Background
s: In terminally ill cancer patients, delirium must be considered to be important clinically and for the quality of life. We reviewed cases of delirium in hospitalized cancer patients with the aim to recognize and treat delirium. Methods: We reviewed retrospectively the medical records of patients admitted with terminal cancer from April 2003 to April 2004 in the department of family medicine, National Health Insurance Corporation Ilsan Hospital. A total of 71 patients were evaluated with age, sex, oncological diagnosis, metastases, morphine (oral morphine equivalents/day, OME) use and amount, sedatives use, duration from delirium to death, and laboratory fi ndings. Analysis was conducted to fi nd the characteristics of delirium patients and to quantify the relationship between delirium and predicting factors. Results: Among 71 cases, those patients who developed delirium were 41 (57.7%). Among them, gastric cancer was the most common diagnosis with 10 patients (24.4%), followed by colon and lung cancers (9: 22%, 5: 12.2%). The patients receiving sedatives or morphines were 24 (58.5%) and 28 (68.3%), respectively. The mean amount of morphine was 168.6 ± 125.5 mg OME/day. Hyperbilirubinemia (4.2 ± 9.2 mg/dL) and hyponatremia (132.5 ± 4.5 mM/L) were found. Not only bone metastasis and the use of morphine or sedatives but serum Na were signifi cant (P = 0.047; P < 0.001; P = 0.069; P = 0.029). By logistic regression analyses, the occurrence of delirium was increased with decreased serum Na (odds ratio [95% CI] 0.798 [0.649-0.981]) and increased use of sedatives (5.955 [1.080-32.835]).Conclusion: In terminally ill cancer patients, the risk factors of delirium were bone metastasis, the use of morphine or sedatives, and serum Na level. Among these, the use of sedatives and serum Na level were independent risk factors.

Citations

• Risk factors for delirium in advanced cancer patients: A systematic review and meta-analysis
  Yating Guo, Yan Mu, Tingting Wu, Qian Xu, Xiuxia Lin
  European Journal of Oncology Nursing.2023; 62: 102267.     CrossRef
• Validation of Modified Models of Objective Prognostic Score in Patients With Advanced Cancer
  Seok-Joon Yoon, Sang-Yeon Suh, Yusuke Hiratsuka, Sung-Eun Choi, Sun-Hyun Kim, Su-Jin Koh, Shin Ae Park, Ji-Yeon Seo, Jung Hye Kwon, Jeanno Park, Youngmin Park, Sun Wook Hwang, Eon Sook Lee, Hong-Yup Ahn, Shao-Yi Cheng, Ping-Jen Chen, Takashi Yamaguchi, Sa
  Journal of Palliative Medicine.2023; 26(8): 1064.     CrossRef
• Association between Principal Diagnosis with Mental Diseases among Inpatients
  Sung-Soo Kim
  Journal of Health Informatics and Statistics.2022; 47(1): 57.     CrossRef
• Retrospective Cohort Study on the Administration of Sedative for Delirium in Terminally Ill Cancer Patients and Survival Time
  Hyoung Sook Park, Dae Sook Kim, Eun Hee Bae, Jung Rim Kim, Jung Hwa Seo, Jung Mi Yun
  The Korean Journal of Hospice and Palliative Care.2016; 19(2): 119.     CrossRef
• Risk Factors Related to Development of Delirium in Hospice Patients
  Hae Jin Ko, Chang Ho Youn, Seung Eun Chung, A Sol Kim, Hyo Min Kim
  The Korean Journal of Hospice and Palliative Care.2014; 17(3): 170.     CrossRef

Background
Accurate prediction of survival in terminal cancer patients is important for planning effective palliative care. But, the prediction of survival most often relies on the physicians' prediction. Recently, simple prognostic scores such as Palliative Prognostic Index and Palliative Prognostic Score have been developed to estimate duration of survival. The aim of this study was to validate these prognostic scores and physicians' prediction for terminally ill cancer patients in Korea to determine its value in clinical practice. Methods: The subjects of this study were 40 terminal cancer inpatients of one hospital who died between March to May 2005. All patients' Palliative Prognostic Index, Palliative Prognostic Score, and physicians' prediction were recorded on admission by a physician. Results: When a Palliative Prognostic Index of more than 6 was adopted as a cut-off point 3 weeks' survival was predicted with a sensitivity of 90% and a specificity of 60%. When the three groups were grouped by Palliative Prognostic Scores (group A: ≤5.5, group B: 5.6∼11, group C: ＞11), the 30 day survival probability were 60% for group A, 16.7% for group B, and 4.3% for group C, respectively. Physicians' prediction showed moderate correlation (correlation coefficient=0.604) with actual survival and had a tendency to overestimate survival. Conclusion: Palliative Prognostic Index was proved to be a reliable survival prediction tool in Korea. Palliative Prognostic Score had a tendency to overestimate survival as compared with other studies. Physicians' prediction had a correlation with actual survival, and it was presumed to be more accurate when combined with other prognostic score. (J Korean Acad Fam Med 2007;28: 682-689)

Background
Dermatophytoses tend to have a poorer outcome in diabetic patients than in non-diabetic patients. Therefore, diabetic patients need to pay a closer attention to the prevention and treatment of dermatophytoses. The aim of this study was to determine the level of understanding of the dermatophytoses in diabetic patients and to clarify the factors associated with the level of understanding. Methods: A questionnaire survey was carried out from June to July, 2005, targeting 200 patients who had visited two hospitals in Seoul for the management of diabetes. There were 163 respondents (response rate 50.9%). The degree of understanding was calculated by giving 1 point to each question, with a maximum of 12 points. Results: The average degree of understanding of dermatophytoses was 6.68 points (SD 1.79). Younger age (P= 0.0002), high education level (P=0.0035), and high income (P=0.0013) were the factors related to a better understanding of dermatophytoses. The patients who had obtained the information on dermatophytoses from the websites, broadcasts, newspapers, or magazines showed higher recognition points than others (P=0.0377). The body mass index, the duration of diabetes, the complications associated with diabetes did not affect the understanding of dermatophytoses. Conclusion: There are many diabetes patients who do not know enough about dermatophytoses. Diabetes itself is not related to the level of understanding of dermatophytoses. However, diabetic patients who are older, have a lower level of education, and a low income will need to be informed about prevention and treatment of dermatophytoses. (J Korean Acad Fam Med 2007;28: 359-366)

Background
: Central venous catheterization allows the measurement of hemodynamic variables, the delivery of medications and nutritional support. It also has been used as a means to treat sepsis, cardiogenic and hemodynamic shocks. Arterial puncture, hematoma, and pneumo-hemothorax are the most common mechanical complications during the insertion of central venous catheters. This study was done to find out the factors attributing to the increase of puncture attempts in subclavian venous catheter insertion.

Methods : We have conducted surveys in residents who had previous experience with insertion of subclavian venous catheterization in Ilsan hospital from 01/09/2003 to 30/11/2003. A total of 40 cases were marked as two groups, those with less than three puncture attempts and those with more than or equal to three attempts.

Results : The incidence of three or less insertion attempts were 23, whereas in 17 cases three or more attempts were required. The results of the comparison between these two groups proved that the patient's hemoglobin level, skeletal deformity, the level of experience (more than 20), puncture site marking and insertion in the mid-clavicular line were significant factors (P＜0.05).

Conclusion : It seemed necessary to try three or less puncture attempts in order to decrease the incidence of mechanical complications. The operator factors such as previous experience with the procedure, puncture site marking prior to insertion, and insertion in the mid-clavicular line had affected the number of puncture attempts.

Background
: Numerous diabetes patients do not know the name of hypoglycemic agents that they are taking, even though they have taken them for a long time. The aim of this study was to find out the percentage of diabetes patients who recognize the name of their hypoglycemic agents and to clarify whether such recognition have effect on their glycemic control.

Methods : A cross-sectional questionnaire survey was done from March to May 2004, targeting inpatients and outpatients who had been taking oral hypoglycemic agents for diabetes treatment in 2 hospitals.

Results : 134 patients (89.3%) of 150 completed the questionnaire. Only 20 (14.9%) patients accurately knew the name of at least one of the hypoglycemic agents they were taking. Smoking (P=0.0086), recognition of the name of hypoglycemic agents (P＜0.0001), history of change of prescribed hypoglycemic agents (P=0.0095), diet and exercise (P＜0.0001), explanation of hypoglycemic agents (P=0.0231), and forgetting to take medicine (P＜0.0001) were significantly related to the HbA1c level. Among these factors, history of change of prescribed hypoglycemic agents (P=0.0006), diet and exercise (P=0.0002), and forgetting to take medicine (P＜0.0001) were the independent related factors after adjustment.

Conclusion : The recognition rate of the name of hypoglycemic agents was low. It may be associated with patients' HbA1c, but was not an independent related factor.

Background
: Because doxylamine succinate (DS) is an over-the-counter medicine, it can be obtained easily and is frequently used in suicidal attempts. Patients usually recover without serious complications, but occasionally rhabdomyolysis and even death can occur in DS intoxication. In this study, the authors tried to find out the independent predictors of high peak serum CK levels, i.e. probable rhabdomyolysis in DS intoxication.

Methods : The medical records of 41 patients who visited a hospital for DS intoxication from January 1, 2002 to April 30, 2003, were reviewed retrospectively.

Results : In the group of DS only, initial occult blood of urine (P=0.003), initial WBC count (P=0.003) and confusion (P= 0.007) were the best predictors of the peak serum CK level (r²=0.724). In the group of DS with other drugs intoxication, initial creatinine level (P=0.003) and initial occult blood of urine (P=0.007) were the best predictors of the peak serum CK level (r²=0.784). In the cases of rhabdomyolysis patients, the time taken for the CK level to be increased over 1,000 IU/L was 1.9±0.6 days.

Conclusion : In DS only intoxication, occult blood in initial urine analysis, initial high WBC count and confusion can be thought of as useful clinical predictors for high peak serum CK level case. In DS with other drugs intoxication, initial creatinine level and initial occult blood of urine can be considered as the best predictors. More than 2 days will be needed for the observation of serious complications in DS intoxication.

Background
: In Korea, there has been a few medical studies on the relationship between religion and health. In future, active research is anticipated in this area. However, the validity and methods of performing religious inquiry should be tested beforehand. This study was designed to look into the attitudes of patients about religious inquiries by their physicians and to suggest better methods of religious approach to aid future researches on the effect of religion on health.

Methods : A survey was performed on the religious attitude among 177 patients among which 92 were randomly selected from an outpatient clinic of tertiary teaching hospitals and 85 from two local family practice offices on August, 2002. Χ² test was used to verify the difference of results between the subgroups.

Results : As a whole, more than half of patients disagreed with religious inquiries by their physicians regardless of medical situation; however, there was a trend that a critical health reasons produced a higher percentage of patients accepting religious inquiry than in ordinary patients. There was no significant difference in answer between the two practice settings but a significant difference among the subgroups with strong religious belief and among those with a particular type of religion existed.

Conclusion : The results of this study may be used as data on the method of approaching patients with religious inquiries for future studies on the relationship between religion and health, and also should encourage active researches on this subject.

Background
: A lot of "Folk Remedies" on rheumatoid arthritis treatment prevail in Korea, but they have never been evaluated or investigated systemically. Therefore we studied folk remedies used in rheumatoid arthritis patients.

Methods : We delivered 12 questionnaires to 106 rheumatoid arthritis out-patients of family medicine, internal medicine, and orthopedics, located in Seoul and Kyungki area. These questionnaires addressed to demographic characteristics, duration of rheumatoid arthritis, current treatments, kind of folk remedies experienced, decision to choose folk remedies and its subjective effects, and volition to try new folk remedies.

Results : There were up to 27 kinds of folk remedies used by 77 people (72.8% of total). Lower education level was proved to be correlated with folk remedies experience. Most patients began their remedies introduced by relatives or close friends(83.1%). Many patients on folk remedies were skeptical about its effect, but they were still willing to try new folk medicine(80.6%).

Conclusion : Many rheumatoid arthritis patients experienced folk remedies and were skeptical about its effects, but they were still willing to try new folk medicine. Therefore, education on folk remedies is needed.

Background
: Individual propensity towards depressive mood has been influenced by various socio-demographic factors. Studies on the relationship between socio-demographic variables and degree of individual depressive mood in korea do not seem sufficient. In order to see the correlation of education level with the degree of depressive mood we surveyed to provide available data which are useful in the treatment of depression.

Methods : We randomly sampled 315 out of 452 patients based on the availability of chart record and questionnaire sheet. They were admitted to the department of family medicine in one university medical center in Seoul between Jan. 3. 1999 and Mar. 31. 2000. Out of 315 patients, we chose 271 patients between 30 and 80 years of age according to socio-demographic variables. Korean Beck Depression Index (BDI) questionnaire sheet method with 21 questions was use to collect the data for the degree of individual depression. The study group was subdivided into three (Group 1: group less educated than high school level, Group 2: group educated in high school, Group 3: group educated in college or above). BDI of each group was compared using ANOVA test.

Results : Age and sex among the three groups showed a significant difference. Other socio-demographic variables were not significantly different. The average of BDI was as follows: Group 1 BDI revealed significant difference among the groups according to education level. When Tukey method was applied to see the inter-group difference, Group 1 BDI was higher than Group 2 and Group 3 BDIs. No significant difference was found between Group 1 BDI was higher than Group 2 and Group 3 BDIs. No significant difference was found between Group 2 and Group 3.

Conclusion : People educated below high school level revealed more propensity towards depressive mood with a statistical significance. Such result implies that education leved be considered in the treatment of depressive patients.

Background
: The most frequent disease seen in the anal area is hemorrhoid. The main therapeutic approach has been surgical treatment. However, in case of first degree and second degree hemorroids, the high frequency therapy is available. It can be applied on the OPD basis by the family pratitioners.

Methods : The data have been collected between Nov. 1997 and Apr. 1999, 464 cases are surveyed on the basis of sex, age, symptom duration, main symptom, location and duration of hemorrhoid, associated anal disease, therapeutic complication, and patients subjective satisfaction. Only 220 out of the 464 cases were available for the patients satisfaction study because of limited follow-up study.

Results : The sex ratio is 1.18:1 (252 in male, 212 in female). Age distribution shows a clustering pattern around the middle age(158 cases in the 30s, and 142 in the 40s respectively). Symptom duration before their first hospital visit reveals 118 cases(25.4%). under 5 years, 105 cases (22.6%) over 10 years, 102 cases (22.1%) 5 to 10 years orderly. The main symptom includes hemorrhoidal mass, bleeding, and pain. 146 cases (31.5%) had all the symptom descrived above. Patients with mass and bleeding were 122 patients(26.3%). In case of the degee of internal hemorrhoid, the second degree of hemorrhoid was the most common (386 cases: 83.2%) followed by the first degree(43 cases: 9.3%), the third degree (24 cases: 5.1%) and the forth degree(11 cases:2.4%). Total number of the patients with therapeutic complication were 99 cases. The complications were acute urinary retension (46cases: 46.5%), perianal edema (30 cases: 30.3%), bleeding (18cases: 18.2%) and anal stricture (5 cases: 5.0%). Satisfaction survey was based on the 220 follow-up case study. 125 cases revealed very satisfied. (56.8%), 66 slightly satisfied (30.0%) and 29 unsatisfied(13.2%).

Conclusion : As shown in the study above, the high frequency therapy provided the patients with the high level of satisfaction. Based on the this fact, it is suggested to the family practitioners.

BACKGROUND
The author surveyed and analyzed the changes of perception and satisfaction about family medicine. So that the outcome may bring us a reference to advance family medicine more.
METHODS
247 in and out patients in one general hospital in Seoul were surveyed by the questionnaire from July 26, 2000 to June 20. The date was analyzed statistically by SAS program.
RESULTS
As for the knowledge of family medicine, 61.5% of the patients answered that they knew what it is, and the most of them, 54%, via medical institution. The office workers, married , and highly educated people tend to know more about family medicine (P<0.05). As for attitude, 68% of the group answered that family medicine is necessary, because "family medicine doctors give proper advice and consult through out all fields of medicine"(58.8%). As for the preference so prirate doctor, 56.7% of the group answered that they would register for family medicine clinic, and students and office workers are fond of family medicine(P<0.05). As for the satisfaction, 34.4% were ever been to family medicine clinic, and 35.5% out of them were dissatisfied, mainly due to the lack of knowledge of physicians about their diseases(70.1%).
CONCLUSION
The perception of family medicine are still scanty compared to the old studies.

BACKGROUND
Psychiatric disorders have been known to occur by the interaction of biologic, psychologic and social factors. A family can affect the occurrence of psychiatric disorders as a primary social factor. On the other hand, psychiatric disorders can affect family function. There fore, we studied to compare family function between the families of psychiatric inpatients and those of normal persons, using Family APGAR and FACES III.
METHODS
Between July 1, 1999 and August 31, 1999, we examined the subject group as 40 relatives to visit psychiatric inpatient and the control group as 40 persons whose family members did not have chronic diseases or psychiatric disorders, using questionnaire of socio-demographic factors and family function.
RESULTS
Family APGAR scores in subject group were lower than those of control group, but not statistically different. But the degrees of 'Partnership' of the Family APGAR in subject group were significantly lower than those of control group.(P<0.05) Adaptability scores of FACES III in two groups were not different. Cohesion scores of FACES III in subject group were lower than those of control group but not statistically different. The Family APGAR scores in the families of the schizophrenics were significantly lower than those of control group. The duration of psychiatric disorders did not affect family function.
CONCLUSION
The family function of subject group was worsened but not statistically different. But in the families of the schizophrenics, the Family APGAR scores were significantly lower than those of control group. Therefore, we should consider serious family dysfunction in the families of schizophrenics.

Background
: Up to the present, there has been little study on chronic fatigue or chronic fatigue syndrome, and there is equally sparse relevant statistical data For this reason, we attempted to investigate the present status of fatigue, particularly its incidence and actual conditions.

Methods : The study subjects were 12,152 outpatients who visited family practice in hospitals all over Korea between July 24 and September 21,1997. They were given a questionnaire which included questions reflection the (U.S) Center for Disease Control criteria defining chronic fatigue syndrome.

Results : Among the subjects, 861 people complained of fatigue in their response to the questionnaire-re and they became the focus of the study. Of this fatigue group, 426 people(49.4%) had manifested fatigue for more than 6 months, and the male/female ratio was 54%/46%, respectively. People who re-ported that fatigue impaired their ability to function on a daily basis made up 35.8% of the fatigue group and the percentage of people who had considered visiting a clinic due to fatigue was an unexpectedly high 52.8%. The reported causes of fatigue, in decreasing order, were: social interactions(males 68.5%/females 45.1%); sleep disturbance(males 26.8%/females 21.8%); and physical maladies(males 24.2%/fe-mals 26.5%). There were significant gender differences in social interaction relating to domestic problems(males 4.7%/females 16.7%) and emotional problems(males 12.2%.femals 21.4%). Among 33 chronic fatigue syndrome patients who indicted what they thought were the causes of their problems, 68.8% reported physical maladies, 65.5% social life, 31.3% emotional problems, 21.9% sleep disturbance, and 21.9% domestic problems. The associated symptoms of fatigue reported in both males and females, in de-creasing order, included: myalgia, headache and neurological symptoms. The prevalence of chronic fatigue was 0.27%.

Conclusion : Our study showed that 7.1% of family practice outpatients complained of fatigue and that their daily activities or occupational life were disturbed as a result. This group demonstrates is serious need for medical assistance. Therefore, doctors should have more interest in fatigue, particularly in chronic fatigue syndrome, so as to provide real and versatile care.( J Korean Acad Fam Med 1999;20:978-990)

Background
: Smoking is the single most considerable factor, which may likely affect one's health most adversely. Therefore, an effective control upon smoking has been the most important issue for all of the practitioners. Furthermore, the latter's concern on the alternative medicine has been steadily mounting these days. Accordingly, a series of clinical group study has been mapped out in order to clarify the effect and the outcome of acupuncture treatment and its rate of success.

Methods : The survey has been conducted from April 7th, 1998 for six months with the voluntary help of 130 students as our study objects, who were the 1st, 2nd and 3rd graders at two metropolitan high-schools in Seoul. A basic questionnaire has been prepared and collected at the first interview. The acupuncture treatment has been alternately administered at each side of ears once a week for the respective object students and the information had been questioned in the survey. When 5 months lapsed with no treatment after the initial four weeks of intensive application, a further follow-up survey was repeated all over again(once every week for 4weeks and another after 6 months). for the analysis of our finding, the SAS V6.12 has been used together with the one was ANOVA test, t-test, and Cochran-Armitage trend test.

Results : Those who managed to stop smoking after the acupuncture treatment of one week, four weeks and six months respectively were found as follows; 2 students(61%), 12 students(37.5%), and 8 students(25%), proving that the success rate for smoking cessation after six months was 25%. Those who decreased their number of smoking more than half were; 13 students(39.4%), 15 students(46.9%), 25 students(75%). The number of withdrawal symptom and the smoking cessation as well as the smoking reduction rate were not found correlated each other. The frequency of their smoking, the frequency of the smoking attempt, the period of their abstinence from smoking, the facts whether their family members of relatives smoked or not, the FTQ(Fagerstrom Tolerance Questionnaire), the frequency of their drinking and the motivation types of smoking(Why test) were found not influential upon the change of smoking tastes and their intensity of smoking wish by the treatment of the auricular acupuncture.

Conclusion : The change of smoking taste and the change on the intensity of smoking wish as the outcome of acupuncture treatment for the stop-smoking has been statistically significant.

Background
: It is well known that nutrition is very important to growth and development of infants. Especially until 6 month of age breast feeding is superior to artificial feeding on not only nutritional aspect but also immunologic aspect and gives close sensual contact to the mother and infant. Therefore this study ws conducted to investigate to show the superiority of breast feeding and to encourage the breast feeding.

Methods : This study subjects were mothers of 15 month of baby who visit public health center for MMR(measles, mumps, rubella) vaccination in Seoul, Daejeon, Ok-chun, Gang-wha. The monther and doctors of health center discussed and then answered the questionnaire. We recieved 240 questio-nnaites then excluded eigh which were infants with congenital anomaly, severe traumam severe medical problem during neonatal period preterm baby below 37 weeks of low birth weight below 2.5kg.

Results : The rate of breast feeding was not different by mother's age, education, economic status but significantly decreased by occupation. Frequency of enteritis were less with breast feeding.(1.098 vs 0.684, P<0.05) Frequency of non-surgical admission was also less with breast feeding.(0.262 vs 0.157) The first episode of illness was delayed by breast feeding.(P<0.01)

Conclusion : Enteritis and admissions were reduced by breast feeding. Breast fedding also delayed the first episode of illness.

Background
: Today, adolescent smoking is one of the most serious problems in our society. In this study we surveyed the smoking status and patterns, nicotine dependency and factors associated with smoking for general high school students to provide helpful informations on adolescent smoking and its major risk factors which can be used to make intervention for high risk group.

Methods : In Feb. 1995, a total of 1803 students from 9 male and 8 female general high schools located in Seoul were assessed with self-completing questionnaire.

Results : Percentage of male smokers was 27.7% and that of female smokers was 6.6%. The median score of FTQ was 3.0 among male smokers and 2.0 among female smokers. Percentage of students with high FTQ score(FTQ≥7) was 6.3%. Major risk factors of adolesecnt smoking among males were low APGAR score, having smoking siblings, low marks at school, high proportion of the number of smoking friends, unclear perceptions of the negative effects of smoking, positive view to smoking behaviors. among females, low APGAR score, high proportion of the number of smoking female friends, unclear perccptions of the negative effects of smoking, positive view to smoking beha-viors were significant risk factors.

Conclusion : Adolescent smoking was more closely associated with quality of family functions and school/peer environmental factors rather than superficial family environmental factors. Since there are many different aspects of daily activities between high school students and adults, it is necessary to modify some items of FTQ in order to apply it more properly to smoking adolescents.

Background
: Owing to a recent socioeconomical development, a variety of health-seeking behaviors to improve one's own health are in vogue. In this study we intended to search for the correlation between each health-seeking behavior and upper respiratory tract infection which primary care physi-cians are most commonly in contact with.

Methods : From March. 17, 1994 to April 16, 1994, we questiond 736 students of 3 universities in Seoul about their health-seeking behaviors and the duration of upper respiratory tract infection which they contracted from November 1993 to February 1994 via questionnaire and then analyzed 718 responses, excluding cases with insufficient answers.
Result: Singificantly more collegewomen(80%) than collegemen(68%) experienced URI symptoms for 4 months in winter. The collegewomen group who asserted alcohol abstinence and smoking cessation for health experienced URI symptoms less frequently than other groups. The collegewomen showed significant positive relations of URI with sportstime. However, the duration of URI symptoms in collegemne wast not related with sportstime. In view of the relation between smoking and URI sysmptoms, we found more incidence in smokers than non=smokers among collegemne. The survey of the reliance on the tonis or herb medicine revealed that 266(48.2%) collegemen and 75(45.2%) collegewomen were relying on tonics or herb medicine for health. But no significant correlation were found between tonics or herb medicine and the duration of URI symptoms, in collegemen or in collegewomen. Otherwise, there was no correlation between the duration of URI symptoms and heat-keeping diet, or drinking habits.

Conclusion : In this study we have a conclusion that primary care physicians should encourage people to abstain from smoking and to avoid excessive exercise in order to prevent URI infection Furthermore, it may be necessary that we should perform prospective study based on the widespread, epidemiological data about health-seeking behaviors in order to uncover the correlation between the illness and one's desirable health-seeking behaviors.

Background
: Clinicians are based on routine urinalysis when they treated urinary tract infection as primary laboratory finding. In this study we analyzed the relationship between routine urinalysis and the results of urine cultures in order to identify predictors of cultures result in the diagnosis of UTI.

Methods : Bacteriuria, pyuria and nitrite test as predictors of UTI's in patients, who were not tooked medication, were eveluated in 158 visits in one hospital, using a positive urine culture as a gold standard.

Results : The overall culture positivity rate was 34.8%(55 out of 158 cases). A difference was not found between ages(P>0.05). The sensitivity and specificity of microscopic bacteriuria were 78.2% and 79.6%, repectively. The results of nitrite of nitrite test were 50.9% and 87.3%. The validity of pyuria was increased by increasing number of WBC, but specificity was higher than sensitivity. Urine tests consisting of a positive nitrite test, microscopic bacteriuria, microscopic WBC>15/HPF, the sensitivity and specificity were 34.8% and 89.5%, respectively.

Conclusion : Sensitivity and specificity of bacteriuria and specificity of nitrite test were contributed the highest validity in the prediction of urine culture result.

Background
: Specimens obtained by means of a endoscopic bite biopsy are too small and superficial to arrive at a correct histological diagnosis of gastric submucosal tumors. However, Strip biopsy which was devised and developed to obtain larger and deeper specimens of gastric mucosa has made it possible to diagnose and resect submucosal tumors.

Methods : Strip biopsy was done in 26 patients with submucosal tumor lesions who visited Seoul Medical hospital from January in 1992 to August in 1994, and clinical characters including histopathology were evaluated.

Results : Mean age of patients was 47.5 years old. The sex ratio of the male to female was 1:1.17, The removed gastric lesions were mostly from 1.0cm to 1.9cm in size(38.5%), and the biggest lesions was 4cm in size. According to Yamada type, type I was most common(46.2%). The most common location of lesions was gastric antrum 12(46.2%). The common clinical symptoms were epigastric pain(46.2%), epigastric discomfort(26.9%), nausea and anorexia(26.9%), and indigestion(23.1%), These were non-specific symptoms, compared with other gastric lesions. Histopathologic examinations revealed that the leiomyoma was most common(26.9%), and the remainders was heterotopic pancreas(7.7%), gastritis cystica profunda(3.8%), telangiectatic blood vessels in submucosa(3.8%), benign stromal nodule(3.8%), severe edematous & fat cell at submucosa(3.8%), hypertropy of muscularis mucosa(3.8%), microretention cyst(3.8%), and as only mucosal lesion, fundic gland hyperplasia(19.2%), chronic gastritis(15.4%), tubular adenoma(3.8%) and adenocarcinoma(3.8%). Bleeding from the artificial ulcer was developed in Two cases and these patients could be treated endoscopically. But, there was one case with gastric perforation which tumor was 4cm in size.

Conclusion : Strip biopsy, by which large and deep specimens can be obtained, is a useful procedure for the purpose of diagnosing gastric submucosal tumors. But, it is considered that 4cm sized tumor demands partial resection for complication, gastric perforation.

Background
: The screening tests for alcoholics have been made and use, however, there were few tools to assess the psychopathologic condition of alcoholics objectively for treatment. In this situation, as we can say that treatment of alcoholics begins from the recognition of disease by the patient, we tried to evaluate insight of alcoholics objectively and to investigate the associated factors.

Methods : Among the patients admitted to Alcohol Clinic due to problem of drinking between April and September in 1994, 41 patients who were admitted longer than one month diagnosed as alcoholism by DSM-Ⅲ-R, from whom we get information can be related to insight through data sheet inquiring demographic characteristics. A new insight scale, preliminary Insight Scale for Alcoholics(ISA) was made by this study as tools to measure insight of alcoholics based on insight scale which is used to other psychiatric diseases.

Results : Cronbach's alpha coefficient analysed internal consistency of the preliminary Insight Scale for Alcoholics(ISA) was 0.8371 by SPSS and the correlation between each item score and global score was used for another evaluation of reliability, and then correlation coefficient were from 0.3488 to 0.6851 in both scale done twice(P<0.05). This scale was analysed by factor analysis, and then yielded 8 factors, the factors accounted for more than 65% of items in the scale. These results show that this scale approximates to some of the aspects of insight in the definition of this stydy. The insight scale for alcoholics were enforced twice after earlier detoxification treatment and the education for abstinence from alcohol for 4 weeks, there were significatn changes statistically in scores of the insight scale for alcoholics(P<0.001). Although correlation analysis between MAST scores and scores of these insight scales was proportional(r=0.49), if the history of education for abstinence from alcohol was mediated, it was not significant statistically. The history of admission due to drinking was no significantly for those who has the history of education for abstinence from alcohol than those who has not(P<0.01) and for those who had the withdrawal symptoms(P<0.05). There were no significant between duration of drinking, APGAR score, psycho-social stress and scores of the insight scales.

Conclusion : Although it is necessary to refine the insight scale for alcoholics of this article, is was clinically possible to assess the insight and to evaluate the change of the insight. There was no close relation between MAST scores and the scores of the insight scale for alcoholics, and regardless of the times of admission the education for abstinence from alcohol is important factor associated with insight.

Background
: Alcoholics have been increased realistically, but the cause of withdrawal symptoms is not established. The role of magnesium has been claimed, therefore, we intends to see the relation of serum magnesium with alcohol withdrawal symptoms in this study.

Methods : The one hundred fifteen patients were cohsen, who were diagnosed as alcohol dependence in Alcohol clinic department of Dae Jeon Hani I1 Hospital from 1993. 10. 1 to 1994. 9. 30. The symptoms of selected patients were classified by DSM Ⅳ classification of alcohol withdrawal, and then compared with serum magnesium concentration at admission.

Results : The mean serum magnesium concentration of total 115 patients was 1.99±0.39 eEq/L. Among them, 61(53%) patients show sweating, 6(55.7%) tremor, 25(21.7%) delirium tremens, 26(22.6%) hallucination, 64(55.7%) agitation, and 24 patients(20.9%) have no withdrawal symptom. According as existence and/or nonexistence of withdrawal symptom, the difference of serum magnesium concentration was noted. The mean magnesium concentration of withdrawal symptom group is 1.90±0.31mEq/L, on the other hand, nonwithdrawal symptom group is 2.34±0.32eEq/L. As to magnesium concentration of each withdrawal symptom, sweating group is 1.79±0.27mEq/L, tremor group 1.84±0.36mEq/L, delirium tremens group 1.74±022mEq/L, hallucination group 1.83±0.39mEq/L. agitation group 1.89±0.38mEq/L, and so, the significant difference between symptom and nonsymptom group was seen.

Conclusion : The relation of serum magnesium concentration with alcohol withdrawal symptoms was observed, therefore, we guess the role of magnesium for alcohol withdrawal. Our study suggests that the active study and application of magnesium for the treatment of alcohol withdrawal may be required.

Background
: Until recently, the study of knowledge and practice rate of adult immunization is insufficient. The aim of this study is to provide reference data about adult immunization for primary physician.

Methods : We assessed 258 out-patients and their caregivers who visited 3 local clinics in Seoul and near-Seoul area, and completed questionnaires given from June to August, 1993. Vaccine-preventable diseases using this study are tetanus, rubella, hepatitis B, influenza and pneumoccoccal pneumonia. The immunization schedule of each diseases insisted briefly to subjects before answering questionnaires.

Results : Among 258 cases, male subjects were 104 in number(40.3%), and female were 154(59.7%). The mean age was 33.9 years. The subjects answered that the most useful method of knowing names of vaccine-preventable diseases was mass-communication(72.9%). About tetanus booster immunization for adult, the cognition rate was mass-communication (72.9%). About tetanus booster immunization for adult, the cognition rate was 16.7% and the performance rate qas 2.3%. The number of female in reproductive ages between 15 and 49 years was 140. Among them, the cognition rate of rubella immunization was 25.7% and the performance rate was 39.3%. About hepatitis B, the cognition rate was 95.0% and the performance rate was 58.9%(P<.0001). The number of those aged 65 years or more was 9, and they all did not know and not perform influenza or pneumococcal pneumonia immunization.

Conclusion : With all disease entities of adult immunization except hepatitis B, the cognition and performance rates were revealed low. 84.7% of all subjects answered that adult immunization is necessary.

Background
: The breast cancer is the fifth common tumor in statistics in mortality rate. The aim of this study is to evaluate the diagnostic efficacy of mammography and ultrasonography to dectect the breast cancer.

Methods : This retrospective study was carried out in 266 subjects who visited Youngdong Servrance Hospital due to breast disorders from March, 1992 to July, 1993. They were confirmed by pathology and preoperative mammography and/or ultrasonography.

Results : Among the 266 cases, breast cancer were 66 cases(24.8%) and benign breast disorder were 200 cases(75.2%). The cases which performed mammography were 207 cases, and the cases which performed ultrasonography were 164 cases. Among total 266 cases, the cases which performed both mammography and ultrasonography were 176 cases.
Mean age was 45.03 years in breast cancer group but mean age was 38.73 years in benign disorder group(P<0.01). In breast cancer group, chief complaints on admission were palpable msss(90.3%), breast pain(7.6%), abnormal finding in periodic health examination(7.6%). But in benign disorder group, chief complaints were palpable mass(53.5%), abnormal finding in periodic health examination(21.5%), nipple discharge(8.5%) The efficacy of film mammography to detect breast cancer was as followed : sensitivity was 87.7%, specificity was 66.7% and positive predictive value was 54.8%. The efficacy of ultrasonography to detect breast cancer was as followed : sensitivity was 82.8%, specificity was 66.7% and positive predictive value was 45.2%.

Conclusion : Film mammography is useful for mass screening because of high sensitivity, and ultrasonography is useful as additional study to detect breast cancer.

Background
: With reports on the relation between smoking and depression appearing since 1980, it has become clear that depression is one of the psychodynamics of smoking, though there has been little or no progress made in the study of whether or not there is indeed a relation between depression and nicotine dependence. After establishing the hypothesis that an assessment of depression and nicotine dependence is established, as a measurement for predicting the success rate of an attempt on the part of the smoker to stop smoking and that through the treatment of that depression a smoker's sucess rate in quitting can be substantially raised, this study was carried out in order to verify this hypothesis.

Methods : In periodical examination and checkups between the months of June and August, 1992, using 403 adult healthy male, we inquired as to each age, marital status, education level, monthly salary, whether or not they smoked and if so, at what age they started and the number of attempts made at quitting. Stress levels were measured by using the 'Social Readjustment Rating Scale, SRRS', depression levels by using the 'Beck Depression Inventory, short form, SBDI' and nicotine dependence using the 'Fagerstrom Tolerence Questionaire, FTQ'.

Results : The average SBDI was 7.86±5.01, and the depression levels of the subjects who smoke were higher, with the smoking group at 8.85±5.29 and the non-smoking group at 5.44±3.17(P<0.001). In the case of 13 points being the cutoff for the diagnosis of depression noted from the SBDI, 75 men(18.6%) among all study subjects could be diagnosed as depression, and among these 68 of them(90%) were smokers.(P<0.001) The annual Life Change Unit(LCU) of social Readjustment Rating Scale, which is using the level of stress, averaged 202.31±226.65. There were 79 men (18.6%) with an LCU of over 300 points, a high measured level of stress, and among them 66(83.5%) were smokers, notable difference.(P<0.01) The average FTQ of the 286 smokers was 4.81±2.70, and the number of smokers with more than 7 points, which indicates a high dependence on nicotine, was 94(23%), their average SBDI being 12.84±4.93. Futhermore, the average SBDI of those with a FTQ of less than 6 points was 6.89±4.27, indicating a sizable difference(P<0.001), and the average FTQ of 68 smokers which showed signs of depression was 7.00±1.80(P<0.01). As a result of analyzing the independent effect that each variables has upon nicotine dependence using the stepwised multiple regression analysis, we found that among them depression has the most pronounced effect.(P<0.001)

Conclusion : According to this study, an individual smoker's inclination towards depression is the most important factor in predicting the nicotine dependence of that smoker. For an effective strategy to quit smoking, we think that the assessment of depression should be include among the headings for evaluating smokers, and that selecting smokers who show sign of depression and then treating that depression would be a great help in increasing the success rate of those who attempt to quit smoking. We feel that in the future a study on such a treatment will be needed.

Background
: The aged is steady increasing and now represent about 5.0% of our country population and utilize a majority of primary health care resources. The goal of this study was to suggest basic data for comprehensive and continuous management of geriatric patient increasing rapidly.

Methods : This study is a clinical analysis of 484 cases in geriatric center of Young-Dong severance hospital from October. 17, 1990 to June 1992, the outpatient's chart was reviewed and analyzed.

Results : The number of patients was 484 in which male were 206 cases (42.4%) and the number of female was 278 cases (57.7%) respectively. The largest age group of 70~74 was 176 cases(36.2%). The 3 most common past diseases were hypertension(34.0%), diabetes mellitus(15.2%), major operation history(13.2%).
The 3 most frequent chief complaints were arthralgia and myalgia(19.9%). headache(12.7%), chest pain(9.0%). In classifying diseases of cardio-vascular systems with 374 cases (33.3%), the 2nd was musculoskeletal disorder with 179 cases (15.9%), the 3rd was endocrine disorder with 154 cases (13'7%). The 3 most common present diseases were hypertension(21.8%), degenerative joint disease(15.9%), DM(13.7%). The most frequent medications were digestives with antacid and peptic ulcer drugs (22.8%), antihypertensive with diuretics (15.6%), analgesics (10.5%).

Conclusion : The study represents the symptom and disorder, diagnosis and treatment of people over 65. There were many differences in clinical aspects between the all age group and old age group. Therefore, the health problems of old age group had many characteristics, and then more study needed.

The diabetic patients were evaluated by Diabetes Quality of Life(DQOL) measure in this study. The diabetes quality of life(DQOL) was initially designed for use in the Diabetes Control and Complication Trials.
The purpose of this study is to evaluate DQOL toward fasting blood sugar, sex, treatment modality, duration of the D.M., and site of life. This study has been made of 105 patients that have been visited to Severance, Kanghwa, Chungmu hospital during 6 months (1990.4-1990.9)
1. The difference between males and females was not found on the total DQOL, but males were significantly less distressed than females in diabetes related worry individual scale. (P<0.05)
2. The difference in fasting blood sugar levels was not found on the DQOL. There were no significant differences in fasting glucose levels.
3. The difference in treatment modality group such as diet & exercise group, oral hypoglycemic agent group, and insulin therapy group were found on the the total DQOL, with diet & exercise group being significantly less distressed than oral hypoglycemic agent group and insulin therapy group were found on the the total DQOL, with diet & exercise group, being significantly less distressed than oral hypoglycemic agent group and oral hypoglycemic agent group being significantly less distressed than insulin therapy group.(P<0.01), especially in satisfaction and impact individual scale.
4. The difference between urbans and rurals, was found a total DQOL, with urbans being significantly less distressed than rurals.(P<0.01), especially in worry individual scale.

Fatty change of the liver is a histological finding caused by various diseases such as chronic alcoholism, obesity, diabetes mellitus, malnutrition and certain hepatotoxic drugs.
For the purpose of comparison of characteristics between fatty and normal liver diagnosed by abdominal ultrasonography. we analyzed 126 cases of fatty liver and 133 cases of normal liver among the 1,736 patients, who visited at the Youngdong Severance Hospital for heath care mainterance.
The results were as follows;
1. The fatty liver groups were statistically significant in case more alcohol drinking, obesity, diastolic hypertension, hypercholesterolemia, abnormal SGOT and γ-GT than normal liver groups.
2. There were no significant difference between fatty and normal liver group in smoking, diabetes, systolic blood pressure, HDL-cholesterol, SGOT and alkaline phosphatase.

For women in Korea, the overall incidence of breast cancer has been increasing recently. Long-term survival in breast cancer currently rests on detection and appropriate therapy at the earliest possible stage, with survival being excellent in patients whose cnacers are discovered at small size and without dissemination. Discovery of lesions at the smallest possible size is therefore desirable.
From July 1st, 1990 through Sep. 30th, 1990, KAP on early detection of breast cancer survey among 260 women over age 35 was carried out at Youngdong Severance, Chungmu and Cha Hospital.
The results were as follows:
1. Film-mammography users are better educated(p<0.05) and higher economic status(p<0.05) than nonusers.
2. Regarding BSE(Breast Self Examination), 17.7% said they practiced BSE monthly and there is no significant difference on practical aspect of BSE between users and nonusers.
3. Women's attitudes toward breast cancer, users have more appropriate insight(p<0.05).
4. Women's attitudes toward screening mammography, users show more active response on breast cancer screening in asymptomatic period(p<0.05), and 58.7% women knew that mammography was useful in detecting breast cancer at an early stage.
5. When nonusers were asked why they did not have a mammography, the most common responses related to poor information(27.9%) and not knowing the test was necessary(22.1%).
6. The experience of film-mammography itself dose not seem to be a negative one, and more acceptible cost was cited for screening test.

Serum lipids level were studied in 281 non-insulin dependent diabetic patients who were admitted at Yonsei University Hospital from January 1989 to December 1989.
The results obtained were as follows :
1. There was significant difference according to sex in cholesterol, LDL : cholesterol and HDL : cholesterol in diabetic patients.
2. There was no significant difference according to age and treatment modality in serum lipid level.
3. There was significant difference according to the duration of diabetes in cholesterol and LDL-cholesterol.
4. There was significant difference accrding to fasting blool sugar in triglyceride.
5. There was significant difference according to duration of diabetes in cholesterol and LDL-cholesterol.
6. There was significant difference between hypertensive and normotensive patients in cholesterol and LDL-cholesterol.

Chest pain is important to patients and clinicians because it can signal a threat to life and produce difficult diagnostic and therapeutic challenges. Although there are many reports about emergencies, the literature has underemphasized the importance of the chest pain in our country. Authors made an analysis on 451 patients treated at Sevrance Hospital Emergency room from March 1989 to Febraury 1990 due to chest pain.

The results were as follows
1. Male was 53.6%, female was 46.4%, respectively.
2. The age distribution of patients was 15 through 90 years olds. The age group of 60-69 years old was the largest.
3. Overworking and psychic stress were found to be the common precipitating factors.
4. The mean number of laboratory examination performed was 3.91 by each patient. Among laboratory examinations, ECG was the most common laboratory examination. The number of normal ECG was 90(22.8%) and that of abnormal ECG was 409(77.2%).
5. Admission rate of chest pain patients (19.6%) were lesser than the admission rate of all patients in emerency room (34.3%).
6. Most of the patients had disease that could be diagnosed at a primary care level.
7. The 3 most common diseases of chest pain visited emergency room were coronary heart disease, psychosomatic disease and gastointestinal disease.

Communication is generally accpeted as one of the most crucial facets of interpersonal relationships.
Olson, Russell, and Sprenckle has developed a theoretical model of marital and family systems known as the Circumplex model.
They hypothesized that effective communication facilitates movement to and maintenance of systems at the desired(balanced) level on the two collected from 116 families(a couple and an adolescent) through the questionnaire method based on FACESⅢ, Parent-Adolescent communication scale, and Sociodemographic sheet.
In this study, the correlation between Parent-Adolescent communication and sociodemographic factors was evaluated.
The higher Father-Adolescent communication level was related to the higher educational and economic status. The Mother-Adolescent communication level was not related to any sociodemographic factor.
It was evident that the families with high reported cohesiveness and balanced families had the most positive communication patterns.

To study the various factors related with hypertriglyceridemia, 2,011 persons who visited Yongdong Health Examination Center for general check-up during the period from May. 1990 to Sep. 1990 were examined by means of questionnaire on living environment and health behavior and laboratory findings.
Hypertriglyceridemia was defined as plasma triglyceride over 250mg%.
We made the nongypertriglyceridemic control group by random matching each hypertriglyceridemic person by age and sex(1:1 matching).
There were 128 persons for nonhypertriglyceridemic group and 128 persons for hypertriglyceridemic group.

The results were as follows.
1. The incidence of hypertriglyceridemia was 128(6.3%) among 2,011 cases and sexual distribution was 102/1215(8.4%) in males and 26/796(3.3%) in females.
2. The incidence of hypertriglyceridemia was increasing while patient's age increased and which was statistically significant(p<0.05).
3. In hypertriglyceridemic group, smoking rate(p<0.01) and smoking amount(p<0.05), alcohol drinking rate(p<0.05), hypertension(p<0.05), diabetes mellitus(p<0.05), fatty liver(p<0,05), total cholesterol level, HDL cholesterol level and LDL cholesterol level were significantly different from nonhypertriglyceridemic group by statistics.
4. In respect of obesity, there was no significant difference between hypertriglyceridemic and nonhypertriglyceridemic groups.

On the 1980s drug abuse became one of the serious problems in Korea and philopon abuse still more. There are various view points in approaching drug analysis as a way of preventing and treating the drug abuse.
As the philopon abuser group, we took 49 cases among respondents who were criminally admitted to medical institutions in Busan and Kyungsangnam-Do from March to September, 1990. And as a control group we took 50 cases of adults who are non-philopon abuser in Seoul.
The results were as follows:
1. Age distribution of philopon abuse group is as follows : 4th decade were 22 cases(44.9%), 3rd decade were 17 cases(34.7%).
2. In smoking rate, philopon abuse group were significantly higher than the control group(P<0.001), but smoking amount were not significant between the two groups.
3. Basic motivation study of abuse group
a. first motivation for philopon : curiosity 26 cases(53.1%), friends' temptation 6 cases(12.2%).
b. place of drug use : house of his own or others' 20 cases(40.9%), hotel 18 cases(36.7%).
c. partner of drug use : alone 12 cases(24.5%), friends or fellows 11 cases(12.2%).
d. real causality of abuse : away from everyday-life 15 cases(30.6%), for pleasure 11 cases(22.4%).
4. In view of family cohesion, disengaged and enmeshed groups of the abuser' were significantly higher than the control group(P<0.05). But family adaptibily showed no significant difference between the 2 groups.
5. Balanced families were significantly lesser and extreme families were significantly more than the control group(P<0.05).

In order to be available in fundamental data for establishment & assesment of OB & Gyn. Curriculum and for practice guidance in family practice residency program practiced by a family physician at a community hospital from Jan. in 1990.
The results were as follows ;
1. The age distribution in 277 outpatients of this study was 39.9% in the twenties, 22.2% in the thrties, 16.4% in forties, 13.3% in fifties, 6.45% in the over sixty years old, 1.8% in the under nineteen years old.
2. The total number of chief complaints of problems of the outpatients was 436 and among them, leukorrhea was the most common problem(20.4%) 2nd was amenorrhea or antenatal care(18.7%). The percentage of problems from the most frequent to the 10th most frequent was 91.9%.
3. The following history takings were asked to the patients by physican : menstrual & parity history to 93.6%, 91.6% of patients, respectively. Contraceptives & sexual history to 29.2% of patients, family history & other medical history to 27.9% of patients.
4. The average number of diagnostic tools done per patient was 1.4, of which the top 10 most commonly performed tests comprised 99.2% of the total.
Gram stain & wet smear ranked first comprising 21.8% of the total and followed by Pap smear with 19.0%, and pelvic sonogram with 15.0%.
5. The diagnosis by physician were classified according to 378 items in the ICH PPC-2 defined method. Among 356 diagnoses, pregnancy or antenatal care was the most common diagnosis(21.9%) and followed by nonspecific vaginitis(18.0%).
The cumslative percentage from the most common diagnosis to 19th most common accounted for 95.9%.
6. Among them, normal delivery was 87.8%, vacuum delivery was 4.9%, and Cesarean section was 7.3%.

For the evaluation of the epidemiologic state of mumps and efficacy of mumps vaccine the field evaluation 261 population from September 1990 in a October 1990 in a part of large city that was reported as mumps-outbreak area by a family practitioner.
The results were as follows.
1. Boys were 132(50.6%) and girls were 129(49.4%) and the case of mumps patients were 74(28.4%). The incidence by age group was 7.0% in 1-4 years, 35.5% in 5-6 years, 38.0% in 10-14 years and 7.7% in 15-18 years.
2. Mumps-vaccination rate was 88.9% in total study population, 72.7% in patient group and 94.7% in non-patient group.
3. The percentage that the vaccination was injected to the children before 2 year old was 94.2%. The 5 cases(2.2%) were injected twice at 9 months and 15 months of age.
4. The occurrence of mumps was mainly in spring and summer(97.3%).
5. The order of clinical findings was parotitis (100%), fever(85%) and sore throat(80.4%).
There were no difference between vaccination and non-vaccination group in parotitis duration, frequency of bilateral parotitis, fever duration, the number of hospital visit and school absence.
6. The incidence of mumps was 43.9% in the vaccinee and 75.0% in the non-vaccinee, therefore efficacy of mumps vaccine was 41.5%.

Family physician should understand the various changes by family life cycle, and know the risk factors which can be expected from each stage. So he can help a family to cope with a change in a new stage. This study was designed to understand the changes of family and marital satisfaction according to the family life cycle.
For this purpose, we surveyed 341 men and women who had visited 3 general hospitals OPD in Seoul and Seochun from May to August in 1990. The family satisfaction(adaptability;6 items, cohesion 8 items) and the marital satisfaction(10 items) was evaluated according to the family life cycle(5 stages).

The results were as follows;
1. The family satisfaction score was higher in stage 5(launched; 52.5) and stage 1(beginning family; 52.4) than in other stages, but there was no significant difference.
2. The family adaptability score was the highest in stage 5(launched; 23.5), and was the lowest in stage 3(school age; 22.0).
The family cohesion score was the highest in stage 1(beginning family; 29.8), and the lowest in stage 4(launching; 28.3)
3. The marital satisfaction score was the highest in stage 1(beginning family; 37.6), and decreased gradually according to the family life cycle, and was the lowest in stage 4 (launched; 31.7), and increased in stage 5(launched; 33.8). There was a significant difference(P<0.01).
4. The marital satisfaction had a significant difference in the items (P<0.01) of personality, role, communication, sexual relationship, family & friends, and the item(P<0.01) of conflict resolution, but had no significant difference in the items of financial management, leisure activities, children, religious orientation.
5. The family satisfaction and the marital satisfaction had a significant correlation in each family life cycle stage (r=0.69, P<0.01).

The results of 2674 case with periodic health examination which were performed at hospitals located in were reviewed.
1. 544 cases(20.3%) were abnormal in the primary check-up, including hypercholesterolemia(24.4%), positive HBsAg(22.4%), high BP(17.3%), hyperglycemia(10.1%), elevated SGOT/SGPT(10.0%), abnormal finding of the chest x-ray(5.1%), low blood Hb(5.0%), positive VDRL test(2.0%), abnormal urine analysis(1.3%), hemorrhoid, skin lesion, lymphadenopathy, conjunctivitis.
2. Secondary check-up were applied to these 544 cases with the results of the followings ; Hepatitis B virus-related liver disease(34.2%), hypertriglyceridemia(22.7%), other liver disease(10.3%), diabetes mellitus(9.5%), hypertension(7.6%), anemia(7.65), serology-positive syphilis(3.1%), renal disease(0.85), pulmonary disease(0.65).
3. 37 cases among 54 cases with elevated SGOT/SGPT have abnormal LFT. (68.5%)
4. 34 cases among 55 cases with hyperglycemia are proven to have DM.(61.8%)
5. 81 cases among 133 cases with hypercholesterolemia are proven to have hypertriglyceridemia or abnormal HDL-cholesterol(60.9%)
6. 27 cases among 94 cases with high BP have abnormal EKG(28.7%)
7. 28 cases among 122 HBs Ag(+) cases have abnormal LFT.(23.0%)

A clinical analysis was made by 83 cases of snake bitten patients who received the emergent treatment at the Yong In Severance Hospital from Jan. 1988. to Dec. 1989. The results were as follows;
1. Sex ratio was 1.9:1 and the age distribution was the most prevalent in the 7th decade.
2. The seasonal distribution was frequent in July(30.2%), and the most common bitten site of the body was the finger(42.2%).
3. The one fang mark was observed in 39 cases(47.0%).
4. In 40 cases(48.2%), it took within one hour for the first aid treatment, and in 77 cases (92.8%) of studied patients were arrived at emergency room within 24 hours.
5. The tourniquet was applied in 21 cases(25.3%).
6. The most frequent general symptom or sign was dizziness(38.6%), followed by visual disturbance(15.7%), fever(10.8%), nausea or vomiting(10.8%), and dyspnea(10.8%), and the most frequent local symptom of sign was pain(95.2%), followed by swelling(85.5%), skin color change(8.4%) and bleeding from wound site(2.4%).
7. In laboratory findings, coagulation time was prolonged in 13 cases(86.7%) of 15 cases who were performed this test, and elevated SGOT was seen in 24 cases(55.8%) of 43 cases.
8. The treatment was consisted of the medical and the surgical treatment. In medical treatment, 66 cases(79.5%) were received the tetanus antitoxin and 79 cases(95.2%) received antivenin. In surgical treatment, 73 cases(87.9%) received skin incision and irrigation, 7 cases(8.4%) received skin incision and suction.
9. There were 18(21.7%) complicated cases, the phlegmon was 10 cases(12.0%) followed by lymphadenitis in 5 cases(6.0%), arthritis, abscess and gastroenteritis in 1 case(1.2%).

This is a study on the types of family systems through questionnaire about the FACES Ⅲ, in 53 patients with somatization disorder and in 53 patient with medical and surgical service for the control at the Seoul & Sechun Hospital from March to July 31, 1990.

The results were as follows:
1. In the levels related to cohesion and adaptability, those of the control families were adequate(seperated & connected, flexible & structured) but those of somatization families were enmeshed or disengaged cohesion type.
2. Types of family systems for the control group showed that balanced types were statistically more significant than extreme types, but vice versa for the somatization group.

In the many studies of the family relationship, it is essential to figure out the marital satisfaction to know how much the people of their society enjoy happy life and it is necessary to solve the causes of dissatisfaction to study which factors have irfluence and give satisfaction.
This study was performed in order to measure the sociodemogaphic factors which influence marital satisfaction during the school age stage of the family life cycle by the Dr. Olson's Marital Satisfaction Scale.
Responese to self-administered questionnaire, which were given to 120 married couples were analysed.

The results were as follows:
1. Maital satisfaction of those who are male(p<0.05), have higher income(p<0.01), have son in children(p<0.05) were significantly higher than those who are not. But, there were no significant differences in age, education levels, occupation, house, total family number, number of children, and living with their parents.
2. In marital satisfaction of married couples, the marital satisfaction scores of husband were significantly higher than those of wife in family which have income of 300-590 thousand won for month(p<0.01), have 4-6 persons in member, have two children, have son or sons in children, and which does not live wiht their parents(p<0.05).
3. In subscale analysis of marital satisfaction scale, the marital satisfaction scores of husband were significantly higher than those of wife in PERSONAL CHARACTERISTICS(p<0.01), COMMUNICATION(p<0.01), SEXUAL RELATIONSHIP(p<0.01), ROLE RESPONSIBILITIES(p<0.05), RELATIONSHIP WITH FAMILY AND FRIENDS(p<0.05), but, in the part of CONFLICT RESOLUTION, LEISURE ACTIVITY, the marital satisfaction of husband tend to be higher than those of wife but there were no significant difference, and the marital satisfaction scores of wife were higher than those of husband in FINANCIAL CONCERNS, PARENTS RESPONSIBILITY, RELIGIOUS ORIENTATION, but there were no significant difference.

A retrospective study has been made of 1,253 cases of traffic accidents which had been treated at the H hospital in Seoul from May 1989 to April 1990.
This study was conducted to find out the nature and pattern of the traffic accident from the clinical and epidemiologic standpoint. The aims of this study were not to indicate direct preventive measures but focus attention on fields in which best results should be given by the preventive measures.

The following results were obtained;
1. Accidents occurred most frequently from 6 p.m. to midnight, 54.2%.
Although there was no significant difference, the descending order of monthly incidence was January(12.3%), March(9.6%), and August(9.6%).
2. Male to female ratio was 2.63:1.
The highest incidence was in age group between 20-29 year(34.7%).
3. The majority of trauma was from taxi and passengers' car (64.1%).
Pedestrians were most commonly injured(43.4%).
4. The types of injury were almost neurosurgical and orthopedic injury(88.1%).
5. Abrasion and contusion were most frequent(25.0%) and cerebral concussion was 21.7%.
6. In abdominal trauma, small bowel (33.3%), spleen(25.0%), liver(12.5%), kidney(8.3%) was the descending order of frequency.
7. Brain damages were responsible for the majority of cause of death (53.6%) and mortality rate was 4.1% in the admitted patients.

To test the hypothesis that family function differs in diabetic patients according to their level of glycemic control, family function was assessed using the Family Adaptability & Cohesion Evaluation Scales Ⅲ(FACESⅢ) questionnaire.
From June to August, 1990, 57 patients with adult-onset diabetes mellitus(Type Ⅱ NIDDM) to be diagnosed and managed for more than 6 months in the Youngdong Severance Hospital were randomly selected. The patients were divided into three groups(good, fair, poor) according to the level of their glycemic control which was obtained in the clinic visits during the 6 months before the date of the assessment of family function.
The results were as follows:
1. There was no statistically significant difference in the state of glycemic control when related to age, duration of diabetes, income, and marital status ; however, there was a statistically significant difference in the state of glycemic control when related to enforcement through diet therapy.
2. In the cohesion according to the level of glycemic control, separated and connected types were more common in the good and fair control groups than in the poor control group, and disengaged type was more common in the poor control group than in the good and fair control groups. This result was statistically significant.
3. In the adaptability according to the level of glycemic control, structured and flexible types were more common in the good and fair control groups than in the poor control group and chaotic type was more in the poor control group than the good and fair control groups.
This was not statistically significant.
4. In the family types according to the level of glycemic control, the relatively more extreme family type was effected more significantly in the poor control group than in the good and fair control groups.

Patient satisfaction is a concept that has been addressed as important for many years. To investigate the patient satisfaction, we utilized the Smith-Falvo Patient-Doctor Interaction Scale analysed validity and reliability and surveryed to 279 consecutive patient-initiated visits from June to July 1990. Also, making use of the reconsidered items, we surveyed the frequency of each item which has positive effect on patient satisfaction and the frequency of each item according to the characteristics of both patients and physicians.

1. Patient satisfaction is scored 55.8%(73%), as mean, and the dispersion is scored from 32(42%) to 76(100%).
2. Patient's sex, age, education, econmoic state, admission history and interview history does not effect patient satisfaction.
3. Patient satisfaction to family physician is higher than that to internal physician as 57.4(71%) and 54.4(71%)(P<0.05), but no difference between hospital and local clinic.
4. In Doctor's professional attitude and manner to patient, patient satisfaction to family physician is higher than that to internal medicine physician as 24.8(77%) and 23.1(72%)(P<0.05), but no difference between hospital and local clinic.
5. In doctor's explanations given to patient, patient satisfaction to family physician is higher than that to internal medicine physician as 11.7(73%), and 10.9(68%)(P<0.05), but no difference between hospital and local clinic.
6. In comparative survey of patient satisfaction about each 19th scale, family physician is highly scored in 'It seems that doctor is interesting about my condition'. and other 9 scales, but no difference between hospital and local clinic.

In recent years, increasing attention has focused on providing preventive services that have been associated with dramatic reductions in morbidity and mortality.
To compare the desires of patients, recommendations of physicians and actual performance of health care centers, we surveyed 977 patients from three university based family outpatient clinics and six private family clinics and 59 family physicians by questionnaires and we investigated health care contents that were performed by 23 health care centers in Seoul, in July, 1989.
The results were as follows :
1) Of the 977 patients, 482 patients(49.3%) desired a periodic health examination, even if feeling well. There were no differencies in age, sex, marital status between who desired a periodic health examination and those who did not, but more educated, higher income patients were more desired it.
2) In counselling of periodic health examination, physicians recommended more than patients desired and a few item was performed at health care centers.
3) In physical examination, physicians recommended more than patients desire, and the most selected item was blood pressure by physicians and patients. At health care centers, height and weight, blood pressure, vision, hearing were performed more than patient's desire and physician's recommendation, but oral cavity, mammography, pelvic examination, digital rectal examination were performed less than.
4) In diagnostic procedure, physicians recommended more than patients desire, and patients selected more than counselling and physical examination. At health care centers, laboratory examination through blood and urine samples were performed more than patient's desire and physician's recommendation, but Pap smear(78.9%). mammography(39.1%), barium enema(0.0%) were performed less than.
5) In frequency of selected health care items, patients desired more frequently than physicians recommended, and there was no recommendation about it at health care centers.

It required 4 months to collect data(May 1-August 31, 1989), its data were collected by the FACESⅢ questionare that the 56 families of high school students were regarded as the normal functioning families, the 56 families of the inpatients and outpatients of the Shinchon Severance Hospital psychiatry deptment as the dysfunction families.
Its result were as follows.
1. In psychiatric families, the total scores of cohesion and adaptability were significantly lower than those of normal families.
2. In the levels related to cohesion and adaptability, those of the normal families were adaquate (separated & connected, flexible & structured) but those of psychiatric families were disengaged cohesion type and rigid adaptability type.
3. The family types of normal families showed that balanced types were higher significantly than the extreme types, but vice versa in psychiatric families.
4. No difference was noted in family type related to psychiatric disease.

The purpose of the study presented were to compare the health-promting behaviors of older adults with those of young and middle-aged adults to examine the relationship of age and other sociodemographic characteristics to life style throughout adulthood, and to identify differing lifestyle patterns. and to check out the problems among the older adults.
Six dimensions of life sytle were measured by the 'Health-promoting Lifestyle Questionnaire' in 36 elderly and 76 young and middle aged adults.
Older adults had lower scores (53.4±6.8) in overall health-promoting life styles than both young and middle aged group, but it had no significant statistical difference.
It was remarkable that older adults had significant lower scores in the demension of smoking habits and prohibition of smoking.

Thirty-seven suicidal attempters and depressed patients were examined in an effort to determine the importance of life stress as factors in suicidal attempt.
The results were as follows :
1) The suicide group was found to be younger than the depressed group(P<0.05). Sex distribution and socioeconomic status score were revealed no significant difference between two groups.
2) Structured Interview Guide for Hamilton Depression Score(SIGH-D) was not significantly different between two groups.
3) Total stress score and total negative stress score were significantly high in suicidal group than in depressed group(P<0.05), but total positive stress score was not significantly different between two groups.
As a result, this study suggested that suicidal attempt is high in early adulthood group and in high stressed group under the control of degree of depression.