Background
Many patients with "cold hands/feet syndrome" have been taking herbal medicine or medicine to improve blood circulation without proven evidence. Raynaud's disease had been neglected in primary care. This study was conducted to investigate the recognition for Raynaud's disease and "cold hands/feet syndrome" by family doctors. Methods: A questionnaire was posted to 905 family doctors who were in practice from January to July 2003. Results: Among the 274 respondents, 58 (21%) reported that they have seen patients with "sensitive to cold" frequently and 208 (76%) doctors have seen such patients sometimes. Only 8 (3%) doctors answered that they have never seen patients with such symptoms. When such patients see a doctor and complain of "cold hands/feet syndrome", most doctors (60%) prescribed medicine that improved blood circulation (83%) or calcium channel blockers (9%). In case of questions like 'Do you suspect "cold hands/feet syndrome" or "sensitive to cold" contain Raynaud's disease?', 132 (48%) doctors answered 'yes'. And among the 132 doctors, only 15 (11.2%) doctors thought that those patients with "cold hands/feet syndrome" had Raynaud's disease. In addition when the doctors diagnosed the condition as Raynaud's disease, 54% prescribed medicine that improved blood circulation (52%) or calcium channel blockers (40%). Conclusion: Most doctors prescribe medicine that improves blood circulation for cold hands/feet syndrome. Many doctors also prescribe medicine to improve blood circulation for Raynaud's disease frequently. The result of our study suggests that there is a need to train doctors so that recognized and diagnosed Raynaud's disease can be correctly. (J Korean Acad Fam Med 2007;28:339-345)

Backginformaround: Patient education is an important component of family practice. Pamphlets and the websites have been one of the most common resources for patient education. Patient information has been assessed using criteria with marks allocated for its content, design, readability. Up to present there have been studies on content, design but not readability. The WHO identifies readability as an essential tool for people to increase control over their health. Therefore, patient information should be assessed readability. The objective of our study was to assess patient information leaflets and the websites on hypertension to determine the readability of information currently available to patients. Methods: Ten leaflets were reviewed, five form the internet and five from other sources. A total of ten subjects were assessed for readability using 'grading system of vocabulary' presented by the Academy of Korea Education in 2002. Results: In five leaflets, about 41.3% vocabularies were comprised of 1st and 2nd grade. The portion of vocabularies in higher grade than 4th was 35%. In the five websites, 41.3% vocabularies in 1st and 2nd grade were used. The mean reading level (calculated with weight) was 2.057 for the five leaflets and 2.050 for the five websites. These results indicated that the leaflets were easier to read than websites. But, both of them were not comprehensible to the majority of patients. Conclusion: All 10 patient information materials for hypertension were at higher readability level than high school level. As recommended levels of readability were lower than 2nd grade, educational materials need to be modified to meet the information needs for the people with low reading skills. (J Korean Acad Fam Med 2007;28:346-351)

Background
The North Korean defectors are suffering from multiple psychologic and physical health problems. However, because of their emotional maladaptation, noncooperation and suspiciousness and distrust toward others, it is difficult for South Korean doctors to build effective therapeutic relationships with them. Therefore, we made efforts to clarify the characteristics of North Korean defectors in symptom expressions and illness behaviors which would help South Korean doctors to gain rapport. Methods: We performed qualitative study with focus group interview. Three focus groups were composed of 14 North Korean defectors and group interviews were performed twice for each group. The contents of each interview were analyzed and conclusions were drawn by extracting and arranging significant findings. Results: The North Korean defectors showed psychologic symptoms such as anxiety, depression and various somatic symptoms. Among them, 'Laeng-Dol ('cold mass') and 'Jeog' mean subjective mass-feeling, such as globus sensation. And 'Tag-Gi-Byeong ('chicken heart disease')' means recurrent chest pain. These expressions reflect their anxious, depressive, and somatizing tendency. Among illness concept, 'Laeng-Byeong' ('cold related disease') means that they consider the cold weather to be the cause of various somatic symptoms. Characteristic illness behaviors include continuous complaining of recurrent symptoms, distrusting medical staffs and institutions, self-diagnosis, self- prescription, and reliance upon folk remedies. These illness behaviors were precipitated by the current breakdown of health-care system and economic crisis of the North Korea. Conclusion: South Korean doctors should be able to understand these characteristics of the North Korean defectors in order to build effective therapeutic relationship with them. (J Korean Acad Fam Med 2007;28:352-358)

Background
Dermatophytoses tend to have a poorer outcome in diabetic patients than in non-diabetic patients. Therefore, diabetic patients need to pay a closer attention to the prevention and treatment of dermatophytoses. The aim of this study was to determine the level of understanding of the dermatophytoses in diabetic patients and to clarify the factors associated with the level of understanding. Methods: A questionnaire survey was carried out from June to July, 2005, targeting 200 patients who had visited two hospitals in Seoul for the management of diabetes. There were 163 respondents (response rate 50.9%). The degree of understanding was calculated by giving 1 point to each question, with a maximum of 12 points. Results: The average degree of understanding of dermatophytoses was 6.68 points (SD 1.79). Younger age (P= 0.0002), high education level (P=0.0035), and high income (P=0.0013) were the factors related to a better understanding of dermatophytoses. The patients who had obtained the information on dermatophytoses from the websites, broadcasts, newspapers, or magazines showed higher recognition points than others (P=0.0377). The body mass index, the duration of diabetes, the complications associated with diabetes did not affect the understanding of dermatophytoses. Conclusion: There are many diabetes patients who do not know enough about dermatophytoses. Diabetes itself is not related to the level of understanding of dermatophytoses. However, diabetic patients who are older, have a lower level of education, and a low income will need to be informed about prevention and treatment of dermatophytoses. (J Korean Acad Fam Med 2007;28: 359-366)

Background
This study was conducted to survey the current status of family medicine residency programs and to evaluate the difficulties in training of the curriculums. Methods: Questionnaires on residency programs were sent to all the centers of residency programs by mail in April 2006. The questionnaire included detailed characteristics of residency programs, curriculum schedule, reasons for failed specific curriculum, and review and measures by the program center and the Korean Academy of Family Medicine to resolve problematic curriculums. Results: A total of 113 residency programs responded. Among the 93 residency programs except for the 20 subsidiary hospitals, inadeguate subjects were mainly dermatology (12 programs, 12.3%), psychiatry (6 programs, 7.5%), ophthalmology (5 programs, 7.1%), and otolaryngology (5 programs, 7.1%). Training rejection rate was higher in dermatology (13 programs, 14.4%), radiology (11 programs, 13.1%), gastrofibroscopy (8 programs, 9.5%), and psychiatry (5 programs, 6.2%). Emergency me-dicine in 4 programs and general surgery in 3 programs had a longer duration of training than initially planned. Difficulties in training some subjects were due to failed establishment of specific curriculums in non-university hospital. Commonly established clinics were health promotion center, obesity clinic, smoking cessation clinic, geriatric clinic, stress clinic, and clinical nutrition clinic. Family medicine center programs included gastrofibroscopy, obesity, smoking cessation, geriatrics, hospice care, and evidence-based medicine. Conclusion: There is repeated demand for taking measures to promote better curriculum in the nation-wide view of family medicine. Dermatology, radiology, psychiatry, and otolaryngology were the subjects difficult to receive training. Measures to strengthen the weak subjects are urgently needed. (J Korean Acad Fam Med 2007;28: 367-374)

Residents in family medicine often have difficulty of gathering to have a conference when they are sent to different hospitals according to training programs. From 2001, for resident conference of family medicine in pohang hospital and gyeongju hospital, dongguk university medical center, an Internet-based video conference system was used for video conferences. The Internet-based video conferences for the members who work at difference hospitals had the same effects as they gather at one place. In addition, the participants could lower the burden of preparing the presentation, listen to the presentation lively, and have a discussion with questions and answers immediately, enhancing the efficiency of conferences. They also could have a sense of affinity as they talk face to face. We reported this case as the application cases and effects of Internet-based video conferences. (J Korean Acad Fam Med 2007;28:375-378)

Background
Cotinine, a nicotine metabolite detected in urine, has been recommended as the best quantitative marker of smoking and environmental tobacco smoke (ETS) exposure. The aim of this study was to analyze the relationship between indoor ETS and urinary cotinine level of the passive smokers. Methods: We selected 42 nonsmokers who lived in Seoul and were not exposed to passive smoking at least 5 days before test. Urinary cotinine levels were measured by Smokescreen Colorimeter (Surescreen Diagnostics LTD, U.K.). We measured urinary cotinine levels twice (before and after smoking exposure). Results: The mean urinary cotinine level was 0.33μg/mL before smoking exposure, and 0.46μg/mL after smoking exposure. There was statistically significant difference (P-value=0.003). There was no significant difference between exposure time and increase of urinary cotinine level(P=0.138, r=⁣0.233). There was also no significant difference between measuring time taking after exposure and increase of urinary cotinine level (P=0.671, r=0.067). Conclusion: One experience of indoor exposure to ETS caused significant elevation of urinary cotinine level. (J Korean Acad Fam Med 2007;28:379-382)