Comparison of Health Behaviors between Adults with Hypertension in Single- and Multi-Person Households: Based on the 8th Korea National Health and Nutrition Examination Survey

Background@#The risk of hypertension is known to be higher in single-person households than in multi-person households. This study was performed to investigate the differences in health behaviors of patients with hypertension by household type. @*Methods@#This cross-sectional study used data in the 8th National Health and Nutrition Survey to investigate the lifestyle habits of 3,093 patients with hypertension aged 18 years or above. Health behaviors of single- and multi-person households were analyzed using chi-square test and t-test by gender. Multivariate logistic regression analysis was conducted to analyze the odds ratio (OR) and 95% confidence interval (CI) of health behaviors by household type. @*Results@#According to gender, there were differences in demographic distribution and health behaviors between single-person household and multi-person households. The results in the comparison between single- and multi-person households by multivariate logistic analysis showed: single-person households showed a 1.50-fold increase of being a current smoker (OR, 1.50; 95% CI, 1.01-2.22) in males, 2.18-fold (OR, 2.18; 95% CI, 1.06-4.48) in females. With respect to nutritional intake, women in single person household showed lower intake in various nutrients such as protein, fat, water, fibers, and sodium, as well as total calorie (but not carbohydrate), while men in single person household showed lower intake in fibers only. @*Conclusions@#The results of this study shows that adults in single-person households have an increased risk of being smokers. Also, nutritional support could be necessary. Based on such findings, physicians, nurses and other health professionals are recommended to focus more on health behaviors such as smoking and diet in patients with hypertension, particularly in single households.

Relationship between Abdominal Obesity and Prevalence of Other Chronic Diseases in Korean Adults: Based on the Korea National Health and Nutrition Examination Survey 2016 to 2020

Background@#The burden of disease caused by obesity is high worldwide, and the rate of obesity among adult men in Korea is increasing rapidly. Previous studies have shown that people with abdominal obesity have a higher risk of chronic diseases, including cardiovascular disease. Therefore, in this study, we analyzed the association between abdominal obesity and the risk of chronic diseases among Korean adults. @*Methods@#Using raw data from the Korea National Health and Nutrition Examination Survey 2016-2020, adults over 19 years of age were selected as research subjects. A chi square independence test was conducted to investigate the basic demographic characteristics of patients with abdominal obesity and the prevalence of chronic diseases. The relationship between abdominal obesity and each chronic disease was verified using multiple logistic regression analysis that adjusted for multiple chronic diseases. @*Results@#The risk of all chronic diseases was higher in the abdominal obesity group than in the non-abdominal obese group. When multiple logistic regression analysis was performed with adjustments for age, gender, education level, income level, smoking, alcohol use and multiple chronic disease, the risk of hypertension, dyslipidemia, diabetes, and arthritis was higher in the abdominal obesity group. @*Conclusions@#Abdominal obesity is related to chronic diseases. The management and prevention of abdominal obesity should be emphasized to reduce the risk of chronic diseases.

Health promotion: the essence of primary healthcare

Health promotion is well known for its role in disease prevention and non-pharmacological treatment, and how it has helped improve disease prognosis. It is also one of the most important functions of a well-qualified primary care physician.Current Concepts: The four main areas of health promotion in primary care are smoking cessation, nutrition, physical activity, and weight control. There is strong evidence to suggest that quitting smoking can prevent a variety of tobacco-related cancers. A well-balanced diet along with the right amount of exercise and resulting weight control are just as important as pharmacologic treatments for comorbidities related to obesity and cardiovascular diseases. As can be deduced from the leading causes of deaths in Korea in 2021, the majority of them are caused by diseases on which health promotion can prove to be a useful remedy. The potentially significant impact of health promotion is emphasized here.Discussion and Conclusion: Although it may not produce dramatic results, the essence of primary care is health promotion as it also saves great lives in the long term. Despite the importance of health promotion in overall patient care, there is a lack of public awareness and support on this issue, and primary care physicians are sometimes underappreciated. Reinforcement of nationwide financial support for health promotion is needed for primary care physicians practicing with earnest conviction to prevent and treat diseases.

Plasma Neutrophil Gelatinase-Associated Lipocalin as a Marker of Tubular Damage in Diabetic Nephropathy

BACKGROUND: An increase in neutrophil gelatinase-associated lipocalin (NGAL) indicates tubular injury. Diabetic nephropathy causes typical changes in the kidney, characterized by glomerulosclerosis and eventual tubular damage. We validated the usefulness of plasma NGAL (pNGAL) as a biomarker of tubular damage in patients with diabetic nephropathy. METHODS: We included 376 patients with diabetes mellitus (260 patients with chronic renal insufficiency who had not received hemodialysis and 116 hemodialyzed due to diabetic nephropathy) and 24 healthy controls. Patients with chronic renal insufficiency were divided into three groups according to urinary albumin excretion (UAE) levels. pNGAL levels were measured using the Triage NGAL test (Alere, San Diego, CA, USA) and were compared between groups. We also examined whether pNGAL level was related to the degree of albuminuria and cystatin C-based glomerular filtration rate (GFR). RESULTS: Mean pNGAL levels of the healthy controls, chronic renal insufficiency patients with diabetes mellitus, and hemodialyzed patients were 61.9±5.3 ng/mL, 93.4±71.8 ng/mL, and 1,536.9±554.9 ng/mL, respectively. pNGAL level increased significantly in patients with severe albuminuria (P < 0.001) and had a moderate correlation with the degree of albuminuria (r=0.467; P < 0.001) and GFR (r=0.519; P < 0.001). Multivariate regression analysis showed that the pNGAL level was associated with tubular damage independent of patient age, sex, and GFR. CONCLUSIONS: pNGAL level independently reflects the degree of tubular damage in patients with diabetic nephropathy. Measurement of pNGAL, combined with UAE, would enable simultaneous, highly reliable assessments of tubular damage for such patients.

Experience of Lifetime Health Maintenance Clinic in a Tertiary Hospital: Patients Satisfaction and Associated Factors

BACKGROUND: Lifetime health maintenance program (LHMP) is designed for individualized disease prevention and health promotion through regular health check-ups and improving risk factors. This study aimed to investigate patients' satisfaction of lifetime health clinic (LHC) in a tertiary hospital and to evaluate associated factors in order to support primary health care strengthening policy. METHODS: We conducted surveys for patients, who visited LHC in a department of family medicine at a tertiary hospital from March 1st 2016 to December 31st 2016. We analyzed proportions and characteristics associated with patients, who were willing to recommend LHC. The relationship between willingness to recommend LHC and associated factors were evaluated by multivariate logistic regression analyses. RESULTS: Among the patients who answered the questionnaires, 83.7% responded that they would recommend LHC to others. Results from multivariate analyses suggested that patients living in provinces (odds ratio [OR] 4.21, 95% confidence interval [CI], 1.36-13.02), patients who were recommend by others to visit LHC (OR 3.99, 95% CI, 1.29-12.35), and those who had a large number of medical service preference items (OR 5.91, 95% CI, 1.48-23.58) were significantly associated with willingness to recommend LHC. CONCLUSIONS: LHC pursues the goal of primary care. Findings highlight the fact that high quality health service should be provided in small and municipal hospitals to improve patients' satisfaction. Furthermore, it is essential to establish family physician networks and health service infrastructure that can reflect various opinions.

The Effect of Sleep Quality on the Development of Type 2 Diabetes in Primary Care Patients

Sleep has important effects on physical and mental health, and sleep disorders are associated with increased mortality and morbidity. This study was conducted to evaluate the relationship between sleep duration or sleep quality and the risk of type 2 diabetes. The FACTS (FAmily CohorT Study in primary care) was established to investigate the relations between familial environment and health which was conducted at 22 family medicine outpatient clinics in general hospitals. Total 563 patients without diabetes who received > or =1 year follow-up examination were included in the analysis. We used the Pittsburgh Sleep Quality Index to determine sleep quality, and a score of > or =5 was considered to define poor sleep quality. Patients taking oral hypoglycemic agents, having a fasting glucose level of >126 mg/dL, or diagnosed with diabetes by physicians were classified as having diabetes. The median follow-up period was 2.5 years. Poor sleep quality was associated with a higher risk of diabetes after adjusting for age, sex, body mass index, income, physical activity, and family history of diabetes (relative risk=2.64; 95% confidence interval, 1.03-6.78). As a risk factor for the development of diabetes, poor sleep quality may independently increase the incidence of diabetes.

The Impact of a Spouse's Depression on Family Functioning and Communication

BACKGROUND: Depression is known to affect family function and communication. However, the distress experienced by those who have spouse with depression has not been properly assessed to date. This study attempted to examine the effect of depression on family function and communication as reported by the spouses of the depressed patients. METHODS: The participants of this study were 445 couples who visited 28 family doctors from April 2009 to June 2011. The Family Adaptability and Cohesion Evaluation Scale III (FACES-III) was used to evaluate the family function, and the family communication scale in FACES-IV was used to evaluate communication among family members. A score of more than 21 points on the CES-D scale was used to indicate depression. The relationships between family type, family communication, and the depression of one's spouse were analyzed using the chi-square test and logistic regression. RESULTS: The odds ratios, indicating how the family is heading towards an extreme level, were statistically significant in all male and female respondents (male: odds ratio [OR] 3.08, 95% confidence interval [CI] 1.73-5.48; female: OR 2.09, 95% CI 1.02-4.27). On the other hand, only female respondents with depressed spouses reported their family communication not to be good (male: OR 1.65, 95% CI 0.88-3.07; female: OR 2.48, 95% CI, 1.25-4.93). CONCLUSIONS: This study revealed people perceive their family function and communication not good when they have spouses with depression. There was no gender difference in the evaluation of their family function, but the perception on their family communication were different by gender.

Management of long-term gastric cancer survivors in Korea

The incidence of gastric cancer is high, and gastric cancer has one of the highest survival rates of any type of cancer in Korea. With increased long-term survival in a growing number of patients, more patients suffer from health problems such as treatment-related symptoms, malnutrition, chronic diseases, anxiety, and depression. Gastric cancer survivors also have a higher risk of developing a second primary cancer and recurrence. Therefore, survivorship care guidelines for gastric cancer survivors that address surveillance for recurrence, screening for second primary cancers, assessment and management of physical and psychosocial long-term effects of cancer and its treatment, health promotion, and care coordination are needed. The role of primary care physicians is essential for providing continuous care to gastric cancer survivors and their family.

The Relationship between a Spouse's Alcohol Use Disorder and Family Communication / 가정의학회지

BACKGROUND: Alcohol use disorder (AUD) affects not only an individual's health but also their family. This study was conducted to examine effects of a spouse's AUD on family functioning and family communication. METHODS: We conducted a cross-sectional study using data from 890 participants (445 couples) in a Korean family cohort in primary care. Participants with Alcohol Use Disorders Identification Test in Korea scores of 8 or greater were classified into an AUD group. Family functioning was classified into three groups (balanced, midrange, and extreme) using the Family Adaptability and Cohesion Scale (FACES)-III questionnaire, and then reclassified into two groups (appropriate and extreme groups) for binominal analyses. Family communication was classified into three groups (high, moderate, and low) using the Family Communication Scale, FACES-IV, and also reclassified into two groups (good and poor). RESULTS: There was no significant difference in adaptability and cohesion between both male and female participants with a spouse with AUD and participants with a spouse without AUD. Using multivariate logistic regression to adjust for potential confounders, there was no significant difference in family type and communication between the two groups in males. However, there was a significant decrease in family communication (odds ratio, 2.14; 95% confidence interval, 1.29 to 3.58) in females with a spouse with AUD compared to females with a spouse without AUD, even after adjusting for the participant's own AUD. CONCLUSION: In females, family communication is significantly worse when spouses have AUD. This suggests that a husband's alcohol consumption has negative effects on his wife's family communication.

The Korean guideline for breast cancer screening

Breast cancer is the second most common malignancy among Korean women. The 2002 National Cancer Center screening guideline breast cancer was revised via an evidence-based approach to provide medical personnel with a standard protocol of screening breast cancer. There is moderate-level evidence that biennial screening mammography in asymptomatic women aged 40 to 69 reduces breast cancer mortality, while low-level evidence suggests that screening mammography in women 70 years or older does not reduce breast cancer mortality. The committee concluded that the current evidence is insufficient to assess the benefits and harms of either ultrasonography or clinical breast examination as screening modalities for breast cancer. Future researches about the benefits and harms of the National Breast Cancer Screening Program in Korea are strongly required because the characteristics of breast cancer in Korea are different from those in the West, especially regarding dense breast. In conclusion, the committee recommends biennial screening mammography in asymptomatic women aged 40 to 69 years (grade B recommendation). The committee recommends selective screening mammography in women 70 years or older according to individual risk and preference (grade C recommendation). The committee neither recommends nor opposes ultrasonography and clinical breast examination as screening modalities (grade I recommendation). Symptomatic and high-risk women, however, should be offered complementary measures including ultrasonography and clinical breast examination under clinical supervision.

Management of cancer survivors in Korea

With the early detection of cancer and advances in cancer treatment, the number of cancer survivors is increasing dramatically and is currently over 1 million. Many cancer survivors face lifetime risks associated with their cancer therapy, with a significant proportion at risk for serious morbidity and premature mortality. The long-term physical and psychosocial effects of cancer treatment on cancer survivors and their families are increasingly being recognized as emerging problems from both clinical and public health perspectives. This article summarizes the core principles of management of cancer survivors: follow-up of primary cancer; screening and prevention of a second primary cancer; management of late effects of cancer treatment and comorbid conditions; promotion of healthy behaviors such as smoking cessation, exercise and physical activity, nutrition, and weight management; management of psychosocial problems; and support for family caregivers. Finally, we discuss the way forward for improving survivorship care: shared care between oncologists and primary care physicians; a comprehensive cancer support program; and further research to generate relevant evidence regarding these management principles.

Management of cancer survivors in Korea

With the early detection of cancer and advances in cancer treatment, the number of cancer survivors is increasing dramatically and is currently over 1 million. Many cancer survivors face lifetime risks associated with their cancer therapy, with a significant proportion at risk for serious morbidity and premature mortality. The long-term physical and psychosocial effects of cancer treatment on cancer survivors and their families are increasingly being recognized as emerging problems from both clinical and public health perspectives. This article summarizes the core principles of management of cancer survivors: follow-up of primary cancer; screening and prevention of a second primary cancer; management of late effects of cancer treatment and comorbid conditions; promotion of healthy behaviors such as smoking cessation, exercise and physical activity, nutrition, and weight management; management of psychosocial problems; and support for family caregivers. Finally, we discuss the way forward for improving survivorship care: shared care between oncologists and primary care physicians; a comprehensive cancer support program; and further research to generate relevant evidence regarding these management principles.

Association Between Hypertension Management and Blood Pressure Screening Among Adults in 30s and 40s

BACKGROUND: Although adults in 30s and 40s are at risk for hypertension management due to low rates of awareness, treatment, and control of hypertension, there has been a lack of study on hypertension management for this population. Thus, the purpose of this study is to examine blood pressure screening and other associated factors with hypertension management in terms of awareness, control, and treatment. METHODS: Secondary data analysis was performed on the data from the Fourth Korea National Health and Nutrition Examination Survey in 2007-2009. To examine whether blood pressure screening affects hypertension management in 929 subjects aged 30s and 40s with hypertension. Other factors, such as socio-demographics, health status, and health behaviors, were also included for data analysis. Chi-square test and multiple logistic regression analysis were carried out using SAS 9.1. RESULTS: Hypertension awareness rates were high in those who had diabetes mellitus (odds ratio [OR] 2.23; 95% confidence interval [CI] 1.27-3.90), self-rated their health status as poor (OR 2.89; 95% CI 1.82-4.58), and received a blood pressure check up (OR 5.96; 95% CI 2.90-12.25). Hypertension treatment rates were high in women (OR 2.50; 95% CI 1.47-4.27), and high in those who had diabetes mellitus (OR 2.59; 95% CI 1.49-4.47), self-rated their health status as poor (OR 2.53; 95% CI 1.54-4.14), self-reported as past smoker (OR 2.01; 95% CI 1.22-3.29), and received a blood pressure check up (OR 12.64; 95% CI 4.87-32.77). Hypertension control rates were high in women (OR 2.47; 95% CI 1.29-4.72), and high in those who self-reported as past smoker (OR 2.46; 95% CI 1.35-4.50), and received a blood pressure check up (OR 9.24; 95% CI 3.15-27.15). CONCLUSIONS: For effective hypertension management in 30s and 40s, we should encourage this population to have a regular blood pressure screening.

Factors Associated with Poor Sleep Quality in Primary Care / 가정의학회지

BACKGROUND: Sleep disorder is a common problem in adults and affects physical and mental health. We investigated factors associated with poor sleep quality in Korean primary care. METHODS: A total of 129 couples (129 husbands and 129 wives) aged 30 to 79 years were included in this study from March, 2009 to February, 2010. The subjects were surveyed using a specific questionnaire. Sleep disorder was defined by a Pittsburgh Sleep Quality Index global score greater than 5 (poor sleepers). The subjects were divided into a group of good sleepers (n = 160) and a group of poor sleepers (n = 98). Socio-demographic and clinical covariates including age, sex, depression, spouse sleep disorder, and spouse depression were reported. RESULTS: Poor sleep quality was present in 38.0% of total subjects. According to chi-square test results, female, patients with depression, and low sleep quality of spouse were significantly associated with sleep disorder. In multivariate logistic regression analysis, depression increased the risk of poor sleep quality (odds ratio [OR], 7.775; 95% confidence interval [CI], 2.555 to 23.661), and non-risky drinking decreased the risk of poor sleep quality (OR, 0.343; 95% CI, 0.128 to 0.924). CONCLUSION: In our study, more than one-third of participants had poor sleep quality. Depression was a strong independent factor associated with sleep problems.

Factors Associated with Compliance Using Diamicron in Patients with Type 2 Diabetes

BACKGROUND: Diabetes mellitus (DM) is one of the most important chronic diseases in public health, thus optimal management of this condition is crucial. For this purpose, oral hypoglycemic agents (OHA) are commonly prescribed with their consistent use being mandatory to maintain adequate blood glucose levels. We aimed to evaluate the compliance with OHA in patients with DM, and to determine the factors associated with compliance. METHODS: From March 2006 to December 2007, we enrolled patients with type 2 DM who were newly diagnosed or had discontinued OHAs for more than four weeks. For OHA, diamicron was prescribed to the participants and response to medication was evaluated by physicians after 12 weeks. Compliance was defined as patients taking diamicron continuously or stopping the medication due to well-controlled blood sugar levels. Demographic characteristics, anthropometric measurements, fasting glucose, and lipid profiles were collected and analyzed. RESULTS: The mean age of our 326 subjects was 56.0+/-9.9 years and 74.5% was defined to be compliant. Logistic regression analysis adjusting for age and sex revealed that combined medication use (odd ratio [OR], 2.03; 95% confidence interval [CI], 1.04-3.97) and diabetes-related nutritional education (OR, 2.08; 95% CI, 1.08-4.03) (P<0.05) were factors associated with compliance with OHA. CONCLUSIONS: About three quarters of the DM patients in our study, using diamicron for the first time, showed compliance after 12 weeks of treatment. Concomitant medications and diabetes-related nutrition education were associated with compliance.

Factors of Compliance in Patients with Hypercholesterolemia Using Rosuvastatin in Primary Care / 가정의학회지

BACKGROUND: In order to evaluate the factors of compliance with a lipid lowering therapy, a prospective observational study of patients with hypercholesterolemia using rosuvastatin was carried out. METHODS: A total of 2,607 patients who were newly prescribed rosuvastatin were enrolled from 32 family physicians in Korea from March 2009 to December 2009. Of them, 301 patients were excluded due to incomplete data or follow-up compliance data. The patients were regularly observed to ascertain the compliance associated with rosuvastatin at intervals of 12 and 24 weeks. We collected risk factors for the compliance using a structured questionnaire. The criteria for evaluating compliance are to measure clinic attendance, to assess the continuity of therapy, and to calculate the percentage of doses taken. RESULTS: Among a total of 2,306 patients, the degree of compliance was 54.1%. According to logistic regression analysis, the factors for compliance with the lipid lowering drug included old age (odds ratio [OR], 2.68; 95% confidence interval [CI], 2.09 to 3.45), frequent exercise (OR, 1.76; 95% CI, 1.43 to 2.18), previous statin therapy (OR, 4.02; 95% CI, 3.22 to 5.01), hypertension (OR, 1.80; 95% CI, 1.48 to 2.19), diabetes mellitus (OR, 2.20; 95% CI, 1.69 to 2.87), concomitant medication (OR, 2.28; 95% CI, 1.88 to 2.77), and high coronary heart disease (CHD) risk category (OR, 1.82; 95% CI, 1.39 to 2.38). The compliance decreased with high low density lipoprotein cholesterol levels (OR, 0.20; 95% CI, 0.16 to 0.26). CONCLUSION: The compliance of patients using rosuvastatin was 54.1% in primary care. The factors related to higher compliance were old age, regular exercise, previous statin therapy, concomitant medication, presence of hypertension or diabetes, and higher CHD risk level.

The Efficacy and Safety of a Combined Alendronate and Calcitriol Agent (Maxmarvil): A Postmarketing Surveillance Study in Korean Postmenopausal Women with Osteoporosis / 가정의학회지

BACKGROUND: Combined therapy with alendronate and calcitriol may have additive effects on bone density. An observational study was performed to evaluate the efficacy and safety of Maxmarvil, a combinative agent of alendronate (5 mg) and calcitriol (0.5 microg), and to identify factors associated with efficacy. METHODS: A total of 568 postmenopausal women with osteoporosis were enrolled by family physicians in 12 hospitals. The study subjects took Maxmarvil daily for 12 months. Questionnaires about baseline characteristics, socioeconomic status, and daily calcium intake were completed at the first visit. Adverse events were recorded every 3 months and bone mineral density (BMD) in the lumbar spine was measured using dual-energy X-ray absorptiometry at baseline and after 12 months. We evaluated the efficacy and safety of Maxmarvil, and the factors related to BMD improvement. RESULTS: A total of 370 patients were included in final analysis. The median BMD was 0.81 +/- 0.12 g/cm2 at pre-treatment and 0.84 +/- 0.13 g/cm2 after one year. The average BMD improvement was 3.4% +/- 6.4% (P < 0.05), and 167 (45.1%) patients showed improvement. Factors associated with improved BMD were continuation of treatment (odds ratio [OR], 2.41; 95% confidence interval [CI], 1.15 to 5.07) and good compliance (OR, 2.54; 95% CI, 1.29 to 5.00). Adverse events were reported by 35 of the 568 patients, with the most common being abdominal pain and dyspepsia. CONCLUSION: Maxmarvil was found to be safe, well tolerated and effective in osteoporosis treatment. Continuation of treatment and good compliance were the factors associated with efficacy.

Correlations of Clinical Assessment Tools with Written Examinations / 한국의학교육

PURPOSE: Despite the goal of medical education, which is 'training to be a primary care physician,' only written examinations (WEs) generally have been used to assess medical student ability. We assessed clinical competence using the CPX (clinical performance examination), PA (portfolio assessment), VMA (video-monitoring assessment), CGD (case group discussion), and PCP (primary clinical practice) during students' clerkships in family medicine and correlated these clinical assessment tools with WEs. Also, we correlated these tools with each other to determine the feasibility of each as a replacement of the other tools. METHODS: Thirty-nine fourth year students at University of Ulsan College of Medicine took part in their clerkship in family medicine for 2 weeks during the first session of 2005. They took 1 CPX, 2 VMAs, 6 CGDs, and 2 PCPs and were required to submit their portfolios at the end of the clerkship. We evaluated the correlations of these tools and WEs by the overall scores of each class year and in each subject. RESULTS: The CPX, VMA, and PCP showed no significant correlation,while PA showed strong correlation with 4th year students' overall WEs. The CGD showed strong correlation with all overall scores and with almost all subjects. In addition, the PA correlated significantly with CGD. CONCLUSION: New clinical assessment tools, such as CPX, PA, and VMA, have no significant correlation with WE, even though these tools closely correspond with real clinical practice. Therefore, these tools should be considered as complementary instruments to better assess clinical competence.

Methodology of Korean Lifetime Health Maintenance Program / 가정의학회지

Korean Lifetime Health Maintenance Program (KLHMP) represents one of several efforts to take a more evidence-based approach to the development of recommendations on a wide range of preventive services. This paper summarizes the methods of the third KLHMP developed by Korean Academy of Family Medicine. The review process of KLHMP was mainly based on trans contextual guideline adaptation of United States preventive service Task force (USPSTF) recommendation. The method of review process was done according to categories of recommendation (adotion of USPSTF's recommendation, adatation of USPSTF's recommendation, development of new recommendation). If the recommendation done by USPSTF is up to date and acceptable in Korean context, it was translated and adopted. If the USPSTF recommendation was not up to date, nor applicable, the recommendation was drawn by adaptation process. If the condition has not been reviewed by USPSTF, the recommendation was drawn by de novo development process, forming key question, literature search (primary researchs, systematic reviews, guidelines), literature evaluation, evidence systhesis, considering of applicability and acceptability of evidence.

Periodic Health Examination and Prevention Guidelines for Koreans / 가정의학회지

Periodic Health Examination and Prevention Guidelines for Koreans were first proposed since 1988. Based on that guideline, clinical preventive services has been applied to clinic population in a few University Hospitals since 1991. In 1995, LHMP development committee in Korean Academy of Family Physician Society first published evidence based clinical practice guidelines and updated the guidelines in 2003. Lifetime Health Maintenance Program (LHMP) commitee represents efforts to take a more updated evidence-based approach to the development of the third updated clinical practice guideline in 2009. We focused on approaches that can reliably assess the extent of updating required, a model of limited literature searches with modest expert involvement to reduce the cost and time.