Background
: Smoking greatly increases the risk of cancer, cardiovascular diseases and osteoporosis. Besides direct harm from smoking, some dietary pattern of smokers have been reported to increase such risk. This study aimed to analyze various nutrients by smoking status, and to find out whether smokers maintain harmful dietary patterns.

Methods : One thousand and six hundred fourteen men were selected who visited the health promotion center of an university hospital in Seoul. The inclusion criteria was the completion of dietary survey. Dietary analysis was done by calculation of amounts of each nutrients from 24-hour recall method. We compared total intake of each nutrients and total calories by smoking status with analysis of variance (ANOVA). Then we adjusted the results for exercise and education level by ANCOVA (analysis of covariance).

Results : The study subjects were 840 current smokers (52.0%), 479 ex-smokers (29.7%) and 295 non-smokers (18.3%). The consumption of total fat and cholesterol was significantly high in smokers than non-smokers (P=0.012, P=0.005). The alcohol intake was higher in smokers and ex-smokers than non-smokers (P＜0.001, P=0.007). The smokers and ex-smokers had less calcium than non-smokers (P=0.001, P=0.044). Furthermore, the smokers exercised less than ex-smokers and non-smokers (P＜0.001).

Conclusion : The smokers consumed more total fat and cholesterol which increases the risk of cardiovascular diseases. They also had less calcium and drank more alcohol. Comprehensive approach which includes intervention for dietary intakes in addition to smoking cessation is desirable to decrease health risk for smokers.

Background
: Although lack of exercise is well known to be a risk factor of osteoporosis, it is unclear whether weight-bearing exercise has different effects on bone mineral density compared to non weight-bearing exercise, and the amount of exercise needed to prevent osteoporosis is not clearly defined. This study was performed to clarify the relations between the type and the amount of exercise with BMD.

Methods : This was a cross-sectional study of 3,661 women who had undertaken health screening including BMD measurement at Health Promotion Center of SNUH between May 1997 and March 1999. Information on sociodemographic characteristics, menarche, childbirth andexercise were gathered by means of self-reported questionnaire, and BMD was measured using DEXA.

Results : The number of women with lumbar osteoporosis were 601 (16.4%) and femoral neck osteoporosis 372 (10.2%). Lumbar osteoporosis occurred more frequently with increasing age and age at menarche, and in menopausal women, but less frequently with increasing fat-free mass in multiple logistic regression analysis. When adjusted for age, age at menarche, menopause and fat-free mass, lumbar osteoporosis was less common in women who exercised, but the type and the amount of exercise had no bearing. Especially, lumbar osteoporosis was least common in women engaging in moderate amount of exercise. Femoral neck osteoporosis decreased significantly only in weight-bearing exercise group and in women engaging in high amount of exercise.

Conclusion : The results of this study suggest that lumbar osteoporosis can be prevented through exercise regardless of its type and amount, and high amount or weight- bearing exercise is most effective to prevent femoral neck osteoporosis.

Background
: Female sexual function is influenced by much more factors than that of male and has a close relationship with psychosocial factors. A satisfying sex life has a high correlation to a happy married life. A questionnaire provides easy access to private matters and in a multidimensional manner. The objective of this study was to identify the factors related to female sexual function to help sexual adjustment in marriage.

Methods : A hundred married women living with their spouses, who visited an outpatient clinic of family medicine department of a university hospital in Seoul were studied. After filling out the self-administered questionnaire, a face-to-face interview was done on all study subjects. For multivariate analysis of the related factors, the outcome variables were a binary response of the normal female sexual cycle ?drive, lubrication, orgasm, and satisfaction.

Results : The multivariate analysis showed that the household income was a significant factor related to Drive (Odds Ratio: OR=0.6, 95% Confidence Interval: CI 0.4∼0.9). Age was a significant factor related to Insufficient Lubrication (OR=1.1, 95% CI 1.0∼1.3). Insufficient foreplay was a risk factor for Insufficient Lubrication (OR= 2.4, P=0.052). In multivariate analysis of the Orgasm related factors, the perceived health status showed an OR of 7.1 (95% CI 1.5∼32.6) and both marital satisfaction and open communication showed an OR of 6.0 (95% CI 1.3∼26.8) and an OR of 5.8 (95% CI 1.2∼28.2), respectively. The significant related factors to Satisfaction were in order of importance of sex life, education, and open communication, with an OR of 3.6 (95% CI 1.7∼7.6), 2.5 (95% CI 1.1∼5.9), and 2.0 (95% CI 1.0∼3.8), respectively.

Conclusion : The positively related factors to female sexual function were good perceived health status, high marital satisfaction, placing importance in sex life, and open communication regarding sexual matters. Increasing age and household income were found to be factors adverse to female sexual function.

Background
: The risk of overweight and obesity to health is well know. Physical activity is important in the treatment of obesity in terms of healthy body composition and maintenance of body function. This study is a follow-up study to identify the impact of changes of leisure time physical activities on body weight.

Methods : The study subjects were people who visited a health examination center in Seoul at least twice between 1995 and 2000. Seven hundred people who completed physical activity questionnaires each time they visited were included. Three hundred eighty two of them were men, and 318 were women. The questionnaire was Baecke physical activity questionnaire, consisted of items for work activities, sports activities, and non-sports leisure activities. Each index of activities was calculated.

Results : Ninety seven people (13.9%) reduced their weights more than 5% of initial body weights. Twenty eight people (4.0%) gained their weights more than 5% of initial body weights. In five hundred and seventy five people (82.1%) their body weights were changed within 5% of initial body weights. Non-sports leisure time indices increased greatly and were significantly more than sports indices in reduced weight group. Non-sports leisure time indices were not changed significantly in gained weight group. The dose-response relationship existed between changed body weight (kg) and difference of leisure time indices. The multivariate analysis showed that female was a significant factor related to reducing weight (odds ratio=4.5, 95% confidence interval 2.7~7.5). Increase of non-sports leisure indices showed borderline significance (odds ratio=1.4, 95% confidence interval 0.9~2.0).

Conclusion : To increase non-sports leisure activities for the purpose of reducing body weight is actively recommendable. Such activities performed on a daily basis may have impact on reducing weight through repeatability and ease of access.

Background
: Amezinium methylsulfate(Risumic) is the useful drug in the treatment of essential hypotension. This drug elevate blood pressure by stimulating sympathetic nervous system and improve symptoms related hypotension. This study was designed to evaluate efficacy and safety of Risumic for patients with essential hypotension.

Methods : This study was performed in patients with systolic blood pressure less than 100mmHg from June, 1999 to December, 1999. Risumic blood pressure response, improvement of symptom and side effect were examined in a double-blind, placebo-controlled, crossover trial.

Results : Total of 54 patients participated in this study and only 55.6% of them were finished and the rest of them(44.4%) was stopped. 6 patients of this patients were stopped because of side effects. But there was no difference in side effects in Risumic and placebo periods. In diastolic BP, Risumic group is 5mmHg higher than placebo group. And then there was significant difference in statistics.

Conclusion : In essential hypotensive patients, Risumic is elevater DBP than SBP, side effects frequency was no significant difference in Risumic and placebo group.

Background
: Familial aggregation of coronary risk factors is well known, which are hypertension, hyperlipidemia, diabetes mellitus, and obesity. However interspouse relation of the risk factors has remained controversial. As spouses are not blood-related, any risk factors to which the couple is exposed. Moreover, the effect of assortative marriage should be considered. This study is designed to identify interspouse relation of coronary risk factors and to document the effects of marriage duration to spouse concordance.

Methods : From May 1995 to March. 1999, we enrolled 1,859 couples who had visited the Health Promotion Center at Seoul National University Hospital. We analysed interspouse correlation of body mass index, blood pressure, glucose, serum lipid factors, uric acid, smoking, alcohol drinking, and stress known as coronary risk factors. The correlation coefficients were compared according to marriage duration.

Results : There was statistically significant spouse concordance for all risk factors with the exception of smoking. The correlation coefficients of blood pressure, total cholesterol, and triglyceride increased with marriage duration but troughed at 30-39 years of marriage. Those of body mass index and glucose peaked at early and late marriage duration. Those of HDL-cholesterol and uric acid was relatively fixed throughout marriage.

Conclusion : The presence of significant interspouse correlation for most of the coronary risk factors reflect the influence of assortative marriage and environmental factors on spouse concordance. If a spouse has many cardiovascular risk factors, partner should be evaluated for risk factors.

Background
: The current various case-finding instruments for detecting depression in Korea are too cucumbersome and time-consuming for routine use in primary care or student and soldier groups because of too many questions. We carried out this study in order in to investigate the validity of the two-question case-finding instrument for detecting depression easily in the primary case or the mentioned groups.

Methods : We selected one boy high school in Seoul and 155 sophomer students answered the questionnaire by self-report. The questionnaire included two questions about depressed mood and anhedonia: (1) "During the past month, have you often been bothered by feeling down, depressed or hopeless" (2)"During the past month, have you often been bothered by little interest or pleasure in doing things(e.g., studying, playing or talking with friends) ?"
And then a resident of family medicine interviewed them and made a diagnosis for depression using the diagnostic criteria of DSM-IV. Simultaneously we compared the test characteristics of a two-question case-finding instrument with those of a previously validated Beck Depression Inventory as a currently world-wide used screening instrument for depression.

Results : The prevalence of major depression as determined by the interview was 6.6%(10 of 151). The two-question case finding instrument had a Cronbach's α of 0.663-internal consistency, a sensitivity of 100%, a specificity of 54.6%, a positive likelihood ratio of 2.20 and a negative predictive value predictive value of 1.00.(A "yes" answer to either of the two questions was considered a positive test.) And the BDI had a sensitivity of 90%, a specificity of 68.1%, a positive likelihood ratio of 3.63 and a negative predictive value of 0.99(cut-off point=15). Area under the ROC curves of the two-question case-finding instrument was 0.882, greater than that of the BDI, 0.834.

Conclusion : The test characteristics of a two-question case-finding instrument were higher compared to those of BDI for major depression. Therefore, the two-question case-finding instrument is a useful measure for detecting depression and less time-consuming in primary care and certain groups.

Background
: Previously, a large epidemiological study has found that an increase in the serum triglyceride level is an independent risk factor of coronary artery disease and by treating it, the mortality due to coronary artery disease could be decreased. Our study is designed to analyze the serum triglyceride level in healthy adults and to study various factors influencing the serum triglyceride level.

Methods : Study involved all patients who visited Seoul National University Hospital Health Promotion Center from May 1995 to Feb 1997. After a complete history and a physical examination, each participant answered a questionnaire involving sociodemographics, tobacco, alcohol, exercise, menstrual cycle and daily dietary contents. A blood chemistry was also drawn after 12 hours of fasting. We used analysis of covariance and multiple regression analysis to correlate triglyceride level with forementioned variables.

Results : Healthy 3,332 men and 2,986 women were statistically analyzed. The average triglyceride level was 110.7mg/dl(geometric mean). Men at 50's had the highest level of triglyceride. As women aged, their triglyceride level increased. The proportion of participants in their 40's in men and 70's and over in women with triglyceride >220mg/dl, a value of clinical importance, was 19.0% and 18.4%, respectively. The triglyceride level changed significantly according to BMI, exercise, physical fitness, alcohol, tobacco, blood pressure, uric acid and glucose. However, no statistically significant difference was found among diet, thyroid function, income and region. For men, a multiple regression analysis revealed that the factors influencing triglyceride level in decreasing order, were BMI, uric acid, tobacco, diastolic blood pressure, ALT and maximal oxygen uptake. However, for women, a similar analysis showed that BMI, systolic blood pressure, exercise, tobacco and age played a significant role(p<0.001).

Conclusion : Serum triglyceride level was associated with correctable behavioral factors such as obesity, smoking, alcohol, exercise, and physical fitness. Among these factors obesity was the most related factor with triglyceride level.

Background
: Social support is defined as interpersonal transaction ; the giving of symbolic or material aid to another. It has been shown to have both buffering effects and direct beneficial effects on diverse health related outcomes. But there has been the dearth of wee-validated measurement instruments. This article describes the development of Korean version of the Duke-UNC functional social support questionnaire(DUFSS), focusing on the aspect of social support.

Methods : The 13-item, self-administered questionnaire was translated to Korea language. It was evaluated on 177 patients attending the family medicine clinic of Seoul National University Hospital during one month(November, 1996.) Comparisons to the family APGAR, COOP/WONCA functional status chart are made to assess validity. Factor analyses are performed. Correlation of the questionnaire score with the sum of family APGAR and each items of COOP/WONCA functional chart are measured Internal consistency are evaluated.

Results : The questionnaire score are correlated with significantly correlated with social activity item. The total Cronbach's alpha is calculated as 0.89. The four content areas developed by factor analyses are donfidant support(items 8,9,10), affective support(item 4,5,6,7), instrumental support(item 3,12) and quality of support(item 1). These shows similarity to American study results.

Conclusion : The Korean version of the Duke-UNC functional social support questionnaire has been documented as having high reliability and moderate validity. It covers two dimensions well(confidant support, affective support) with a small enough number of questions. Instrumental support may need further study.

Background
: Recently, disease pattern in Korea is changing with the change of lifestyle, which results in increased mortality rates by atherosclerosis. Hyperlipidemia is the most important risk factor for atherosclerosis. Early detection and lowering of cholesterol level reduces mortality rates from atherosclerosis. Serum total cholesterol is a choice screening test for hyperlipidemia.
Our study was done to find the correlations between serum total cholesterol level and other factors expected to have influence on the serum total cholesterol level. Factors such as drinking, smoking, physical activity, diet, blood pressure, and fasting blood sugar level were chosen.

Methods : We measured height, weight, blood pressure, fasting blood sugar and fasting serum total cholesterol level of 445 men who received Employee Periodic Health Examination. Data for drinking, smoking, physical activity, and diet were collected through interview by three residents of family medicine.

Results : Correlation coefficients with serum total cholesterol level was 0.213 for age, 0.266 for Body Mass Index, 0.196 for systolic blood pressure, 0.144 for diastolic blood pressure, 0.233 for fasting blood sugar.(P<0.05) Drinking, smoking, diet had low correlation with serum total cholesterol. Serum total cholesterol level was not affected by the level of exercise.(P>0.05)

Conclusion : Age, blood pressure, Body Mass Index, blood sugar level had weak correlation with cholesterol but drinking, smoking, diet, physical activity had no relationship with serum total cholesterol.

Background
: There is probably overwhelming consensus that addictive disorder such as cigarette smoking is markedly resistant to long-term modification. But studies of nontherapeutic populations indicate that long-term self-cure of smoking is relatively common events. So it is of considerable importance to understand variables which are as associated with quitting among smokers.

Methods : Among 1627 about males who registered in life long health maintenance program of Seoul National University Hospital, 121 quitters (for more than 1 year) and 277 persistent smokers were selected. We analyzed the contents of health risk appraisals of them

Results : The variables positively associated with smoking cessation included age, education, marriage, and exercise. But multivariate analysis showed that age, education and exercise were associated with smoking cessation and marriage was not related with smoking cessation.

Conclusion : This analysis focused upon the relationship between baseline variables and cessation for smokers who were not offered any particular program. These findings could be used in the future design of more refined study on baseline factor associated with smoking behavior and more effective smoking cessation program.

Background
: In order to make accurate diagnosis and to avoid unnecessary use of medications in UTI, family physicians require sensitive & rapid diagnostic methods. In this study we analyzed the relationship between symptoms and the results of microscopic examination of urine with the results of urine cultures in order to identify predictors of cultures result in the diagnosis of UTI.

Methods : Usual symptoms, signs, and urinalysis (including microscopy of urinary sediment) as predictors of UTPs in patients were evaluated in 65 primary care visits in two community based hospitals, using a positive urine culture as gold standard (which was defined by colony count≥10).

Results : 1) The overall culture positivity rate was 26.2%(17 out of 65 cases). The 17 isolated was 26.2%(17 out of 65 cases). The 17 isolated bacteria were E.coli (11), Serratia species(4), G(+) Bacilli(1), Acinetobacter species(1), in order of decreasing frequency. 2) A difference was not found between sexes(p=,206), but was among age groups(p=.046). 3) The presenting features with the higher efficacy were dysuria, frequency, generalized symptoms, and no history of previous antibiotic use. A positive nitrite test, albuminuria, and ketonuria had relatively high specificities, but relatively low sensitivities. 4) The sensitivity and specificity of microscopic bacteriuria were 41.2% and 85.4%, respectively. At the maximal cutoff point for microscopic leukocytes(10/HPF) and erythrocyte(2/HPF), the sensitivity and specificity were 94.1% and 64.6%, 70.6% and 54.2%, respectively. 5) In cases of symptoms and signs consisting of dysuria, urgency, abdominal pain, or costovertebral angle tenderness, and microscopic findings of WBC≥(10/HPF), the sensitivity and the specificity were 94.1% and 64.6%, and the positive and negative predictive values were 48.5% and 96.9%, respectively. 6) In cases of any symptoms and signs consisting of dysuria, urgency, abdominal pain, or costovertebral angle tenderness, and urine tests consisting of a positive nitrite test, microscopic bacteriuria, microscopic WBC≥20/HPF, the sensitivity, specificity, positive and negative predictive values were 88.2%, 70.8%, 51.4%, and 91.4%, respectively, and were the most predictive values in our study.

Conclusion : Among some diagnostic methods, the finding of at least 10 WBC/HPF was found to have the highest correlation with positive urine culture. Specificity of WBC result is increased by symptoms & signs of patients and microscopic examinations of organism & RBC. This is further enhanced by addition of a nitrite test. The combination of these diagnostic methods yield the highest validity in the prediction of urine culture result.

Background
: During recent years, for the purpose of evaluating the health related behaviors, many instruments especially such as health risk appraisal l(HRA) questionnaire were developed. The HRA questionnaire needs reliability for generalized usage. This study evaluated the reliability of Health Risk Appraisals(HRA) questionnaire in SNUH lifetime health monitoring program (LHMP) with test-retest method. This questionnaire evaluates individual's health risk factors and is composed of 23 items(18 optional types, 2 descriptive types, 3 mixed types).

Methods : A total of 140 selected adults aged 20 to 67 years registered in SNUH LHMP completed an HRA questionnaire on two occasions 2 to 6 weeks apart. Test-retest reliability was assessed by agreement index in optional and descriptive type, and kappa index in optional type. Moreover, non-response rate was obtained for each respondent and each question.

Results : The average of non-response rate was 0.10 by each respondent and 0.14 by each question. The range of test-retest reliability of responses to the questionnaire(by each respondent) was 1.00-0.57 by agreement index. The range of test-retest reliability (by each question) was 1.00-0.51 (unchangeable group) and 0.95-0.38 (changeable group) in optional type by kappa index, 0.88-0.16 in descriptive type by agreement index. Respondents generally gave consistent responses over 'fair' level in all items of optional type by kappa index, but relatively less consistent responses in descriptive type by agreement index.

Conclusion : The reliability of HRA questionnaire in SNUH lifetime health monitoring program (LHMP) was above fair level. and we can use this HRA questionnaire generally for evaluating the health related behaviors.

Background
: Cervix cancer is the most common cancer in women. The incidence and the number of deaths from cervical cancer were reduced by the effective screening test-Pap smear. Therefore we carried out this study to determine the most effective way for increasing the rate of cervical cancer screening.

Methods : We tried four compliance enhancing intervention strategies (group I -reminder postcard/group Ⅱ-reminder phone call/group Ⅲ-postcard and education material/group Ⅳ-postcard and education material and phone) to 224 female patients who visited previously family medical center, and compliance predictors were examined by questionnaires.

Results : Total compliance rate was 35.8% and compliance rates of each group were 32.5%, 34.9%, 31.8%, 44.7%. Difference among the four groups was not statistically significant (X²=1.7087 P=0.6084). The likelihood of obtaining the cervical cancer screening test were linked to the number of Pap smears the previous years, education level, the number of visit to hospital the previous year, family history of cervical cancer(P<0.05).

Conclusion : Postcard reminder is the simple and cost-effective measure. To increase the compliance of cervix cancer screening test, primary care physicians should take more active role in extending cervical screening coverage.