Journal of Geriatric Medicine.2024; 16(4): 289. CrossRef
Development and validation of a nomogram to predict the risk of constipation after lumbar interbody fusion surgery
Mingxin Chen, Si Cheng, Dian Zhong, Tao Hu, Xin Wang, Zhongliang Deng, Qingshuai Yu, Zhengjian Yan
Archives of Orthopaedic and Trauma Surgery.2024; 144(5): 1907. CrossRef
A survey on functional constipation and its risk factors in older people in Shahreza, Iran
Mina Amiri, Akbar Hassanzadeh, Majid Rahimi
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Eosinophilic Esophagitis in Adults: A Concise Overview of an Evolving Disease: Amir Mari, Emmanouela Tsoukali, Afif Yaccob; Korean J Fam Med 2020;41(2):75-83. Published online February 17, 2020; DOI: https://doi.org/10.4082/kjfm.18.0162

Abstract
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Eosinophilic esophagitis (EoE) is a chronic inflammatory disease that encompasses esophageal symptoms along with eosinophilic infiltration of the esophageal epithelium. EoE is an evolving disease that has been a subject of interest to many researchers since the first studies recognized this condition as a new and distinct clinicopathological entity 25 years ago. Clinical presentation in adult patients may include dysphagia, food impaction, vomiting, and reflux symptoms. The diagnosis of EoE is based on the combination of clinical history suggestive of esophageal dysfunction, endoscopic features indicative of the disease, and histology revealing eosinophilic infiltration of the esophageal epithelium that persists after a trial of proton pump inhibitor therapy along with the exclusion of other disorders that may be associated with esophageal tissue eosinophilia. The interplay between EoE and gastroesophageal reflux disease (GERD) is complex, and differentiating these two conditions continues to be difficult and challenging in clinical practice. The mainstay treatment includes dietary modification, topical steroids, and/or endoscopic dilation. The primary care physician (PCP) plays an important role in improving patient care and quality of life by ensuring early referral and participating in management and follow-up. This article provides an overview of the current knowledge base regarding the disease including epidemiology, genetics, pathogenesis, common clinical presentations, the interplay between EoE and GERD, diagnostic approaches, and therapeutic options available to the PCP.

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Case Report

A Diagnosis to Consider in an Adult Patient with Facial Features and Intellectual Disability: Williams Syndrome: Özlem Akgün Doğan, Pelin Özlem Şimşek Kiper, Gülen Eda Utine, Mehmet Alikaşifoğlu, Koray Boduroğlu; Korean J Fam Med 2017;38(2):102-105. Published online March 22, 2017; DOI: https://doi.org/10.4082/kjfm.2017.38.2.102

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Williams syndrome (OMIM #194050) is a rare, well-recognized, multisystemic genetic condition affecting approximately 1/7,500 individuals. There are no marked regional differences in the incidence of Williams syndrome. The syndrome is caused by a hemizygous deletion of approximately 28 genes, including ELN on chromosome 7q11.2. Prenatal-onset growth retardation, distinct facial appearance, cardiovascular abnormalities, and unique hypersocial behavior are among the most common clinical features. Here, we report the case of a patient referred to us with distinct facial features and intellectual disability, who was diagnosed with Williams syndrome at the age of 37 years. Our aim is to increase awareness regarding the diagnostic features and complications of this recognizable syndrome among adult health care providers. Williams syndrome is usually diagnosed during infancy or childhood, but in the absence of classical findings, such as cardiovascular anomalies, hypercalcemia, and cognitive impairment, the diagnosis could be delayed. Due to the multisystemic and progressive nature of the syndrome, accurate diagnosis is critical for appropriate care and screening for the associated morbidities that may affect the patient's health and well-being.

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Pavan Manohar Patil, Seema Pavan Patil
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Original Articles

Qualitative Research on Experience of Primary Physicians Operating Their Primary Health Care Centers.: Daegeun Lee, Myung Sun Yi, Eun Young Park, Sung Hee Jo, Sang Min Park; Korean J Fam Med 2010;31(4):275-283. Published online April 20, 2010; DOI: https://doi.org/10.4082/kjfm.2010.31.4.275

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Background
The purpose of the study was to understand how family physicians managed their primary health care centers and to identify the factors for successful management of their privative clinics. Methods: The data was collected through individual interviews from five family physicians who operated their private clinics. All interviews were tape-recorded and transcribed into verbatim data. The data was analyzed using qualitative content analysis. Results: Three major categories were identified: 1) types of physician based on major value as a doctor; 2) difficulties in operation and management; 3) desirable operating strategies for success. The first category described what kinds of value the physicians pursued as they operated their private clinics. Two different types were identified. One was intrinsic value oriented and the other was extrinsic value oriented. The second category illustrated many difficulties that family physicians faced in operating and managing their private clinics. Lack of private time, social isolation, and gap between mission and reality of practice were identified as major difficulties. Desirable strategies for the successful management were four subcategories: location; self-oriented developmental plan; specialization of the services; and activating network with larger hospitals. Conclusion: The results of the study would be helpful in setting up and operating private clinics through understanding the difficulties and strategies of primary physicians and recognizing mission and major value of them.

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The Impact of Diabetes Fear of Self-injecting (FSI) and Fear of Self-testing (FST) on Glycemic Control and Diabetes Self-management.: Sumi Seo, Seongho Han, Youngjin Park; J Korean Acad Fam Med 2008;29(10):768-780. Published online October 10, 2008

Abstract
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Background: This study was done to examine the impact of diabetes fear of self-injecting (FSI) and fear of self-testing (FST) on glycemic control and diabetes self-management. Methods: A questionnaire survey was performed in the form of one-on-one interviews with 100 insulin-treated diabetic patients. The questions included subject traits, FSI/FST, and confidence in diabetes self-care (CIDS). Glycemic control was determined by the measurement of glycated hemoglobin (Hemoglobin A1_C). Results: The patients who did not have a spouse and were less well educated showed high FSI/FST scores and low CIDS scores. The patients who had taken high quantities of insulin, had diabetes related complications, and performed self-monitoring of blood glucose less frequently showed high FSI/FST scores. The patients who had received diabetes education, possessed glucometer and performed self-monitoring of blood glucose frequently had high CIDS scores. High FSI/FST scores were positively related to each other, negatively related to low CIDS scores and not significantly related to Hemoglobin A1_C. On the other hand, a significant correlation was seen between CIDS scores and Hemoglobin A1_C. Conclusion: High levels of FSI and/or FST were associated with high diabetes-related distress, poor general well-being, and psychologic comorbidity as well as poorer adherence to the diabetes treatment regimen. It is important in diabetes care to lower injection-related fears and improve diabetes self-management through systematic desensitization, relaxation therapy, the use of pen- type injection device, and proper education such as insulin injection amount adjustment, properties of insulin, and the risk of hypoglycemia for the patients and their families. (J Korean Acad Fam Med 2008;29:768-780)

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Effect of Short-term Obesity Management Program for Local Community Residents.: Ji Won Lee, Jee Aee Im, Duk Chul Lee; J Korean Acad Fam Med 2008;29(2):121-133. Published online February 10, 2008

Abstract
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Background
The incidence of obesity is acutely increasing resulting in increased mortality rate and medical expenses among Koreans. But it is rare to find effective obesity management program, that are readily accessible by general local community residents. This study was aimed to develop and evaluate an effective and specialized obesity management program utilizing the local public health institutes. Methods: One hundred forty nine obese adults residing in Kwangju were enrolled in a tentative, 12-week scheduled obesity management program from August 2006 to October 2006. The program constituted of weekly education and practice by specialists, and exercise for more than an hour for 5 days a week. The effectiveness of the program was evaluated according to the change of body weight, body component, blood pressure, and serum lipid concentration. After the program was completed, each participant was surveyed on the degree of satisfaction and lifestyle changes. Results: Ninety participants (60.4%) completed the program to the end. The average decrement of body weight after the program was 1.9±1.5 kg. Eleven participants (12.2%) lost more than 5% of the initial body weight. The waist circumference and average blood pressure significantly decreased among the group who lost more than 5% of the initial body weight. The total cholesterol and triglycerides also slightly decreased among this group. Overall 87.3% of the participants were satisfied with the results of the program. The lifestyle of the participants had also changed by the program. Conclusion: The authors expect that establishing easily- approachable obesity management program in local public health institutes will make a great contribution to the maintenance of proper body weight and decrement of cardiovascular diseases among local community residents. (J Korean Acad Fam Med 2008;29:121-133)

1,519 View
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Knowledge and Attitudes of Family Physician and Oncologist toward Cancer Pain Management in Korea.: Young Ho Yun, Sang Min Park, Kiheon Lee, Ki Young Son, So Yeon Chung, Dae Seog Heo, Si Young Kim, Young Seon Hong, Bong Yul Huh; J Korean Acad Fam Med 2005;26(7):397-403. Published online July 10, 2005

Abstract
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Background
: Two representative groups of family physicians and oncologists were surveyed concerning their knowledge and attitudes toward cancer pain management (CPM).

Methods : A questionnaire, designed to assess knowledge (13 items) and attitudes (6 items) toward CPM, was sent to 2,200 members of Korean Association of Family Medicine and 800 members of Korean Cancer Association.

Results : Three hundred and eighty eight family physicians (17.6%) and one hundred and forty seven oncologists (18.4%) responded and completed the questionnaire. They had inadequate knowledge toward CPM, especially, chance of respiratory depression, tolerance to adverse effect, ceiling effect, risk of addiction, and use of adjuvants. Most of the physicians had positive attitude toward importance of CPM, best judge of pain severity, and priority of CPM but had negative attitude toward concerns about potential problem of addiction and earlier prescription of maximum dose of opioid. Family physicians displayed more lack of knowledge about CPM in 9 of 13 items and more negative attitudes toward 4 of 6 items. Adjustment for demographic characteristics and experiences in cancer patients with pain showed that while family physicians had poor knowledge of tolerance to confusion, they had more adequate knowledge on the effect of antidepressant and had positive attitude towards best judge of pain severity and priority of CPM. Poor knowledge about CPM was rated by 66.3% of physicians as the most important barrier to adequate CPM.

Conclusion : These findings that most of the physicians had poor knowledge and negative view toward CPM suggest a continuous need for comprehensive education program focused on CPM for physicians.

1,546 View
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Managing Outpatients with Dyslipidemia in a University Hospital.: Ha Jung Choi, Kayoung Lee, Bit Na Kim, Tae Jin Park, Jeong Nyeo Lee; J Korean Acad Fam Med 2005;26(7):384-390. Published online July 10, 2005

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Background
: We evaluated physician's management of hypercholesterolemia on the basis of the third Adult Treatment Panel (ATP III) report of the National Cholesterol Education Program.

Methods : The subjects were 85 adult patients. The inclusion criteria were as follows: outpatients with an initial total cholesterol level of ≥200 mg/dL or HDL-cholesterol ＜40 mg/dL from October to November in 2002, and those visiting the clinic at least three times for the 12 weeks after the baseline test. We reviewed the patients' cardiovascular risk factors (age, low and high HDL, hypertension, history of coronary heart disease (CHD), and diabetes) and the use of LDL-lowering drugs using hospital records. Smoking status and family history of premature CHD were obtained from 19 patients out of 36 patients without CHD or diabetes by telephone. On the whole, cardiovascular risk in 68 patients was identified. Among the total, 52 patients responded to telephone interview concerning education of therapeutic lifestyle change (TLC) provided by a physician.

Results : Forty nine (72.1%) of 68 patients were diagnosed as CHD or diabetes. Fifty three (77.9%) showed undesirable LDL that was categorized by the number of cardiovascular risk factors (≥160 mg/dL for patients with risk factor＜2; ≥130 mg/dL for patients with risk factors ≥2; ≥100 mg/dL for patients with CHD or diabetes). In 59.5% of patients with undesirable LDL reported that they did not provide education about TLC and in 40.0% of patients with desirable LDL were provided prescription of LDL-lowering drugs from physicians. Physicians were more likely to prescribe if the patients had more risk factors (P=0.001) and educated patients when they prescribed them (P=0.049). However, physicians did not educate on TLC and did not recheck lipid profile prior to first prescription.

Conclusion : The physicians did not follow the ATP III guideline for management of hypercholesterolemia. Barriers to comply with these guidelines and ways to eliminate barriers should be found.

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Survey on Screening and Management of Obesity in Health Promotion Centers.: Sang Min Park, Dong Ryul Lee, Ji Hun Rho, Jong Sung Kim, Bong Yul Huh; J Korean Acad Fam Med 2002;23(10):1237-1244. Published online October 10, 2002

1,339 View
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Hepatitis B examination and recognition change after 1 year in girls' high school students.: Ill Hwan Kim, Ok Min Kim, Chul Gab Lee; J Korean Acad Fam Med 2001;22(8):1271-1278. Published online August 1, 2001

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Background
: Korea Academy of Family Medicine recommands HBsAb and HBsAb test in youth health promotion program. Adequate management are necessary for prevention of vertical transmission at perinatal period. especially girls' high school students as a future's conceivable woman. Health examination program for the first grade students of high school which was established by the Educational Ministry has been acted since 1998. So, throught the students health examination we'd like to find an adequate method of prevention and management in hepatitis B.

Methods : Our study examines HBs Ag/Ab about girl's high school students at two high schools in an city. According to the results of hepatitis B, active intervention in carrier group, passive intervention in candidate were done. And then a year later, hepatitis B management was investigated through the questionnaire.

Results : In active intervention group, regular check up of hepatitis B is 21.4%, hepatitis B blood test in family is 39.3% and in passive intervention group, hepatitis B vaccination rate after health examiantion is 9.1%.

Conclusion : More active intervention such as mass vaccination are required in health examination for the purpose of hepatitis B management at youth.

1,191 View
9 Download

Management patterns of upper gastrointestinal symptoms.: Sung Soo Hwang, Jae Man Ki, In Ku Lee, Jae Ik Bae, Ki Heum Park, Nak Jin Sung; J Korean Acad Fam Med 2001;22(6):886-894. Published online June 1, 2001

Abstract
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Background
: Upper gastrointestinal symptoms is the one of the most frequent symptom in primary medicine, those manifestations are various and can not find the cause in many cases. In Korea the management patterns for upper gastrointestinal symptoms are using drug store. oriental medicine, folk methods, diet therapy in addition to medical service. We have investigated the behavioral patterns for the control of upper gastrointestinal symptoms.

Methods : The authors surveyed the patients who had visited Dong-guk university Kyung-ju hospital with upper gastrointestinal symptoms from April 1 to Jun 30 in 2000.

Results : 269 questionnaires were collected and among them 247 completed ones were analysed. 112 subjects were used medical service only(45.3%(, 135 subjects were used alternative methods also(54.7%). Among the 135 subjects who used alternative methods, 60 visited to drug store(44.4%), 36 took oriental medicine(26.7%), 18 used folk herbal remedy(26.7) 5 used diet therapy(3.7%) 16 used folk manual therapy(11.9%), most commonly. Women more commonly used alternative methods(P<0.01). By occupation, housewives more commonly used alternative methods and specialists less commonly used alternative methods. There were no significant difference between two groups in other general characteristics, most severe symptom, cost, satisfaction.

Conclusion : We find the behavioral patterns for relieving upper gastrointestinal symptoms are using alternative methods(drum store, oriental medicine, folk herbal remedy, folk manual therapy, diet therapy) in addition to using medical service. Women and housewives more commonly used alternative methods, and specialist less commonly used alternative methods.

1,208 View
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Waist circumference as a screening tool for cardiovascular risk factors in Korea: Evaluation of receiver operating characteristics(ROC).: Keum Mi Lee; J Korean Acad Fam Med 2000;21(3):395-405. Published online March 1, 2000

Abstract
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Background
: Epidemiologic studies indicate that the central fat distribution rather than obesity itself may be an independent predictor for cardiovascular disease and metabolic disorders. The purpose of this study was to investigate the significance of waist circumference as index of central obesity and to investigate waist circumference as a measure for increased risk of cardiovascular disease in Korean adults using the ROC curve.

Methods : Four hundred seventy six subjects (339 men and 137 women) were included for this study. Subjects were selected among patients who visited the Health Promotion Center of Yeungnam University Hospital for general health evaluation from January to June 1999. Self-reported questionnaire of socioeconomic, health and lifestyle were recorded followed by measurement of higher, weight, waist and hip circumference, percent body fat, blood pressure, blood chemistry. We analysed best cut-off point of waist circumference for those with highest sensitivity and specificity of cardiovascular risk factors using the ROC curve.

Results : Waist circumference was related with blood pressure, total cholesterol, HDL and LDL cholesterol, triglyceride, but not with glucose in men. In women, waist circumference was related with blood pressure, glucose, total cholesterol, triglyceride, but not with HDL and LDL cholesterol.
Waist circumference at risk of cardiovascular disease seems different in Koreans compared to those of Caucasians. ROC curves showed that 84cm in men(sensitivity and specificity were 66.4% and 58.7%) and 78cm (Sensitivity and specificity were 78.3% and 53.4%) in women were useful in identifying those with at least one risk factors. There were some differences according to disease, age, smoking state, and alcohol intake. Cut-off point of waist circumference with at least one risk factor was about 3cm higher in age over 45years men, age over 55 years or postmenopausal women, smoker, and alcoholics

Conclusion : Measurement of waist circumference 84cm in men and 78cm in women could be adopted as a simple index for health promotion, to alert those at risk of cardiovascular disease, and as a guide to risk avoidance by self-weight management in Korea.

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The recognition and management of obesity at primary care in urban area.: Young Jin Jeoung, Young Ju Yoon, Hye Soon Park; J Korean Acad Fam Med 1999;20(7):886-893. Published online July 1, 1999

Abstract
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Background
: Recently, the prevalence of obesity has increased due to the development of industries and westernized diet pattern. Also, chronic diseases associated with obesity have increased as well. Although management of obese patients is important in health promotion program, there is no data that support recognition and management of the obesity in primary care. Therefore, surveys concerning such issues were done among internists and family physicians in Seoul.

Methods : In 1997 May, questionnaire was sent by mail to each 887 internists and family physicians working in primary care in Seoul.

Results : A total of 186 replied to the questionnaire consisting of 21% of the total. The proportion of respondents who replied that obesity is a problem for management was 66.3%. Diet control and exercise was recognized as the most effective treatment method 82.1% of respondents recognized that failure to control weight was due to patients themselves. Personal experience in managing obesity patients using informational sources was only 14.5%. The proportion of respondents replied that those whose weight and height were measured for all first-visit patients was 50%, that obese patients received care in was 71%. Behavior modifications, diet control, and exercise were widely recommended, but drug therapy was not. 73.6% of respondents simple explained to control weight to obese patients, but only 17.1% continuously evaluated and managed them.

Conclusion : The degree of recognitions for obesity by primary care physicians in urban area was relatively low, regardless of its importance in health promotion. And, screening for obesity and continuous management for obese patients was inadequate. Efforts to manage obesity patients adequately in primary care is necessary.

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The Concept and management of Hepatitis B Virus Infection: Difference between General Practitioners and Hepatologists.: Jin Ju Paik, Hyeon Jin Lee, Young Ho Lee, Ka Young Lee, Tae Jin Park; J Korean Acad Fam Med 1998;19(4):326-336. Published online April 1, 1998

Abstract
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Background
: Korea is one of the endemic areas of viral hepatitis B, and 6-8% of general population are hepatitis B virus carriers. Although there have been little reduction in morbidity and infectivity of viral hepatitis B owing to newer vaccines and the effects of immunizations, there are some differences among physicians in managing hepatitis B virus infection, and guidelines have not been established. Therefore in this study, we investigated general practitioners' concept and the practical management of viral hepatitis B in comparison with the hepatologists'.

Methods : Information was obtained through questionnaires sent to 67 hepatologists and 400 general practitioners(general internists, general surgeons, family physicians, general physicians, and public health center managers) in Pusan during the 5 months from April to August, 1997. Overall respondents were 142(116 General practitioners, 26 Hepatologists), and the response rate was 32.9%.

Results : In general practitioners, the most commonly used serologic test for viral hepatitis was HBsAg/HBsAb(71.0%). 51.9% of subjects underwent anti-HBs test 3-5 months later after vaccination. The most common revaccination method for healthy non-responders of initial vaccination was 3 series of immunizations with the same vaccine of equal dosage(36.9%). 65.7% of subjects were tested for LFT every 6 months for chronic carriers, and 41.5% of them were advised α-interferon treatment for chronic active hepatitis patients only if the patients requested it. In comparison with general practitioners, hepatologists had a tendency to add anti-HCV test for the serologic evaluation of hepatitis(56.6% vs 26.2%), to limit age for vaccination(82.6% vs 54.1%), and to delay prescribing hepatotonics until the AST and ALT levels increased up to 2 folds normal(53.8% vs 39.1%). 38.5% of hepatologists did not recommend giving booster injection of hepatitis.

Conclusion : Practical guideline is necessary to manage viral hepatitis B patients.