Frequency and Severity of Hypoglycemia in Type 2 Diabetes Mellitus Patients Treated with a Sulfonylurea-Based Regimen at University-Affiliated Hospitals in Korea: The Naturalistic Evaluation of Hypoglycemic Events in Diabetic Subjects Study / 가정의학회지

BACKGROUND: We assessed the frequency and severity of hypoglycemia in type 2 diabetes mellitus patients treated with sulfonylurea monotherapy or sulfonylurea+metformin. METHODS: We conducted a retrospective, observational, cross-sectional study in 2011 and 2012 including patients with type 2 diabetes mellitus aged ≥30 years who were treated with ≥6 months of sulfonylurea monotherapy or sulfonylurea+metformin at 20 university-affiliated hospitals in Korea. At enrollment, glycated hemoglobin (HbA1c) was assessed; participants completed self-reported questionnaires describing hypoglycemia incidents over the past 6 months. A review of medical records up to 12 months before enrollment provided data on demographics, disease history, comorbidities, laboratory results, and drug usage. RESULTS: Of 726 enrolled patients, 719 were included (55.6% male); 31.7% and 68.3% were on sulfonylurea monotherapy and sulfonylurea+metformin, respectively. Mean±standard deviation age was 65.9±10.0 years; mean HbA1c level was 7.0%±1.0%; 77.8% of patients had hypertension (89.4% used antihypertensive medication); 60.5% had lipid disorders (72.5% used lipid-lowering medication); and 52.0% had one or more micro- or macrovascular diseases. Among patients with A1c measurement (n=717), 56.4% achieved therapeutic goals (HbA1c <7.0%); 42.4% (305/719) experienced hypoglycemia within 6 months of enrollment; and 38.8%, 12.9%, 12.7%, and 3.9% of patients experienced mild, moderate, severe, and very severe hypoglycemia symptoms, respectively. Several reported hypoglycemia frequency as 1–2 times over the last 6 months. The mean number of very severe hypoglycemia episodes was 3.5±5.5. CONCLUSION: Among type 2 diabetes mellitus patients treated with sulfonylurea-based regimens, glycemic levels were relatively well controlled but hypoglycemia remained a prevalent side effect.

Associations between atherosclerosis and periodontitis, physical health and dental care: a pilot study / 대한구강보건학회지

OBJECTIVES: This pilot study aimed to obtain preliminary data on the associations between atherosclerosisand periodontitis, physical health status, and general and oral health behaviors. METHODS: Thirty-three subjects were recruited from among those who underwent carotid computed tomography (CT) angiography and general health check-up at the Seoul National University Hospital Health Examination Center (SNUHHEC). Two trained dentists conducted a periodontal examination to evaluate probing pocket depth and clinical attachment loss. A self-administered questionnaire was completed by study subjects, following informed consent. Data on physical health status were collected through review of medical records from the SNUHHEC. Information on general health behavior was obtainedfrom the self-reported questionnaire. Descriptive and comparative analyses were performed using IBM SPSS Statistics 21.0®. Statistical significance was set at P<0.05. RESULTS: A marginal, but non-significant association was noted between atherosclerosis and periodontitis(P=0.373). Flossing habit showed a significant association with periodontitis (P=0.007) and obesity (P=0.033). A possible association was noted between daily exercise and flossing (P=0.073). The habitual use of interdental brush also showed borderline association with smoking (P=0.098) and a stronger associationwith previous periodontal treatment (P=0.067); however, these associations were not statisticallysignificant. CONCLUSIONS: Our pilot study did not show an association between arteriosclerosis and periodontal disease.However, positive oral health care behavior, especially flossing, seems to alleviate arteriosclerosis. In other words, in this pilot survey, we confirmed the possibility that healthy oral care behavior can help to alleviate arteriosclerosis. Future large-scale studies are needed to confirm whether positive oral health care behaviors improve overall health.

Prediction of cardiovascular disease in Korean population: based on health risk appraisal of national health screening program

Health risk appraisal (HRA) is a systematic approach for collecting information regarding individual risk factors, predicting the probability of disease occurrence and death, and linking patients with interventions to promote health and prevent disease. Because the risk factors of cardiovascular disease are well established, several cardiovascular disease risk prediction models have been developed over multiple decades. The health risk appraisal prediction model of the Korean national health screening program will be revised and updated using the latest well-validated studies to reflect the current characteristics of the Korean population and to improve the effectiveness of education and behavioral modifications. It is necessary to provide various tools such as a web page and smartphone application to increase the utility of this program in the future.

Genome-Wide Association Study of Bone Mineral Density in Korean Men

Osteoporosis is a medical condition of global concern, with increasing incidence in both sexes. Bone mineral density (BMD), a highly heritable trait, has been proven a useful diagnostic factor in predicting fracture. Because medical information is lacking about male osteoporotic genetics, we conducted a genome-wide association study of BMD in Korean men. With 1,176 participants, we analyzed 4,414,664 single nucleotide polymorphisms (SNPs) after genomic imputation, and identified five SNPs and three loci correlated with bone density and strength. Multivariate linear regression models were applied to adjust for age and body mass index interference. Rs17124500 (p = 6.42 × 10⁻⁷), rs34594869 (p = 6.53 × 10⁻⁷) and rs17124504 (p = 6.53 × 10⁻⁷) in 14q31.3 and rs140155614 (p = 8.64 × 10⁻⁷) in 15q25.1 were significantly associated with lumbar spine BMD (LS-BMD), while rs111822233 (p = 6.35 × 10⁻⁷) was linked with the femur total BMD (FT-BMD). Additionally, we analyzed the relationship between BMD and five genes previously identified in Korean men. Rs61382873 (p = 0.0009) in LRP5, rs9567003 (p = 0.0033) in TNFSF11 and rs9935828 (p = 0.0248) in FOXL1 were observed for LS-BMD. Furthermore, rs33997547 (p = 0.0057) in ZBTB and rs1664496 (p = 0.0012) in MEF2C were found to influence FT-BMD and rs61769193 (p = 0.0114) in ZBTB to influence femur neck BMD. We identified five SNPs and three genomic regions, associated with BMD. The significance of our results lies in the discovery of new loci, while also affirming a previously significant locus, as potential osteoporotic factors in the Korean male population.

Relationship between Metabolic Syndrome and Rheumatoid Arthritis / 가정의학회지

BACKGROUND: Rheumatoid arthritis (RA) and metabolic syndrome (Mets) are considered to be diseases with common traits that can increase the risk of cardiovascular disease incidence; studies in other countries examined the relationship between these diseases. However, existing studies did not show consistent results. In the present study, the relationship between RA and Mets in Koreans was examined using the data of the 4th and 5th Korea National Health and Nutrition Examination Survey (KNHANES). METHODS: The present study used the data of the 4th and 5th KNHANES, conducted between 2007 and 2012. Among 25,812 adults aged over 40, 19,893 were selected as study subjects, excluding 5,919 who did not have variable information needed for the analysis. T-test and chi-square test were used for the analysis of related variables. To determine the relationship between diagnostic status of RA and Mets, multivariate logistic regression analysis was performed by controlling confounding variables, which were selected through literature review and statistical analysis. RESULTS: Multivariate logistic regression analysis was conducted to examine the relationship between diagnostic status of RA and Mets. When age, education level, average monthly household income, smoking, alcohol consumption, and level of physical activity were adjusted, the prevalence of Mets was lower in RA patients (adjusted odds ratio [aOR], 0.79; 95% confidence interval [CI], 0.65 to 0.96). Multivariate logistic regression analysis was performed to examine the relationship between treatment status of RA and Mets. When age, education level, average monthly household income, smoking, alcohol consumption, and level of physical activity were adjusted, there was a significant negative correlation in women (aOR, 0.65; 95% CI, 0.44 to 0.96). CONCLUSION: The relationship between RA and Mets showed a significantly negative correlation in Korean women. The group that received RA treatment showed significantly lower prevalence of the Mets as compared to the untreated group in Korean RA women.

The Current Status of End-of-Life Care in Korea and Legislation of Well-Dying Act

Recently, the Well-dying Act was legislated in Korea, and it will come into force in 2018. The rapid aging of this society has made many older patients and their families suffer from pain and disability for a long time towards the end of life. Hospice care, when compared to life-sustaining treatment, can relieve such burdens. Regarding the decision of choosing hospice care at the end of life, advance care planning and advance directives can help people express their preference beforehand. In Korea, hospice care is still not actively used and most patients endure life-sustaining treatment until death. Many patients want hospice care, but there has not been a legal basis for such a decision, leading to social conflict and many legal problems. The Well-dying Act will provide a legal basis for such a decision. This will help establish and promote hospice care in Korea. However, sufficient discussion and preparation are required before enforcing the Act.

Terminal Versus Advanced Cancer: Do the General Population and Health Care Professionals Share a Common Language? / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Many end-of-life care studies are based on the assumption that there is a shared definition of language concerning the stage of cancer. However, studies suggest that patients and their families often misperceive patients' cancer stages and prognoses. Discrimination between advanced cancer and terminal cancer is important because the treatment goals are different. In this study, we evaluated the understanding of the definition of advanced versus terminal cancer of the general population and determined associated socio-demographic factors. MATERIALS AND METHODS: A total of 2,000 persons from the general population were systematically recruited. We used a clinical vignette of a hypothetical advanced breast cancer patient, but whose cancer was not considered terminal. After presenting the brief history of the case, we asked respondents to choose the correct cancer stage from a choice of early, advanced, terminal stage, and don't know. Multinomial logistic regression analysis was performed to determine sociodemographic factors associated with the correct response, as defined in terms of medical context. RESULTS: Only 411 respondents (20.6%) chose "advanced," while most respondents (74.5%) chose "terminal stage" as the stage of the hypothetical patient, and a small proportion of respondents chose "early stage" (0.7%) or "don't know" (4.4%). Multinomial logistic regression analysis found no consistent or strong predictor. CONCLUSION: A large proportion of the general population could not differentiate advanced cancer from terminal cancer. Continuous effort is required in order to establish common and shared definitions of the different cancer stages and to increase understanding of cancer staging for the general population.

Physical Activity Level of Korean Adults with Chronic Diseases: The Korean National Health and Nutritional Examination Survey, 2010-2012 / 가정의학회지

BACKGROUND: Proper physical activities are known to be helpful in the prevention and management of chronic diseases. However, the physical activity level of patients with chronic diseases is low. Therefore, this study aimed to investigate the physical activity compliance of patients with hypertension, diabetes, and dyslipidemia in Korea. METHODS: This study analyzed the 2010-2012 Fifth Korean National Health and Nutrition Examination Survey data. We included 13,873 individuals in the analysis. The level of physical activity compliance was measured by performing multivariate logistic regression analyses. RESULTS: In the univariate analysis, the subjects with hypertension or diabetes tended to comply with the physical activity guidelines less faithfully than their healthy counterparts. The proportion of subjects with hypertension who were insufficiently physically active was 65.4% among the men and 75.8% among the women. For diabetes, the proportions were 66.7% and 76.8%, respectively. No significant difference was found between the subjects with dyslipidemia and their healthy counterparts. In the multivariate logistic regression analysis, no significant difference in physical activity compliance was observed between the subjects with hypertension, diabetes, or dyslipidemia and their healthy counterparts for both sexes. CONCLUSION: The patients with hypertension or diabetes tended to have lower physical activity prevlaence than their healthy counterparts. However, for dyslipidemia, no significant difference was found between the two groups. Given the significance of physical activities in the management of chronic diseases, the physical activities of these patients need to be improved.

The Effect of Asthma Clinical Guideline for Adults on Inhaled Corticosteroids PrescriptionTrend: A Quasi-Experimental Study

In order to increase inhaled corticosteroid (ICS) use and to reduce hospitalization, emergency department visits and ultimately the economic burden of asthma, "Korean Asthma Management Guideline for Adults 2007" was developed. To assess the guideline effects on physician's ICS prescription for asthma, we conducted segmented regression and multilevel logistic regression using National Health Insurance claims database of outpatient visits from 2003 to 2010. We set each quarter of a year as a time unit and compared ICS prescription between before and after guideline dissemination. A total of 624,309 quarterly visits for asthma was observed. The ICS prescription rate before and after guideline dissemination was 13.3% and 16.4% respectively (P < 0.001). In the segmented regression, there was no significant guideline effect on overall ICS prescription rate. In multilevel logistic regression analyses, the effect of guideline on overall ICS prescription was not significant (odds ratio, 1.03; 95% CI, 1.00-1.06). In subgroup analysis, ICS prescription increased in secondary care hospitals (odds ratio, 1.15; 95% CI, 1.02-1.30) and in general hospitals (odds ratio, 1.10; 95% CI, 1.04-1.16). However, in primary clinics, which covered 81.7% of asthma cases, there was no significant change (odds ratio, 0.98; 95% CI, 0.94-1.02). From the in-depth interview, we could identify that the reimbursement criteria of the Health Insurance Review and Assessment Service and patient's preference for oral drug were barriers for the ICS prescription. The domestic asthma clinical guideline have no significant effect on ICS prescription, especially in primary clinics.

Effects of the 2008 Global Economic Crisis on National Health Indicators: Results from the Korean National Health and Nutrition Examination Survey / 가정의학회지

BACKGROUND: The relationship between economics and health has been of great interest throughout the years. The accumulated data is not sufficient enough to carry out long-term studies from the viewpoint of morbidity, although Korea National Health and Nutrition Examination Survey (KNHANES) was carried out yearly since 1998 in Korea. Thus, we investigated the effect of the 2008 global economic crisis on health indicators of Korea. METHODS: Health indicators were selected by paired t-test based on 2007 and 2009 KNHANES data. Age, gender, body mass index (BMI), smoking, drinking, exercise, education, income, working status, and stress were used as confounding factors, which were analyzed with logistic and probit analyses. Validation was done by comparing gross domestic product (GDP) growth rates and probit analyses results of 2007-2012 KNHANES data. RESULTS: Among several health indicators, the prevalence of hypertension and stress perception was higher after the economic crisis. Factors related with higher hypertension prevalence include older age, male gender, higher BMI, no current tobacco use, recent drinking, lower education levels, and stress perception. Factors related with more stress perception were younger age, female gender, current smoking, lower education levels, and lower income. GDP growth rates, a macroeconomic indicator, are inversely associated with hypertension prevalence with a one-year lag, and also inversely associated with stress perception without time lag. CONCLUSION: The economic crisis increased the prevalence of hypertension and stress perception. In the case of GDP growth rate change, hypertension was an inversely lagging indicator and stress perception was an inversely-related coincident indicator.

Regional Factors Associated with Participation in the National Health Screening Program: A Multilevel Analysis Using National Data

High participation rates are important for maximizing the effects of a health screening program. Previous studies have suggested that individual or regional characteristics have effects on health behaviors. In this study, we investigated the determinants of participation in the National Screening Program for Transitional Ages by simultaneously analyzing individual and area-level factors by multilevel analysis. A total of 1,081,216 subjects, aged 40 and 66 yr and nested in 254 areas, were included. There was a significant variation in participation rates across the areas even after adjusting for individual and area-level variables. Among the individual-level variables, increasing age, sex, higher income, and mild disability grade were associated with a higher participation rate. In urban areas, the 40-yr-old group had higher participation rates than the 66-yr-old group. Deprived areas had significantly high participation rates for both age groups. The number of screening centers per 1,000 inhabitants had no significant effect on participation in the screening program. In conclusion, regional characteristics are associated with participation rates independent of personal features and regional factors have differential effects with respect to age. A multi-dimensional approach is recommended to promote participation in health screening programs.

Association of Health Risk Behaviors with Mental Health among Elderly Koreans

BACKGROUND: Korea is currently experiencing a rapid aging of its population. With regards to healthy aging, a mental health status is an important factor in the elderly. The purpose of our study was to investigate the prevalence of mental health problems (depression symptoms, anxiety symptoms, poor quality of life) and to examine the relationships between health behaviors and mental health status. METHODS: The data were collected from the Korean Longitudinal Study on Aging, which was designed to compile information on several aspects of aging for use, as a basic statistical data in interdisciplinary research. A total of 5,548 elderly aged 60 years or older were included in this descriptive cross-sectional study. The results were examined with multiple logistic regression analysis. RESULTS: The prevalence of depression, anxiety experience, and poor quality of life was 40.8%, 29.9%, and 54.6%, respectively. Current smoking was significantly associated with the risk of anxiety symptoms and poor quality of life (adjusted prevalence odds ratio [POR], 1.24; 95% confidence interval [CI], 1.02 to 1.52 and adjusted POR, 1.34; 95% CI, 1.12 to 1.60, respectively). Also, not exercising regularly was significantly associated with all of the mental health problems (depression and anxiety symptoms, and poor quality of life), which were measured in this study (adjusted POR, 1.31; 95% CI, 1.14 to 1.51 and adjusted POR, 1.39; 95% CI, 1.19 to 1.62 and adjusted POR, 1.45; 95% CI, 1.27 to 1.65, respectively). CONCLUSION: Elderly Koreans with health risk behaviors are likely to be vulnerable to mental health concerns. This finding underscores the continued needs to design and implement mental health policies at the community or the country level, especially in elderly Koreans with health risk behaviors.

Risedronate-related Localized Amnesia in an Elderly Patient with Osteoporosis

Osteoporosis is the most common metabolic bone disease that results in an increased risk of fragility fractures. Bisphosphonates are commonly used in the treatment of osteoporosis. Concerns about their association with several possible adverse effects have been raised. Here, we experienced a rare case regarding a 63-year-old female patient who had localized amnesia related to once-monthly oral risedronate. A clear cause-and-effect relationship between the treatment of risedronate and this event has not been established and the mechanism behind the adverse effect is unknown. As clinical uses of bisphosphonates continue to expand, clinicians should be aware of the rare but potential adverse effects associated with bisphosphonates including neuropsychiatric problems.

Predictive Accuracy of a Health Risk Appraisal Program Using Mortality Risk Age in 116,927 Korean Men

Health risk appraisal (HRA) is a tool for determining health risk factors and motivating individuals to maintain a healthy lifestyle. We performed this study to describe the HRA algorithm and evaluate the accuracy of an HRA program for 10-yr mortality prediction in Korean men. We used data derived from periodic health examinations of 116,927 male public officials and school personnel aged 20 or older. Risk age and the difference between risk age and calendar age were calculated. We obtained the hazard ratio (HR) of 10-yr mortality according to the calculated age difference. Of the 116,927 subjects, 1,900 (1.6%) died during the 10 yr after the 1992 medical examinations. The HR of 10-yr mortality increased significantly with age difference. Compared with the HR in the reference group (age difference below 2 yr), the HR in the group with a 2- to 6-yr age difference was 1.20 (95% confidence interval [CI]: 1.05 to 1.38) and HR in the group with more than 7-yr age difference was 1.35 (95% CI: 1.14 to 1.75). Risk age is a relatively good predictor of 10-yr mortality in Korean men and may be useful in identifying high-risk middle-aged men for health interventions.

Physical Activity and Exercise for Men with Late Onset Hypogonadism / 대한남성과학회지

Late onset hypogonadism (LOH, also referred to as age-associated testosterone deficiency syndrome, TDS) is a clinical and biochemical syndrome associated with advancing age and characterized by symptoms and a deficiency in serum testosterone levels. It may result in a significantly reduced quality of life and adversely affect the function of multiple organ systems. Although the treatment of LOH is primarily based on hormone replacement, other treatment modalities (medical or non-medical treatment) can also be considered for various accompanying symptoms. The efficacy of exercise in the treatment of LOH has already been evaluated in several studies, and many of them show beneficial effects for some specific symptoms and diseases. This study was designed to evaluate the relationship between exercise and plasma testosterone levels, and the potential beneficial effects of exercise for each specific symptom of LOH, and finally to consider the appropriate exercise treatment for LOH.

Dietary Intake of Calcium and Distal Colorectal Adenomatous Polyps in Korean Adults / 가정의학회지

BACKGROUND: Colorectal cancer is fourth in prevalence of carcinoma and fourth most cause of death from malignant neoplasm, which has been increasing in Korea. In this study, we tried to investigate the association of dietary intake of calcium and distal colorectal adenomatous polyps known as precursors of colorectal cancer. METHODS: A total of 2,456 subjects who visited a health promotion center in one university hospital in Seoul, Korea, from June 2003 to June 2006 underwent sigmoidoscopy and completed a 24-hour dietary recall. RESULTS: Among the selected 2,408 subjects, the prevalence of distal colorectal adenoma found in sigmoidoscopy was 12.54%. After adjusting for age and total serum cholesterol by multiple logistic regression, the odds ratio of the male subjects who had the highest quintile of dietary intake of calcium was 0.512 (95% CI: 0.305-0.859; P = 0.011) compared with the lowest. CONCLUSION: In male subjects with the highest quintile of dietary calcium density was associated with a low risk of distal colorectal adenomatous polyps.

The Relationship between Pain and Stress in Senior Citizens Residing in a Certain District

BACKGROUND: In spite of its high prevalence and social impact, pain in the elderly has not been managed appropriately. Understanding the multidimensional aspect of pain is crucial in its effective management. Patients with chronic pain are known to be more profoundly affected by psychological and social factors. We, therefore, classified chronic pain patients and especially focused on the relationship between pain and stress. METHODS: The subjects were 149 persons older than 60 years attending a certain geriatric college. A survey was peformed employing the Korean version of Geriatric Pain Measure (GPM-K), the Korean Version of Brief Pain Inventory (BPI-K), the Elderly Life Stress Inventory (ELSI), the Perceived Stress Scale (PSS), the Geriatric Depression Scale Short Form-Korea Version (GDSSF-K), and the Revised Chalder's Fatigue Scale (Fatigue). RESULTS: A total of 103 people, who completed both the questionnaires on pain and stress were enrolled. There was a significant correlation between GPM-K and ELSI (ELSI: r=.38, P<0.01). In chronic pain patients, not only ELSI, but also PSS was correlated with GPM-K (ELSI: r=.37, P<0.01, PSS: r=.25, P=0.04). CONCLUSION: There was a significant correlation between GPM-K and ELSI in the elderly. In chronic pain patients, it was more closely associated with GPM-K. We, therefore, believe that stress management can be useful in the management of pain, especially in the management of chronic pain patients.

The Usefulness of Maximal Step Length to Predict Annual Fall Risk

BACKGROUND: Many clinical measures have been used to assess fall risk in elderly adults. The first objective of this study was to assess the clinical availability of maximal step length (MSL) as a measurement predicting falling probability in future. The second objective of this study was to try to find out how to use MSL more easily in a clinical setting. METHODS: The study population consisted of 50 community-dwelling people (> or =60 yrs). Demographic data were reviewed by self-recorded questionnaire and MSL, US and TUG had been done when the subjects visited a clinic in March and April 2004. They revisited the clinic after one year and information of fall incidence was obtained and their visual acuity was examined. To examine the association between many performance tests (MSL Unipedal stance, Timed up and go) and their real falling after tests, we analysed data by Mann-Whitney rank Test, pearson correlation and multiple regression. RESULTS: The average MSL predicted future falling (P-value 0.025), but Unipedal stance, Timed up and go did not. The predicting ability of MSL was preserved using many MSL measures (average MSL corrected by leg length and height, one direction measure among six directions of MSL, and average of left and right three directions of MSL). CONCLUSION: This study showed that MSL had the ability to predict elderly adults' falling in future. And this study showed that MSL can be used more easily in a clinical setting.

A Parasitic Infection with Eosinophilia in a University Medical Center

BACKGROUND: The causes of eosinophilia are allergies, parasite infections, medications, skin diseases, and others. But, the etiologies of eosinophilia and variables associated with eosinophilia are not well known in Korea. METHODS: This study included patients in a health check up at a general hospital from May 21, 1995 until February 14, 2004. Through self-report, serology, and stool exam, variables associated with eosinophilia were tested. RESULTS: In the eosinophilic group, 5% were helminth infected, and more of C. sinensis infection were found the eosinophilic group with 3.9% compared to the non-eosinophilic group with 1.2% (P<0.05) Associated variables with eosinophilia were old age, high BMI, drinking, smoking, the season of testing helminth infections, and Clonorchiasis infection. But allergy was not associated with eosinophilia. The odds ratios for eosinophilia after adjustment were 2.280 (1.694~3.068) in helminth infections and 2.391 (1.716~3.331) in Clonorchiasis infection. CONCLUSION: In the eosinophilic group, 5% were helminth infected, and more C. sinensis infection were found. Associated variables with eosinophilia were old age, high BMI, drinking, smoking, the season of testing, helminth infections, and Clonorchisis infection. But allergy was not associated with eosinophilia.

Assessing the Quality of Internet Health Information Using DISCERN / 대한의료정보학회지

OBJECTIVE: This study was conducted to evaluate the quality of health information on the internet using DISCERN. METHODS: Breast cancer, asthma, depression, obesity were selected to be the tracer conditions of the health information. To collect information about these 4 tracer conditions, we first select top 9 popular Korean websites which provide health information in January 2004. Nine websites include 6 commercial, 3 hospital. To compare quality of internet health information provided by Korean public institute and other countries', we select Healthguide in Korea, MEDLINEplus in USA and NHS direct online in UK. Overall, a total of 45 heath information provided by 10 Korean, 2 other countries' websites were evaluated by two nurses independently using DISCERN. DISCERN is a heath information quality assessment instrument consists of sixteen five-point- scale item questionnaire. The score was compared between Korean commercial and hospital websites and between Korean public institute's website and those of USA and UK. RESULTS: Korean internet health information scored 2.0 for overall quality score. Internet health information of commercial websites scored 1.8 for overall quality score that was lower than hospital websites(2.4). Internet health information provided by Korean public institute scored 3.0 compared 3.3(MEDLINEplus) and 3.8(NHS direct online). CONCLUSION: Internet health information in Korea hardly meets DISCERN standard that means Korean health information have a problem in quality. Especially, Internet health information of commercial websites needs relatively urgent improvement in quality.