Background
: Physicians’ satisfaction with their professional life influences the quality of patient care they provide and helps to determine the number and type of students attracted to the various fields of medicine. In South Korea, two decades have passed already since the introduction of family medicine. But, S. Korean health policy has not developed a strong plan a strong plan to control a high medical cost and ineffective utilization of medical resources. Additionally, the number of students applying for family medicine is less than that for internal medicine or pediatrics. The purpose of this study was to de-lineate factors relation to professional satisfaction among family physicians in South Korea.

Methods : The subjects were 840 family physicians who had been trained formally and registered to the Korean Academy of Family Physicians. The self-administered questionnaires were collected by three mailings during March 18 to May 24 in 1998.

Results : Completed questionnaires were received from 292 South Korean family physicians. With respect to income, there showed ‘satisfaction in 31.4%, ‘middle’ 47%, and ‘dissatisfaction’ 20.5%(no response 1.0%). Three periods of certification acquisition(P=0.001), four practice types(P=0.005), and three degrees of training satisfactioni(P=0.003) had significantly different degrees of satisfaction. In the aspect of pride as a family physician, there showed ‘high’ in 42.1%, ‘middle’ 45.8%, and ‘low’ 10.9%(no response 1.2%). In the aspect of future view as a family physician, there showed ‘bright‘ in 40.6%, ‘middle’ 40.6%, and ‘dark’ 17.6%(no response 1.2%).
After confounding variables were controlled, practice types(faculty family physicians rather than private practitioners) (P=0.003), the degree of training satisfaction(P=0.001, positive relationship), and the number of patients encountered per an hour(P-0.0098, positive relationship) were significant variables of the degree of general professional satisfaction.

Conclusion : Though standard measure of professional satisfaction have not been developed, this survey result seems to help understand factors relating to professional satisfaction of S. Korean family physicians. This information may be useful in the development of policy to structure a primary care oriented health care system in S. Korea.( J Korean Acad Fam Med 1999;20:1697-1708)

Background
: Advising lifestyle modification to patients suffering from hypertension is important. However, how strictly hypertensive patients in Korea are adherent to non-pharmacologic recommendation has not been well known. This study was performed to determine the compliance of hypertensive patients to the recommendation for life style modification and to find out on factors related to compliance.

Methods : Ninety ? six patients, diagnosed as hypertensive between November 1997 and April 1998 in the Department of Family Medicine, Samsung Medical Center were educated on lifestyle modifications by their physicians during routine outpatient consult questionnaires inquiring of demographic and clinical characteristics, and health habits were Self administered done before and after the education. Blood pressure, height, and weight were measured repeatedly. The relationships between various characteristics and the compliance with lifestyle modification and follow-up visits were evaluated using Chi-square test and multiple logistic regression analysis.

Results : Among 96 patients, 47 patients(49.0%) attended for regular check-up two months after being diagnosed as hypertension. Being prescribed with antihypertensive agent, non-smoking, and doing regular exercise were the significant factors related to higher compliance with regular check-up. A total of 19 patients (40.4%) among 47 patients who have attended for regular check-up were adherent to the recommendation for modification of one or more health habits. The proportion of patients doing regular exercise increased significantly after education. Although 15 patients(53.6%) among 28 patients whose body mass indices were over 25 km/㎡ reported that they had made efforts to reduce body weight, no significant differences were observed in the change of body mass index between patients who reported their efforts for reducing body weight and those who did not. There was no association between various characteristics and compliance with lifestyle modification.

Conclusion : Low compliance with recommendation for lifestyle modification during routine outpatient consultation and no association between various clinical and demographic characteristics and patient compliance suggests the necessity of developing special program and its active application to all hypertensive patients. ( J Korean Acad Fam Med 1999;20:1709-1720)

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
: Alcohol has much effect on our lives as a taste food that people in almost all of the world generally have had. The effects of alcohol cause social problems as well as physical and psychological problems. Recently, interest about drinking increasingly rises as the rate of drinking accident increases in Korea. For this, our study examined the amount of alcohol consumption and early at-risk alcohol intake.

Methods : The prepared questionnaire was presented to subjects who were employees in Inchon. The anonymous, self-administered questionnaire was composed of questionnaire concerning alcohol consumption, early at-risk alcohol intake and doctor’s role in drinking behaviour.

Results : Among 305 subjects, there were 189(62%) men, 116(38%) women whose mean age was 37 9 years. 87(28.5%) subjects were classified as high alcohol group and 218(71.5%) low alcohol group. High alcohol group was defined as early at-risk alcohol intake for men who were consuming 135g of alcohol per day, 630 per week and for women 90g per day, 270g per week. Low alcohol group was defined as early at-risk alcohol intake for men whose consumption was 90g per day, 450 per week and for women 45g per day, 270g per week. Mea alcohol consumption of drinker was 158.9g per week. 3 days per week people should not drink in order to avoid risk. Although 54% of respondents thought doctors should ask about their drinking habits, only 16.4% of respondents reported ever being asked about alcohol intake on the subject.

Conclusion : Early at-risk drinking subject in the study was much more than those suggested by NIH(National Institutes of Health). We conclude that primary care physicians should take more inter-est in screening, treating and preventing alcohol related problems and advise and educate patients to cut down or quit drinking. ( J Korean Acad Fam Med 1999;20:1732-1740)

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
: Assessment of aerobic capacity(VO₂max) is one of the essential components in exercise prescription for health promotion and maintenance. This study was conducted to compare the validity of four exercise tests to assess aerobic capacity in young adult male subjects by comparing them to the values measured from maximal ergometer exercise test(criterion VO₂max).

Methods : twenty young healthy adult males(M±SD=21.1±1.5 years) volunteered as subjects. Criterion VO₂max was calculated and printed out automatically by computerized analysis system of expired air samples collected during maximal ergometer exercise test. VO₂max was estimated for each subjects from heart rate at submaximal workloads on the cycle ergometer using the Åstrand-Rhyming nomogram(A/R) and Fox protocol(FOX) and the computerized multiple extrapolation method (XTP). The score got from Harvard step test(H/S) was used to compare the validity. The validity of the procedures was based on the evaluation of the predicted VO₂max (from A/R, FOX, XTP, and H/S) versus the criterion VO₂max via the calculation of constant error(CE=mean difference for predicted minus criterion VO₂max), r value, standard error of the estimate[SEE=SD-(1-r²)1/2], total error[TE=(∑(predicted VO₂max ? criterion VO₂max)²/n)1/2].

Results : In relation to criterion VO₂max, the XTP and A/R underpredicted (XTP : 40.8 ml/kg/min SD = 4.1; A/R: 37.3 8 ml/kg/min SD = 5.0) and the H/S and FOX overpredicted(H/S: 48.0 8 ml/kg/min SD = 5.9; FOX 46.3 8 ml/kg/min SD = 5.5). Dunnett post-hoc procedures revealed that there were significant(P<0.05) mean differences(CE) for VO₂max from A/R versus criterion. The validity coefficients for VO₂max derived from XTP, H/S, A/R, and FOX were 0.68,0.53,0.50, and 0.49, respectively. TE of the XTM, FOX, H/S and A/R, which accounts for the effects of both the CE and SEE, were5.73,6.13,6.75, and 8.87, respectively.

Conclusion : These results suggest that the XTP is recommended first for estimation VO₂max in young adult males. It is also considered that further studies about female and other age groups are necessary.

Background
: Hypertension is a common disease and one of the most important risk factors of cardiovascular diseases. Majority of patients with hypertension are unaware of their conditions until complications develop. Awareness of hypertension is important in treating and controlling of hypertension. Therefore, we conducted a study o the factors related to awareness of hypertension.

Methods : Awareness of hypertension was evaluated by measuring blood pressure(BP) in 3,344 subjects visiting a health promotion center in Pusan National University Hospital from June 1996 to May 1997. All subjects completed a questionnaire including socio-demographic factors and family history. Hypertension was defined as systolic BP above 140mmHg and/or diastolic BP above 90mmHg. 135 subjects were diagnosed as hypertension.

Results : Among 315 hypertensive, only 135 subjects(42.9%) were aware of their conditions. With respect to sex, women had a getter awareness of hypertension than men(51.6% vs. 36.9%, P<0.005). The awareness was greater for the subjects aged over 60 years than for the subjects aged 30-49 years(53.3% vs. 36.5%), and it was statistically significant(P<0.005). The subjects with stage III hypertension had a better awareness of hypertension than the subjects with stage I (65.5% vs. 32.6%, P<0.005). In the occupation-types, the awareness was highest in the group without occupations. But except the group without occupations(56.2%), the awareness was highest in the group of domestic affairs (housewives, 53.2%). Education level and monthly mean income were not related to awareness of hypertension. With respect to marital state, the rate of awareness is highest in the group of widows or widowers(55.8%, P<0.05). The subjects with family history of hypertension had a better awareness of hypertension than the subjects without(59.6% vs. 35.7%, P<0.05). The rate of alcohol drinking(47.4% vs. 66.7%), smoking(21.5% vs. 31.6%) and high salt intake(17.0% vs. 25.0%) were lower and the performance rate of regular exercise(24.4% vs. 13.3%) was higher in those who were aware of their hypertension than those who were not.

Conclusion : The awareness of hypertension was also associated with sex, age, marital state, occupation, stage of hypertension, family history of hypertension, and was related too the performance of life-style modification (alcohol drinking, smoking, salt intake, exercise).

Background
: Seasonal variation of blood pressure(BP) is well documented. It means that season should be considered in diagnosis ad treatment of hypertension. This study was done to evaluate seasonal influence on blood pressure of hypertensive patients who had been taking the same antihypertensive medicine for a long time.

Methods : In medical records, we reviewed the blood pressure recordings of 328 hypertensive patients who had been taking the same medicines through the consecutive summer(June., Jul., & Sep.) and winter(Dec., Jan., & Feb.) period. We evaluated the blood pressure difference between summer and winter, and also evaluated influence of age, sex, BMI, smoking, alcohol drinking and exercise on seasonal difference of blood pressure.

Results : An average of four blood pressure readings per patient, two for summer and two for winter were recorded. Ambient temperature was over 22°C in summer and below 4°C in winter. The systolic blood pressure in summer and winter were 135.5mmHg ad 140.5mmHg, respectively, and the diastolic blood pressure in summer and winter were 85.0mmHg and 87.4mmHg, respectively. Both systolic and diastolic blood pressure increased significantly in winter. Both I systolic ad diastolic blood pressure, sex, smoking, alcohol drinking, exercise did not have an influence on seasonal difference. Age and BMI did not have an influence on seasonal difference of systolic blood pressure. But in diastolic blood pressure, age and BMI had an influence on seasonal difference and elderly patients had a greater seasonal difference in diastolic blood pressure than younger patients.

Conclusion : In hypertensive patients who had taken the same antihypertensive medicines for a long time, both systolic and diastolic blood pressure was significantly increased during the winter. Therefore season should be considered in the treatment of hypertension even though patients are stable with the same medicines.

Background
: Hepatitis B is a world widely distributed disease. The hepatitis B prevalence of South East nations is reported to be higher than that of America or Europe. Korea is known to be one of high prevalent nation among Asia-Pacific nations. But hepatitis B prevalence in North Korea, separate from South Korea due to politics and ideology, is not reported. This study was performed using the data of North Korean defectors to estimate the prevalence of hepatitis B in North Korea.

Methods : We analyzed the data of 107 persons (98, males, 9 females) who defected from North Korea and underwent screening examination in a general hospital from July 1987 to March 1996. Twenty nine persons(25 males, 4 females) were excluded because of incomplete data. The HBsAg test was carried out by reversed passive hemagglutination(RPHA) and the anti-HBs test was carried out by passive hemagglutination(PHA). The liver function tests were carried out by biochemical quantitative analysis method of Dimension.

Results : The study group was 73 males(93.6%) and 5 females(6.4%). Mean age was 33.0±8.4 years and third decade was the largest as 35 persons(44.9%). The overall HBsAg positive rate was 15.4% and anti-HBs positive rate was 33.3%. Those who need vaccination were 51.4%. The only item among liver function tests which was statistically different by the hepatitis B viral marker groups was alkaline phosphatase. Mean total cholesterol was 176.4±38.0mg/dL. But no other item of liver function tests was statistically different in abnormal value by the hepatitis B viral marker groups.

Conclusion : The overall HBsAg positive rate of North Korean defects was much higher than that of South Korean and anti-HBs positive rate was much lower. So HBsAg positive rate of North Korean seems to be higher than that of South Korean. We think that a large study of hepatitis B for North Korean should be performed at y opportunity and take a measure to meet the situations. ( J Korean Acad Fam Med 1999;20:1778-1783)

Background
: Patients with chest pain are common among outpatients. Several researches shows that chest pain patients can suffer from psychiatric illnesses such as hypochondriasis, depression, anxiety, somatization, panic disorder and so on. This study aims to examine the psychogenic symptoms in patients with noncardiac chest pain.

Methods : In this study, the 98 people who have undergone treadmill test for chest pain during the three months from June 1st to September 30 of 1998 were selected, and the 98 patients were asked to respond to the prepared questionnaire and SCL-MPD(symptom check list-minor psychiatric disorders) before they underwent treadmill test. And then, they were classified into two groups. One group consisted of patients with noncardiac chest pain, and the other group of patients with cardiac chest pain. These two groups were compared in 19 measures, and the compared results were analyzed by t-test.

Results : Among the 25 patients with cardiac chest pain, 15 patients were males and 10 patients (33%) were females, and among the 44 patients with noncardiac chest pain, 31 patients(70%) were males, 13 patients (30%) were females. The average age was 47 years old. The average age in patients with noncardiac chest pain was 48, and the 46 for those patients with cardiac chest pain. In the statistical analysis between the patients with cardiac chest pain and those with noncardiac chest pain, significant difference(p<0.005) was shown in the measures such as somatization, depression, phobic anxiety, obsessive-compulsive, neurasthenic, hypochodrial, anxiety, anger-hostility, interpersonal sensitivity.

Conclusion : As in the analysis the patients with noncardiac chest pain showed significant difference in the symptom check list minor psychiatric disorder compared to those with cardiac chest pain. We conclude that primary care physician should take more interest in evaluating psychiatric symptoms in patients with noncardiac chest pain.( J Korean Acad Fam Med 1999;20:1784-1793)