No abstract available.

Background
: Death form coronary heart disease is increasing and this study is to evaluate the effect of longitudinal changes of lifestyle and biological parameters on the blood lipid levels, as the risk factor of the coronary heart disease.

Methods : Total cholesterol and total cholesterol to HDL-cholesterol ratio (atherosclerogenic index) as an indicator for risk of coronary heart disease were examined longitudinally in sample(n=463) of middle-aged men by 2 years. The independent variables were body mass index, smoking, alcohol, exercise, diastolic blood pressure, uric acid. All data was drawn form questionnaire, blood chemistry, and review of chart.

Results : ANOVA test according to categorized variables revealed that for total cholesterol, uric acid (P<0.01) and diastolic blood pressure (P<0.01), and for atherosclerogenic index, and body mass index (P<0.001) were significant. In correlation analysis, total cholesterol was associated with uric acid (r=0.20, P<0.001), diastolic blood pressure(r=0.15, P<0.001) and body mass index(r=0.30, P<0.05). and for atherosclerogenic index so was body mass index (r=0.18, P<0.001). In regression, uric acid(β=6.07, P<0.001), diastolic blood pressre(β=0.36, P<0.01) for total cholesterol, and body mass index(β=0.22, P<0.001) for atherosclerogenic index were significant. But changes in alcohol consumption, smoking, and exercise were not statistically significant.

Conclusion : In order to reduce risks of coronary heart disease, the more aggressive medical intervention for the uric acid, DBP, and BMI, would be essential. This study was done without medical intervention. So, further study with intervention, adequate duration and intensity for parameters modification is required.

Background
: Patients known as 'difficult' who make doctors get negative fillings can be products of 'difficult' doctor-patient relationship. This study describes the reasons for difficulty, demographic characteristics, and contents of medical care of 'difficult' patients as compared with control patients of nine third-year residents in hospital-based family practice center.

Methods : Fifty-nine difficult patient sample was generated by asking residents to indicate patients whose care they considered difficult. And control sample was generated by random sampling after matching about duty doctor and being registered to Lifetime Health Maintenance Program in department of Family Medicine, Seoul National University Hospital. The control and difficult patient charts were audited and we compared two groups about various medical and demographic characteristics.

Results : Thirty-nine percent of difficult patients were selected due to medical problems and the others were selected due to psychosocial problems. There were no differences in demographic characteristics such as age, sex, marital status, educational level, and number of adults and children in family. Difficult patient group had more chronic problems, psychotropic drug use, provider continuity, and less total duration of care than control group. Two patient groups did not differ significantly in acute problems, chronic medications, samplings, radiological examinations, special tests, referrals, total visits to family practice center, and total duty doctors. After covariance analysis adjusting for total duration of care, significant differences remained between the two groups for chronic problems, psychotropic drug use. Also, after the covariance analysis the differences between difficult patient group and control group in number of acute problems and referrals became significant with the patient group having more acute problems and more referrals.

Conclusion : This study result suggest that residents experience a lots of difficulties in medical work-up and therapeutic plan of certain conditions, and that demographic characteristics and contents of medical care of difficult patients differ from previous studies.