Background
: Recently, many large epidemiological studies revealed that total cholesterol (TC) / high density lipoprotein-cholesterol (HDL-C) ratio is a better predictor of risk for coronary heart disease than total cholesterol, high density lipoprotein-cholesterol, or low density lipopoteim-cholesterol as a single factor. Our study is designed to examine the factors associated with TC/HDL-C ratio in healthy Korean adults.

Methods : The study involved 6,584 adults who visited the SNUH Health Promotion Center from March 1997 to February 1998. We examined their demographic data, medical history, smoking habits, alcohol intake and exercise through a questionnaire. Serum lipid levels were checked after 14 hours of fasting. We analyzed the data by covariance and multiple regression analysis.

Results : 3,774 healthy adults (men 1,976, women 1,798) were statistically analyzed. The average TC/HDL-C ratio was 4.2±1.2 in men, 3.6±1.0 in women. TC/HDL-C ratio was highest in over age 70(4.4±1.3), and was increased as BMI, the amount of smoking increased, and was decreased as alcohol intake increased in men. In women, TC/HDL-C ratio was increased as BMI increased, and was lower in exercise groups(3.5±1.0) than inactive group(3.7±1.0), but there was no difference according to the smoking amount. Regression analyses revealed a positive correlation between TC/HDL-C ratio and BMI, smoking (P<0.05, respectively), and a negative correlation between TC/HDL-C ratio and alcohol intake(P<0.05) in women, there was a positive correlation between TC/HDL-C ratio and BMI, age(P<0.05, respectively), and a negative correlation between TC/HDL-C rato and exercise amount and alcohol intake(P<0.05, respectively). In both men and women, BMI showed the highest correlation with TC/HDL-C ratio.

Conclusion : BMI, smoking, exercise as well as sex and age are related to TC/HDL-C ratio. Thus, primary physicians should consider correction of these factors.

Background
: Osteoporosis is a skeletal condition that is characterized by reduction in bone volume and an increased vulnerability to fracture, practically of the proximal femur and vertebrae. But the etiology of osteoporosis in most men without history of alcohol abuse, or glucocorticoid excess in unknown. Several studies revealed that bone density in aged men was associated with serum sex steroids or sex hormone binding globulin (SHBG).

Methods : We have analyzed bone density and sex steroids, and SHBG of healthy 100 middle aged men who visited one university hospital located in Taejon city from Jan. 1997 to Nov. 1997. Aim of this study as to determine whether bone density in middle aged men was associated with serum sex steroids or SHBG.

Results &

Conclusion : Body mass index was significantly associated with serum FEI. BMI also associated negatively with SHBG. Bone density at lumbar spine was significantly positively associated with FEI (Free Estradiol Index) (r=0.359, P<0.001). SHBG was negatively associated (r=-0.273, P<0.01) with lumbar bone mineral density. After controlling for age, FEI and SHBG were still associated with BMD of lumbar spine. Because of these associations, multiple stepwise regression models were constructed, and accounted for 12-17% of the variability in bone density. Also, these results showed consistent, significant positive associations between bone density and FEI, BMI in middle aged men. Therefore, our data suggest that FEI and BMI may play an important role in the maintenance of the male skeleton.

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
: Adolescence offers unique opportunities for investment in health and well-being. The purpose of this study was to examine the common physical symptoms and diseases and medical utilization rate and the prevalence of health behaviors among school-aged adolescents.

Methods : This study was carried in 1998. Subjects consisted of 3,771 adolescents (ages 10 to 18) who attended an elementary, middle, and high school in Seoul and 3,246 parents. Self-report questionnaire was administered to the students and their parents to measure self-reported physical and psychosocial problems, practice of health behavior, medical care utilization rate, and the most common diagnosis.

Results : 1)Academic performance was the most common psychosocial problem for adolescents and their parents. 2)The perceived health status was highest in middle school students, lowest in female high school students. 3)As adolescents went to higher grades, the medical institute and dental clinic utilization rate tended to be decreased, and oriental clinic utilization rate did not change. The most common diagnosis during the past year was dental caries. The next most common diagnosis was respiratory infection. Accidents(males), headache(females) were more common in high school than middle school. 4) The most frequently reported symptom was fatigue in middle and high school students. More than half of female high school students reported fatigue, dizziness, headache, dysmenorrhea, hypersomnia during the last month. 5) The higher their grade was, the less adolescents practiced behaviors. 21.9% of males and 1.9% of female high school students were smokers. 34.5% of males and 13.3% of female high school students drank alcohol on a regular bases. The prevalence of obesity was 12.0% in males, 10.0% in female high school students. Male adolescents tended to deal with stress with leisure activities, female adolescents did by talking about their problems with related people.

Conclusion : This overview of health associated issues among adolescents provided a unique view of differences in health care needs between younger and older teens and between male and female teens. These data have meaningful implications for health promotion program for adolescents.

Background
: Esophagogastroduodenoscopy(EGD) is a useful diagnostic procedure and an important basic skill in family practice residency program. But currently we have no guidelines for EGD training in family practice residency program.

Methods : In March 1999, we mailed a self-administered questionnaire to the residency directors of all KAFM-accredited family practice residency program. 63 out of 109 programs responded to the questionnaire(57.8%)/

Results : Among the total of 63 hospitals that responded to the questionnaire, secondary hospitals were 55.6% and tertiary or university hospitals were 44.4%. 98.4% reported that their residents receive training to perform EGD. 57.1% of the total received training to perform EGD during internal medicine training. EGD was performed by family physicians in 38.1% of total family practice residency programs. In the mjority of these programs(34.9%, cumulative percent 74.6%), the minimal requirements for technical skills in EGD training were 50 cases and for both technical skills and cognitive skills at least 100 cases of EGD(41.3%, cumulative percent 79.3% was necessary). The most difficult component during EGD procedure seemed to be esophageal intubation followed by retroflexed maneuver and entering the pylorus in series.

Conclusion : To perform EGD in primary care, it is required for trainee to perform at least 50 cases of EGD under supervision in a family practice residency program.

Background
: Acquired immune deficiency syndrome (AIDS) is becoming more prevalent in the world, but there is no definite treatment method and no proved vaccine available. Therefore, prevention is the best method to lessen it and blocking it's transmission route is the most effective method. We conducted a survey on the changing trend of knowledge, attitude and perception for AIDS between the year 1993 and 1999 among freshmen of a university.
Method: The subjects were 2,340 freshmen of a university in Seoul and the study period was one month from Jan. 16 to Feb. 15 1999. The survey had been done with pre-designed questionnaire methods which was same to the one in 1993. Total 2,305 cases were analyzed and compared with the results in 1993 excluding 35 cases with insufficient responses.

Results : Among the questions about knowledge for AIDS the increasing trend was found in 13 items "AIDS is caused by a virus", "AIDS can be contracted by light kissing with AIDS patients", "AIDS can be contracted by hugging AIDS patient", "AIDS can be contracted by using AIDS patient's belongings", and so on. The decreasing trend was found in items "All homosexuals are apt to get AIDS", "Most of AIDS patients die of the disease", "AIDS patients are easy to contract other diseases", and "AIDS can be contracted by other sexually-transmitted viruses".

Conclusion : The freshmen entered in 1999 knew the transmission route of AIDS relatively well. They thought tat AIDS was not a serious disease but they could get ADIS. The changing trend showed that public education had a considerable effect on students' knowledge and attitude for AIDS.

Background
: The goals of this study are to evaluate the propensity to depression in Korean internet users associated wit internet using environment and attempt to aid proper management of internet users in the field of family practice.

Methods : A group of 1,674 subjects who replied to internet research were selected from March 26 to 28, 1999. Making use of CES-D-K for Korean internet users, we investigated t propensity to depression. At the same time, general characteristics, internet using environmental characteristics were investigated and their relationship was assessed.

Results : The CES-D-K score was 16.19. The CES-D-K score was significantly higher in females, in younger age and low education level group(P<0.001). There was no significance between CES-D-K score and region. In internet using environmental characteristics, the CES-D-K score was significantly higher in low velocity users, long internet using time per day group (P<0.001). There was no significance between CES-D-K score and internet using year.

Conclusion : There was a significant correlation between internet using velocity, internet using time per day and the propensity to depression. Therefore, family physician should think about the correlation of the propensity to depression and internet using environment, if internet users have symptoms of depression.

Background
: Smoking is closely related to pulmonary diseases, especially pulmonary function. Past studies were defective in that pulmonary function was not included for ex-smokers and the study population being too small. This study attempted to show the change of pulmonary function parameters according to post-smoking years of ex-smokers and pack-years of current smokers.

Methods : We analyzed the results of parameters derived from the forced expiratory spirogram in 3,713 adults who visited Kyungpook National university Hospital Health Screening Center between May 1997 and March 1998. Independent variables used were age, sex, height, weight and smoking status. Dependent variables were pulmonary function parameters. Multiple regression analysis was used.

Results : 1. Overall, there was a significant change in pulmonary function parameters among the subjects studied. Significant variables shown were age, sex, height and pack- years. Weight and post-smoking years turned out to be relatively less significant variables. 2.Positive correlation was seen in both FEV1/FVC and FEF25-75% in ex-smokers with longer post-smoking years. 3.There was negative correlation in all the parameters of current smokers with longer pack-years.

Conclusion : The results of this test show that smoking slowly reduce pulmonary function and even those smokers who quit smoking can not be expected to have normal pulmonary function as healthy nonsmokers. However, ex-smokers can expect some improvement in certain pulmonary function parameters as the post-smoking years become longer.

Background
: It is reported that approximately 10.7% of Korean reproductive women use rhythm method to avoid pregnancy, which is higher in comparison to other countries. However, few surveys on practicing natural family planning methods have been done and awareness of it is also very low. Our study examined women's interest and related factors in using natural family planning either to become pregnant or to avoid it.

Methods : A questionnaire was given to 1,700 women, ages 18 to 50, who visited general hospitals in Seoul and Kyounggido for health examination from the months beginning July and ending September in 1998.

Results : Of the 604 answered questionnaires, 361 were from women who were potentially fertile. Of these women 45.4% indicated that they would likely use natural family planning in the future to avoid pregnancy, and 30.5% indicated that they would likely use natural family planning in the future to become pregnant. Past use of any method of natural family planning to avoid pregnancy was associated with interest in future use of modern methods of natural family planning to avoid pregnancy. Age under 30, past use of natural family planning to become pregnant and the possible desire for future pregnancy were associated with interest in future use of natural family planning to conceive.

Conclusion : Interest in future use of natural family planning is associated with past use of natural family planning including other factors. Many women who have not used natural family planning showed interest in using natural family planning, either to avoid pregnancy or to conceive. Therefore, clinicians should include modern natural family planning methods in all of their discussions with women about family planning options.

Background
: Many studies to reduce serum lipoprotein(a) are done because serum lipoprotein(a) has been known to be an independent risk factor of coronary artery disease along with age, smoking, diabetes, hypertension, and hyperlipidemia. Till now, oral estrogen/androgen therapy, niacin analogue and plasmapheresis are known therapeutic methods. This study examined the relative effects of three antihyperlipidemic agents, acipimox, lovastatin, fenofibrate.

Methods : Among 70 subjects(male-19, female-51) with their serum cholesterol level of more than 240mg/dL, 56 subjects who were completed 2 months antihyperlipidemic treatment (acipimox-20, lovastatin-18, fenofibrate-18) were examined for baseline total cholesterol, HDL cholesterol, triglyceride, and lipoprotein(a) and were followed up 2 months later.

Results : Mean values of each group for acipimox, lovastatin, fenofibrate were as follows: total cholesterol (268.1±19.03, 287.1±36.42, 268.9±25.99), HDL cholesterol (43.5±10.99, 42.7±11.88, 37.9±8.20), triglyceride (226.1±165.03, 260.4±175.98, 234.3±124.33), LDL cholesterol (179.3±30.40, 192.3±41.52, 184.1±38.08), lipoprotein(a) (26.2±15.32,34.8±18.56,29.9±12.58). Mean percentile reduction of lipoprotein(a) was acipimox-41.4%(P<0.0001), lovastatin-22.2%(P<0.0001), fenofibrate-16.1%(P<0.05), and p value was less than 0.05 in the comparison of groups. Lipoprotein (a) showed no relations with age, sex, BMI, WHR, smoking, total cholesterol, HDL cholesterol, triglyceride and LDL cholesterol. After 2 months treatment, mean reduction percentages of total cholesterol was acipimox-12.2%(P<0.0001), lovastatin-17.6%(P<0.0001), fenofibrate-8.85%(P<0.05). LDL cholesterol was acipimox-16.12%(P<0.0001), lovastatin-22.89%(P<0.0001), fenofibrate-12.06% (P<0.05). Triglyceride was acipimox-17.24%(P<0.0001), lovastatin-17.39%(p<0.0001), fenofibrate-9.78%(p<0.05). HDL cholesterol was elevated in acipimox-17.24%(P<0.05), lovastatin-16.10%(P<0.05) and fenofibrate-12.06(P<0.05). In total cholesterol(P<0.05) and LDL cholesterol(P<0.05), there were significant differences among 3 groups, but not in HDL cholesterol and triglycerides.

Conclusion : In two months treatment of acipimox, lovastatin and fenofibrate in hyperlipidemic patients, lipoprotein(a), known for independent risk factor of coronary artery disease, was reduced significantly in the order of acipimox, lovastatin and fenofibrate.

Background
: Unlike that of adults, depression of adolescents need screening because learning ability, physical growth and social adaptation are seriously affected. But Beck Depression Inventory(BDI), the assessment tool for adults, is generally used for adolescents as well because only few are available. The purpose of this study is to examine the reliability of a Korean version of BDI(K-BDI) as a screening instrument of adolescent depression.

Methods : From May 1, 1998 to June 1, 1998 we visited two high schools (one male, one coeducation) in Sungnam city and K-BDI questionnaires were given. The subjects were 1,107 high school students. This study was to evaluate the reliability of BDI and to find out factor structure through analysis.

Results : The sex distribution of subjects was 929(83.9%) males and 178(16.1%) females. Cronbach's internal consistency and Spearman-Brown split half correlation coefficient was 0.85, 0.86, respectively, in the male group, 0.74, 0.86, respectively, in the female group and 0.85, 0.86, respectively, in the total group. By principal axis factoring, 4 factors were extracted. Which were factor I: Negative Self Attitude, factor II: Performance Difficulty, factor III: Guilty and Psychomotor Retardation, and factor IV: Somatic Symptom. All of the correlations between total BDI score and the individual items showed positive correlation(P<0.001).
Average BDI score and prevalence rate was 11.7±7.24, 11.4%, respectively, in the male group, 18.51±6.65, 34.8%, respectively, in the female group and 12.85±7.56, 15.2%, respectively, in the total group.

Conclusion : The results suggest that the K-BDI is a reliable tool in adolescence. Therefore, it may be used as a screening tool for adolescent depression.

Background
: As childhood-onset obesity has been known to have a poor prognosis, and its prevalence is rapidly increasing, many children and adolescents are becoming concerned about obesity and try various weight control methods. This study assessed the experience and behaviors of weight control in obese adolescents.

Methods : A total of 732 among 840 obese students from 28 schools in Seoul metropolitan area were assessed with a self-administered questionnaire.

Results : Middle school students showed the highest trial rate of weight control. Elementary and high school girls showed significantly higher trial rates of weight control than boys(p<0.05). The methods more frequently used were physical exercise, and diet, drugs and other methods, and visits to obesity clinics in than order. Elementary school girls most frequently tried physical exercise while high school girls went on a diet more frequently. All groups of girls were dieting significantly more often than boys(p<0.05). High school girls were the most frequent users of drugs and other methods while elementary school boys and middle schoolgirls visited obesity clinics most frequently. Unhealthy weight control methods observed were monodiet(2.7%), fasting(1.9%), dieting pills(1.4%), and vomiting(0.1%). The mean number of weight control methods was decreased with increasing age. The possibility of overall weight control was significantly higher in girls, having higher weight dissatisfaction levels. The possibility of physical exercise was significantly higher in younger ages, having mother with a career and a family history of obesity. The possibility of dieting was significantly higher in girls, older ages, having higher obesity index. The possibility of using drugs and other methods was significantly higher if they had higher weight dissatisfaction levels and a family history of obesity. The possibility of visiting obesity clinics was significantly higher if they had higher obesity index.

Conclusion : Although, exercise and diet were frequently chosen by obese adolescents for weight control, the number unhealthy methods chosen were found to be higher and physical exercise decreased wit increasing age. Therefore, an appropriate weight control program that is not detrimental to normal growth and development is called for in early adolescence.

Background
: The smoking rate of Korean male workers is top in the world. To establish the effective smoking cessation strategy, we conducted a study to evaluate the factors associated with smoking and smoking cessation.

Methods : We surveyed 509 male workers in a university hospital about age, marital status, drinking, exercise level and checked their awareness and seriousness for diseases due to smoking, benefits from smoking cessation, motivation derived from mass-media and books and their will to quit smoking by self-administered questionnaire.

Results : The significant factors associated with smoking cessation were higher education (OR=1.85, 95% CI 1.26-2.74), non-religion(OR=0.56, 95% CI 0.38-0.83), drinking(OR=0.40, 95% CI 0.27-0.61), awareness(OR=1.30, 95% CI OR=1.03-3.25) and seriousness (OR=1.29, 95% CI 1.19 95% CI 0.74-0.86), motivation(OR=1.21, 95% CI 1.12-1.30), and the will to quit smoking(OR=1.70, 95% CI 1.56-1.85).

Conclusion : This study suggested that effective smoking cessation program should be based on awareness and seriousness due to smoking related diseases, health benefit and barrier to quitting smoking, company's support, the individual's will to quit and various motivation methods.

Background
: An inverse relationship between cholesterol level and the degree of depressive symptoms was found in several studies targeted to Westerners. But, other studies failed to replicate this finding giving diverse opinion on this matter. The objective of the study was to investigate the association between the degree of depressive symptoms and lipid level, total calorie intake and fat intake respectively in adults screened in a health promotion center in Korea.
Method: The study group consisted of 352 men and women who visited the Health Promotion Center of Seoul National University Hospital from Jane to August in 1998. Their depressive symptoms were measured by Korean version of the Center for Epidemiologic Studies Depression Scale(CES-D). Lipid level was measured by enzymatic methods with fasting blood specimen. Total calorie and fat intake were calculated from a self-reported questionnaire on the types and amount of food.

Results : Depressive symptoms were not significantly related to lipid levels, total calorie intake, fat intake, age, exercise, BMI, smoking or alcohol consumption(p<0.05). But sex(p<0.05), marital status(p<0.05). educational level(p<0.05) and average income(p<0.05) were significantly related to depressive symptoms in the whole study group(n=352). Educational level(p<0.05), menopausal status(p<0.05) and LDL cholesterol(P<0.05) were significantly related to depressive symptoms only in women(n=185). However in multivariate models which adjusted for confounding factors these associations were not found(p>0.05).

Conclusion : In contrast to the results of previous studies, no significant association between he degree of depressive symptoms and lipid levels, total calorie intake and fat intake respectively were found in Korean adults after adjusting for several factors related to health.