Background
Osteoporosis and hearing impairment are known to be associated, but specific data regarding gender, bone mineral density (BMD) measurement sites, and hearing frequency ranges remain unclear. This study aimed to clarify the relationship between hearing loss and BMD in adults over the age of 50. Additionally, the study sought to determine the frequency ranges of pure tone audiometry (PTA) related to osteoporosis, identify BMD measurement sites, and investigate gender differences.
Methods
A total of 1,523 adults (651 men and 872 women) over the age of 50, who participated in a medical health check-up at a university hospital, were included. PTA was conducted to assess hearing, and BMD was measured using dual-energy X-ray absorptiometry at the lumbar vertebrae (LV) and femur.
Results
In women over the age of 50, a significant association was observed between hearing impairment and osteoporosis (P<0.01), but no such association was found in men. Lumbar BMD (L1–4) in women was significantly associated with hearing loss at 4,000 and 8,000 Hz (both P<0.05), whereas femoral neck and total femur BMD showed no significant relationship. In multiple logistic regression analysis, the odds ratio (OR) between osteoporosis and hearing threshold at 4,000 Hz (OR, 2.078; 95% confidence interval [CI], 1.092–3.954) and 8,000 Hz (OR, 2.648; 95% CI, 1.543–4.544) remained statistically significant in women after adjusting for age and other risk factors.
Conclusion
In women over the age of 50, low BMD at the LV is significantly associated with hearing impairment, particularly at the high frequencies of 4,000 and 8,000 Hz.

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  Lu Yin, Sidong Li, Yongmei He, Lin Yang, Li Wang, Chao Li, Yaqin Wang, Jing Wang, Pingting Yang, Jiangang Wang, Zhiheng Chen, Ying Li
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• Association between childhood obesity and familial salt intake: analysis of data from Korean National Health and Nutrition Examination Survey, 2014–2017
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• Association of rheumatoid arthritis and high sodium intake with major adverse cardiovascular events: a cross-sectional study from the seventh Korean National Health and Nutrition Examination Survey
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  Young Gyu Cho
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Background
Metabolic syndrome (MetS), characterized by abdominal obesity, hypertriglyceridemia, low high-density lipoprotein (HDL) cholesterol, high blood pressure, and high fasting glucose level, is a common risk factor for cardiovascular disease and associated complication. We examined the relationshipbetween the metabolic syndrome and risk of chronic kidney disease (CKD) in Korean women. Methods: We used data from 10,170 women, aged 30-89 years, who had visited the health examination center at a tertiary care hospital in 2006. The data were studied cross-sectionally. MetS was identified using the modified criteria of the National Cholesterol Education Program Adult Treatment Panel Ⅲ (NCEP-ATPⅢ). CKD was defined as an estimated GFR< 60 ml/min per 1.73 m². The multivariable-adjusted(adjustment for age, a high school education, body mass index (BMI),alcohol drinking, current and former smoking, previous coronary heart disease, menopause and physical inactivity) odds ratio of CKD (95% CI) associated with each component of the metabolic syndrome, was calculated using logistic regression models. Result: 1,039 participants developed MetS. The multivariable-adjusted odds ratios (OR) of CKD in participants with MetS, hypertriglyceridemia and high blood pressure compared with participants without those factors were 2.68 (95% CI, 1.77-4.06), 1.96 (95% CI, 1.34-2.88), 2.00(95% CI, 1.38-2.89). Compared with participants with no MetS traits, those with one, two, equal to or more than three traits of MetShad OR of CKD of 1.24 (95% CI, 0.75-2.06), 1.56 (95% CI, 0.89-2.75), 2.18 (95% CI, 1.21-3.93), respectively. Conclusion: We found that Korean women with MetS had an increased risk for developing CKD. Finally, earlier identification and management of MetS might improve patient health and prevent the progression of CKD.

Background
Recently, an elevated serum homocysteine level has been reported to be associated with increased fracture risk and reduced bone mineral density (BMD). So far, little research has been done to evaluate such association in Korean population. Therefore, we investigated the association between serum homocysteine levels and BMD in Korean adults. Methods: The subjects consisted of 2,750 adults who visited a health promotion center at a university hospital from January 2005 to March 2006. Self-administered questionnaires provided information about lifestyle and medical history. Fasting plasma samples were collected and BMD of the lumbar spine and femoral neck were obtained by dual energy X-ray absorptiometry. To adjust for menopausal state, the female subjects were divided into three groups according to age (≤45 yrs, 46∼55 yrs, 55 yrs ＜). Multiple linear regression analysis was used to evaluate the association between serum homocysteine levels and BMD in each gender and age group. Results: The results adjusted for alcohol and smoking history showed significant association between serum homocysteine levels and BMD in women (Lumbar spine: Ղ=-0.006, P=0.015, Femoral neck: Ղ=-0.065, P=0.012) but not in men (Lumbar spine: Ղ=0.001, P=0.240, Femoral neck: Ղ=0.001, P=0.242). With analyses by three age groups, plasma homocysteine level was associated with both lumbar and femoral BMD in age 46∼55 women (Lumbar spine: Ղ=-0.014, P=0.024, Femoral neck: Ղ= -0.007, P=0.019). Conclusion: Our study suggests that increased serum homocysteine level is an independent risk factor for low BMD among women, especially perimenopausal women. Further studies about the sexual differences and the mechanisms linking serum homocysteine level to BMD are needed. (J Korean Acad Fam Med 2008;29:175-181)

Background
Recently, the diagnosis of non-alcoholic fatty liver disease (NAFLD) has been made more frequently, as the use of ultrasonography on health screening has been on the rise. The aim of this study was to elucidate the relationship between NAFLD and the metabolic syndrome defined by NCEP-ATP III criteria. Methods: A total of 1,675 subjects, who attended for routine physical check‐ups, were screened. Among those, 401 subjects were selected after excluding the subjects with either significant alcohol consumption, evidence of viral or toxic hepatitis, significant liver or renal dysfunction, or overt thyroid disease. NAFLD was diagnosed if the subjects had a "bright liver" on ultrasonographic examination. The diagnosis of metabolic syndrome was made according to the criteria of NCEP-ATP III established in 2001. Results: The prevalence of NAFLD was 27.2%. Blood pressure, body weight, body mass index, waist circumference, and serum levels of total cholesterol, triglyceride, fasting glucose and liver enzymes were higher among the subjects with NAFLD than the control. The prevalence of obesity, IFG/DM, dyslipidemia and hypertension was higher in the NAFLD group. The prevalence of the metabolic syndrome was 19.2%, which was higher in the NAFLD group than the control group. The odds ratio of NAFLD for the metabolic syndrome was 6.458 (95% C.I. 3.178∼13.124). Conclusion: NAFLD was closely associated with the metabolic syndrome regardless of the presence of obesity. (J Korean Acad Fam Med 2007;28:667-674)

Background
: Reduced pulmonary function is a common outcome in pulmonary patients with reduced bone mineral density. But, there are few studies on the relationship in adult females who do not have pulmonary diseases. Thus, this study was to assess the correlation between bone mineral density and pulmonary function in healthy women.

Methods : A total of 193 subjects was selected among adult females who visited a health promotion center. BMD was measured by Dual energy X-ray absorptiometry and T-score of lumbar spine (L1-L4) was used. Pulmonary function was measured by spirometer and questionnaire survey was used to obtain information from the subjects.

Results : Mean T-score of L-spine was -0.284, FEV₁ (pred %) was 98.82% and BMI was 23.50 kg/m². The results showed positive correlation (0.128) between BMD and FEV₁ by multiple regression analysis (P＜0.05).

Conclusion : As FEV₁ of subjects increased, BMD increased in adult women who did not have pulmonary diseases.

Background
: Previous studies reported an increased risk of pancreatic cancer among diabetes patients, and fasting blood glucose level is widely used to determine the presence of diabetes mellitus. The aim of this study was to analyze the influence of fasting blood glucose level on pancreatic cancer death by a large, prospective cohort study in Korean population.

Methods : A total of 1,306,476 participants in the Korean Cancer Prevention Study (KCPS) were enrolled. A health examination including fasting blood glucose level and life style questionnaire was done as a baseline examination from 1993 to 1995, and they were followed up to 2002. Pancreatic cancer death outcome for 10 years according to the fasting blood glucose level was explored.

Results : At the beginning 63,510 (4.9%) participants had diabetes mellitus. In multivariate Cox proportional hazards models, controlling for age and current smoking, the presence of diabetes increased the risk of mortality for pancreatic cancer excluding those who died of pancreatic cancer within 1 year (Men: HR 1.7; 95% CI, 1.4∼2.1, P＜0.0001, Women: HR 1.8; 95% CI, 1.3∼2.6, P=0.0003). As fasting blood glucose level, elevated the pancreatic cancer risk was increased. Men with fasting blood glucose level≥140 mg/dL had a higher risk of pancreatic cancer than those with FBG＜100 mg/dl. (Men: HR 2.0; 95% CI, 1.6∼2.5, P＜0.0001, Women: HR 2.1; 95% CI, 1.4∼3.1, P=0.0002).

Conclusion : Elevated fasting blood glucose level increased the risk of pancreatic cancer death among Koreans.

Background
: Breastfeeding is not common in Korea despite its known benefits. The role of family physicians is important in promoting breast-feeding since they can provide prenatal and postnatal care on lifelong basis. This paper analyzed a survey of family physicians on their knowledge, attitude, experience, and training concerning breastfeeding.

Methods : The survey was carried out by e-mail enquiry to the residents and board-certified physicians registered in the Korean Academy of Family Medicine. The enquiry was developed by Gary L. Freed composed of 18 questions about knowledge, attitudes, experience, and training. The answers to the questions were analyzed to give frequency and the associations between the variables.

Results : Among the total, 64% of the residents and 76% of the physicians answered yes to whether breastfeeding was the best means of feeding an infant under 6 months of age. Also, 83% of the residents and 85% of physicians answered it was right to quit breastfeeding completely when breast abscess developed. The breastfeeding promotion was done more frequently by those who had personal experience. They had higher rate of educating patients than those who did not (28% vs. 9%, P＜0.0001). Despite its importance, 86.5% of the residents and 77.6% of the physicians answered that they did not have enough opportunity to learn about breastfeeding during their training years.

Conclusion : Although family physicians are required to play a role in promoting breastfeeding, they are insufficiently trained under the current system. Therefore, it is necessary to develop a training program to educate the residents on breastfeeding.

Background
: Obesity has been proposed as a risk factor for cardiovascular diseases. CRP has been proposed as an independent risk factor for cardiovascular diseases, and has been associated with body weight and body fatness. It has been known that weight reduction reduces CRP. We examined the hypothesis that weight loss can reduce plasma CRP levels in Korean, obese premenopausal women.

Methods : In a sample of 36 Korean obese (BMI 25.00 ∼47.02 kg/m²), premenopausal (22∼48 years) women, we measured hsCRP, plasma lipid profiles, blood glucose, body weight, body mass indexes, body fatness and intraabdominal body fat area. A 12-week weight reduction program was conducted in 36 obese women. When the program was finished, fat distribution, hsCRP and lipid profile test was repeated. The effects of weight loss on CRP levels were tested by means of paired t-test and nonparametric Wilcoxon signed rank test.

Results : We found that plasma CRP level was positively associated with body weight, body mass index, body fatness, CT-measured abdominal visceral and subcutaneous fat area. After a 12-week weight loss protocol, the average weight loss was 7.97±3.46 kg (P＜0.0001) with loss of fat mass 5.29±0.59 kg, and 1.98±1.20 kg lean body mass. Plasma CRP levels were both positively associated with plasma CRP level reductions (P=0.0437).

Conclusion : Obesity and adiposity influenced significantly on plasma CRP in Korean premenopausal women on cross sectional basis. Moreover, 12-week caloric restriction induced weight loss decreased plasma CRP levels. Weight loss represents an intervention to reduce plasma CRP and can mediate to reduce cardiovascular disease risk in Korean obese premenopausal women.

Background
: The aim of this study was to elucidate the relationship between nonalcoholic fatty liver disease diagnosed by ultrasonography and the metabolic syndrome defined by NCEP-ATP III criteria.

Methods : Sixty-nine adult male subjects with negligible alcohol consumption underwent an anthropometric and laboratory investigation. The ultrasound scan of the liver was performed to determine the presence and the severity of nonalcoholic fatty liver disease.

Results : Nonalcoholic fatty liver disease was diagnosed in 36 cases by ultrasound scan. According to the severity of nonalcoholic fatty liver, triglyceride, HDL- cholesterol, alanine aminotransferase, aspartate aminotrasnferase, fasting insulin level, HOMA-IR, and obesity related variables (body mass index, percent body fat, waist circumference) showed a significant difference. The independent variables which account for the severity of nonalcoholic fatty liver disease was waist circumference, and alanine aminotransferase which is a predictor of nonalcoholic steatohepatitis. The prevalence of metabolic syndrome was 41% vs 6.1% in nonalcoholic fatty liver group vs control group, respectively, and the odds ratio was 11.1 (95% CI 2.29∼53.6). The prevalence of nonalcoholic fatty liver was increased with increasing the number of features of metabolic syndrome.

Conclusion : Nonalcoholic fatty liver disease was closely related to the metabolic syndrome and the severity classification of nonalcoholic fatty liver by ultrasound scan could be useful to predict of the severity of insulin resistance, and the risk of nonalcoholic steatohepatitis.

Background
: Korea is a highly prevalent area of isolated anti-HBc with a rate of 15%, but there is neither vaccination nor management guideline agreed. To know the management for Hepatitis B Vaccination for adults with isolated anti-HBc, we investigated immune response to hepatitis B vaccination in adults with isolated anti-HBc.

Methods : The 23 adults with persistent isolated anti-HBc, who visited a health promotion center from Dec. 1998 to Aug. 1999, were vaccinated with Hepavax^±-B by the standard schedule (0, 1, 6 month) and anti-HBs titers were measured 1 month after 1st and 3rd vaccinations (1, 7 month).

Results : After the 1st vaccination, 18 (78.26%) developed anti-HBs seroconversion. Among them, 4 (17.39%) had titers of 10∼49 mIU/ml, 8 (34.78%) 50∼99 mIU/ml, and 6 (26.09%) more than 100 mIU/ml. All non-responders after the 1st vaccination remained as such even with 3 doses of complete vaccination. The majority of seroconverted group did not show more anti-HBs response with further vaccination.

Conclusion : Since none of adults with isolated anti-HBc had a primary response, which indicated few false positive results. Therefore they should be excluded on vaccination programs in Korea. To differentiate between immunity and occult infections, a single dose of vaccine with a follow-up anti-HBs test is preferable for adults with isolated anti-HBc. If the test shows a seroconversion it would indicate protective immunity, if not, then occult infection may be suspected.

Background
: Urinary incontinence has a negative impact on the lifestyle of sufferers, affecting not only their physical condition but also their well-being. But only few patients visit doctors for treatment. The purpose of this study was to measure the quality of life in women with urinary incontinence.

Methods : Among the people who visited a tertiary hospital in Seoul for a health exam or primary care during April 2002, we selected 161 women over 20 years old. We measured their quality of life by the Medical Outcomes Study (MOS) 36-Item Short-Form Health Survey (SF-36) questionnaire. Excel 2000 statistical program was used for statistical analysis.

Results : The active incontinence group, who experienced urinary incontinence within 1 year, were 48 women and the normal group without urinary incontinence at all were 65 women. The average SF-36 score was 76.5 in total women, 69.0 in active incontinence group, and 81.5 in normal group. The percentage of those seeking treatment was 10.4% and 64.6% of women have never sought help.

Conclusion : These results suggest that the incontinent patient had a much lower quality of life than normal women, but there were only few patients who sought treatment.

Background
: As the population with chronic degenerative disease or functional impairment has increased in terms of the advanced aging society, the inevitability of home health services for the homebound have been augmented as a token of the trend toward the nuclear family along with the family capacity of care declined. For the past several years, home nursing service facilities have been enlarged and partially have been fulfilling these requirements. However, there are a great number of demands for home health service by physicians. Thereupon, we designed the following study to observe the cases of home visits by a medical office practice and to provide some information about the need of the home visit and its clinical features.

Methods : The study was conducted reviewing currently remained 84 data of home visit records at a home-visit- specialized medical office practice for 10 months in 1999. Its information collected was as below: patient's sex, age, frequency and duration of visit, distance to visit location, reason being homebound, and reason for visit.

Results : Of the reviewed records of 84 patients, comprised of 356 home visits, the median age of the patients was 67.5 years. They were visited 2 times as a median and with a median duration of 4 days. Physician drove a median distance of 6.1km one-way. Most common diagnoses were cancer and cerebrovascular diseases, equally with 10.8%. Reasons for being homebound were neurologic problem (28.6%), frail elderly (21.4%), terminal illness (20.2%) in order. Sixty two patients (73.8%) were permanently homebound and 12 patients (14.3%) were not. Reasons for visits were routine follow-up (42.1%) and evaluation of a new problem (19.9%) in the chronic homebound and terminal illness care (17.1%). While 102 visits (28.6%) should have begun by doctor-based visit, 233 visits (65.4%) including routine follow-up could be considered to be replaced for home nursing services. Even out of 233 visits, not all could be replaced and some should remain as physician's regular follow-up.

Conclusion : There were needs of home visit in both permanent and transient homebound patients, in cases of exacerbation, new problem and routine follow-up of chronic homebound patients, and also in acute illness of previously healthy persons. To meet the needs of homebound patients in seeing the physician, and to offer adequate health services, the physician's role should be acknowledged in home nursing service, and home visit by physician should be institutionalized and carried into effect.

Background
: Comprehensive geriatric assessment is identified as a dynamic process responsive to the changes on health status that occurs over time in the context of extremely increasing trend in the numbers of the elderly people, their office visit, and the medical cost universally. We completed the comprehensive geriatric assessment and applied it to the Korean elderly through the multi-center trials.

Methods : We performed studies variables using questionnaires, with interviewing, physical examination to number of total 312 elderly people who visited the department of family medicine or physical medicine and rehabilitation of the 11 university hospital or general hospital in Korea from July 1, 1999 through October 31, 1999. We, the geriatrician, met and discussed 3 times to complete the comprehensive geriatric assessment through the consensus panel.

Results : We found the sex ratio of 312 subjects was 1 to 2 (104 males and 208 females) and the average age was 73.2 years old. The orders of more frequency of self-reported health status of the respondents were hypertension, arthritis, cataract, gastrointestinal disturbance, diabetes mellitus, urinary/fecal incontinence, depression, cerebrovascular accident, anemia, and heart disease. Nearly 15% of those showed depression 41.6% of those were in the status of socially isolation. We found 43.1% of those showed hypertension, 3.7% isolated systolic hypertension, and 20.2% orthostatic hypotension. Of those, cognitive impairment were measured in 37.1%, gait disturbance 13.0%, and the risk of malnutrition 39.6%. Geriatrician spent 21.1 minutes per person during the process of comprehensive geriatric assessmnet.

Conclusion : We realized we could diagnose and intervene effectively certain hidden conditions/ diseases, particularly urinary incontinence, falls, visual impairment, hearing impairment, pain, depression, social isolation, cognitive impairment, and orthostatic hypotension, with using the comprehensive geriatric assessment. These results reflected the fact that the comprehensive geriatric assessment might be necessary for the care of the elderly.

Background
: The prevalence of dementia is estimated to be as high as 5-10% over 65 years of age in Korea. it is important to evaluate of dementia for the elderly, Because of the chronicity and progressiveness of the disease. However, cognitive impairment often goes unrecognized by physician because the many previous tools to evaluate cognitive function in the clinical setting are complex, time-consuming and sometimes questionable correlation with real world functioning. The purpose of this study is to assess the usefulness of T도 Time and Change test as screening test for dementia, on the basis for the correlation between this measure(T&C) and MMSE-K.

Methods : The subject for this study consisted of 64 elderly who visited to the outpatient depa-rtment of family medicine of the Ehwa Mok-dong hospital or Elderly Welfare Center in Seoul. They received the T&C test and MMSE-K examination. Sensitivity, specificity, negative predictive value, and Pearson' Correlation coefficient were calculated using standard formulas.

Results : The T&C had a sensitivity of 505, a specificity of 88%, a positive predictive value of 60%, a negative predictive value of 77%, respectably. when timed cutpoints were added, The T&C test had a sensitivity of 95%, specificity of 83%m a positive predictive value of 75%, a negative predictive value of 97%. respectivaly.

Conclusion : The Time and Change(T&C) tests can be an effective, simple and performance based tool to recognize dementia. Further validation with a representative elderly sample is needed to establish screening value in primary care of community populations.

Background
: Brief intervention with problem drinkers have been shown to be effective, but physicians often do not ask about alcohol use because of time constraints and lack of knowledge. If a single question can be used to screening for problem drinker effectively, primary care physicians could detect problem drinker earlier and reduce future complication and morbidity. The purpose of this study was to evaluate the usefulness of single-question.

Methods : One family medicine’s resident interviewed 163 patients who visited Dongdaemun Hospital’s Health care management center of Ewha Woman’s university from January 27th 1999 to February 26th 1999, and the patients answered the written forms of questionnaires. This written forms contained the followings: (1) age, sex, education, income level, occupation, smoking, drunken driving, (2) “On any single occasion during the past 3 months have you had more than a bottle of Soju or three bottles of beer or five glasses of whisky?” (3) CAGE, NAST test, Quantity of alcohol was determined by the calendar-based review in the past 4 weeks. At-risk drinker defined as drinking more than 56g on one occasion, or more than 196g of pure alcohol during a week for men; more than 42g on one occasion, or more than 96g of pure alcohol during a week for women. Also alcohol use disorder was defined by the DSM-IV criteria and problem drinker was defined as either at-risk drinker or a alcohol use disorder.

Results : The single question had a positive predictive value of 82.2%, and negative predictive value of 95.5% with a sensitivity of 93.8% and a specificity of 86.9% for problem drinkers.

Conclusion : A single question about alcohol-use would be a effective tool for detecting problem drinker.

Background
: Upper respiratory infection account for many of the visits in primary care. As most URIs are caused by viruses, antibiotic therapy is not desirable. However, for URI treatment antibiotic therapy is commonly used, which causes many public health proplems such as drug-resistant becteria and high medical cost. This paper examines patient knowledge of the normal presentation of a URI, beliefs in the effectiveness of antibiotics and health care utilzation.

Methods : A survey of 200 outpatients or their families was conducted in one university hospital from March to April, 1998. Two URI conditions were given for the survey:(1) a condition of 5 days' duration with cough, sore throat, and clear nasal discharge (question 1), (2) a condition of the same symptom as (1) except discolored nasal discharge (question 2). For various questions in each of these conditions they were to answer in 5 point Likert-type scale. Statistical softwares of SAS 8.0 and GAUSS 3.21 were used for analyzing the survey data.

Results : For question 1, 61% of the sample reported that they would seek care from a physician while for question 2, 75% of the sample reported that they would do so (p<0.1). the health service suppliers, in the order of visiting frequencies, were pharmacy (58%), hospital (38%), no visit (2.5%), public health center (0.5%), and Chinese medicine clinic (0.5%) for question 1 and pharmacy (54%), hospital (42%), no visit(2%), Chinese medicine clinic(0.5%) and public health center (0.0%) for question 2. For question 1, 54% of the sample and for question 2, 63% reported that they believe antibiotics were effective (p=.068). For question 1, 79.5% and for question 2, 89.5% of the subjects reported that they had complied to prescriptions of doctors or pharmacists (p<0.05). Out of those subjects, only 19.5% for question 1 and 21.2% for question 2 reported that they checked the presence of antibiotics in the prescriptions. A multivariate analysis shows that older people, normally used antibiotics and current smokers had higher tendency of seeking care and stronger beliefs in the effectiveness of antibiotics.

Conclusion : There is a lack in patient understanding of normal presentation of a URI and the effectiveness of antibiotics as a treatment. A confusion about the meaning of discolored nasal discharge is particularly evident. The patients visited pharmacies more often than hospitals, and majority of them (80%) did not know the details of their prescriptions.

Background
: Hypertension, diabetes, hyperlipidemia and coronary heart disease are closely related to obesity. Recently incidence of such diseases are remarkably increased. Many researches have been done to find out to implement prevention and treatment of such diseases. Abdominal obesity is one of the most important contributing factors of metabolic complication. This study was done to compare indicators of obesity with abdominal fat amount which was measured by anthropometric parameter and computed tomogram, and to find correlation between the risk factors of atherosclerosis and the indicators of obesity.

Methods : Fifty nine healthy premenopausal women without diabetes, coronary heart diseases or history of other chronic disease were enrolled. Blood pressure and simple anthropometric parameter were measured. Computed tomograms in umbilical and femoral regions were performed. From serial blood samples, plasma fasting glucose and insulin, cholesterol and triglyceride were measured and atherogenic index was calculated.

Results : The ratio of visceral fat area and skeletal muscle area at the mid-thigh level was found to be highly correlated(R=0.965, p<0.001) and atherogenic index showed similar patterns to the waist circumference, the waist/height ratio and the waist/hip ratio. Especially, the waist/height ratio was found to be the most reliable indicator of obesity to predict atherogenic index.

Conclusion : Although the ratio of visceral fat and skeletal muscle area at the mid-thigh level which is measured by computed tomogram was the best indicator of visceral fat, these results proved that waist circumference and the waist/height ratio were also good indicators of the risk factors of atherosclerosis. By simple anthropometric measurements, it can help to find the remedy and prevention of obesity in practices.

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
: The waist/hip ratio is an useful index of abdominal obesity, but it includes two variables which may result in a false interpretation. The purpose of this study is to evaluate the usefulness of waist/height ratio as a predictor for the risk factors of coronary artery disease(CAD).

Methods : 1395 persons(818 men & 577 women) were selected as subjects who visited the Health Examination Center at Ewha Mokdong Hospital from October 1996 to March 1997. Waist circumference was measured at the level of umbilicus with standing position. Hip circumference was measured at the level of the largest circumference of the hip. We set the criteria of the risk factors as hypertension(systolic BP≥140mmHg and/or diastolic BP≥90mmHg), glucose intolerance(fasting blood glucose≥115mg/dl), hypertriglyceridemia(>160mg/dl), hypercholesterolemia(≥200mg/dl), and low HDL-cholesterol level(<35mg/dl). The morbidity index of CAD was calculated by the sum of the risk factor scores(one point per item if present).

Results : There was significant correlation between waist/height ratio, waist/hip ratio and body mass index(BMI)(p=0.0001). BMI had more strong correlation with waist/height ratio(r=0.81) than waist/hip ratio(r=0.48). According to the simple regression analysis, BMI, waist/hip ratio and waist/height ratio had significant correlation with all of the risk factors and the morbidity index. According to the multiple regression analysis, waist/height ratio had significant correlation with age, weight, height, systolic BP, triglyceride, cholesterol and HDL-cholesterol. The risk factor morbidity index of the groups with waist/height ratio over 0.45 was significantly more higher than the group of the lowest risk factor morbidity index(waist/height ratio under 0.4) in men(p=0.01). For women, 0.46 was the level which the risk factor morbidity index increased significantly(p<0.01).

Conclusion : Waist/height ratio can be a useful index of abdominal obesity. And it may be used as a more easier and better predictor of multiple CAD risk factors than waist/hip ratio. We can predict that waist/height ratio over 0.45 in men and over 0.46 in women may have more higher coronary artery disease risk.

Background
: Korea is an endemic area of viral hepatitis B with a rate of 5~10% carrier state. Therefore, hepatitis B vaccination is performed nationwide. But 5~15% of health individuals fail to respond adequately to the vaccine and an approved guideline for the nonresponders has not been developed yet. This study is designed to identify risk factors for those who lack anti-HBs after hepatitis B vaccination and to document the results of a double-dose revaccination in such nonresponders to the primary vaccination.

Methods : From Feb. 1996 to Aug. 1997, we assessed 51 healthy subjects(HBs Ag negative, anti-HBs negative, anti-HBs negative and a normal LFT). All subjects were vaccinated with Hepavax-B® 1.0ml, 24 by a rapid schedule(0, 1, and 2 months) and and 27 by a standard schedule(0, 1, and 6 months). Anti-HBs titers were evaluated 3 months after the third vaccine and assessed the nonresponders(anti-HBsTiter < 2mIU/ml) and the hyporesponders(2~10 mIU/ml). All 13 nonresponders were revaccinated with 2 ml of Hepavax-B 3 months after the primary vaccination. Anti-HBs titers were evaluated 1 month later.

Results : The difference in age(p<0.01) and smoking amount(p<0.05) between the responders andhe hypo and the nonresponders were statistically significant. There were more males and higher body mass index in the hypo and the nonresponders but not statistically significant. The seroconversion rate after the double-dose vaccination was 92.3%(12/13) with an average titer of 58.08 mIU/ml(1~132.4 mIU/ml).

Conclusion : Increase in age and smoking amount were the risk factors of the nonresponders after the primary vaccination. Most of the hypo and the nonresponders to the primary vaccination responded adequately to the double-dose revaccination.

Background
: Research is essential for the development of family medicine as a professional field in primary care, Since information is available through the articles in the Journals of Family Medicine which contain subjects such as disease mechanism, pathophysiology, drug or new treatment method, and it is necessary to evaluate the contribution of recent researches in this field. The paper is intended to evaluate the current status of the quality of papers published in the Journal of the Korea Academy of Family Medicine (below JKAFM) and provide statistical data & direction of studies in the future.

Methods : 1218 articles in 185 editions of JKAFM were analyzed among 188 editions published from Nov.1980 to Dec. 1996. The papers were classified into Case Report, Original Article, Review Article by the type of papers, and then categorized into descriptive studies, analytic studies, and clinical trials by its methodology. In each category, the papers were stratified by the topic. Also, the analysis was conducted according to the authors, research subjects, sampling methods and the statistical methods, and observed the changes each year through 1980s to 1990s.

Results : The portion of original articles has increased from 18.6% in 1980s to 73.9% in 1990s. In terms of research methodology, the portions of analytical studies and clinical trials occupy 28.8% and 2.1% in 1990's respectively, compared with those of 1.8% and 0.6% in 1980's. When the papers were stratified by study topics, topics on family medicine showed the highest of 34.9% of the total. According to the detailed stratification, the principle of family medicine recorded 24.2%. In terms of sampling method, 89% and above was from the clinical data when current data were used, and 69.1% was by questionnaires when the data were newly collected. The most of the study subjects were outpatients of family medicine departments. The portion of papers in which the statistical analysis was not included was 29.9% in 1980s which decreased to 15.7% in 1990s. In terms of the statistical analysis methodology, the Chi-square test was the most frequently used(26.2%), followed by Descriptive(19.6%), t-test(18.2%) and ANOVA(8.7%) were the next.

Conclusion : The academic performance of family medicine can be most effectively measured by the analysis of the journals on family medicine. According to the analysis, the papers based on clinical activity is increasing in recent years with substantial contribution, which means that the field of family medicine has found its own position in medical science and is developing actively. In terms of study methodology, the portion of analysis study is getting larger, and the various method are being tried. The application of statistical methods is being developed in its quality and quantity. It should be noted that research on family medicine should provide the basis for new knowledge and promote public health by the integrated and intensive efforts.

Background
: The functional dyspepsia gives rise to such a symptom similar to peptic ulcer without showing a noticeable lesion(e.g, gastric or duodenal ulcer) by endoscopy or upper GI serises, and it has been known that this is about twice as many as the peptic ulcer. However, there is no exact theory about its pathophysiology and it is suggested that multiple factors including genetic, physiologic, psychologic, environmental factors are engaged. Especially, in respect to the occurrence of functional dyspepsia and psychological factors, there have been many clinical studies over the world. But, we still need more studies in this country, therefore, this study has been initiated to give help patients of functional dyspepsia, investigating their characteristic traits through MMPI.

Methods : From March to September in 1996, the patients who visited the family medicine out-patients department of St. Mary's hospital of Catholic Medical College were sampled in this study. There were 46 patients having a similar symptoms to peptic ulcer without showing pathologic lesions by endoscopy. Through an interview and some basic tests, the 41 controls who had no dyspeptic symptoms and were not affected to a noticeable physical or physiological disorders were selected for the normal reference group. The standardized MMPI of our country was applied to the whole object groups to get a result. Then each average value were analyzed by the t-test and chi-square test. And the psychological pattern analysis was done.

Results : In demographic aspects, there were no significant differences between the two groups. The mean T score for each measure of the two groups falls within the normal ranges with their values being of between 30 to 70. And the average of L, F and K measure, known as the validity measure, did not give a significant differences between the two groups. The measure of Hs, D, and Hy have appeared significantly high in the patients group(p<0.01) and the Pd measure, too(p<0.05). While Mf, Pa, and Ma measure have not shown a significant differences, Pt, Sc, and Si measure have very significant differences(p<0.01).

Conclusion : In the patient group with the functional dyspepsia, the measures of Hs, D, and Hy where they indicate a neurotic pattern have shown a very significantly high point as well as those of Pd, Pt, Sc, and Si where they indicate a psychotic pattern. This reveals that in the group of the functional dyspepsia neurotic or psychotic trends to attribute. However, it is very hard to define the characteristics of a group with just on test, so further study with more variable test will be necessary.