Korean Journal of Family Medicine

"Eon Sook Lee"

Review Article

Evidence-Based Guideline for the Treatment of Smoking Cessation Provided by the National Health Insurance Service in Korea: Cheol Min Lee, Yoo-Bin Seo, Yu-Jin Paek, Eon Sook Lee, Hye Seon Kang, Soo Young Kim, Sungwon Roh, Dong Won Park, Yoo Suk An, Sang-Ho Jo, The Guideline Development Group for Developing the Korean Clinical Practice Guideline for Tobacco Cessation; Korean J Fam Med 2024;45(2):69-81. Published online February 28, 2024; DOI: https://doi.org/10.4082/kjfm.23.0142

Although major countries, such as South Korea, have developed and disseminated national smoking cessation guidelines, these efforts have been limited to developing individual societies or specialized institution-based recommendations. Therefore, evidence-based clinical guidelines are essential for developing smoking cessation interventions and promoting effective smoking cessation treatments. This guideline targets frontline clinical practitioners involved in a smoking cessation treatment support program implemented in 2015 with the support of the National Health Insurance Service. The Guideline Development Group of 10 multidisciplinary smoking cessation experts employed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE)-ADOLOPMENT approach to review recent domestic and international research and guidelines and to determine evidence levels using the GRADE methodology. The guideline panel formulated six strong recommendations and one conditional recommendation regarding pharmacotherapy choices among general and special populations (mental disorders and chronic obstructive lung disease [COPD]). Strong recommendations favor varenicline rather than a nicotine patch or bupropion, using varenicline even if they are not ready to quit, using extended pharmacotherapy (>12 weeks) rather than standard treatment (8–12 weeks), or using pharmacotherapy for individuals with mental disorders or COPD. The conditional recommendation suggests combining varenicline with a nicotine patch instead of using varenicline alone. Aligned with the Korean Society of Medicine’s clinical guideline development process, this is South Korea’s first domestic smoking cessation treatment guideline that follows standardized guidelines. Primarily focusing on pharmacotherapy, it can serve as a foundation for comprehensive future smoking cessation clinical guidelines, encompassing broader treatment topics beyond medications.

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Korean Clinical Practice Guideline of Korean Society for Research on Nicotine and Tobacco (KSRNT) and National Evidence-Based Healthcare Collaborating Agency (NECA) on Treatment of Tobacco Use 2024
Yoo-Bin Seo, Haine Lee, Yu-Jin Paek, Hyeon-Jeong Lee, Cheol Min Lee, Eon Sook Lee, Heejin Kimm, Hye-Ji An, Eun-Jung Bae, Ji Soo Kim, Sungwon Roh, Yoo Suk An, Sang-Ho Jo, Seo Young Kang, Yun Hee Kim, Kyung Hyun Suh, Sang Hwa Shin, Jin-Kyoung Oh, Dong Won P
Journal of Korean Medical Science.2025;[Epub] CrossRef

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Original Articles

Development of the Perceived Stress Inventory: A New Questionnaire for Korean Population Surveys: Eon Sook Lee, Ho Cheol Shin, Jun Hyung Lee, Yun Jun Yang, Jung Jin Cho, Gwiyeoroo Ahn, Yeong Sook Yoon, Eunju Sung; Korean J Fam Med 2015;36(6):286-293. Published online November 20, 2015; DOI: https://doi.org/10.4082/kjfm.2015.36.6.286

Abstract
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Background

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.

Methods

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.

Results

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.

Conclusion

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.

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Temple stay diet and its impact on gut microbiome and irritable bowel syndrome: a prospective cohort study
Sang Hoon Kim, Woorim Kang, Minyoung Kim, Sanghee Hong, Hyun Kim, Jun Kyu Lee
Food & Function.2025; 16(12): 4894. CrossRef
Menopausal stage transitions and associations with overall and domain-specific perceived stress in middle-aged Korean women
Yoonyoung Jang, Yoosoo Chang, Sang Won Jeon, Junhee Park, Byungtae Seo, Jeonggyu Kang, Ria Kwon, Ga-young Lim, Kye-Hyun Kim, Hoon Kim, Yun Soo Hong, Jihwan Park, Di Zhao, Juhee Cho, Eliseo Guallar, Seungho Ryu
Maturitas.2025; 200: 108660. CrossRef
Childhood adversity and late-life depression: moderated mediation model of stress and social support
Jin-kyung Lee, Jinhee Lee, Moo-Kwon Chung, Ji Young Park, Taeksoo Shin, Kyoung-Joung Lee, Hyo-Sang Lim, Sangwon Hwang, Erdenebayar Urtnasan, Yongmie Jo, Min-Hyuk Kim
Frontiers in Psychiatry.2023;[Epub] CrossRef
Non-Cognitive Adaptive Resourcefulness: Scrutiny of Its Multidimensionality and Nomological Validity
Andrew Denovan, Neil Dagnall, Kenneth Drinkwater
Psychological Reports.2023;[Epub] CrossRef
Psychological Stress Management in Primary Care
Eon Sook Lee
Korean Journal of Family Practice.2021; 11(2): 90. CrossRef
Perceived stress and non-alcoholic fatty liver disease in apparently healthy men and women
Danbee Kang, Di Zhao, Seungho Ryu, Eliseo Guallar, Juhee Cho, Mariana Lazo, Hocheol Shin, Yoosoo Chang, Eunju Sung
Scientific Reports.2020;[Epub] CrossRef
Influence of the Perception of Aging Symptoms as a Mediator and Moderator on the Relationship between Family Function and Stress in Middle-Aged Adults
Hyun-E Yeom, Kyoung Ok Ju
Korean Journal of Adult Nursing.2020; 32(2): 175. CrossRef
Subclinical Hypothyroidism and Incident Depression in Young and Middle-Age Adults
Ji Sun Kim, Yiyi Zhang, Yoosoo Chang, Seungho Ryu, Eliseo Guallar, Young-Chul Shin, Hocheol Shin, Se-Won Lim, Juhee Cho
The Journal of Clinical Endocrinology & Metabolism.2018; 103(5): 1827. CrossRef

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Association of ENPP1 K121Q Polymorphism with Metabolic Syndrome.: Hyeon Ju Kim, Mi Hee Kong, Young Ree Kim, Keun Hwa Lee, Sung Ha Kang, Jung Sik Huh, Eon Sook Lee, Cheol Hwan Kim; Korean J Fam Med 2010;31(12):913-922. Published online December 20, 2010; DOI: https://doi.org/10.4082/kjfm.2010.31.12.913

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Background
Metabolic syndrome is a cluster of several metabolic disorders (central obesity, dyslipidemia, hyperglycemia, and hypertension). It is closely related to the cardiovascular risk factors. ENPP1 is an inhibitor of insulin-induced activation of the insulin receptor. The aim of this study was to investigate the association between ENPP1 K121Q polymorphism and metabolic syndrome in Korean.Methods: We measured BMI, waist circumference, blood pressure, lipid profile, fasting glucose in the participants who visited Health Promotion Center, Jeju National University Hospital from February to July 2008. ENPP1 K121Q polymorphism was determined by restriction fragment-length polymorphism polymerase chain reaction in 84 patients with metabolic syndrome and 114 control group. Results: The frequencies of ENPP1 K121Q polymorphism were 27.4% in metabolic syndrome and 9.6% in control group. BMI, waist circumference, blood pressure were increased in male K121Q group and triglyceride was increased in female K121Q group.Conclusion: K121Q polymorphism was more frequent in the patients with metabolic syndrome among Koreans. There were differences of the metabolic components according to the genotype. It supports the K121Q polymorphism was associated with the genetic susceptibility for metabolic syndrome.

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Validity, Reproducibility of Visual Analogue Scales in Assessment of Appetite Sensations.: Hong Bum Kim, Eon Sook Lee, Sang Woo Oh, Yoon Ho Kim, Dong Eun Lee, Choon Keong Hwang, Eun Young Lee, Yeong Sook Yoon, Yun Jun Yang; J Korean Acad Fam Med 2008;29(10):736-745. Published online October 10, 2008

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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)

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The Current Educational Measurement of Family Practice Residents.: Min Jeong Kim, Ho Cheol Shin, Cheol Hawn Kim, Youn Seon Choi, Hang Lee, Ae Kyung Choi, Yu Jin Paek, Eon Sook Lee, Jin Ho Park, Yoon Jung Chang; J Korean Acad Fam Med 2007;28(8):616-625. Published online August 10, 2007

Abstract
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Background
The educational assessment of residents is very important in order to check their knowledge and to improve their ability. In case of family practice, the residents spend most of their training time in outside rotations with other specialities. Therefore, they are requested to be evaluated by each specialist after each rotation. To give more accurate assessment, we surveyed directly our family practice residents and family practice faculties. Methods: A questionnaire was sent to family practice residents and family practice faculties in 116 hospitals from May to June 2006. The response rate was 29% and 78%, respectively. Results: Among the total, 70.2% of family practice residents thought an assessment is necessary, but only 51.7% were evaluated. Overall, 90.4% of family practice faculties knew about the assessment of residents made by other specialists, and only 56.7% of faculties requested other specialists to assess their family practice residents. Conclusion: Most of the family practice residents and their faculties knew the need for assessment, but they complained there were no objectivity and the assessment tool was lacking. In order to solve this problem, it is urgent to develop a unified form and guidelines of assesment. (J Korean Acad Fam Med 2007;28:616-625)

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Curriculum and Training Difficulties of Family Medicine Residency Programs in Korea.: Yu Jin Paek, Ho Cheol Shin, Cheol Hawn Kim, Youn Seon Choi, Hang Lee, Ae Kyung Cho, Eon Sook Lee, Jin Ho Park, Yoon Jung Chang, Min Jung Kim; J Korean Acad Fam Med 2007;28(5):367-374. Published online May 10, 2007

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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)

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The Factors Associated with Successful Smoking Cessation in Korea.: Eon Sook Lee, Hong Gwan Seo; J Korean Acad Fam Med 2007;28(1):39-44. Published online January 10, 2007

Abstract
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Background
: We conducted a cross-sectional survey to determine the associated factors with successful smoking cessation, longer than 1 year, as compared with current smokers who had made at least one attempt to quit in the past and failed.

Methods : Smokers and ex-smokers were randomly selected by stratification at three levels (geographic location of home, age and sex). Among the subjects were 97 ex- smokers who had stopped smoking longer than 1 year and 71 current smokers, who had made at least one prior attempt to quit. Nicotine dependence and number of the smokers in the 5 closest friends were measured.

Results : A high Fagerstrom score (OR=0.784; CI 0.667∼0.921) and the number of the smokers among their 5 closest friends (OR=0.681; CI 0.511∼0.909) were significantly associated with a relapse in smoking adjusting confounding factors such as age, sex, alcohol consumption and so on.

Conclusion : In Korean ex-smokers, lower nicotine dependence and the number of friends who smoked were associated factors in successful smoking cessation longer than 1 year.

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The Amount of Physical Activity of Korean Adults Measured from the 2001 Korean National Health and Nutrition Survey.: Yun Jun Yang, Yeong Sook Yoon, Sang Woo Oh, Eon Sook Lee; J Korean Acad Fam Med 2005;26(1):22-30. Published online January 10, 2005

Abstract
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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 1^st, 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.

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The Attention of Primary Physician on Depression of the Elderly Patients.: Young Seong Kim, Eon Sook Lee, Jung Han Chun, Yang Hyun Kim, Min Gyu Kim, Jong Soo Hwang, Yoon John Yang, Sang Woo Oh, Yeong Sook Yoon; J Korean Acad Fam Med 2004;25(11):818-825. Published online November 10, 2004

Abstract
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Background
: It has been known that the prevalence of depression is increasing and depressive mood is accompanied with various physical symptoms in the elderly. In this research, we studied various physical symptoms of the elderly patients and how many of those symptoms were associated to depressive mood. We also investigated how much their doctors were concerned about depressive symptoms of the patients.

Methods : The subjects were 135 patients over 60 years old, who visited geriatric center and department of family medicine in a university hospital from December 2002 to May 2003. Individual interviews were conducted among the subjects and all symptoms who suffered from within a month from the time of interview, depression score, stress score, functional status and their sociodemographic factors were assessed. Finally, doctor's diagnosis or comments on depressive mood were assessed based on the medical documents of the elderly patients with depression.

Results : 56% of the subjects had depressive mood. Common symptoms of subjects were memory impairment, visual disturbance, fatigue, arthralgia, and thirsty sense. The more depressive mood the elderly have, the more physical symptoms they have. The physician paid their attention to depressive mood in 13% of the cases among the elderly with depressive mood. Depressive mood was affected by whom they lived together with, regular exercise and stress.

Conclusion : This study shows that most of the elderly patients had depressive mood and their common symptoms were associated to depressive mood. The stress and living together with their children were risk factors for depression of the elderly. However, depressive mood was less found among those patients who had spouse and who exercised regularly. Though physicians more likely recognize the depressive mood of the elderly as depression was severer, still little attention was paid to depressive mood in the elderly.

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Current State and Demand of Esophagogastroduodenoscopy Training in Family Practice Residency Programs.: Jung Han Chun, Yeong Sook Yoon, Sang Woo Oh, Eon Sook Lee, Min Gyu Kim, Young Seong Kim, Yang Hyun Kim, John Yang; J Korean Acad Fam Med 2003;24(12):1092-1098. Published online December 10, 2003

Abstract
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Background
: Most recently, there is an increased use of EGD (esophagogastroduodenoscopy) for primary care among family physicians, which tends to promote EGD training programs in the course of Family Practice Residency. This study determined to survey current status of EGD training programs among residents in family medicine, identify relevant problems, and present some suggestions for their improvement.

Methods : The subjects were residents selected among family medicine training hospitals, which were registered in the KAFM (Korean Academy of Family Medicine). The residents were in their 3rd year of training or had already completed the EGD training program. Surveys were sent out to those hospitals by mail and electronic mail surveys were performed by researchers.

Results : Among 66 subject hospitals a total of 27 surveys (40.9%) were returned. Most EGD training were performed in the department of internal medicine. The mean duration of training period was 8 weeks. The averale number of hands on experience of the procedure was 62. It was found that most residents thought that EGD training period and the number of hands on experience of the procedure were insufficient. The longer period of actual experience of the procedure and the more number of EGD caseloads they had, the more they were satisfied with their EGD training programs. It was also found that there was a high demand for a follow-up learning opportunities for EGD (p＜.05), because the residents who had already had many EGD caseloads further wanted to receive continuous education even, after they acquired license. There were no relationships observation period, period of actual experience of the procedure, and number of EGD caseloads during residency with demand for follow-up learning opportunities.

Conclusion : In summary, there was insufficient EGD training period and actual experience of the EGD procedure in family practice residency. There was low satisfaction of EGD training programs and high demand for continuous education. Therefore, it is recommended to establish EGD training program, proper practice training, and regular continuing education after completing residency.

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Recognition of tabacco health warning labelling in korean family physicians.: Tong Hyun Roh, Hong Gwan Seo, Cheol Hwan Kim, Shin Hung Kim, Mi Lyou, Eon Sook Lee; J Korean Acad Fam Med 2001;22(10):1503-1510. Published online October 1, 2001

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Background
: Tobacco health warning labelling as one of the smoking education act has been improved in many countries. But there was no change of tobacco health warning labelling after 1989 in korea. So, for the purpose to help developing new tobacco health warning labelling, we searched the recognition rate of tobacco health warning labelling in family physician and their evaluation of labels which were required form 1976 to 1988, and after 1989 in korea.
Method: Family physicians who were participated in autumn conference 2000 of the Korean Academy of Family medicine were questioned about their recognition and evaluation of tobacco health warning labelling required form 1976to 1988 and after 1989.

Results : Response rate to questionnaire was 25%(250/1000), but completely filled response rate included in study was 14.5%(145/1000). The recognition rate of tobacco health warning labelling required in 1976-1988(86.7%) was higher then after 1989(61.4%). When compared by sex, age, and smoking status, each results are similar. Respondents evaluated the tobacco health warning labelling required in 1976-1988 that the information was absolutely small and the vagueness of sentences lead smokers misconceived adverse effect of smoking, and also pointed out that the changed labelling after 1989 is not enough to transmit sufficient information. Respondents recognized that because government provided military personnel with tobacco of free charge, it decreased confidence and warning effect of tobacco health warning labelling(72.4%). Respondents answered active campaign of government against smoking would increase the effect of tobacco health warning labelling(92.4%), but the monopoly of tobacco production by government would support (local) government finance(75.9%).

Conclusion : New tobacco health warning labelling is needed to increase readability, warning, information against smoking, because present labelling is not recognized well and limited to give information against smoking.

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The opinions of doctors about korean traditional medicine and unification of medical care system.: Eon Sook Lee, Hong Gwan Seo, Cheol Hwan Kim, Il Soo Kim; J Korean Acad Fam Med 1998;19(8):662-670. Published online August 1, 1998

Abstract
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Background
: There were a lot of problems in the health care system of Korea, which was divided into Western and Korean Traditional Medicine since 1951. In 1976 WHO published program of "The promotion and development of traditional medicine'. In 1977, Korean Medical Association(KMA) asked 'unification of health care system' to government. But there was no progress because there were the lacks of mutual respect and understanding between doctors of Western and Korean Traditional Medicine. As one health care group competed with the other, so KMA proposed the unification of health system again in 1997. The objectives of this research are to analyze attitude and opinions of western medical doctors on Korean Traditional Medicine and to analyze the opinions on the unification of medical care system in Korea.

Methods : A list of western medical doctors in Seoul and Incheon was obtained form Korean Medical Association. We sampled 937 doctors by stratified random sampling method. We sent them postal questionnaires with prepaid return envelopes two times during March and April 1997. Of the 937 questionnaires, 266 replies were received. We analyzed the preference score related to referral, Korean Traditional Medicine education and unification of medical care system. We analyzed the data by Chi-square test, t-test, ANCOVA.

Results : This study shows that the western doctors have negative attitude on Korean Traditional Medicine(M=18.8, SD=5.2). They thought Korean Traditional Medicine was not reliable because it was not scientific(79.4%). Doctors, who didn't take oriental medical education, preferred unification of health care system, but it was not statistically significant. Those who experienced oriental medical education used oriental medical treatment more frequently(F=1.17, p=0.04). The more positive attitude they have about Korean Traditional Medicine, the most frequently they refered the patients to oriental medical doctors(t=3.57, p=0.0004).

Conclusion : Western medical doctors have a negative attitude on Korean Traditional Medicine. Doctors, who did not have oriental medical education, preferred unification of health care system, but it was not statistically significant. In summary, the lack of mutual respect and understanding between doctors of the Western and Korean Traditional Medicine prevent unification of medical care system.