Background
: Up to the present, there has been little study on chronic fatigue or chronic fatigue syndrome, and there is equally sparse relevant statistical data For this reason, we attempted to investigate the present status of fatigue, particularly its incidence and actual conditions.

Methods : The study subjects were 12,152 outpatients who visited family practice in hospitals all over Korea between July 24 and September 21,1997. They were given a questionnaire which included questions reflection the (U.S) Center for Disease Control criteria defining chronic fatigue syndrome.

Results : Among the subjects, 861 people complained of fatigue in their response to the questionnaire-re and they became the focus of the study. Of this fatigue group, 426 people(49.4%) had manifested fatigue for more than 6 months, and the male/female ratio was 54%/46%, respectively. People who re-ported that fatigue impaired their ability to function on a daily basis made up 35.8% of the fatigue group and the percentage of people who had considered visiting a clinic due to fatigue was an unexpectedly high 52.8%. The reported causes of fatigue, in decreasing order, were: social interactions(males 68.5%/females 45.1%); sleep disturbance(males 26.8%/females 21.8%); and physical maladies(males 24.2%/fe-mals 26.5%). There were significant gender differences in social interaction relating to domestic problems(males 4.7%/females 16.7%) and emotional problems(males 12.2%.femals 21.4%). Among 33 chronic fatigue syndrome patients who indicted what they thought were the causes of their problems, 68.8% reported physical maladies, 65.5% social life, 31.3% emotional problems, 21.9% sleep disturbance, and 21.9% domestic problems. The associated symptoms of fatigue reported in both males and females, in de-creasing order, included: myalgia, headache and neurological symptoms. The prevalence of chronic fatigue was 0.27%.

Conclusion : Our study showed that 7.1% of family practice outpatients complained of fatigue and that their daily activities or occupational life were disturbed as a result. This group demonstrates is serious need for medical assistance. Therefore, doctors should have more interest in fatigue, particularly in chronic fatigue syndrome, so as to provide real and versatile care.( J Korean Acad Fam Med 1999;20:978-990)

Background
: Helicobacter pylori(H. Pylori) is a major risk factor for chronic gastritis, peptic ulcer, and low grade gastric lymphoma of mucosa-associated lymphoid tissues(MALT). Eradication of H. pylori can induce prevention of peptic ulcer relapse and regression of gastric MALT lymphoma. Smoking has also been known to be a major risk factor for peptic ulcer. The purpose of this study is to evaluate the effects of smoking on eradication of H. pylori according to smoking status, amount of smoking, and smoking cessation.

Methods : We studied 132 patients with H. pylori-positive gastroduodenal diseases. Diseases com-posed of gastritis in 36.4%, peptic ulcer 62.1%, gastric MALT lymphoma 1.5%. Patients were treated with amoxicillin 1.0g, clarithromycin 500mg, omeprazole 20mg bid for a period of 7 days. Patients underwent a follow-up gastroendoscopy 6 weeks later after eradication treatment. H. Pylori status was confirmed by initial and follow up biopsies of gastric antrum and corpus using Hematoxylin0Eosin stain and Wharthin0Starry silver stain. At the beginning of treatment, 66.7% of 132 patients were smokers, 9.8% ex-smokers, 25.3% non-smokers. Smokers were advised to stop smoking through education and counseling at each office visit.

Results : H. Pylori eradication was achieved in 111 patients(84.1%). The number of smokers who had quit smoking successfully during treatment were 25(28.4%). The rate of eradication did not seem to influence by initial smoking status and total amount of smoking(pack-years). However, during treatment, success group for smoking cessation(100%) had a higher rate or eradication than non-cessation group. Daily amount of smoking had an effect o eradication with significant statistical difference; Non-smokers showed 89.9% eradication rate, mild smokers (≤20 cigarettes/day) 81.8%, and heavy smokers ( >20/day) 50%.

Conclusion : These results suggest that current smoking status and daily amount of smoking during treatment seem to influence the rate of eradication of H. Pylori rather than past smoking history alone. There was some improvement in the eradication rate by quitting or reducing smoking together with H. Pylori eradication treatment. ( J Korean Acad Fam Med 1999;20:991-999)

Background
: In postmenopausal women, progesterone should be added to protect the endometrium from hyperplasia or carcinoma induced by the unopposed estrogen. However, the effects of progestogen on bone mineral densities and serum lipoproteins have not been precisely evaluated in Korean postmenopausal women.

Methods : To evaluate the effects of progestogen on bone mineral densities and serum lipoprotein in estrogen replacement therapy, we conducted a 2-year trial of long conjugated equine estrogen(conjugated estrogen 0.625mg/day) with or without cyclic progestogen(MPA 5mg/day for 12 days) in 120 postmenopausal women. In all subjects, bone mineral density was measured in lumbar vertebra(L2-L4) and femur neck using dual energy X-ray absorptiometry(DEXA) and serum lipoprotein was measured from the beginning of the treatment, 12 months, and 24 months later, respectively.

Results : BMD of femur neck in both groups increased but not significantly compared to basal level at 12 months and/or 24 months of treatment. As for BMD of lumbar spine, it increased significantly in both groups. Both groups showed a significant decrease in the levels LDL cholesterol, but there was no statistical significance in serum triglycerides. Conjugated estrogen plus MPA group in contrast to conjugated estrogen only group showed a significant decrease in total cholesterol levels.

Conclusion : These results suggest that the addition of MP of the daily of 5mg for 12 days cyclically in estrogen replacement treatment appear to be effective in postmenopausal women with protection on bone mineral density and maintenance of long-term favorable effects on serum lipoprotein.

Background
: In a health examination program, advice from physician for change of health-related behavior and distribution of health educational pamphlets is routine. This study was done prospectively to analyze factors such as personal general characteristics, results of health examination, health examination satisfaction that related to change of health promotion attitudes and compliance towards overweight, smoking, heavy drinking, elevated blood pressure, dyslipidemia, chronic diseases such as diabetes, hypertension.

Methods : The subject population was 689 cases from May 1997 to Jue 1997i a general hospital health examination center. After health examination, 60.2%(415 cases) showed personal satisfaction by questionnaire. Three to four months later 78.4%(540 cases) responded to eh telephone survey on change of health beliefs, health-related attitudes and compliance.

Results : In the telephone survey, 239 cases(46.0%) comprised high compliance group that had positive attitudes toward abnormal health examination results, 145 cases(27.9%) were mid compliance group. In males there was higher frequency of high compliance group than females(p<0.05). According to age, the older, the higher frequencies of high compliance group(p<0.05). In educational level group, the higher the educational level, the lower the frequencies of high compliance group(p<0.01). There was no difference in frequency of each compliance group between symptom motive and non-symptom motive group with each satisfaction group(p>0.05). In positive responders to the correspond advice of physician or health educational pamphlets, the frequencies for quit smoking, reduction of drinking amount, regular exercise, Compliance with taking antihypertensive, blood sugar control, diet control for dyslipidemia, taking antihyperlipidemics were higher(p<0.01).

Conclusion : Health examination service including advice of physician and education changed health belief and influenced positively to health promotion attitudes. Health examination is not only important for early detection of disease but also to promote positive change of health-related behavior. Further studies are needed to understand the changing process of management of health and disease.( J Korean Acad Fam Med 1999;20:1012-1026)

Background
: Although family physicians are performing an increasing number of esophagogastoduodenoscopies(EGDs), there is little research conducted in Korea. Thus, the purpose of this research is to assess the ability of family physicians in performing EGD.

Methods : All EGDs performed by family physicians in the department of family medicine of one general hospital from January 1995 to December 1996 were reviewed retrospectively through medical records. The including physicians a family physician and nine family residents, performed EGDs five times per week.

Results : 4,468 EGDs were performed on 4,313 persons during the two years. No major complications were noted and all of the procedures were completely investigated to the second portion of the duodenum. Normal findings were 1,268 cases(28.4%) and abnormal findings were 3,200 cases(71.6%). Among the abnormal findings, gastritis was the most common finding(73.7%). The most common pathologic diagnosis was peptic ulcer 37.7%(177/470cases). Positive rate of CLO test was 89.4%. Family physicians, endoscopic diagnosis agreed with pathologic reports in 86.6%. The number of EGDs performed by each family physician ranged from 2 to 1,503 cases. Data of six physicians who performed more than 200 EGDs for their diagnostic were comparatively analyzed ability. Diagnosis of normal, gastritis or gastric ulcer was significantly different(P<0.05) according to each physicians but the diagnosis of duodenal ulcer was not statistically different(P<0.05). There was little difference among physicians in the biopsy rate. The agreement ratio between endoscopic diagnoses and pathologic reports among those physicians who performed more than 200 procedures were 79.7-93.3% and were not statistically different(P<0.05).

Conclusion : This study is the first report of EGDs performed by family physician in Korea. Some family physicians performed more than 4,000 EGDs without major complications in primary care. These data confirm the ability of some family physicians to perform EGD. Biopsy analysis indicates the diagnostic accuracy is high. Further study on performance of EGD by family physicians and its standardization concerning description of endoscopic are needed.( J Korean Acad Fam Med 1999;20:1027-1039)