Primary care research in South Korea: its importance and enhancing strategies for enhancement

Lively discussion has been underway regarding primary care in South Korea as an alternative medical policy in the face of rising medical costs and health care disparities. However, the lack of research about primary care in South Korea makes it difficult to move policymakers, so it is time to enhance primary care research in South Korea. Primary care research can be defined as research directed toward the better understanding and practice of the primary care function. Primary care research traditionally has included basic research, clinical research, health services research related to primary care, health systems research, and research on primary care training; and each field is complementary. In primary care research, participation of primary care physicians is essential because primary care research is different from other conventional studies of disease prevalence, patient characteristics, diagnostic methods, and the treatment environment. Primary care research findings in other countries cannot be applied to South Korea as the characteristics of the health system and medical practice are different. To enhance the research on primary care in South Korea, financial assistance, promoting the research capacity of primary care physicians, and more attention from primary care physicians to research are needed.

Implementation of a Videoconferencing System between Multiple Family Medicine Departments / 가정의학회지

Attending conferences is important for doctors and residents in family medicine. Nevertheless, departments of family medicine at many hospitals find it difficult to hold regular conferences. Holding joint videoconferences between Family Medicine Departments of several hospitals through a videoconferencing system could solve this problem. Therefore, Family Medicine Departments of Seoul National University Hospital, Seoul National University Bundang Hospital, and Kangwon National University Hospital decided to hold regular joint videoconferences via a videoconferencing system. Eighty-one joint videoconferences were held from April 1 to October 29, 2010. PowerPoint slideshows were transferred to the other two locations in the same resolution as presenter's monitor. Image and voice of the speaker were transferred in real time and in acceptable quality. Joint videoconferences are feasible, satisfactory and useful for medical education, especially when individual family medicine departments are small and lack resources to hold face-to-face conferences. We expect that more family medicine departments will choose to participate in implementing similar joint videoconferencing systems in the future.

The Association Between Eating Frequency and Metabolic Syndrome

BACKGROUND: Metabolic syndrome increases the risk for cardiovascular diseases and type 2 diabetes mellitus. Many studies have revealed that eating frequency influences the total serum cholesterol level, glucose tolerance and obesity. Hypothesizing that an increase in eating frequency decreases the prevalence of metabolic syndrome with total energy intake adjusted, we evaluated the association between eating frequency and the risk of metabolic syndrome in Koreans aged more than 20 years old. METHODS: We used the data from the 2005 Korean National Health and Nutrition Examination Survey. Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III and the Asia-Pacific regional obesity guidelines. To examine the association of metabolic syndrome with eating frequency, snack frequency and meal frequency, we performed multiple logistic regression analysis adjusting for age, sex, physical activity, daily caloric intake, smoking and drinking. RESULTS: Meal frequency was associated with metabolic syndrome in the 20-45 years group (P=0.011). Eating frequency was significantly related with metabolic syndrome in the group aged more than 45 years (P=0.025). Within the subgroup of subjects more than 45 years who had one or two meals a day, snack frequency showed a significant association with metabolic syndrome (P=0.038). CONCLUSIONS: These results suggest that a decreased eating frequency is associated with a risk of metabolic syndrome, although the causal relationship is not exactly known. It would be useful to pursue this question through further studies.

Maximum Meal Calorie Variation and Cardiovascular Risk Factors / 가정의학회지

BACKGROUND: Diet pattern of regular and three meals per day is commonly recommended. Studies investigated the health effect of gorging pattern of diet using meal frequency and meal skipping, but the health effect of meal calorie variation between three regular meals has never been investigated. In this study, maximum meal calorie variation was defined as subtraction calorie for a meal with minimum energy intake from calories for a meal with maximum energy intake between three meals and examined the effect of maximum meal calorie variation between three regular meals a day on cardiovascular risk factors. METHODS: A total of 4,680 healthy subjects aged 20-87 years who underwent medical screening examination, at one tertiary hospital health screening center and completed 24-hour dietary recall was included. Serum cholesterol subfractions, fasting glucose and blood pressure were measured. RESULTS: Maximum meal calorie variation was significantly related to serum concentration of total cholesterol (beta = 1.77; 95% confidence interval [CI], 0.36 to 3.18) and low density lipoprotein-cholesterol (LDL-C) (beta = 1.64; 95% CI, 0.37 to 2.91), body mass index (beta = 0.24; 95% CI, 0.12 to 0.37) and waist circumference (beta = 0.66; 95% CI, 0.34 to 0.98) after adjustment for potential confounders. CONCLUSION: This study suggests the notion that concentration of total cholesterol and LDL-C and obesity indices are related to maximum meal calorie variation between three meals, independently of energy intake and other confounding factors in free-living population.

Long-term Maintenance of Smoking Cessation and Related Factors of Relapse / 가정의학회지

BACKGROUND: Long-term maintenance of smoking cessation is important to reduce smoking related diseases. There are few studies that evaluated long-term maintenance and related factors. For effective cessation treatment, we analyzed the relapse pattern after cessation and related factors. METHODS: We selected people who visited a health care center more than two times between January 1995 and December 2006 and who have succeeded in cessation after the first visit. Telephone survey was done and their medical records was analyzed. A total of 308 people whose medical records corresponded to the results of the telephone survey were finally included and analyzed. RESULTS: The mean follow-up duration was 112 months and the mean age of the first visit was 47.9 years. The median maximum duration of abstinence was 5.50 years, and the annual hazard ratio of relapse was about 2.5-4.2% from two to seven years of duration of abstinence. Mean age of smoking onset was 22.9 years, the mean smoking duration was 24.5 years, and the mean smoking amount per a day was 20.0 cigarettes. In single-variate analysis, the total number of cessation success, the age of smoking onset, the mean smoking duration, the mean smoking amount per day, the cessation method, the reason for trying cessation were related with the long-term cessation maintenance. In multivariate analysis, the total number of success for cesstion, the reason for trying cessation, the cessation method, the mean number of cigarettes per day were related. CONCLUSION: The experience of relapse, the motive of cessation and self-willingness were shown to be important for long-term maintenance of smoking cessation.