| Yun Jun Yang | 21 Articles |
The health benefits of physical activity have been well established. However, more than a quarter of the adult population in the world is insufficiently active (not performing at least 150 minutes of moderate-intensity physical activity per week, 75 minutes of vigorous-intensity physical activity per week, or any equivalent combination of the two), and there has been little improvement since 2001. In South Korea, the prevalence of insufficient physical activity was 54.4% in adults and 94.1% in adolescents in 2020. There was continuous decrease in the prevalence of sufficient aerobic physical activity, from 58.3% in 2014 to 45.6% in 2020. However, daily duration of sedentary behavior increased from 7.5 to 8.6 hours in the same period. Interventions to promote physical activity are necessary in various fields including clinical and policy approaches. As physical activity has decreased during the coronavirus disease 2019 pandemic, safer and more effective strategies to promote physical activity are required.
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Background
Continuity of care in primary care settings is crucial for managing diabetes. We aimed to statistically define and analyze continuity factors associated with demographics, clinical workforce, and geographical relationships. Methods We used 2014–2015 National Health Insurance Service claims data from the Korean registry, with 39,096 eligible outpatient attendance. We applied multivariable logistic regression to analyze factors that may affect the continuity of care indices for each patient: the most frequent provider continuity index (MFPCI), modified-modified continuity index (MMCI), and continuity of care index (COCI). Results The mean continuity of care indices were 0.90, 0.96, and 0.85 for MFPCI, MMCI and COCI, respectively. Among patient factors, old age >80 years (MFPCI: odds ratio [OR], 0.81; 95% confidence interval [CI], 0.74–0.89; MMCI: OR, 0.84; 95% CI, 0.76–0.92; and COCI: OR, 0.81; 95% CI, 0.74–0.89) and mild disability were strongly associated with lower continuity of care. Another significant factor was the residential area: the farther the patients lived from their primary care clinic, the lower the continuity of diabetes care (MFPCI: OR, 0.74; 95% CI, 0.70–0.78; MMCI: OR, 0.70; 95% CI, 0.66–0.73; and COCI: OR, 0.74; 95% CI, 0.70–0.78). Conclusion The geographical proximity of patients’ residential areas and clinic locations showed the strongest correlation as a continuity factor. Further efforts are needed to improve continuity of care to address the geographical imbalance in diabetic care. Citations Citations to this article as recorded by
Background
In the Republic of Korea, which medical specialties should take the responsibility for primary care and what the role of primary care should be are still unclear. In this study, we focused on the comprehensiveness of primary care to identify related factors. Methods The National Health Insurance Service (NHIS)-National Sample Cohort is a population-based cohort, sampled in the 2002 NHIS database and followed up until 2015. We used data collected from January 2014 to December 2015, including 20,423,832 outpatient visits in 19,557 office-based clinics. The Korean government has designated 52 simple or minor disease groups (SMDGs) to enhance the experience of patients who attend primary care for managing those diseases. We assessed comprehensiveness for each clinic as the number of SMDGs treated in each clinic for 2 years. We also identified the factors related to higher comprehensiveness, using logistic regression for analysis. Results The clinics included in the study had provided treatment for an average of 14 SMDGs during a 2-year period. Compared to general practitioners, internal medicine physicians presented higher comprehensiveness with an odds ratio (OR) of 2.29 (95% confidence interval [CI], 2.03–2.59), and family medicine physicians illustrated higher comprehensiveness (OR, 4.96; 95% CI, 3.59–6.83). Other specialties showed lower comprehensiveness than general practitioners. Clinics located in the capital city and metropolitan area tended to have lower comprehensiveness. Clinics hiring more doctors and having hospitalization facility showed higher comprehensiveness. Conclusion General physician, internal medicine, and family medicine are the fields providing comprehensive medical care in Korea. Clinics located in metropolitan area and capital city show lower comprehensiveness. The number of physicians is related to higher comprehensiveness of clinics. Citations Citations to this article as recorded by
Primary care physicians should encourage their patients to engage in adequate physical activity. Current recommendations for physical activity in adults are as follows: at least 150–300 minutes per week of moderate-intensity, 75–150 minutes per week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity. Adults should also perform muscle-strengthening activities of moderate intensity or higher that involve all major muscle groups for 2 or more days per week. The elderly should perform additional balance training and fall prevention exercises more than 3 times a week. Children and adolescents should perform at least 1 hour of moderate-to-vigorous physical activity daily, which includes vigorous aerobic activity at least 3 days per week. As part of their 60 minutes or more of daily physical activity, resistance training and bone strengthening exercise should be done at least 3 days per week. According to new evidence, one bout of any exercises can be shorter than 10 minutes. Previously, physical activities were recommended for more than 10 minutes. For patients with diabetes, it is advisable to perform resistance exercise or short-distance running before aerobic exercise to prevent hypoglycemia. New evidence shows that dynamic resistance training is safe and effective in patients with hypertension provided the load is not too heavy. Exercise reduces pain and improves quality of life and physical function in patients with osteoarthritis,. Therefore, the treatment guidelines for osteoarthritis have been changed recently from not recommending exercise to highly recommending it.
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Given emerging evidence of the association between stress and disease, practitioners need a tool for measuring stress. Several instruments exist to measure perceived stress; however, none of them are applicable for population surveys because stress conceptualization can differ by population. The aim of this study was to develop and validate the Perceived Stress Inventory (PSI) and its short version for use in population surveys and clinical practice in Korea. From a pool of perceived stress items collected from three widely used instruments, 20 items were selected for the new measurement tool. Nine of these items were selected for the short version. We evaluated the validity of the items using exploratory factor analysis of the preliminary data. To evaluate the convergent validity of the PSI, 387 healthy people were recruited and stratified on the basis of age and sex. Confirmatory analyses and examination of structural stability were also carried out. To evaluate discriminatory validity, the PSI score of a group with depressive symptoms was compared with that of a healthy group. A similar comparison was also done for persons with anxious mood. Exploratory factor analysis supported a three-factor construct (tension, depression, and anger) for the PSI. Reliability values were satisfactory, ranging from 0.67 to 0.87. Convergent validity was confirmed through correlation with the Perceived Stress Scale, Center for Epidemiologic Studies Depression Scale, and State-Trait Anxiety Inventory. People with depressive or anxious mood had higher scores than the healthy group on the total PSI, all three dimensions, and the short version. The long and short versions of the PSI are valid and reliable tools for measuring perceived stress. These instruments offer benefits for stress research using population-based surveys. Citations Citations to this article as recorded by
Combined therapy with alendronate and calcitriol may have additive effects on bone density. An observational study was performed to evaluate the efficacy and safety of Maxmarvil, a combinative agent of alendronate (5 mg) and calcitriol (0.5 µg), and to identify factors associated with efficacy. A total of 568 postmenopausal women with osteoporosis were enrolled by family physicians in 12 hospitals. The study subjects took Maxmarvil daily for 12 months. Questionnaires about baseline characteristics, socioeconomic status, and daily calcium intake were completed at the first visit. Adverse events were recorded every 3 months and bone mineral density (BMD) in the lumbar spine was measured using dual-energy X-ray absorptiometry at baseline and after 12 months. We evaluated the efficacy and safety of Maxmarvil, and the factors related to BMD improvement. A total of 370 patients were included in final analysis. The median BMD was 0.81 ± 0.12 g/cm2 at pre-treatment and 0.84 ± 0.13 g/cm2 after one year. The average BMD improvement was 3.4% ± 6.4% (P < 0.05), and 167 (45.1%) patients showed improvement. Factors associated with improved BMD were continuation of treatment (odds ratio [OR], 2.41; 95% confidence interval [CI], 1.15 to 5.07) and good compliance (OR, 2.54; 95% CI, 1.29 to 5.00). Adverse events were reported by 35 of the 568 patients, with the most common being abdominal pain and dyspepsia. Maxmarvil was found to be safe, well tolerated and effective in osteoporosis treatment. Continuation of treatment and good compliance were the factors associated with efficacy. Citations Citations to this article as recorded by
Background
In the primary care setting, compliance with lipid lowering therapy was relatively low. In order to compare the efficacy of a short messaging service (SMS) text messaging and postal reminder as means of improving attendance rates during the first 24 weeks of lipid-lowering therapy, a randomized controlled trial of 918 patients from 19 family practice clinics was conducted between February 2003 and June 2006. Methods: Patients were randomly assigned into 3 groups: SMS (327), postal (294),and control (297) group. To ascertain attendance rates, patients were followed up at 24 weeks after their treatment. Reminders were sent at 16 weeks from the coordinating center. Results: Overall attendance rate was 74.1%. This differed between groups, with 76.1% attendance for the SMS group, 73.5% for the postal group, and 72.4% for the control group. According to a multivariate analysis, the SMS group had a significantly higher attendance rate (Odds ratios [OR] 1.48; 95% confidence interval [CI], 1.01 to 2.16) than the control group, but the postal group (OR, 1.15; 95% CI, 0.79 to 1.69) did not. Moreover, the cost per attendance for the SMS reminder (155 Korean Won [KRW]) was much lower than that for the postal reminder (722 KRW). Conclusion: SMS reminder may be more cost saving method to improve the attendance rate compared with the postal reminder. Citations Citations to this article as recorded by
Background: Appetite control and weight reduction is important for the treatment of chronic disease such as obesity, hypertension, and diabetes mellitus. Visual analogue scales (VAS) is widely used to assess appetite. We investigated the reproducibility and the validity of the Korean version of VAS for appetite which will be helpful for clinical use. Methods: The subjects received the same test meal and 8 VAS questionnaires between 6 weeks. They started to fill out the questionnaire before lunch, continued after lunch every hour, and ended after dinner. The questionnaire was asked about hunger, satiety, fullness, prospective consumption, sweet, salty, savoury, and fatty. During the test meal, the subjects could eat ad libitum until 'comfortable satisfaction'; and after the test meal we calculated energy intake. We assessed the correlation between test-retest VAS for each appetite and evaluated the validity of VAS for hunger with energy intake as "gold-standard". Results: The VAS curves of each appetite were similar between the test and the retest. The VAS of each appetite on the test day was strongly correlated with that on the retest day. The CRs of 4.5 hour mean VAS (20∼34 mm) was smaller than the CRs of fasting VAS (35∼54 mm). The correlation coefficient of Hunger VAS before dinner and the energy intake was 0.436 on the test day and 0.400 on the retest day. The VAS of the sweet was correlated to the total glucose intake (P＜0.05), and the VAS of salty to the salt intake. Conclusion: The validity of the VAS score for appetite, especially hunger, sweet and salty taste was good. Indeed, the reliability of VAS for appetite was good to use this scale in a clinical setting. (J Korean Acad Fam Med 2008;29:736-745)
Background: Nowadays, decreased physical activity is considered to be a contributor to increase the prevalence of many diseases such as obesity, coronary heart disease and so on. Many researches demonstrated that regular physical activity reduce all cause mortality. To increase the physical activities of the population, accurate estimation of the activities is needed. Actical and actigraph are confirmed as accurate tools to measure physical activities. But the target populations of the validity studies were not Asian people. Therefore, the accuracy of the accelerometers should be confirmed in Asian people. The accuracy of the tools could be different. Therefore head to head comparison study between the tools would be needed. Methods: Thirty volunteers from the community, ages over 20 yrs, were recruited. The participants put on the two accelerometers (Actical, Actigraph) on the waists, secured with elastic belts, and performed a session of rest and three structured activities (two walking speeds, 4 km/hr and 6 km/hr, and one jogging speed, 8 km/hr). During each activity, expired respiratory gases were collected, and oxygen consumption (VO2) was measured by indirect calorimetry (Model Quark Ղ2Ⱂ). The calories measured by gas analyzer and two accelerometers were compared by correlation analysis using SPSS program. Results: Pearson correlation coefficient between gas analyzer and two accelerometers was calculated at three structured activities. The r in Actical was 0.747, 0.785, and 0.677, at speed of 4, 6, 8 km/hr, respectively (P＜0.05), and the same measures in Actigraph was 0.617, 0.737, and 0.530 (P＜0.05), respectively. Pearson correlation coefficient was also calculated between the two accelerometers, and the r was 0.881, 0.927, and 0.824, at each speed. Conclusion: The Actical and Actigraph are valid tools for measuring physical activities in Korean people. (J Korean Acad Fam Med 2008;29:668-674)
Background
This study was performed to evaluate the reliability and the validity of the Korean version of IPAQ short form. Method: Sixty-nine volunteer adults completed the questionnaires twice at 1 week interval, and the second one was compared to the results of ActicalⰒ in order to test validity. Results: The Korean version of IPAQ was accepted as a proper one by the IPAQ developers. Spearman Rho coefficients and Kappa values of test-retest reliability were 0.427∼0.646 (median 0.542) and 0.365∼0.620 (median 0.471), respectively. The Kappa values were above 0.4 in 5 out of 7 questionnaires. The more physically active by the short form questionnaire, the higher the measured value of the ActicalⰒ (P=0.039). Spearman Rho coefficient was 0.267 for the correlation between the results of the questionnaire and measured values by ActicalⰒ. Conclusion: The reliability and the validity of the IPAQ short form were proven. Follow-up studies are needed. (J Korean Acad Fam Med 2007;28:532-541)
Background
: The assessment of how much people exercise needs to be analyzed in order to promote their health status. Methods : Accordingly, 2001 Korean National Health and Nutrition Survey was performed during a two- month period beginning November 1st, 2001. Questionnaires on physical activities have been completed by 9,170 persons (88.45%) among 10,368 persons over 12 years old. We analyzed 7,838 subjects who were over 20 years old. Results : Among the total, 71.8% persons of the respondents did not work out at all. Among them, 14.9% respondents were classified as lower exercise group, 6.9% middle exercise group and 6.4% as higher exercise group. The number of middle and higher exercise groups increased on 2001 survey compared to those in 1998. Daily walking hours were 65.8±73.6 minutes. A proper amount of exercise were performed by older age groups than those in their twenties, by town residents than villagers, by unmarried people than married or divorced or bereaved ones, by higher educated people, by people with more weight, by those who felt less stress, and by non-drinkers. Favorite exercises were walking, mountaineering, jogging and working out at a fitness club which were chosen by 62.6% of the respondents. Conclusion : Many respondents did not work out at all and overall exercise rate was low. The rate of proper exercise was different by demographic features.
Background
: The second version of the Arthritis Impact Measurement Scales (AIMS2) is an improvement on an evaluation instrument that was developed to measure patient outcome in the rheumatic diseases. The goal of this study was to validate a translated version of the revised and expanded Arthritis Impact Measurement Scales (AIMS2) to be used by Korean patients with osteoarthritis (OA) of the knee. Methods : The AIMS2 was translated into Korean according to a recommended translation guideline. The Korean version of AIMS2 (K-AIMS2) was administered to a cohort of 239 outpatients with symptomatic OA of the knee who attended 7 participating University Hospitals in Seoul, Ilsan and Taejon. Forty eight patients readministered the K-AIMS2, 7 days after the first visit, to evaluate the instrument's test-retest reliability. After 6 weeks of NS AIDs therapy, 79 subjects were asked to complete a second survey of the questionnaire. Results : The internal consistency reliability of each scale score, as estimated by Cronbach's alpha coefficient, was high and indicated that the components of the scale measured the same construct. The items were all correlated with each other, but there was no redundancy; this indicated that each domain addressed a somewhat different aspect of functional disability. The test-retest reliability equalled or exceeded 0.86 for 12 scales. Factor analysis provided a three-factor health status model explaining 58.2% of the variance. The upper limb function scales formed the first factor. Psycho-social scale were loaded on the second factor. Arthritis pain together with physical scales for mobility level and walking and bending were loaded on the third factor (the lower limb function). The scale for support from family and friends was not loaded on any factors. These results demonstrate that the physical health status scales of the K-AIMS2 are valid, as shown by the significant, moderate to high correlations between the K-AIMS2 subscales and the majority of the clinical measures. Conclusion : Our data suggest that, like the original questionnaire, the Korean version of AIMS2 is a reliable, consistent and valid instrument for measuring health status and physical functioning in patients with OA of the knee.
Background
: The measurement of carbon monoxide concentration in expired air is used as an objective method to analyze the smoking status. This method has been proven to be reliable and is used throughout the world but it has been only recently accepted in Korea. Therefore the purpose of this study was to examine if measuring the concentration in expired air accurately reflects the Korean's smoking status. Methods : The subjects were from ages of 19 through 75 healthy people including smokers and nonsmokers. The smokers had their carbon monoxide measured after answering a questionnaire. This questionnaire was formed to obtain information concerning smoking status, smoking habit an factors that influence carbon monoxide measurement. Micro II smokerlyzer (Bedfont Instruments Ltd., England) was used to analyze CO concentration in expired air. The method used for measuring CO concentration was to deeply inhale and hole one's breath for 15 seconds and measure CO concentration while exhaling. Results : The total number of subjects was 148(143 males, 5 females) consisting of 114 smokers, 34 non-smokers(never smokers 23, ex-smokers 11). The average CO concentration in exhaled air in smokers was 17.247.30 ppm, in nonsmokers 6.031.06 ppm(in ex-smokers 6.361.29 ppm, in never smokers 5.870.92 ppm). A significant difference was evident between smokers and non-smokers(P<0.0001). The CO concentration values compared among the groups divided in terms of daily smoking rate were as the following 11.885.57 ppm in subjects smoking less than 10 cigarettes/day,17.356.48ppm in those smoking 11-20 cigarettes/day, 20.006.35 ppm in the 21-30 cigarettes/day group, and 24.889.70 ppm in the 31 cigarettes/day group (p<0.0001). In addition, the CO concentration was influenced by the change of the degree of inhalation and the elapsed time since last smoking. Conclusion : The measurement of CO concentration in exhaled air among the Koreas proved to be an accurate and reliable method reflecting the present smoking status.
Background
: The purpose of this study was to provide useful information for prevention and management of childhood obesity in a school-based setting. Methods : One thousand and 981 elementary children from 2 different elementary schools in Seoul were studied. The survey concerning the risks of childhood obesity was carried out by having parents answer a questionnaire. Results : The prevalence of childhood obesity was 18.1% showing significantly higher rate in boys than in girls (P<0.05). It was found that obese children had a higher intake of fish and meat (P<0.05) and a lower intake of vegetables compared to the non-obese group (P<0.05). Obesity was more prevalent among children who frequently skipped breakfast (P<0.05) and also more prevalent among an only child (P<0.05). The obese children significantly spent more time watching TV (P<0.05). There was a higher family history of obesity, hypercholesterolemia and DM in the obese group (P<0.05). The factors which significantly attributed to childhood obesity were birth weight, parenteral BMI, and father's age (P<0.05). Conclusion : The prevalence of childhood obesity was 18.1%. There was a statistically significant correlation between childhood obesity and gender, eating habit, time spent on watching TV, number of siblings, birth weight, parenteral BMI, father's age and family history such as obesity, hypercholesterolemia and DM.
Background
: The relation of initial depression and weight loss in a low calorie diet(LCD) alone or exercise combination in Korean women, was considered and change of emotional state after program was determined in this study. Methods : Sixty obese females were randomly prescribed a LCD(low calorie diet) alone or a LCD with exercise. Thirty obese females were treated with a LCD of 1,000kcal/d for 8weeks(group A). Another thirty obese females were treated with a LCD of 1,000kcal/d combined with supervise aerobic exercise for 8 weeks(group B. Questionnaires including Korean-translated Beck Depression Inventory(BDI), Korean translated Brief Encounter Psychosocial Instrument(BEPSI) were reported before and after 8weeks for this study. Results : 21 out of 30 obese females in group A and 25 out 30 obese females in group B completed the study. At the eighth week, mean weight loss was 5.7±2.2kg(8.0%) in group A, and 6.8±1.7kg(9.5%) in group B. Depression were decreased after program(decreased BDI score in combined group(6.86±6.31: p=0.0001), group A(5.79±4.06:p=0.0001) and group B(7.68±7.58:p=0.0001), but no statistically significant difference between group a and B was noted(p=0.3309). Initial BDI score was negatively correlated with the percent of weight loss in group A(r=0.0099:p = 0.637). In group A and B, the percent of weight loss was not correlated with change of BDI score(group A;r=0.504:p=0.028, group B;r=0.762:p=0.0001). Conclusion : Regardless of the exercise combination, LCD therapy seemed to decrease depression. The degree of weight loss was negatively correlated with initial degree of depression. this negative correlation can be compensated by planned thorough exercise.
Background
: Obesity and its complications are increasing as social economic standard of living is improving and life style has been changing in Korea. There is growing evidence that the visceral/subcutaneus adipose tissue area ratio (VSR) on computed tomography (CT) is closely related to the obesity complication. Therefore, it is important to determine whether the VSR reduction is produced during weight loss. The purpose of this study was to observe and compare the amount of reduction of intraabdominal fat between low calorie diet(LCD) alone and LCD with exercise. Methods : Sixty obese females were randomly prescribed a LCD alone or a LCD with exercise. Thirty obese females were treated with a LCD of 1,000kcal/d for 8 weeks (group A). Another thirty obese females were treated with a LCD of 1,000kcal/d combined with supervised aerobic exercise for 8 weeks(group B). Weight, height, BMI, and body fat distribution were measured in all subjects immediately before and after 8 weeks of this study. The body fat distribution was assessed by CT, by which the total abdominal adipose tissue area (AT), subcutaneous abdominal adipose tissue (SAT), intraabdominal adipose tissue(VAT), and visceral/subcutaneous adipose tissue ara ratio (VSR) were measured at the level of the umbilicus. A venous blood sample was taken after an overnight fast to determine lipid, glucose, and insulin concentrations in all subjects before and after 8 weeks of this study. Results : Body weight, BMI, CT measurement of total(AT), visceral (VAT), and subcutaneous(SAT) fat were found to be decreased significantly in the two groups B decreased significantly (P<0.05) during weight loss. Fasting plasma glucose and total cholesterol levels significantly decreased in the both groups(P<0.001). Fasting plasma insulin and triglyceride levels significantly decreased in the group B, but not in group A. Conclusion : This study shows that the VSR decreased significantly in group B, but not in group A. Fasting plasma inulin and triglyceride levels decreased significantly in group B, but not in group A. These results suggest that the LCD with exercise is more effective in reducing expected complications of obesity than LCD alone.
Background
: Falling in elderly persons can lead to disability, hospitalizations, and premature death. It may also result in a psychological trauma termed fear of falling. Although it has been reported in developed countries that such fear may lead to staying home or other self-restriction of activities with debilitating physical consequences, it has not been studied yet in Korea. So we conducted this study to examine relative frequency of fear of falling and its association with measures of falling, activities of daily-living, depression, frailty in elderly persons living in a home for the aged. Methods : We conducted a cross-sectional study of a sample of 152 subjects among 163 elders living in a home for the aged in Seoul. Data on demographic and medical characteristics, and cognitive(MMSE-K), functional(ADL, Instrumental ADL), and psychological(GDS-K) functioning, and measures of fall and frailty were obtained during assessments. We asked the subjects whether they had fear of falling in a dichotomous manner. Results : The incidence of falls in the prior year was 29.6%, and the relative frequency of fear of falling was 57.2%. The variables associated with fear of falling with a statistical significance were as follow; old age(≥80 years), no education, no alcohol drinking, no smoking, use of assistive device, experience with falls and fall with injury in the prior 12 months, any disability in ADL, 3 or more disability in IADL. In a stepwise logistic regression analysis, experience with falls(OR 2.80, 95% CI 1.12-6.97), 3 or more disability in IADL(OR 2.99, 95% CI 1.33-8.78), and no alcohol drinking(OR 3.23, 95% CI 1.36-7.95) were still associated independently with fear of falling. Conclusion : Fear of falling is common in the institutionalized elderly persons in Korea, and is associated with decreased instrumental activities, recent experience with falls, and no alcohol drinking. Therefore it represents the need for effective intervention to prevent and limit the consequences of falls and fear of falling in elderly persons.
Background
: When Medical students become medical doctors, they should take an active role against smoking. So ti is relevant to have information on their smoking havits and factors associated with smoking and smoking cessation. Medical students in Korea were surveyed to determine their smoking habits and factors associated with smoking and smoking cessation. Methods : In November 1993 an anonymous self-report questionnaire was distributed to medical students of 9 Korean medical schools requestion data on their class year, sex, religion, alcoholic drinks, exercise, smoking status, smoking statuses of their parents, number out of their five best frends who smoke, and allowance. Smokers were asked when they started smoking and the motivation to do so, the amount duration of smoking, their Fagerstorm score, whether they tried to quit smoking, and if so, whether they quit smoking. Results : The resoponse rate was 53.1% of the respondents, 55.6% were current smokers, 3.0% were ex-smokers and 41.0% were non-smokers among males, while 3.2% were current smokers and 96.9% were non-smokers among females. The variables positively associated with smoking included class year, alcohol, allowance, and the number out of five best friends who smoke ; sex and religion were also associated with smoking. The variable positively associated with smoing cessation trials was the duraton of smoking ; there was a negative association with alcohol, the number of cigarettes smoked daily ; the motivation for smoking is also associated with smoking cessation trials. The variable positively associated with smoking cessation was class year ; there was a negative association with the number out of five best friends who smoke, duration of smoking, and Fagerstorm score. Conclusion : The modifiable variables associated with smoking or smoking cessation of medical students included the number out of five best friends who smoke, alcohol and duration of smoking.
Background
: Nowadays more women have jobs and the number of female physicians is increasing. Many studies have shown that sexual discrimination is present. In order to predict medical manpower of women in the future, we studied the status of female physicians and attitudes of physicians about sexual discrimination. Methods : We sent 1,000 questionnaires to male and female physicians from May 1st to June 15th, 1992. The questionnaire was composed of questions about attitudes toward sexual discrimination. Two hundred and eighty four physicians responded. Results : The number of female physicians is increasing.(15% of all physicians, 1991) Female physicians are younger than male physicians and reside more in urban areas. The proportion of specialties of female physicians is less than that of male ones ; Female physicians tend to be employees rather than practice privately. They are employed more in the clinics of other private practitioners than hospitals, They specialize more in finite areas such as Pediatrics, Obstetrics and Gynecology, Family medicine, Anethesiology, Radiology and Opthalmology but less in sugeries. Most male and female physicians think that there was sexual discrimination in medical fields especially in entering residency programs. They felt it is also present in employments and promotions. They said that the reasons for sexual discrimination were mainly the sexual prejudice of society(43.7%), pregnancy and childcare(33.8%). Male respondents added incapacity of female physicians(21.1%) and lack of professionalism(10.2%). Most male(58%) and female(73%) physicians oppose to sexual discrimination induced by pregnancy related problems. Conclusion : Female physicians are increasing and their manpower will be more important than ever. They choose specialties of narrow range and are employed rather than practice themselves. Male and female respondents agree that there is sexual discrimination but don't agree about the reasons and propriety of it.
Background
: In primary care practices we meet patients complaining chest pain frequently. Chest pain is an important problem to both patient and clinician because it can be a signal of danger to life. Although ischemic heart diseases are the most frequent causes for chest pain in developed countries, they are not frequent in Korea. Though there were many studies about chest pain among the patients visited to emergency rooms or admitted to hospitals, there is no study about chest pain among the outpatients. We studied and evaluated the causes of chest pain prospectively. We hoped that this would be the guidance of evaluating chest pain in the primary care settings. Methods : From September 1991 to August 1992 (for 12 months), three family physicians had filled up the ready made protocol about the clinical feature and the diagnostic workup for 33333333492 patients with chest pain visiting to Family Medicine Clinic of Seoul Paik Hospital. We analyzed 467 cases except 25 cases which were inadequately filled up. Results : The percentage of chest pain among the out-patients was 3.78%(492) among 12,932 outpatients during the period. The causes were musculoskeletal diseases 126(27%), psychogenic disorders 122(26.1%), cough induced chest pain 41(8.8%), cardiopulmonary diseases 37(7.9%), gastrointestinal diseases 20(4.4%), and coronary heart diseases 11(2.3%) in order of frequency. There were the other insignificant causes 45(9.6%) and ulcer causes 65(13.9%). The sex ratio was 1.24:1, male dominantly. Their ages were third 164(35.1%), fourth 138(29.6%), fifth 80(17.1%) decades in order of frequency. They had suffered from chest pain for 42.7%(110.2) weeks by means. The period of chest pain was short in chest contusion, rib fracture and herpes zoster but long in psychogenic disorder (p<0.05). Coronary heart disease was frequent in heavy smokers. There was statistically significant relationship between the symptom suggesting the specific disease and the final diagnosis among musculoskeletal diseases, psychogenic disorders, bronchopulmonary diseases and gastrointestinal diseases. The musculoskeletal chest pain was precipitated by chest wall motions and it was located in the one side of chest and its nature was prickling. In the patients complaining psychologically originating chest pain, the duration of chest pain was longer than 1 hour and it was precipitated by emotional upset. In those cases the nature of chest pain was tightness or heaviness. Conclusion : The percentage of the patients complaining chest pain was 3.78% of all outpatients in this study. The causes of chest pain were musculoskeletal diseases, psychogenic disorders, cough and bronchopulmonary diseases in order of frequency. In this study the percentage of coronary heart disease was only 2.3%.
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