Obesity is a chronic systemic disease with multifactorial causes that poses a substantial health and economic burden worldwide. In Korea, obesity is a significant public health concern owing to the increasing prevalence of obesity-related comorbidities and mortality. Obesity is defined as excess adiposity that poses health risks. Adiposity can be assessed using direct and indirect methods, among which body mass index (BMI) is the most widely used anthropometric measurement in epidemiological studies and clinical practice. However, limitations of BMI-centric obesity assessments have been noted in previous studies. Simple adiposity measures cannot capture obesity-related medical conditions, daily functional status, or mental health. Therefore, medical associations worldwide have increasingly emphasized the need for comprehensive obesity assessments, including the 2020 Canadian Adult Obesity Clinical Practice Guidelines, American Association of Clinical Endocrinologists/American College of Endocrinology 2023 Guidelines, 2024 European Association for the Study of Obesity diagnostic framework, and 2025 Lancet Commission’s Clinical Obesity Diagnostic Criteria. Recent perspectives have emphasized multidimensional approaches to obesity assessment to capture individuals’ overall health status. This review aims to evaluate the limitations of BMI-centric obesity diagnosis, summarize emerging recommendations from recent international guidelines, and highlight potential alternative approaches for improving the assessment of obesity and related health outcomes.

Citations

• A year of significant progress for the Korean Journal of Family Medicine
  Seung-Won Oh
  Korean Journal of Family Medicine.2026; 47(1): 1.     CrossRef

Background
Childhood obesity is increasing globally. Primary care doctors are well-positioned to identify children with obesity. This study aimed to assess the usage of clinical practice guidelines (CPG) to determine obesity and the knowledge of primary care doctors regarding childhood obesity.
Methods
An online survey was conducted between November 2023 and February 2024 among primary care doctors in Klang Valley, Malaysia. The questions assessed doctors’ knowledge, practices, beliefs, and usage of the CPG in managing childhood obesity.
Results
There were 246 participants during the study period. Among the doctors, 101 (41%) knew the correct definition of “childhood overweight” while 120 (49%) doctors used the CPG. Doctors using the CPG had higher odds of knowing the correct management (odds ratio [OR], 2.65; 95% confidence interval [CI], 1.30–5.41; P=0.006). Doctors using the CPG had higher odds of screening for childhood obesity complications and measuring body mass index (BMI), blood pressure, and pubertal status. Multivariate analysis showed that doctors working in government clinics (OR, 3.56; 95% CI, 2.01–6.32; P<0.001), having postgraduate training (OR, 3.95; 95% CI, 2.08–7.51; P<0.001) and having worked less than 5 years (OR, 4.53; 95% CI, 1.85–11.08; P<0.001) had higher odds of using the CPG. Doctors working in government clinics (OR, 5.93; 95% CI, 1.95–18.05; P=0.002) and used the CPG (OR, 7.26; 95% CI, 2.09–25.27; P=0.002) had higher odds of measuring the BMI.
Conclusion
Knowledge regarding diagnosis and management of childhood obesity among primary care doctors is still lacking. CPG on childhood obesity could be a useful tool for improving the diagnosis, management, and screening of childhood obesity.

Citations

• Family medicine for all stages of life: turning knowledge into actionable care
  Joung Sik Son
  Korean Journal of Family Medicine.2026; 47(2): 95.     CrossRef

Background
There is a shortage of general practitioners in Japan. With the revision of educational guidelines, general practice (GP) education has improved. However, the amount of education on GP in medical schools remains inconsistent. This study examined the relationship between medical students’ amount of GP-related education and their subsequent choice of GP majors.
Methods
A retrospective cohort study was conducted in a teaching hospital in Japan. Participants were residents in the hospital. The exposure comprised compulsory lectures and training time for community-based medicine in medical schools. The outcome included participants choosing GP majors after their initial 2-year junior residency.
Results
Fifty-one participants were included in the final analysis. Of these, 14 majored in GP and 37 in non-GP after their initial 2-year junior residency. Of the participants who took GP lectures for 18 hours or more, 11 chose GP majors, and 18 chose non-GP majors (risk ratio, 2.78; 95% confidence interval [CI], 0.88–8.79). Of the participants who underwent training for 12 days or more, 10 chose GP majors, and 16 chose non-GP majors (risk ratio, 2.40; 95% CI, 0.87–6.68).
Conclusion
The results do not support the association between the amount of compulsory undergraduate education for community-based medicine and the subsequent increase in the number of residents choosing GP majors in Japan. Educators would do well to explore different approaches, such as improving the quality of education to increase the number of GP residents. Further research is needed to reach more definitive conclusions.

Citations

• Impact of inpatient volume on residents’ In-training examination scores and burnout in Japanese community hospitals: a nationwide cross-sectional study
  Kosuke Ishizuka, Yuji Nishizaki, Koshi Kataoka, Taro Shimizu, Masanori Nojima, Yu Yamamoto, Kiyoshi Shikino, Sho Fukui, Kazuya Nagasaki, Hiroyuki Kobayashi, Mitsuyasu Ohta, Yasuharu Tokuda
  BMC Medical Education.2026;[Epub]     CrossRef
• Rethinking community‐based clinical training in Japan: Toward a more effective model for increasing the number of general practice physicians
  Masanobu Okayama
  Journal of General and Family Medicine.2025; 26(5): 383.     CrossRef
• A Qualitative Study of the Experiences of Medical Students and Preceptor Physicians during Clinical Training at Regional Public Hospitals
  Kyung Hye Park, In Cheol Hwang, So Jung Yune, Kwi Hwa Park
  Korean Medical Education Review.2025; 27(2): 169.     CrossRef
• Advancing primary care education: Lessons from the United Kingdom for Japan
  Lauren Glover, Takashi Watari, Tomoko Miyoshi, Hitomi Kataoka
  Journal of General and Family Medicine.2025; 26(6): 504.     CrossRef
• Impact of enhanced pre-practical training on medical students’ engagement in community healthcare: A study at Showa University School of Medicine using the ACCCA framework and assertiveness role-play
  Rieko Goto, Tsuyoshi Oshiro, Takahiro Mikami, Makiko Arima, Shintaro Suzuki, Edward Barroga, Miki Izumi
  The Showa Medical University Journal.2025; 37(3): 127.     CrossRef
• Understanding the Goals of Service Learning and Community-Based Medical Education: A Systematic Review
  Marina Khan, Hanzala Waqar, Farida Pervez, Palwasha Zahid, Muhammad Abbas Khan, Syeda Sanaa Fatima
  Pakistan Journal of Health Sciences.2025;[Epub]     CrossRef
• Distribution of internal medicine rotations among resident physicians in Japan: a nationwide, multicenter, cross-sectional study
  Kiyoshi Shikino, Miwa Sekine, Yuji Nishizaki, Yu Yamamoto, Taro Shimizu, Sho Fukui, Kazuya Nagasaki, Daiki Yokokawa, Takashi Watari, Hiroyuki Kobayashi, Yasuharu Tokuda
  BMC Medical Education.2024;[Epub]     CrossRef
• Strengthening Primary Health Care through Medical Education
  Seung-Won Oh
  Korean Journal of Family Medicine.2023; 44(4): 181.     CrossRef
• Factors associated with regional retention of physicians: a cross-sectional online survey of medical students and graduates in Japan
  Soichi Koike, Kentaro Okazaki, Akiko Tokinobu, Masatoshi Matsumoto, Kazuhiko Kotani, Hitomi Kataoka
  Human Resources for Health.2023;[Epub]     CrossRef

Background
Human immunodeficiency virus (HIV), the agent responsible for acquired immunodeficiency syndrome, remains a worldwide public health problem. Therefore, this study aimed to assess Portuguese healthcare students’ knowledge of HIV, identify risk behaviors for HIV transmission, and assess the frequency of HIV testing and its dissemination by general practitioners.
Methods
A cross-sectional observational study was conducted using an anonymous questionnaire published online. The questionnaire was administered to Portuguese healthcare students who voluntarily agreed to participate in the study after clarifying its objectives and procedures.
Results
Most students were aware of the three main HIV transmission routes; however, 66.3% were unaware of the level A recommendation for HIV screening in adolescents and adults. In addition, 59.6% of the students were never informed by their general practitioner about HIV screening tests or risk behaviors for HIV transmission. Of the sample, 78.9% had never been tested for HIV infection. Of the 74.6% of sexually active students, 82.0% had or had already had unprotected sex (without a condom). Men showed riskier sexual behaviors than women. None of the inquiries reported intravenous drug use, and most students (69.9%) never shared personal objects.
Conclusion
General practitioners and awareness campaigns need to alert and disseminate HIV screening tests. Sexual health and risk behaviors should be addressed more frequently in schools to educate this population because prevention is the best strategy against HIV transmission/contraction.

Citations

• Sexual awareness, high-risk sexual behaviors and HIV testing: a cross-sectional survey among university students in Xuzhou, Jiangsu
  Hualing Li, Qi Wu, Qinghan Li, Enze Gao, Dehui Yin
  Frontiers in Public Health.2025;[Epub]     CrossRef

Clinical practice guidelines (CPG) can be defined as systematically developed recommendations and related content obtained by reviewing scientific evidence, which help healthcare providers make decisions. CPG is one of the most powerful tools that helps clinicians make evidence-based decisions in practice. Methodologies in areas essential for CPG development, such as for systematic review, risk of bias (ROB) assessment, adaptation, and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations, are rapidly developing. Therefore, they must be well-understood and applied to evidence-based CPG development. In this regard, it is necessary to learn about the updates and changed in the methodologies for CPG development. This manuscript covers the following CPG development methodologies: (1) main principles of CPG, (2) managing conflict of interest, (3) considering patient value and preference, (4) determination of key questions, (5) ROB assessment, (6) adaptation, (7) rapid guideline development, (8) living guideline development, and (9) GIN-McMaster Guideline Development Checklist.

Citations

• Guidelines addressing Motor Neurone Disease (MND): a scoping review
  Cindy Stern, Ines Semendric, Nipun Shrestha, Jay Beasley-Hall, Sabira Hasanoff, Timothy Barker, Danielle Pollock, Camille Schubert, Lynne Giles, Steve Vucic, Tracy Merlin, Zachary Munn
  Neurodegenerative Disease Management.2025; : 1.     CrossRef
• Nephrologists’ perception of the French national guidelines in nephrology
  Latame Komla Adoli, Cécile Vigneau, Arnaud Campeon, Cécile Couchoud, Valérie Chatelet, Thierry Lobbedez, Eric Daugas, Florian Bayer, Elsa Vabret, Jean-Philippe Jais, Sahar Bayat-Makoei
  Scientific Reports.2025;[Epub]     CrossRef
• RoBANS 2: A Revised Risk of Bias Assessment Tool for Nonrandomized Studies of Interventions
  Hyun-Ju Seo, Soo Young Kim, Yoon Jae Lee, Ji-Eun Park
  Korean Journal of Family Medicine.2023; 44(5): 249.     CrossRef
• Association between Conflicts of Interest Disclosure and Quality of Clinical Practice Guidelines in Japan: A Meta-Epidemiological Study
  Norio Yamamoto, Akihiko Ozaki, Shunsuke Taito, Takashi Ariie, Hidehiro Someko, Hiroaki Saito, Tetsuya Tanimoto, Yuki Kataoka
  Journal of Personalized Medicine.2023; 13(12): 1722.     CrossRef

The teaching of family medicine and general practice should aim to develop an appreciation of the unique nature and role of the specialty. Teachers should relate patient cases to the principles of family medicine. These principles include (1) compassionate care; (2) a generalist/holistic approach focusing on the whole person, family, and community; (3) continuity of relationship, i.e., building a patient-physician bond of trust; (4) reflective mindfulness; and (5) lifelong learning. The curriculum, instructional strategy, and assessment should be carefully aligned. Core competencies include patient-centered communication, physical examination skills, clinical procedures, palliative care, humanities in medicine, holistic care, shared decision-making, family therapy, home and community visits, chronic disease care, problem-based documentation, team-based care, data-driven improvement, information mastery, ethics and professionalism, and work-life balance. Family medicine/general practice is defined as the medical specialty that manages common and long-term illnesses, focusing on overall health and well-being. Hence, clerkship schedules should maximize clinical exposure and opportunities for self-reflection. A learner-centered approach should begin with a self-identified inventory of learning needs based on the curriculum; next, these needs should be chosen as topics for student presentations. Teaching methods should include mini-workshops: a combination of didactic lectures and small-group exercises. Individual face-to-face formative feedback should occur at midcourse and culminate in a group reflection on the learning experience. Clinical supervision should gradually decrease as each resident demonstrates safe patient care. Procedure skills training should be closely supervised, formally documented, and constitute about one-fourth of learning sessions.

Citations

• Competências essenciais em medicina de família e comunidade para a graduação médica
  Natália Bortoletto D'Abreu, João Henrique Silva Rizzetto, Bianca Pimenta de Matos, Joana Froés Bragança
  Revista Brasileira de Medicina de Família e Comunidade.2026; 20(47): 4849.     CrossRef
• Factors related to choosing family medicine as future career among senior medical students at King Abdul-Aziz University, Jeddah, Saudi Arabia: A cross-sectional study
  Malikah A. Alsharef, Saeed M. S. Alghamdi, Razan A. Almuhyawi, Najla A. Alajhar, Suhail H. Alrudaini, Mohammed G. Almehmadi
  Journal of Family Medicine and Primary Care.2026; 15(1): 208.     CrossRef
• Medical Students’ Perceptions of the Family Medicine Course at Yarmouk University: A Cross-Sectional Study
  Mohammad Al-Magableh, Batool Eldos, Farah Fraihat, Dema Khdier, Esra'a Freihat, Omar Al-Omari, Taima Migdady, Mo’nes Alali, Rama Mestarihi, Tamara Al-nemrat
  Advances in Medical Education and Practice.2026; Volume 17: 1.     CrossRef
• Competency evaluation using randomized testing: feasibility of a new structured assessment method
  M. Jawad Hashim, Alexander Kieu
  Advances in Physiology Education.2025; 49(3): 801.     CrossRef
• Use of audio-visual aids and case studies to enhance understanding of family medicine among medical students
  Stephen T. Engmann
  African Journal of Primary Health Care & Family Medicine.2024;[Epub]     CrossRef
• Guidelines for nutrition counseling in primary healthcare clinics
  Gyeongsil Lee, Seung-Won Oh
  Journal of the Korean Medical Association.2024; 67(4): 278.     CrossRef
• Disease prevention measures applicable to primary healthcare clinics
  Jae-Heon Kang
  Journal of the Korean Medical Association.2024; 67(4): 226.     CrossRef
• Perception of Family Medicine Residents on the Use of Small Group Discussion in Comparison to Standard Lectures
  Ahmed Mohammed Gharawi, Abdullah Mohammed Alateeq, Ghada Alarfaj, Ayman Afify, Saad Albatal, Alaa Alahmari, Mostafa Kofi
  European Journal of Contemporary Education and E-Learning.2024; 2(5): 3.     CrossRef
• Strengthening Primary Health Care through Medical Education
  Seung-Won Oh
  Korean Journal of Family Medicine.2023; 44(4): 181.     CrossRef

Background
The awareness and practice of pelvic floor muscle exercise (PFME) in the prevention and reduction of the rate of urinary incontinence among pregnant women was considerably poor, despite the increased prevalence of urinary incontinence during pregnancy across Malaysia. There healthcare providers do not give adequate attention to the potential impact of PFME on urinary incontinence and there is limited local intervention addressed urinary incontinence during pregnancy. The objective of this study was to determine the effectiveness of a newly developed PFME intervention in terms of knowledge, attitude, practice, self-efficacy, and urinary symptoms.
Methods
A single-blinded, two-armed, randomized control trial was included pregnant women from 18 to 20 weeks of gestation and was conducted at the Maternity Hospital of Kuala Lumpur. The intervention group received PFME in addition to the usual perinatal care. The data were collected using validated questionnaires at 4 time points: baseline, post-intervention in the early third trimester, late third trimester, and early postnatal period. The intervention effects were analyzed using a generalized estimating equation.
Results
The primary analysis included pregnant women who had at least one follow-up; 122 women (71.8%) in the intervention group had significant improvement in knowledge, attitude, practice, and self-efficacy, as well as in the severity of urinary incontinence over time. However, improvement was not observed in self-reported urinary incontinence.
Conclusion
PFME can be considered an effective initial intervention to provide information about urinary incontinence prevention to pregnant women.

Citations

• Barriers and facilitators to pelvic floor muscle exercises among postpartum women: A meta-synthesis based on the capability, opportunity, motivation, and behavior (COM-B) model
  Zhouli Gui, Yingni Liang, Yiqin Huang, Qingyan Gu, Qian Li, Xixian Li, Ruotong Liu, Li OuYang, Hongwu Liao
  Midwifery.2026; 153: 104695.     CrossRef
• Pelvic floor exercise: Awareness, knowledge, beliefs and practices among pregnant women in a Ghanaian setting
  Yaa Abrafi Ankomah, Bright Anneh Awaitey, Moses Monday Omoniyi, Benjamin Asamoah, Obed Kwame Numadzi, Kwofie Robert Amoah, Joel Innocent Goli, Sunita Panda
  PLOS One.2026; 21(4): e0347199.     CrossRef
• Prenatal Exercise Decreases Urinary Incontinence in Late Pregnancy and 3 Months Postpartum: A Randomized Controlled Trial
  DINGFENG ZHANG, MIGUEL SÁNCHEZ-POLÁN, CRISTINA SILVA-JOSE, ÁNGELES DÍAZ-BLANCO, MAIA BRIK, ARANZAZU MARTÍN ARIAS, PALOMA HERNANDO, RUBÉN BARAKAT
  Medicine & Science in Sports & Exercise.2025; 57(3): 555.     CrossRef
• Effect of lattice CO2 laser combined with Kegel exercise mild moderate stress urinary incontinence and postpartum depression anxiety
  Zhao-Xia Lou, Shu-Ying Huang, Ze-Qiu Wan, Yun Chen, Hua-Ying Shan, Ling-Yan Wang
  World Journal of Psychiatry.2025;[Epub]     CrossRef
• Compliance and Adherence to Pelvic Floor Exercise Therapy in People with Pelvic Floor Disorders: A Systematic Review and Meta-Analysis
  Inmaculada Villa-Del-Pino, José-Jesús Jiménez-Rejano, Manuel Rebollo-Salas, Álvaro-José Rodríguez-Domínguez, Carmen-María Suárez-Serrano
  Life.2025; 15(4): 613.     CrossRef
• A Scoping Review of Quantitative Assessments of Women’s Bladder Health Knowledge, Attitudes, and Beliefs
  D. Yvette LaCoursiere, Shayna D. Cunningham, Camille P. Vaughan, Lisa Kane Low, Haitao Chu, Alayne D. Markland, Diane K. Newman, Sheila Gahagan, Jean F. Wyman
  Journal of Women's Health.2025; 34(9): 1099.     CrossRef
• Influence of pelvic floor muscle training alone or as part of a general physical activity program during pregnancy on urinary incontinence, episiotomy and third‐ or fourth‐degree perineal tear: Systematic review and meta‐analysis of randomized clinical tr
  Dingfeng Zhang, Kari Bo, Rocío Montejo, Miguel Sánchez‐Polán, Cristina Silva‐José, Montse Palacio, Rubén Barakat
  Acta Obstetricia et Gynecologica Scandinavica.2024; 103(6): 1015.     CrossRef
• Knowledge, attitudes, and practices of pelvic floor muscle exercises among pregnant women visiting public hospitals
  Javeria Saeed, Laiba Abdullah
  Journal of Basic & Clinical Medical Sciences.2023; 1: 12.     CrossRef
• Preliminary Findings on Urinary Incontinence Screening Among Childbearing Women Attending Maternal and Child Health Clinic in Kuantan
  Siti Mariam Muda, Umi Maisarah Sutaji, Muzaitul Akma Mustapa Kamal Basha, Haliza Hasan, Zalina Nusee
  Malaysian Journal of Medicine and Health Sciences.2022; 18(s19): 142.     CrossRef
• Effects of exercises for strengthening pelvic floor muscles in pregnant women
  Ranka Ogurlić, Anka Vukićević, Ljiljana Stijepović
  Medicinski casopis.2022; 56(4): 107.     CrossRef

Aging has become a global problem, and the interest in healthy aging is growing. Healthy aging involves a focus on the maintenance of the function and well-being of elderly adults, rather than a specific disease. Thus, the management of frailty, which is an accumulated decline in function, is important for healthy aging. The adaptation method was used to develop clinical practice guidelines on frailty management that are applicable in primary care settings. The guidelines were developed in three phases: preparation (organization of committees and establishment of the scope of development), literature screening and evaluation (selection of the clinical practice guidelines to be adapted and evaluation of the guidelines using the Korean Appraisal of Guidelines for Research and Evaluation II tool), and confirmation of recommendations (three rounds of Delphi consensus and internal and external reviews). A total of 16 recommendations (five recommendations for diagnosis and assessment, 11 recommendations for intervention of frailty) were made through the guideline development process. These clinical practice guidelines provide overall guidance on the identification, evaluation, intervention, and monitoring of frailty, making them applicable in primary care settings. As aging and “healthy aging” become more and more important, these guidelines are also expected to increase in clinical usefulness.

Citations

• Promoting an international consensus on frailty assessment: An urgent call to address the challenges of perioperative management in an aging population
  Ying Xia, Wei Tang
  BioScience Trends.2026;[Epub]     CrossRef
• International landscape of guidelines for perioperative frailty assessment and barriers to clinical translation
  Ya-nan Ma, Kenji Karako, Ying Xia, Peipei Song, Xiqi Hu
  BioScience Trends.2026;[Epub]     CrossRef
• Effect of a wearable-sensor-assisted multicomponent exercise program on physical fitness, cognition and quality of life in frail older adults
  Genghong Tu, Lining Liu, Huiyi Tang, Weizhong Chen, Bagen Liao
  Translational Exercise Biomedicine.2025; 2(3): 201.     CrossRef
• Frailty assessment utilization around the globe–a systematic review
  Samantha Gaston, Elle Billman, Lichy Han, David Drover
  The Journal of Frailty & Aging.2025; 14(6): 100088.     CrossRef
• Exercise Prescription for Frail Older Adults: Impact on Handgrip Strength and Gait Speed – A Systematic Review
  Andreia Carvalho, Vânia Cerqueira Palma, Maria Teresa Tomás
  Physical & Occupational Therapy In Geriatrics.2025; : 1.     CrossRef
• Summary of best evidence for prevention and management of frailty
  Yinning Guo, Xueyi Miao, Jieman Hu, Li Chen, Yimeng Chen, Kang Zhao, Ting Xu, Xiaoman Jiang, Hanfei Zhu, Xinyi Xu, Qin Xu
  Age and Ageing.2024;[Epub]     CrossRef
• Frailty: Assessment and Intervention
  Hana Moon, Geon Ho Lee, DaeHyun Kim
  Keimyung Medical Journal.2024; 43(2): 100.     CrossRef
• Clinical practice guidelines for frailty vary in quality but guide primary health care: a systematic review
  Huaxin Si, Jiaqi Yu, Qinqin Liu, Yanyan Li, Yaru Jin, Yanhui Bian, Xiaoxia Qiao, Wenyu Wang, Lili Ji, Yan Wang, Jian Du, Cuili Wang
  Journal of Clinical Epidemiology.2023; 161: 28.     CrossRef
• Yaşlılarda Kırılganlığın Önlenmesi ve Yönetiminde Kanıta Dayalı Yaklaşımlar
  Ayşe Buket DOĞAN, Özlem CANBOLAT
  Sağlık Bilimlerinde Değer.2023; 13(3): 501.     CrossRef
• Validation of the Korean Academy of Geriatric Dentistry screening questionnaire and oral frailty diagnostic criteria in community-dwelling older adults
  Jeong-Hyun Kang, Seong-Chan Park, Hoi-In Jung, Sun Jae Jung, Hye-Jin Park, Soo-Min Kim, Min-Ji Jo, Yun-Seon Lee, Sun-Young Han
  Epidemiology and Health.2023; 46: e2024008.     CrossRef
• Up-to-date knowledge of frailty
  Chang Won Won
  Journal of the Korean Medical Association.2022; 65(2): 108.     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

Background
Smoking is a preventable cause of chronic morbidity. Patient empowerment is a process through which people establish greater control over their health-related decisions and actions. To assess the effect of patient empowerment versus health education on the nicotine dependence score and progress of patients under different stages of smoking cessation.
Methods
This was a single-blinded randomized controlled clinical trial that included 76 smokers attending family medicine clinics. Participants were divided into two groups: empowerment and health education groups. Their nicotine-dependence score and smoking cessation stage were identified. All study participants were subjected to five health education sessions with a 3-month follow-up period.
Results
The mean nicotine-dependence score decreased significantly in both groups after the intervention. This decrease was slightly higher in the empowerment group; however, the difference was not statistically significant. After the intervention, 16.7% of the health education and 30.0% of the empowerment group transitioned from stage 1 to stages 2–4 of smoking cessation, with the change being statistically significant only in the empowerment group. There was no statistically significant difference in the number of study participants who stopped smoking between the health education and empowerment groups.
Conclusion
Both the empowerment model and traditional health education have similar positive effects on decreasing the nicotine-dependence level. There was a significant improvement in the stage of change for patients under the empowerment model, although there was no statistically significant difference between the groups regarding the number of participants who stopped smoking.

Citations

• Confronting nihilism and stigma in lung cancer: The nurse practitioner's role in restoring hope and trust
  Lisa Carter-Bawa, Timothy J. Williamson, Nancy Alvey, Abbie Begnaud, Dannell Boatman, Deborah P. Brown, Deena Cook, Dusty Donaldson, Jill Feldman, Heidi A. Hamann, Ella Kazerooni, Lauren Kearney, Eugene Manley, Drew Moghanaki, Jamie S. Ostroff, James Pant
  Journal of the American Association of Nurse Practitioners.2026; 38(3): 146.     CrossRef
• The independent and moderator role of communicative health literacy on health, health behaviour and health care utilisation: a population based cross-sectional study
  F. Vincze, F.E.A. Israel, R. Ádány, É. Bíró
  Public Health.2025; 245: 105794.     CrossRef
• Behavioral health care provider’s beliefs, confidence, and knowledge in treating cigarette smoking in relation to their use of the 5A’s intervention
  Midhat Z. Jafry, Jayda Martinez, Tzuan A. Chen, Maggie Britton, Isabel Martinez Leal, Anastasia Rogova, Bryce Kyburz, Teresa Williams, Mayuri Patel, Brian J. Carter, Lorraine R. Reitzel
  Addictive Behaviors Reports.2023; 17: 100493.     CrossRef
• Developing Smoking Cessation Program for Female Smokers and Assessment of Its Impacts
  Kyung Hyun Suh
  STRESS.2023; 31(4): 189.     CrossRef
• Current status of health promotion in Korea
  Soo Young Kim
  Journal of the Korean Medical Association.2022; 65(12): 776.     CrossRef
• Public Health Intervention for Smoking Cessation
  Soo Young Kim
  Korean Journal of Family Medicine.2021; 42(5): 343.     CrossRef

Background
Accreditation is an approach toward quality improvement which has been increasingly implemented in healthcare. This study aimed at developing a national functional accreditation model for primary healthcare with emphasis on family practice in Iran.
Methods
This mixed-method study utilizes a set of research methods purposefully. Initially, the reference models were used for benchmarking accreditation standards through a systematic review. Then, the primary accreditation standards were developed and then they were assessed and approved by the experts of the field via Delphi technique. In the following and after developing essential parts of the standards, the necessary changes in developed model were done according to the pilot test results.
Results
The results of systematic review suggested the superiority of accreditation models of the United States, Australia, Canada, and the United Kingdom globally; and the models of Jordan, Saudi Arabia, Lebanon, and Egypt in Eastern-Mediterranean region. Then, the primary standards including 39 functional standards with 231 measures were developed according to the benchmarked models, and were approved by the experts in Delphi-based study. In pilot test step, the compliance rate of developed standards by primary healthcare centers was calculated 61.61% and 26.37% for self-evaluation and external evaluation phases, respectively.
Conclusion
Regarding the comprehensiveness of developed accreditation model due to its focus on all functional dimensions and the consensus over the developed standards by the experts, it can be an underlying ground for the establishment and evaluation of functional improvement programs in Iranian primary healthcare system.

Citations

• Accreditation of primary health care services: A systematic review
  Babak Rastegarimehr, Ahmad Ahmadi Teymourlouy, Hasan Abolghasem Gorji
  Journal of Education and Health Promotion.2025;[Epub]     CrossRef
• The compliance of the training program for hospital accreditation surveyors in Iran with the international requirements: a mixed-methods study
  Tahmineh Poursaki, Lida Shams, Ali Maher, Farid Gharibi
  BMC Health Services Research.2025;[Epub]     CrossRef
• Challenges and Weaknesses of Leadership and Governance-related Health Policies in Iran: A Systematic Review
  Rahim Khodayari-Zarnaq, Khorshid Mobasseri, Shabnam Ghasemyani, Fatemeh Sadeghi-Ghyassi, Maryam Naghshi, Neda Kabiri
  Archives of Iranian Medicine.2024; 27(9): 508.     CrossRef
• ssessing the performance of comprehensive health care centers in Aradan district based on the national accreditation model
  Farid Gharibi, Jafar Jandaghi, Esmaeil Moshiri
  Koomesh journal.2021; 23(5): 617.     CrossRef

Background
The family, as the smallest social institution, has responsibilities across many functions, including maintaining family health. Increases in chronic diseases and life expectancy require more family support to prevent disease and implement treatment for family members with chronic diseases. Therefore, physician involvement in not only the treatment of diseases but also their prevention and rehabilitation is required In Indonesia. Hence, a new approach for physician involvement with families is required, especially with regard to comprehensiveness. This study aimed to develop a physician involvement program with the family model for primary healthcare in Indonesia.
Methods
A two-round Delphi method with family medicine experts from 17 of the highest accredited medical faculties in Indonesia as participants was conducted, and factor analysis performed thereafter. The items were considered relevant at ≤0.8 validity content ratio. The second step of this research is survey using e-questionnaire involving 101 primary care physician from all over Indonesia. They live scattered in several provinces in the main islands of Indonesia such Sumatra, Java, Kalimantan, Sulawesi dan Bali.
Results
Results showed an adequately measured sample and correlation for all items (Kaiser-Meyer-Olkin of sampling=0.821; Bartlett’s test <0.001). Seven dimensions were derived from results with eigenvalue of >1, and 25 items were filtered after determining the loading factor of >0.5. The Cronbach’s α for each factor varied from 0.602 to 0.829, and that for the total 25 items was 0.913, with a total variation documented as high as 66%.
Conclusion
A new physician involvement model with the family approach model, known as the “GENOGRAM model,” was developed, which consisted of seven dimensions and 25 items.

Citations

• Comprehensiveness in Primary Care: A Scoping Review
  AGNES GRUDNIEWICZ, ELLEN RANDALL, LORI JONES, AIDAN BODNER, M. RUTH LAVERGNE
  The Milbank Quarterly.2025; 103(1): 153.     CrossRef

Citations

• Hepatitis B vaccination status, knowledge and associated factors among healthcare professionals in Dongola, Sudan, 2024: a cross-sectional study
  Mogahid Mohamed Awad, Sami Altalib, Kamil M. Shaaban
  BMC Infectious Diseases.2025;[Epub]     CrossRef
• Hepatitis B in Healthcare Personnel: An Update on the Global Landscape
  Georgia B. Nikolopoulou, Ioannis Tzoutzas, Athanasios Tsakris, Helena C. Maltezou
  Viruses.2023; 15(12): 2454.     CrossRef
• COVID-19 vaccine hesitancy in Sana'a, Yemen
  Redhwan Ahmed Al-Naggar, Hisham Alshaikhli, Reyadh R. Al-Rashidi, Sharon Murtagh
  International Journal of One Health.2022; : 58.     CrossRef
• Prevalence and management of rubella susceptibility in healthcare workers in Italy: A systematic review and meta-analysis
  Francesco Paolo Bianchi, Pasquale Stefanizzi, Giusy Diella, Andrea Martinelli, Antonio Di Lorenzo, Maria Serena Gallone, Silvio Tafuri
  Vaccine: X.2022; 12: 100195.     CrossRef
• Prevention of Hepatitis B among Homeless People: Challenges for Vaccination in Brazil
  Thaynara Lorrane Silva Martins, Marcos André de Matos, Sheila Araujo Teles, Raquel Silva Pinheiro, Paulie Marcelly Ribeiro Carvalho, Márcia Maria de Souza, Camila Canhete Ferreira, Regina Maria Bringel Martins, Karlla Antonieta Amorim Caetano
  Journal of Poverty.2021; 25(4): 347.     CrossRef
• Promotion of healthcare personnel vaccinations among newly employed doctors and nurses: Evidence-guided strategy
  Hyo-Ju Son, Eunjung Lee, Se Yoon Park, Seungjae Lee, Hyohyun Hong, Eun Ju Choo, Tark Kim, Min Hyok Jeon, Shinae Yu, Jung Wan Park, Tae Hyong Kim
  Vaccine.2021; 39(26): 3480.     CrossRef
• Knowledge, Vaccination Status, and Reasons for Avoiding Vaccinations against Hepatitis B in Developing Countries: A Systematic Review
  Putri Bungsu Machmud, Saskia Glasauer, Cornelia Gottschick, Rafael Mikolajczyk
  Vaccines.2021; 9(6): 625.     CrossRef
• A Nationwide Survey on the Hospital Vaccination Policies in Korea
  Sun Hee Park, Mi Suk Lee, Sung Ran Kim, Yee Gyung Kwak
  Journal of Korean Medical Science.2020;[Epub]     CrossRef
• PERCEPÇÕES ACERCA DA IMPORTÂNCIA DAS VACINAS E DA RECUSA VACINAL NUMA ESCOLA DE MEDICINA
  Amanda Hayashida Mizuta, Guilherme de Menezes Succi, Victor Angelo Martins Montalli, Regina Célia de Menezes Succi
  Revista Paulista de Pediatria.2019; 37(1): 34.     CrossRef
• Immunization attitudes, opinions, and knowledge of healthcare professional students at two Midwestern universities in the United States
  Lauren L. Dybsand, Kylie J. Hall, Paul J. Carson
  BMC Medical Education.2019;[Epub]     CrossRef
• Vaccine refusal – what we need to know
  Regina Célia de Menezes Succi
  Jornal de Pediatria.2018; 94(6): 574.     CrossRef
• Measles vaccination status of nurses and associated factors during community measles outbreaks
  Kyung Mi Kim, Jeong Sil Choi
  Japan Journal of Nursing Science.2018; 15(3): 249.     CrossRef
• Comparison of three immunoassays for determination of immunity to rubella virus in healthcare workers
  Su-Yeon Jo, Kyung-Hwa Shin, Sun Min Lee, Eun-Young Jeong, Hyun-Ji Lee, Chulhun L. Chang
  Journal of Immunological Methods.2018; 463: 84.     CrossRef
• Vaccine refusal – what we need to know
  Regina Célia de Menezes Succi
  Jornal de Pediatria (Versão em Português).2018; 94(6): 574.     CrossRef
• Seroprevalence of hepatitis B virus infection and associated factors among healthcare workers in northern Tanzania
  Elichilia R. Shao, Innocent B. Mboya, Daniel W. Gunda, Flora G. Ruhangisa, Elizabeth M. Temu, Mercy L. Nkwama, Jeremia J. Pyuza, Kajiru G. Kilonzo, Furaha S. Lyamuya, Venance P. Maro
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Citations

• Factors influencing contracting of residents with family doctors in China: a national cross-sectional survey
  Ning Zhao, Mei Gu, Jin Li, Haiyan Zhang, Jia Yang
  BMC Health Services Research.2024;[Epub]     CrossRef
• Public Awareness and Perception of Family Medicine in Jeddah, Saudi Arabia
  Bashair M Alshammrani, Renad O Aljuhani, Khadijah M Basaqr, Eman A Bin Mahfouz, Ebtisam M Alhawsawi, Reem Alqahtani
  Cureus.2022;[Epub]     CrossRef
• Aile Hekimliği Uygulamasını Daha Az Tercih Eden Kişilerin Uygulama Hakkındaki Bilgilerinin Değerlendirilmesi: Kesitsel Bir Çalışma
  Fatma Nur ÖZDEMİR, Can ÖNER, Huseyin CETİN, Engin Ersin ŞİMŞEK
  Turkish Journal of Family Medicine and Primary Care.2022; 16(4): 823.     CrossRef
• In the Name of Family Medicine: A Nationwide Survey of Registered Names of Family Medicine Clinics in Taiwan
  Ya-An Liu, Sally Cheng, Ya-Chuan Hsu, Po-Chin Yang, Hsiao-Ting Chang, Ming-Hwai Lin, Tzeng-Ji Chen, Li-Fang Chou, Shinn-Jang Hwang
  International Journal of Environmental Research and Public Health.2020; 17(11): 4062.     CrossRef
• Public's perception and satisfaction on the role and services provided by family physicians in Saudi Arabia: A cross-sectional study
  AmnahAli Abdulqader Elagi, BasemAmer Jaber, AlmontherHussain Ahmed Wassly, RubaMohammed Sallam Ahmed, FatimahAli Ahmed Bosily
  Journal of Family Medicine and Primary Care.2019; 8(10): 3282.     CrossRef

Citations

• Analysis of evidence appraisals for interventional studies in family medicine using an informatics approach
  Alain Nathan Sahin, Andrew Goldstein, Chunhua Weng
  Primary Health Care Research & Development.2019;[Epub]     CrossRef
• Current status of health services research in primary care in Korea
  Hee-Young Lee, Jong-Heon Park, Yong-Jun Choi
  Journal of the Korean Medical Association.2016; 59(11): 888.     CrossRef

Citations

• Hospital rotations in general practitioner training: a scoping review of strengths, issues and concerns
  K Bray, NM Kristensen, PS Gaardsted, JE Møller, TL Guldberg, TL Klitgaard
  Education for Primary Care.2026; : 1.     CrossRef
• A New Role of Case Reports in Family Medicine and Primary Care
  Ki Dong Ko
  Korean Journal of Family Medicine.2021; 42(2): 181.     CrossRef
• Adecuación y calidad de las ecografías abdominales solicitadas por los profesionales de medicina
  Llorenç Caballería, Guillem Pera, Lluís Rodríguez, José Darío Casas, Dolores Miranda, M. Antònia Auladell, Isabel Buezo, Carmen Expósito, Ingrid Arteaga, Pere Torán
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• Acceptability and quality of abdominal ultrasound studies requested by medical professionals
  Llorenç Caballería, Guillem Pera, Lluís Rodríguez, José Darío Casas, Dolores Miranda, M. Antònia Auladell, Isabel Buezo, Carmen Expósito, Ingrid Arteaga, Pere Torán
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• Epiglottic Cyst Incidentally Discovered During Screening Endoscopy: A Case Report and Review of Literature
  Seung-Hwa Lee, Duck-Joo Lee, Kwang-Min Kim, Kyu-Nam Kim, Sang-Wook Seo, Young-Kyu Park, Sung-Min Cho, Young-Ah Choi, Jung-Un Lee, Dong-Ryul Lee
  Korean Journal of Family Medicine.2014; 35(3): 160.     CrossRef

Citations

• The Predictive Validity of the National Board of Osteopathic Medical Examiners’ COMLEX-USA Examinations With Regard to Outcomes on American Board of Family Medicine Examinations
  Thomas R. O’Neill, Michael R. Peabody, Hao Song
  Academic Medicine.2016; 91(11): 1568.     CrossRef

Citations

• Reimagining Radiology: A Comprehensive Overview of Reviews at the Intersection of Mobile and Domiciliary Radiology over the Last Five Years
  Graziano Lepri, Francesco Oddi, Rosario Alfio Gulino, Daniele Giansanti
  Bioengineering.2024; 11(3): 216.     CrossRef
• Beyond the Clinic Walls: Examining Radiology Technicians’ Experiences in Home-Based Radiography
  Graziano Lepri, Francesco Oddi, Rosario Alfio Gulino, Daniele Giansanti
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  International Journal of Computational and Experimental Science and Engineering.2024;[Epub]     CrossRef
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  Adriano de Oliveira Andrade, Adeilson Barbosa Soares, Angélica de Andrade Palis, Ariana Moura Cabral, Cassiana Gabriela Lima Barreto, Daniel Baldoino de Souza, Fernanda de Paula Silva, Fernando Pasquini Santos, Gabriella Lelis Silva, José Flávio Viana Gui
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  Christine Jacob, Antonio Sanchez-Vazquez, Chris Ivory
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  Hyejung Chang
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Background
Sleep is an essential restorative physiologic phenomenon. Impaired sleep results in significant negative effect to the health. Symptoms like sleep initiation difficulty, frequent awakening, severe snoring have related to poor sleep quality. We studied frequency and compared the characteristics of common sleep disorders at family practice.Methods: We surveyed patients over 18 years of age and their guardians who visited 16 familial practices for 6 days. We investigated sleep characteristics, frequency of sleep disorder and associated factors by questionnaires and analyzed by frequency analysis, Spearman's correlation coefficient, multiple logistic regression.Results: We enrolled 1,117 participants. Older participants were more likely to report early sleep onset and off time, short sleep duration. Mean number of awakening during a typical night is 1.69. Female complained difficulties in initiation and maintenance of sleep more than male. A total of 32.5% had these insomnia symptoms and related to hypertension, stroke, stress, arthralgia, depression, urological disorder. 31.1% had excessive daytime sleepiness, related to stress, arthralgia, depression. Loud snoring and gasp for breath showed positive correlation between male, high BMI. Disrupted sleep over 3 times was related to old age, female, diabetes, hypertension, stroke, stress, arthralgia, depression. Restless leg syndrome were high in elderly, high BMI, stress, arthralgia and depression.Conclusion: About one in three who visit in primary medical practice have sleep disorder symptoms like insomnia, daytime fatigue, snoring. 3% of them have gasp for breath, 8% have restless leg syndrome.

Citations

• Effect of Sleep Quality on Fatigue and Quality of Life : a Sasang Constitutional Medicine Perspective
  Ji-Eun Park, Sujeong Mun, Siwoo Lee
  Journal of Physiology & Pathology in Korean Medicine.2020; 34(1): 37.     CrossRef
• The Effect of Health-Related Habitual Consumption and Lifetime on Subjective Health of One Person Households: Focusing on Comparison between Non-One Person Households and Generations
  Ji Kyeung Ha, Seonglim Lee
  Family and Environment Research.2017; 55(2): 141.     CrossRef
• Insomnia: Causes and Diagnosis
  Dong Hyun Ahn
  Hanyang Medical Reviews.2013; 33(4): 203.     CrossRef
• Literature review of effect of work pattern (day shift and night shift) on worker's health
  Ki-Youn Kim, Man-Su Cho, Won-Mo Gal
  Journal of the Korea Safety Management and Science.2013; 15(2): 1.     CrossRef
• Prevalence and predictors of poor sleep quality in Korean older adults
  Jin‐Hee Park, Moon‐Sook Yoo, Sun Hyoung Bae
  International Journal of Nursing Practice.2013; 19(2): 116.     CrossRef

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.

Background
Nowadays 2-year 'Compulsory Clinical Training Program' is on issue. The perception and opinions for the new training system of residents and interns may be essential to establish ideal postgraduate medical education. Methods: A questionnaire survey of postgraduate trainee from March to April 2008 was performed by person to person method. Gender, age, specialty, the location and the facility of the hospital, and 7 questions reflecting individual perception and opinions for the 'Compulsory Clinical Training Program' were reviewed. Results: Among in 1,314, 1,284 subjects completed the survey fully. We divided 1,284 sujects into 4 groups; Intern; Resident of Family Medicine; Resident of Internal Medicine or Pediatrics; Resident of other than Family Medicine, Internal Medicine and Pediatrics. About the vision for independent clinical skills through the 'Compulsory Clinical Training Program', most were negative. They were afraid of 'prolongation of current Internship' or 'unclear quality of the training course'. In case of setting the 'Compulsory Clinical Training Program', most chose additional resident courses for specialty. The main opinion about the ideal model of a primary physician was medical doctors who obtained primary care specialty. Conclusion: Most of the residents and interns think that the specialists of family medicine, internal medicine or pediatrics are suitable for primary care. And on wishing the additional residency course even after 'Compulsory Clinical Training Program', they doubt about the effi cacy of the new training system.

Background
As of 2006, the residents of family medicine occupies about 9 percent among the total. However, expansion of more general practice doctors is in demand to conduct desirable general practice. Accordingly, this study was conducted to survey the motivation to apply for family medicine residency and the actual situation. Methods: A questionnaire survey of 862 residents of nationwide family medicine from June 2006 to July 2006 was performed via e-mails. Hospital, size, years, gender, age, university, career, time and motivation to apply, and existence and nonexistence of lecture in medical school or clinical practice of family medicine for students were reviewed. Results: Among the total, 415 (48.14%) residents from 72 training hospitals answered. For the motivation, 'the necessity to diagnose and treat various patients' was 53.49%, 'advantageous to start practice' was 21.93%, and 'relatively short training period' was 11.33%. For the time, during 'intern' was 49.40%, 'on getting a job' 16.63%, and as a 'student' 15.42%. When they had lectures of family medicine in medical school, decision made as a student was 19.93%, and during clinical practice was 21.61%. Conclusion: Among the reasons that motivated to apply for family medicine, 'the necessity to diagnose and treat various patients' was the biggest, which conforms to the training goal of Academy of Family Physicians. Since there is a tendency to select family medicine residency earlier when they are exposed to lectures of family medicine or clinical practices in medical school, the effort to expand substantial lectures and clinical practices is needed. (J Korean Acad Fam Med 2007;28:931-936)

Background
The educational assessment of residents is very important in order to check their knowledge and to improve their ability. In case of family practice, the residents spend most of their training time in outside rotations with other specialities. Therefore, they are requested to be evaluated by each specialist after each rotation. To give more accurate assessment, we surveyed directly our family practice residents and family practice faculties. Methods: A questionnaire was sent to family practice residents and family practice faculties in 116 hospitals from May to June 2006. The response rate was 29% and 78%, respectively. Results: Among the total, 70.2% of family practice residents thought an assessment is necessary, but only 51.7% were evaluated. Overall, 90.4% of family practice faculties knew about the assessment of residents made by other specialists, and only 56.7% of faculties requested other specialists to assess their family practice residents. Conclusion: Most of the family practice residents and their faculties knew the need for assessment, but they complained there were no objectivity and the assessment tool was lacking. In order to solve this problem, it is urgent to develop a unified form and guidelines of assesment. (J Korean Acad Fam Med 2007;28:616-625)

Background
Consultation and referral are important characteristics of modern medicine which has become more segmented and more specialized. In particular, they give essential value to family practitioners to coordinate patients accordingly for proper care. This study analyzed the referred patients in family practices under Cheonan practice based-research network (CPBRN). Methods: The data was collected via questionnaire in ten family clinics under CPBRN system during the four weeks from June 15, 2006 to July 12, 2006. Results: The total number of referred cases was 103 (0.7%) out of a total of 14,466 office visits. Among the total, 68.9% of referred cases was physician-drived and 31.1% was patient-requested. The reason for referral were 'to get a second opinion of specialist' (34), 'high severity' (20), 'lack of examination tool' (18), 'lack of skill' (10) and 'no response to treatment' (2) in physician-drived cases, whereas in patient-requested cases, they were 'request for advanced hospital' (26) and 'want to meet specialist' (2). The patients were referred to tertiary hospital in 66.7%, secondary hospital in 15.9%, and other specialists of primary setting in 10.1%. Overall, 66.7% of the referred hospital was located in the city area. The main health problems of referred patients was divided into 'gastrointestinal' (17.5%), 'musculoskeletal' (13.6%), 'dermatology' (10.7%) and so on. The speciality consulting physicians were 'internal medicine' (34%), 'pediatrics' (13.6%), and 'orthopedic surgery' (10.7%) specialists. Conclusion: The referral rate of family practice in Korea was 0.7%. The main reason for referral was 'to get a secondary opinion of a specialist'. The most common referral problem was 'gastrointestinal'. 'Internal medicine' was the most frequently consulted specialty. (J Korean Acad Fam Med 2007;28:286-291)

Background
: Family practice academic dissertations are the product of family practice research in the school of medicine. This paper was intended to evaluate the status of family practice academic dissertations, analyze the basic data and suggest directions for family practice research in the school of medicine.

Methods : The total number of masters' and doctoral dissertations from 1992 to February, 2005 was 124. of those, 120 were collected. They were analyzed in terms of research area, subjects, collected data, methodology, and statistical methods.

Results : In terms of research area, health promotion/ disease prevention was the most common (42.5%). For study subjects, out-patients and in-hospital patients were the most prevalent (38.0%), followed by health promotion center visitors and community residents (28.7%). When it came to research methodology, analytic study was the most common by a wide margin (70.8%). Among analytic studies, cross-sectional studies were the most frequent, followed by case-control studies and cohort studies. The most commonly-used data were medical records and questionnaires.

Conclusion : Many advances have been made in research methodology and academic dissertation numbers since 1992. Many research topics, however, were not relevant to primary care. Much research was done in general hospital instead of primary-care facilities. These results must improve in the future.

Background
: When research based evidence is not sufficient, clinical practice guidelines can be based on opinions. In such situations, formal consensus development methods, often based on the modified nominal group techniques are widely used. It can be used to evaluate consistency, generalizability, applicability of recommendation when evidence comes from other countries.

Methods : To develop evidence based guidelines for osterarthritis pharmacotherapy, a consensus expert panel consisting of internists, family physicians, methodologists, and orthopedic surgeons were convened. After an extensive structured literature searching and evaluation, evidence statements for key question were developed. Rating methods for consistency, generalizability, applicability of statement were adopted from those jointly developed by Rand and the University of California, Los Angeles.

Results : We developed 27 evidence statements in 17 question domains. Among 72 rating items, 62 items reached agreement. Among 15 recommendations, 10 recommendation grading were A, 2 were B, and 3 were C.

Conclusion : When research based evidence is not sufficient, clinical practice guidelines can be based on formal consensus of experts, especially modified nominal group techniques. It can be used to evaluate consistency, generalizability, applicability of recommendation when evidence comes from other countries.

Background
: This study aimed at finding out how much the rate of the JNC-7 guideline was carried out, and assessed the degree of evidence based clinical practice patterns and the validity of the new guideline by comparatively analyzing primary care practice patterns in hypertensive patients.

Methods : A questionnaire regarding the management of hypertension was conducted by mail between May 15 and July 15, 2005, to 1,008 of the Korean Association of Family Medicine listed in the address book. There were 195 respondents with a response rate of 19.4%.

Results : Among the total respondents, 91.1% were aware of the new guideline and had received information mainly through training lectures and seminars. They said that the biggest difference between the new guideline from the previous one was the inclusion of prehypertension (62.3%), and 61.1% were using the new term prehypertension in their practice. The most frequency advice given to patients related to lifestyle modification were in the order of smoking cessation (44.8%), exercise (41.7%) and weight reduction (38.0%). Calcium channel blocker was the most commonly used (60.9%) as the first-line agent. When physicians failed to control blood pressure with the first medication in cases of stage 1 hypertension, 67.7% added other agents. In treating stage 2 hypertension, 59.9% started with a single agent and gradually added other agents.

Conclusion : Family physicians in primary care clinics had a good understanding of the JNC-7 guideline. However, the rate at which they applied it in treatment was low. To effectively apply the guideline in actual treatments, aggressive education of practitioners and improvement on medical system and treatment guidelines are needed.

Background
: A considerable portion of patients in primary care are thought to have mental disorders in Korea. But they are not easily noticed and are thus underdiagnosed and approached improperly. This study was done to assess the prevalence of common mental disorders in a hospital-based family practice and to evaluate the utility of a diagnostic tool, the Patient Health Questionnaire (PHQ).

Methods : Ten or more patients each day were systematically selected in family practice clinics for two weeks in a university and a community hospital-based family practice clinics in Seoul, Korea. Routine care was delivered as a control during the first week and the PHQ was administered to patients during the second week and the physicians were allowed to review the PHQ just before making clinical decisions. Physicians were asked to answer whether they recognized patients' with mental disorders before reviewing the PHQ.

Results : The prevalence of mental disorders was higher in the test group than the control except for eating disorders and other anxiety disorders (P＜0.05)(test vs. control group): major depressive disorders 1.75% vs. 3.8%, other depressive disorders 6.8% vs. 11.4%, panic disorders 0.6% vs. 2.3, somatoform disorders 3% vs. 5%, alcohol abuse 2.2% vs. 8.7%, and any mental disorders 20.9% vs. 29.4%. In the test group, the percentage (95% confidence interval in parenthesis) of newly diagnosed mental disorders after physicians' review of the PHQ were 66% (49∼82) in major depressive disorders, 70% (50∼90) in panic disorders, 70% (56∼83) in somatoform disorders, 84% (75∼92) in alcohol abuse, and 68% (62∼74) in any mental disorders. Patients' response to the PHQ was overall very receptive.

Conclusion : One-week prevalence of common mental disorders in the hospital-based family practice was 29.4% and the PHQ tool was efficient to help the family physicians recognize hidden mental disorders.

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.

Background
: This study was conducted to survey current status of research and scholarly activity of residency programs and to evaluate quality of education.

Methods : Questionnaire on research and scholarly activity were sent to all residency training programs by regular mail on May 2003. The questionnaire included detailed characteristics of residency programs, current status of conferences, educations for research activities, degree of faculty involvement, and numbers of published papers and presentations for past year.

Results : A total of 103 residency programs answered the questionnaire. Most of the programs held journal review, book review, and clinical review in regular bases as scholarly activities. Smaller than 50% of the programs held case review, chart review, and psycho- social conference in regular bases. As research activity, 40 programs offered educations on epidemiology and statistics, and 55 programs held critical review of the literatures. Faculties involve actively in residents' research project in the process of designing research questions and selecting the subjects, but less actively in the process of gathering informations, completing manuscripts, and preparing presentations. Degrees of faculty involvement were smaller in the programs which are connected with medical school, had only 1 faculty, and educational experiences of the faculty were insufficient.

Conclusion : Current scholarly activities were active in various aspects, but psychosocial conference and chart audit should be encouraged. Special efforts are required in the research activities, especially in programs which were not connected with medical school and had only one faculty.

Background
: One method for achieving medical practice to be more evident, especially in the field of primary care, is to encourage the use of clinical guidelines. If development of guidelines is difficult because of time and cost, an evidence based foreign guidelines can be selected and translated into Korean for application.

Methods : A team was formed, consisting of 11 family physician experts on evidence based medicine and clinical practice guidelines. We selected six respiratory diseases requiring clinical guidelines because of variability in practice. We searched several clinical practice guideline databases and selected one guideline according to currency, scope of guideline, whether it was evidence based, and its feasibility in the field of primay care. We translated selected guideline's full-texts or summaries which were done by authorized organization into Korean.

Results : The selected respiratory diseases were chronic obstructive pulmonary disease, asthma, pneumonia, sinusitis, rhinitis, and influenza. According to criterion, we selected GOLD (Global Initiative for Chronic Obstructive Lung Disease) for chronic obstructive lung disease, GINA (Global initiative for asthma) for asthma, CDC (Center for disease control) guideline for influenza, IDSA (Infectious Diseases Society of America) guideline for pneumonia, AAP (American Academy of Pediatrics) guideline for sinusitis, and JCAAI (Joint Council of Allergy, Asthma and Immunology) for rhinitis.

Conclusion : We selected six common respiratory diseases and the most appropriate evidence based guidelines for those particular diseases.

Background
: Family medicine clerkship gives undergraduate medical students the opportunity to integrate knowledge and skills taught in class. Impression from clerkship experience and preceptor's role model allow medical students to consider family medicine as a career choice. This study investigated the effect of family medicine clerkship on the preference for family medicine as a career choice in third-year medical students.

Methods : From July through December of 1995, one hundred third-year medical students attended family medicine clerkship at Hanyang University Medical School (HUMS). They were divided into 20 groups of 4∼6 students. Seven half-days of clerkship teaching were provided in a private family medicine clinic and 2 half-days, in an university hospital family medicine clinic. The score of preference for family medicine was measured using the 10 cm visual analogue scale.

Results : The subjects' mean age was 24.1 years. Eighty eighty percent of students were males. The mean score of preference for family medicine as a career choice were 3.2 for pre-clerkship, 6.9 for post-clerkship, and 7.0 at the end of third-year semester exam, respectively. The group preference score was different among groups. Sex, age, hometown, parents' occupation, inhabitation type, religion, and lecture exam score were not related to the preference score. Eleven percent of students hoped to specialize in family medicine in the future. The students' main conception of family medicine were 'primary care', and 'comprehensive care', in descending order.

Conclusion : Third-year family medicine clinical clerkship improved the students' preference for family medicine as a career choice. A continuous program needs to be developed to render positive effect into the final stage of resident selection.

Background
: Family doctor registration program was proposed several years ago and is still in discussion. The success of this program depends on attitude and acceptibility of people. This study was done to describe the attitudes of the people to the family doctor registration program.

Methods : We interviewed 657 adults who lived in Seoul, Bundang, Ilsan and Pyungchon with a preformed questionnaire. The questionnaire was pretested by five family doctor and trainee.

Results : About half of the respondents were favorable for family doctor registration program. The most importantly considered benefits of the program were continuity of care, telephone consultation and management of chronic disease. The most seriously considered drawbacks of the program were only single doctor available cost, and restriction of medical services. Over half of the respondents preferred internists as their treating doctor and family physician, pediatrician followed. About half of the respondents opposed on the fact that the family doctor was restricted to clinic-based practice. Half of the respondents intended to participate in the program and the rate of intention to participate in the family doctor registration program was related to their household income and favorable attitude to wards the program and marginally related to the number in a household, haring a regular doctor, their interest in health. The demographic variables did not influence intention to participate in the program.

Conclusion : Half of the respondents agreed to participate in the family doctor registration program, but others were negative to the principles of the program and cost, sharing.

Background
: As patients can go to specialists and family doctors do not have gate-keeping role, doctor-shopping is very popular in Korea. The introduction of family doctor registration program is proposed several years ago, and the debate is still being done about that issue. This study is to show the possession rate of regular doctor and to investigate the factors associated with it.

Methods : We interviewed 657 adults of Seoul, Bundang, Ilsan and Pyungchon with preformed questionnaire which included the questions about regular doctor and attitudes to the family doctor registration program. Respondents were sampled according to the age structure and population distribution of the cities.

Results : About half of the respondents had regular doctor. Internists were regular doctors of nearly half of the respondents and pediatricians 30.6%, oriental doctors 5.6%, general surgeon 4.4%, and family doctors 3.8%. About half of the regular doctors worked in primary clinic and 48.2% in hospitals. The most important reason choosing regular doctor was distance to the medical facilities. The most frequently provided service by regular doctor was vaccination (57.1%), the least was home visit (2.9%). Factors associated with the possession of regular doctors were residence area, sex of respondents, level of income and education.

Conclusion : Nearly half of the respondents had regular doctors and half of the regular doctors were internists and worked in primary clinics. The area of residence, sex, income level, level of education, and interest for health were related with the possession of regular doctor.

Background
: The purpose of this study was to identify health practices that would be helpful in order to reduce the prevalence of correctable cardiovascular risk factors (CVR), i.e. hypertension, hypercholesterolemia, and hyperglycemia in male workers by examining the association between health practices and the prevalence of the three risk factors.

Methods : For 1,815 male workers at a car manufacturer who participated in the basic health examination, survey on socioeconomic status and seven healthy practices such as not currenly smoking, moderate alcohol drinking, proper weight control, regular exercise, 7-8 hour sleep, eating breakfast regularly, and not eating between meals was done and the prevalence of hypertension, hypercholesterolemia, and hyperglycemia as obtained. χ²test, Fisher's exact test, and multiple logistic regression analyses were done for workers under 40 years old and workers 40 and over in two, separate groups by adjusting socioeconomic variables.

Results : The prevalence of hypertension and hypercholesterolemia was 1.84 times and 5.22 times, respectively, showing, higher in overweight younger workers than in those of normal weight. The prevalence of hypercholesterolemia was 2.02 times higher in younger smoking than in younger non-smokers. In contrast, the prevalence of hyperglycemia was 4.99 times higher in older smokers than in older non-smokers. The prevalence of hyperglycemia was 16.5 times higher in older workers with regular snacking habit than in those without such a habit. The prevalence of hypercholesterolemia was 7.47 times higher only in younger workers practicing healthy behaviors below 3 than in those practicing at least 6 healthy behaviors.

Conclusion : Our study suggests that overweight and smoking habit among younger workers, and smoking habit among older workers sould be controlled in order to decrease the prevalence of hypertension, hypercholesterolemia, and hyperglycemia.

Background
: A standard questionnaire is usually characterized by a set of questions, a scoring method, and psychometric properties. But many studies suggested that previously translated standard questionnaire in Korea had bee used without testing translation validity, scoring system and psychometric properties.

Methods : After developing a preliminary delphi questionnaire from references by a researcher, it was modified from pretest procedure, which was performed to 6 family physicians who had experiences in translating standard questionnaires. Some experts were chosen among authors of standard questionnaire, translation articles in four questionnaire related journals and others were recommended by other experts.

Results : The total number of experts was 53 including 22 family physicians, 15 psychiatrists, 2 psychologists, 8 faculties of preventive medicine and 6 faculties of nursing. The response rates were 85%, 87%, 92% on 1st, 2nd, 3rd delphi round, respectively, and the total response rate was 69%. According to Delphi surveys, minimal requirements for a standard questionnaire translation were translation by two translators, pretest techniques, consideration of age·sex·education level in pretest procedure, reliability validation, validity validation and 0.5 or more of correlation coefficient level in convergent validity validation. Minimal requirement for reliability coefficients was 0.7 or more, but the results did not reach adequate consensus.

Conclusion : Developing minimum requirement guidelines for standard questionnaire translation using Delphi method can be done.

Background
: The purpose of this survey was to assess knowledge of the public on family medicine through the analysis of medical counseling by PC communication and compare them with that of internal medicine.

Methods : This survey analyzed the content of medical counseling by PC communication according to ICPC from Oct. 1996 to Jun. 1998. The survey was done by means of E-mail in Nownuri eyes and the selected medical departments were those of family medicine and internal medicine in Pusan National University Hospital.

Results : The total number of questions was 342, including 181 in the department of family medicine and 161 in internal medicine. In the analysis of medical counseling according to ICPC, there was a significant difference between family medicine and internal medicine in the reasons for questions by components(P<0.001). In family medicine, the reasons were symptoms, complaints(66.9%), diagnoses, diseases(18.8%), treatment, procedure, medication(17.2%), and diagnostic, screening, prevention(5.5%). In internal medicine, the reasons for questions were symptoms, complaints(64.6%), diagnoses, diseases(21.1%), treatment, procedure, medication(9.3%), and test results(4.3%).
There was a significant difference between family medicine and internal medicine in the questions by chapters(P<0.05). In family medicine, the questions about digestive system were 28 cases(15.5%), neurological system were 26 cases(14.4%), musculoskeletal system were 25 cases(13.8%), and unspecified were 25 cases(13.8%). In internal medicine, the questions about digestive system were 76 cases(47.2%), circulatory system were 21 cases(13.0%), and respiratory system were 15 cases(9.3%). The most common symptom was headache in family medicine and generalized abdominal pain in internal medicine.

Conclusion : There were significant differences in the age distribution, the reasons for questions, and the contents of questions between family medicine and internal medicine.

Background
: Esophagogastroduodenoscopy(EGD) is a useful diagnostic procedure and an important basic skill in family practice residency program. But currently we have no guidelines for EGD training in family practice residency program.

Methods : In March 1999, we mailed a self-administered questionnaire to the residency directors of all KAFM-accredited family practice residency program. 63 out of 109 programs responded to the questionnaire(57.8%)/

Results : Among the total of 63 hospitals that responded to the questionnaire, secondary hospitals were 55.6% and tertiary or university hospitals were 44.4%. 98.4% reported that their residents receive training to perform EGD. 57.1% of the total received training to perform EGD during internal medicine training. EGD was performed by family physicians in 38.1% of total family practice residency programs. In the mjority of these programs(34.9%, cumulative percent 74.6%), the minimal requirements for technical skills in EGD training were 50 cases and for both technical skills and cognitive skills at least 100 cases of EGD(41.3%, cumulative percent 79.3% was necessary). The most difficult component during EGD procedure seemed to be esophageal intubation followed by retroflexed maneuver and entering the pylorus in series.

Conclusion : To perform EGD in primary care, it is required for trainee to perform at least 50 cases of EGD under supervision in a family practice residency program.

Background
: This study was conducted to evaluate belief and practice levels of family physicians concerning primary care, to find significant variables that affect those levels and to know opinions of primary physicians whether primary care is settled or not.

Methods : The target population were those family physicians having finished their three-year residency course in family medicine after 1989. Out of 2,075 people, the addresses 945 were identified of This was a sample population. We excluded 62 persons who worked in medical school. The questionnaires were set twice during July to September in 1998, and contents were constructed of general characteristics, items of belief and practice level of five areas of primary care(1977, IOM, Accessi-bility, Comprehensiveness, Continuity, Coordination, Accountability).

Results : Response rate was 32.1% (total : 270 : 1st respondents : 226 : and 2nd : 44).
Average belief level concerning principles of primary care was 4.45 point(5 point scale), and according to area rate continuity, coordination, comprehensiveness, accountability, accessibility. Which was significant(p=0.00). Strength of belief : accessibility, comprehensiveness, coordination, accountability, continuity, which was significant(p=0.00). The highest concordance between belief and practice was accessibility(p=0.00) and the highest practice level(p=0.00). Compared with the unsatisfied group, the satisfied group had higher practice level(p=0.00). Compared with the not-open group, the open group had higher practice level(p=0.00). Significant variables that affect practice level were belief level, opening, satisfaction(r2=0.27, p=0.00). The opinion of whether primary care was settled was mostly negative(95.8%).

Conclusion : Although, family physicians were revealed to have relatively high belief and practice level concerning primary care, their opinions about primary care setting were negative. There is a lot of significant gap between individual level as family physician and societal level in primary care. More studies need to be conducted to determine the causes of such difference. ( J Korea Acad Fam Med 1999;20:1741-1751)

Background
: This study was performed to understand medical student’s feelings and difficulties in the first clinical through student’s perspective.

Methods : The essays of 128 medical students submitted after the first clinical interview were analyzed using qualitative methodology and the results were validated by questionnaire survey.

Results : The author found 5 major categories with 23 themes. In the first clinical interview students showed various emotions that changed during the interview. Difficulties perceived in the interview skill were questioning, judging clinical importance of patient’s story, applying medical knowledge, and eliciting family and social history. Defects in interview behavior were a lock of confidence and overstrain, immature doctor-patient relationship ad a lack of empathic empathic expression. The first clinical interview was appreciated positively by the students.

Conclusion : Medical student’s emotions during the first interview with real patients were well understood as well as defects in the interview skill. This understanding will contribute further to the development of medical interview curriculum.( J Korean Acad Fam Med 1999;20:1721-1731)

Background
: Appropriate referral without failure, one of important health care services provided by primary care physicians, is very helpful not only to patients but also to the referring physicians. This study was performed to observe the rate of referral failure and to evaluate the factors related to referral failure.

Methods : from June 10 to October 31, 1997, all referrals made in the department of family practice in the Samsung Medical Center were studied. Structured questionnaires inquiring of referral initiator, physician's view of clinical severity and referral necessity, and the reason for referral were completed by referring physician whenever each referral was made. On the 60th day after referrals were initiated, medical records of the referred patients were reviewed to obtain the information on the demographic characteristics of the patients referred, the contents of referral, and the patient's attendance the specialist clinic after referral. Each referral was audited by five family physicians working at the Somsung Medical Center to examine the appropriateness of the time when the referral was initiated. The patients who did not attend at specialist clinic to which they were referred to were telephoned to ask about the reasons for the referral failure. Chi-square test and multiple logistic regression analysis used to evaluate the factors related to referral failure.

Results : During the study period, total of 477 referrals were made among 9.384 encounters and the referral rate was 5.08%. Fifty-eight patients failed to complete the referral process within predetermined period and the rate of referral failure was 12.16%. The risk of referrals failure was significantly low in cases whose referral time was assessed as appropriate(odds ratio=0.53). Female was a significant increasing the risk of referral failure(odds ratio=1.91). Being too busy(24.14%) was the most common reason for referral failure. Other reasons included improvement or resolution of symptoms(12.06%), information on the referral was not give(6.9%) and too great a distance the between hospital and the patients home(6.9%). Four patients forgot to attend the hospital.

Conclusion : Considerable proportion of patients being referred did not complete the referral process. Timely referral and sufficient discussion between physician and patient being referred seems to be necessary. to prevent referral failure.

Background
: Physicians who provide primary care should be trained specifically to manage the problems encountered in a primary care practice. This study was carried out to know the residents' concerns and problems during outpatient care by analysing case discussions as an outpatient teaching.

Methods : We used 533 records discussed by 3 residents' teams for 1 year. Of discussion contents, symptoms or diseases were classified into codes and chapters using the ICPC (International Classification of Primary Care) coding system and the main topics of discussion into 12 types. We compared data among 3 residents' teams and also between the discussed contents and the diseases of patients who vis-ited a family practice for 1 year. We used relative discussion ratio to compare data.

Results : Of 533 discussed records, 106 kinds of symptoms or diseases were used and the 20 most common kinds accounted for 61.7%. Contents about menopausal symptom/complaint were 47 records(8.8%) and was the most frequent. Digestive part was the most frequent chapter(22.0%). Distribution of discussed main topics were diagnosis(35.5%), medication(26.8%), other treatment(11.6%), followup(5.8%), etc. There was some difference among 3 residents' teams by chapters and topics.
Visiting patients were 3,436 persons with 79 kinds of symptoms and diseases and prior 20 kinds accounted for 86.6%. Visited patients were some what different with the discussed contents by chapters.

Conclusion : Contents of case discussion in ambulatory setting were some what different among each teams and more diverse than the visiting patients. The residents could exchange many informations and find problems during ambulatory care. We think case discussion can be a good method for outpatient teaching.

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

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

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

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

Background
: This study was designed to evaluate medical instruments purchases by Korean family practitioners in private practice. We then proposed guidelines for purchasing equipments for new physicians who are just beginning their private practice.

Methods : A questionnaire was sent to 646 family practitioners managing their private clinics. The questionnaire assessed current medical equipments purchases. They were then asked which instruments they would recommend or discourage others form purchasing. We analysed 123 returned questionnaires(19%).

Results : The number of instruments they have was between 4 to 26, and the average was 13. The most frequently owned items included in descending order: otoscope (89.9%), electrocardiograph(82.5%), ophthalmoscope(78.9%), ultrasound(78%), ultraviolet sterilizer(73.2%) and microscope(69.9%). The instruments they recommended avoiding were sigmoidoscope(27.3%), cryotherapy kit(25%), laser therapy kit(21.1%), thermo-hemorrhoidectomy instrument(20%), and defibrillator (20%). Instruments they recommended purchasing were otoscope(87.0%), elctrocardiograph(83.0%), ultrasound(74.8%), gastrofiberscope(65.9%), ultraviolet sterilizer(63.4%), microscope(57.7%), and plain radiographic unit(<100mA, 56.1%). The most frequent advice given in purchasing medical instruments was "Avoid over(purchasing) at the beginning". Some instruments were different in possession rate according to sex, age, and practice patterns.

Conclusion : This study evaluated medical instruments purchases of Korean family practitioners in private practice. This compiled list may be of benefit to new physicians who are just opening their own clinic.

Background
: The purpose of this study was to investigate the characteristics of and to analyze the factors related to the cost of the resolution of a medial dispute.

Methods : We have reviewed 2,346 cases reported to the Korean Medical Association(KMA) mutual-aid association from Nov.1. 1981 to Oct. 31, 1994.

Results : The percentage of reported cases of related field were as follows : obstetric-gynecology(OBGYN) 31.9%, general practitice 28.1%, general surgery 13.3%, orthopedics 6.9% and internal medicine 6.4%. 1,829 cases(80.0%) were settled out of court and without public intervention. 310 cases(13.2%) were settled by the police, the public procurator's office or the court. The mean settlement amount per cases was 9,340,000 won with annual growth rate 10.8%, and median settlement amount was 5,890,000 won. The mean settlement amount for OBGYN was 930,000 won, surgical group 8,900,000 won, medical group 7,710,000 won, and general practitice 7,490,000 won. The cases of medical dispute according to the types of medical care were : operation 21.1%, injection 18.0%, treatment and care 13.0%, artificial abortion 10.3%, Cesarian section 7.2% and anesthesia 2.5%. The mean settlement amount according to the types of medical care were : delivery and Cesarian section 15,190,000won, operation and anesthesia 9,500,000 won, others 6,610,000 won, and injection and medication 6,230,000 won. The mean settlement amount that was settled out of court without public intervention was 7,940,000 won. The mean settlement with public intervention in the court was 17,290,000 won. The cases of medical dispute according to the patient's status were : death 37.5%, complications 20.8%, disability 12.2% and others 28.9%. The mean settlement amount for death was 16,150,000 won, disability 9,430,000 won, others 4,850,000 won and complication 3,550,000 won. The mean settlement amount where doctors have asserted that the outcome was inevitable or have not agreed that it was their fault was higher than the cost of cases where they had admitted responsibility. The settlement amount where there was a misiagnosis present had not shown to be higher than when the misdiagnosis was absent. The mean settlement amount for cases where multiple doctors were involved was higher than for cases of single doctor. The mean settlement amount for disturbing the medical practice and suspension of are high. The mean settlement amount for complications was lower than others, and the mean settlement amount for disability and death presented were high. Concerning the types of care, the mean settlement amount for operation/anesthesia, delivery/Cesarian sections were higher than the injection/medication. Concerning the type of settlement, the mean settlement amount in the police and public procurator's office was higher than in out of court without public intervention.

Conclusion : The mean settlement amount depended on the patient's status, the type of settlement, and the disturbance of medical practice regardless of the doctor's misdiagnosis, fault, and standard care. Therefore, a reasonable method of resolution for medical dispute is needed.

Background
: Medical dispute is increasing and its effect on society is serious, but reasonable settlement system is absent. Nevertheless patients and families choose medical dispute. But there is little research on patients and their families who choose to settle by medical dispute. Therefore this study examines the impact of medical malpractice to patients and their families and their reasons for choosing medical dispute after mishap.

Methods : Data were collected from 234 subjects who inquired of Medical Malpractice Family Association about malpractice suit. Questionnaire was composed of demographic characteristics, characteristics of hospital, characteristics of medical malpractice, degree of satisfaction with explanation and attitude of the treating doctor, effect of medical malpractice on patients' life and reasons that patients and their families choose to settle by medical dispute. Factor analysis with varimax rotation was carried out to reduce the reasons to a smaller number of clearly interpretable factors. Multiple regression analysis was carried out to identify the variables relevant to these main themes.

Results : Degree of satisfaction with doctor's explanation and attitude was less than 10%. Over 60% of respondents stated that medical malpractice seriously affected their lives. Four main themes emerged from the factor analysis of reasons for dispute which includes dissatisfaction with doctor's attitude, wanting to prevent similar incident in the future, call to account, and compensation. The relative importance in the order of frequency was wanting to prevent similar incident in the future, dissatisfaction with doctor's attitude, call to account, followed by compensation. Multiple regression analysis was used to identify the variables relevant to these four main themes. Clinical specialty group and degree of satisfaction on attitude were significantly associated with the dissatisfaction with doctor's attitude. Clinical specialty group, patient's condition, effect of medical malpractice on life and degree of satisfaction on attitude were significantly associated with the call to account. Academic career, clinical speciality group, patient's condition, effect of medical malpractice on life and degree of satisfaction on attitude were significantly associated with the compensation.

Conclusion : From the above results, the reasons patients and their families choose to settle by medical dispute were diverse and associated with demographic characteristics, doctor's attitude, effect of mishap on life, et. al.

BACKGROUND
Importance of the participation of clinical practitioners in the development of guideline is increasingly emphasized. We studied the attitude of family physicians to the guideline for hypertension management and compared it with their reported practice patterns.
METHODS
We developed a guideline for hypertension management with reference to other guidelines previously published and used by WHO and health organizations in many countries. A questionnaires asking attitude to the contents of the guideline and real practice pattern was sent to 200 Korean family physicians. Response rate to the questionnaire was 27.5%.
RESULTS
The agreement rate to annual blood screening in persons aged 15 and older was 87%, while the reported practice rate in most of patients was only 42%. The agreement rates to medical history taking in hypertensives were high in all items, but reported practice rate was very low. The agreement rates to physical examination in hypertensives were relatively high in all items, while reported practice rate was high only in lung and heart examination. The reported practice rate of laboratory tests were less than 60% and that of electrolyte check was only 22%. Most of the study subjects agreed with all behavior modification methods. Although 80% of the subjects agreed that diuretics or beta blocker should be used as an initial regimen, the reported practice rate was only 36 %.
CONCLUSION
There observed a big difference between attitude to the guideline and reported practice pattern in this study. It showed the need to narrow the gap between them.