Background
: Family environment has an important effect on the development of children. During childhood and adolescence, depression and anxiety are common forms of psychopathology. Therefore, the relationship between family function and depression·anxiety in children was investigated in this study. This research was intended to aid management of children in the field of primary care.

Methods : This study was based on the survey administered to 193, 4th grade students of two elementary schools in the area of Sung-buk in Seoul, Korea, in May, 2003. We investigated family function, depression and anxiety by self-rating using the Smilkstein's Family APGAR, the Kovacs's CDI and the Reynolds's RCMAS. At the same time, home environment characteristics (Family Structure, Parental Religion, Parental Education and Monthly Household Income) were investigated.

Results : There were no significant differences in home environment characteristics between Family APGAR groups (P＞0.05). CDI scores were significantly higher for children whose parents had education levels of middle school or lower (P＜0.05). However, there was no significant difference in RCMAS scores between home environment characteristics (P＞0.05). CDI score was significantly different between Family APGAR groups (P ＜0.05). And, RCMAS scores was significantly higher in poor family function groups than good family function groups according to Family APGAR groups (P＜0.01). Both CDI and RCMAS scores was negatively correlated with Family APGAR scores (r=-0.376, P＜0.01) (r=-0.266, P＜0.01) and CDI score was positively correlated with RCMAS scores (r=0.711, P＜0.01).

Conclusion : In groups where the Family APGAR score was lower, both CDI and RCMAS scores were significantly lower. Accordingly, when caring for children, family physicians should need to their family function and know that it has an effect on children's emotions.

Background
: Arterial stiffness is a strong indicator of cardiovascular risk. Increased visceral fat confers greater risks of metabolic syndrome and cardiovascular events. The aim of this study was to elucidate the relationships between arterial stiffness and regional distribution of abdominal adiposity (i.e. subcutaneous and visceral adipose tissue).

Methods : Thirty obese participants (M：F=17：13, mean age=53.6±12.0 years) underwent anthropometric measurements, laboratory procedures such as serum lipid levels and abdominal computed tomography scan. The aortofemoral pulse wave velocity was measured by foot to foot method using two continuous Doppler waves.

Results : Pulse wave velocity was positively associated with age, hip circumference (P＜0.01), visceral to subcutaneous abdominal fat ratio and body weight (P＜0.05), but independent of the total abdominal, visceral, and subcutanous fat. Although not positively associated, the mean pulse wave velocity tended to be higher in patients with history of hypertension or diabetes.

Conclusion : The site of abdominal fat distribution contribute to the prediction of arterial stiffness and visceral adiposity is associated with increased risk of cardiovascular events.

In foreign country, lots of studies were reported about the relationship between heart rate variability (HRV) and cardiac mortality. Lower HRV has been identified as a independent risk factor for sudden death. By the time, the study of HRV is confined to physically diseased state such as myocardial infarction or diabetic neuropathy. However recently the tendency of HRV has been toward to make clear the relationship of HRV and psychological problem. It is well known that depressed person is affected frequently by cardiovascular disease compared with normal people. However the mechanism that depression increases cardiovascular disease is not definitely found even though the autonomic dysfunction measured in HRV is suggested a factor for this mechanism. Depressed person has decreased HRV, decreased low frequency which reflects sympathetic activity, decreased high frequency which reflects parasympathetic activity. It means they have lower autonomic activity, so they have high cardiac mortality.

Few physician knows about the utility of heart rate variability and in my thought, especially short time analysis and frequency domain method is first introduced in Korea.

So we introduce this case for as many as physician know the utility of HRV.

Background
: Abdominal obesity is recognized as an important risk factor of metabolic diseases and atherosclerosis. The purpose of this study was to investigate the effects of vibration baths on abdominal fat and blood lipid profiles in obese women.

Methods : From Apr. to Jun 2000, the 32 obese women received vibration baths for 4 weeks (30 minutes/day, repeated 5 times per week). The people were divided randomly into two groups, the case (n=17) and the control (n=15) group. The case group received vibration baths (55 Hz) and the control group took baths only. Body weight, height, body mass index (BMI), body fat distribution, lipid profiles, and blood pressures were measured in all subjects immediately before and after 4 weeks of the study. The body fat distribution was assessed by CT scan by which both total abdominal and visceral fat areas were measured at the level of the umbilicus.

Results : After 4 weeks, 13 subjects remained in both groups, respectively, and the total abdominal and visceral fat area decreased significantly in the case group compared from those of the control group. There were no significant differences in body weight, body fat mass, serum lipid profiles, and blood pressures before and after the baths in the two groups.

Conclusion : These results suggest that vibration baths is effective in decreasing abdominal fat. But there were no significant weight change, the effect is insufficient in obesity treatment goal.

The most common endogenous cause of Cushing's syndrome is Cushing's disease. The evaluation of patients with suspected Cushing's disease and syndrome requires an understanding of the proper use and limitations of the tests commonly included in the diagnostic work-up. The best screening test for Cushing's syndrome is a 24-hour urine collection with analysis for urinary free cortisol excretion. Low-dose and high-dose dexamethasone suppression tests, corticotropin assays, a corticotropin-release hormone stimulation test and inferior petrosal sinus cathaterization may be required for a definitive diagnosis. MRI is useful in localizing the lesion but some limitations. Surgical removal of the lesion by a trans-sphenoidal appraoch is usually successful, but long-term follow-up is required. We report a case of Cushing disease which shows such typical clinical characteristics of Cushing syndrome as weight gain, skin lesions, truncal obesity, striae, hypertension.

Background
: Obesity can be considered as hyperaccumulation of body fat. Therefore, the aim to treat obesity is to decrease body fat. Abdominal total fat calculated in computed tomography is thought to be the most accurate index measuring body fat. The body mass index (BMI) and body fat mass are the representative indices also. Leptin is a protein hormone expressed by obesity gene in adipose tissue. It inhibits food intake and increases energy consumption, thereby controls obesity. With a study of relationship between plasma leptin level and body mass index and abdominal total fat area, we tried to find the usefulness of leptin as an index of adiposity.

Methods : The adiposity level was approximated by BMI, computed tomography and bioelectical impedence. To further explore the relationship with body composition, body fat distribution was determined by computed tomograph. To quantify the relationship between serum leptin level and adiposity, correlation analyses have been conducted.

Results : The subjects were 32 females with a BMI of over 25 kg/m². The mean plasma leptin level was 14.2±5.9 ug/L. We investigated the correlation of plasma leptin level with subcutaneous and visceral fat. The plasma leptin level showed a significant correlation with BMI and body fat mass, and was significantly correlated with subctaneous fat (P＜0.01), but not with abdominal visceral fat.

Conclusion : A significant correlation between plasma leptin level and body fat mass was observed. The distribution of subcutaneous fat showed differences in plasma leptin level. Therefore, the plasma leptin level may be used as an index of change of body fat mass, especially subcutaneous fat.

Background
: Symptoms of musculoskeletal system is a common problem, followed by those of respiratory system. Most patients with problems of musculoskeletal system are examined and treated by a primary doctor. This research was performed to inquire into a method which can increase the effectiveness and the precision of history taking in patients with problems of musculoskeletal system in primary care and also to assess a self-marking method were patients can mark their pain site on a normalized picture.

Methods : In the department of family medicine and rehabilitation of an university hospital in Seoul, 44 patients with musculoskeletal pain on their first visit in an outpatient clinic were asked to put marks on a normalized picture and also mark the degree of pain with a visual analog scale from 0 to 10, before history taking. After history taking, the doctor also marked the spot of the patient's pain on the normalized picture and then compared the spots together. After comparing the two pictures of the doctor's and the patients', they then drew another picture with only one spot to avoid overlapping spots. We compared the differences among the patients in every decade from ages 20 to 60 and divided the value of visual analog scale into 3 groups concerning the spots drawn by patients, and compared the relations between them.

Results : The pain spots drawn by doctor only were on the lumbar spine and the shoulder whereas most of pain spots drawn by patients only were on the upper back, the cervical spine, and the lumbar spin. The older the patient and the lower the degree of pain was, the more humerous it had spots.

Conclusion : It is considered that with a general history taking method and a self-marking method, clinical effectiveness will be great to the patients having pain on the abdomen, the cervical spine, and the lumbar spine and to those who are elderly and with lower pain spots.

Background
: Headache is one of the most common symptoms having experienced by many people. High school girls are expected to experience headache very often. Their proper treatment and adequate medical service is doubtful, and stressful environment of the Korean high school will augment the chronicity of headache. Knowing the forms of headache and categorizing the headache according to headache according to headache classification system is important for proper treatment of headache. Types of headache in high school girls have been categorized using the International Headache Society (IHS) system. The relationship of headache with beck Depression Inventory (BDI) and Family APGAR score of the headache group and the control group were investigated. Thus, the purpose of this study was to attribute to the treatment of headache in female youths.

Methods : The questionnaire on headache, under direct interviews, was given to each high school girls in Seoul, from March 1 to 31, 1999. The headache group was subclassified into migraine group, tension headache group and other headache group, using IHS system, Furthermore, the migraine group was subclassified into migraine with aura (classic migraine), migraine without aura (common migraine) and other migronous disorder. The students who had not experienced any headaches during the recent on year have been selected as the normal group. The normal group was compared with the headache group, I,e., tension headache and megraine. Depressed tendency was assessed using the BDI; and family function was evaluated by Family APGAR. The date were analyzed using SPSS 8.0.

Results : Among the subjects, 304 (60.4%) high school girls had experienced a headache during toe previous on year. The girls with migraine, tension headache, and other types of headache were 110 (38%), 81 (27%) and 113 (35%), respectively. The migraine group showed higher BDI scores (p<0.01). Also, the migraine group showed more depressiveness than the normal group (p<0.01), according to the scores on the BDI which were greater than the cutting score of 21. In the Family APGAR, there was no significant difference between the headache groups and the normal group(p>0.05).

Conclusion : When headache in high school girls was classified by using IHS system, headache in the migraine group was more prevalent than in the tension headache group and the normal group. And the migraine group had more depressive tendency. When physicians deal with headache in high school girls, they need to be aware of migraine headache and associated depressive tendency.

Background
: Few studies have been done regarding the level of DHEA which is influenced by age, and their effect on cardiovascular disease and prevention of cancer. It is a well known fact that the level of DHEA is decreased with age and the aging is not a correctable risk factor for cardiovascular disease. The aim of this study was to identify plasma DHEA-S change by age and to find out if there was any correlation with serum DHEA-S and cardiovascular risk factors.

Methods : The author collected blood from 85 males and 80females who had no particular disease history and no specific findings on physical examination. If there were any changes of DHEA according to age, we analyzed the correlation of DHEA with cardiovascular risk factors such as blood pressure, total cholesterol, triglyceride, low density lipoprotein, high density lipoprotein and obesity index (body mass index, waist/hip ratio).

Results : In both males and females, plasma DHEA-S level peaked at third decade and the concentration of DHEA was significantly decreased according to age (p<0.01). In males, DHEA-S showed no correlations with cardiovascular risk factors. In females, DHEA-S showed negative correlations with systolic blood pressure, diastolic blood pressure, total cholesterol, and low density lipoprotein. Also, high density lipoprotein positively correlated with DHEA-S. These correlations in female subjects, however, disappeared after multiple regression analysis.

Conclusion : In both males and females, plasma DHEA-S was significantly decreased with advancing age. There was no significant correlation between DHEA-S and cardiovascular risk factors in both men and women.

Background
: Patients diagnosed as an advanced cancer and families need accurate information about the length of survival in order to plan for and to make the best use of the time that remains. The health care of that patient can then be redirected toward palliation and mobilizing resources to ensure a comfortable life. The purposes of this study were to evaluate the prognostic value of performance status plus some physical symptoms and some biological indices and therefore to assist in planning appropriate palliative care.

Methods : This study was performed on 151 patients, who had been diagnosed as advanced cancer in Korean University Guro Hospital from July 1999 to July 2000.: We requested Karnofsky performance status scale, mental status, jaundice, severity of pain, anorexia, voiding difficulty, dyspnea and dry mouth. We assessed the biological indices by leukocyte count, plasma albumin, proteinuria.

Results : We could confirm 82 patients' death(54.3%) of 151 patients. Univariate analysis showed that Karnofsky status scales mental status, jaundice, severity of pain, anorexia, voiding difficulty, dyspnea, dry mouth, leukocyte count, albumin and proteinuria demonstrated a statistically significant predictive prognosis. Multivariate analysis using Cox's proportional hazard model showed that age, performance status, albumin, proteinuria were independent predictors of survival and severity of pain had the borderline value.

Conclusion : Age, performance status, albumin and proteinuria were the independent prognostic factors for patients with advanced cancer.

Background
: A predominant accumulation of adipose tissue in abdominal region confers increased risk of cardiovascular disease. The best technology available for measurement of regional fat distribution is computed tomography. However, computed tomography is limited its use for clinical purposes by cost. The aim of this study is to identify the best simple anthropometric index of abdominal visceral fat accumulation.

Methods : To quantify the relationship between anthropometric indices of abdominal obesity (waist circumference, waist-to-hip ratio, waist-to-height ratio, body mass index, abdominal sagittal diameter) and abdominal(total, visceral, subcutaneous) fat areas measured by computed tomography, correlation and multiple regression analyses have been conducted.

Results : No significant difference for waist circumference, body mass index and sagittal diameter between men and women have been found. Mean value of waist-to-hip ratio is larger in women, but waist-to-height ratio is larger in men. The mean abdominal total fat area and mean subcutaneous fat area are higher in women. Interestingly, men, despite lower total fat area, have higher mean abdominal visceral area. Thus, the mean visceral fat-to-subcutaneous fat ratio is much higher in men. Abdominal sagittal diameter shows the highest correlation(men: 0.69), women: 0.76) with abdominal visceral fat area in both genders. stepwise analyses have been performed to determine the best simple anthropometric index of abdominal visceral fat accumulation. In men, the significant indices are abdominal sagittal diameter, body mass index, and waist-to-height ratio. In women, abdominal diameter is the only significant index.

Conclusion : Abdominal sagittal diameter, in comparison with the waist circumference, waist-to-hip ratio, waist-to-height ratio and body mass index, is the best predictor of the amount of abdominal visceral fat.

Background
: A standard questionnaire is usually characterized by a set of questions, a scoring method, and psychometric properties. But many studies suggested that previously translated standard questionnaire in Korea had bee used without testing translation validity, scoring system and psychometric properties.

Methods : After developing a preliminary delphi questionnaire from references by a researcher, it was modified from pretest procedure, which was performed to 6 family physicians who had experiences in translating standard questionnaires. Some experts were chosen among authors of standard questionnaire, translation articles in four questionnaire related journals and others were recommended by other experts.

Results : The total number of experts was 53 including 22 family physicians, 15 psychiatrists, 2 psychologists, 8 faculties of preventive medicine and 6 faculties of nursing. The response rates were 85%, 87%, 92% on 1st, 2nd, 3rd delphi round, respectively, and the total response rate was 69%. According to Delphi surveys, minimal requirements for a standard questionnaire translation were translation by two translators, pretest techniques, consideration of age·sex·education level in pretest procedure, reliability validation, validity validation and 0.5 or more of correlation coefficient level in convergent validity validation. Minimal requirement for reliability coefficients was 0.7 or more, but the results did not reach adequate consensus.

Conclusion : Developing minimum requirement guidelines for standard questionnaire translation using Delphi method can be done.

Background
: Urinary tract infection (UTI) is one of the most common diseases dealt with by primary physicians. UTI is common in the elderly and has a great influence on the quality of the elderly's life. Thus, we conducted a study in one nursing home to find out the prevalence of bacteriuria and epidemiologic characteristics of the elderly.

Methods : The study was performed twice on April 12 and on May 4, 1999 among 108 subjects residing in a nursing home of Hanam City. The authors inquired the subjects pertaining to the history of UTI symptoms, collected urine samples by midstream clean-catch technique and catheterization and performed routine and microscopic urine analysis and urine culture.

Results : The overall prevalence of bacteriuria in subjects was 23.1%(25/108) ; 20%(3/15) in males and 23.7% (22/93) in females. The prevalence of the bedridden subject was 40.9% (9/22). Among the urine samples of 25 cases which were positive in the urine culture, E. Coli was found in 15 cases(60%). The sensitivity, specificiy, positive and negative predictive value of pyuria for bacteriuria were 44.0%(11/25), 87.9%(73/83), 52.3%(11/21) and 83.9%(73/87), respectively, while those of nitrite test for bacteriuria were 64.0%(16/25), 97.5%(81/83), 88.%(16/18) and 90.0%(81/90), respectively. The prevalence of bacteriuria increased by 16.23% as age increased by ten years using the Cochran-Armitage's linear trend test.

Conclusion : The prevalence of becteriuria in the elderly residing in a nursing home was higher than that of the elderly residing in a community. In the elderly over 60 years old, the prevalence of bacteriuria increased as the age increased. Immobility is considered as a risk factor of bacteriuria. Bacteriuria may be treated by antibiotics focused on E. Coli. Thus, we can expect improvement in the quality of life as well as extension of life span.

Background
: About 80 percent of Korean population over 55 years old show radiographic signs of osteoarthritis. Hence, osteoarthritis has become one of the most important public health problem among the old age. Despite the importance of this disease, proper methods for evaluation and diagnosis of osteo-arthritis have not been developed. Authors have investigated the sensitivity and specificity of thermography in diagnosing osteoarthritis.

Methods : Twenty patients who had visited the department of family medicine, Korean University Hospital, with non-traumatic knee pain during the period from April 1 to May 30, 1999, were included in the study. Patients had gone through series of careful history taking, physical examination and laboratory evaluations for clinical evaluation of osteoarthritis of the knee joints. Furthermore, the radiographic and thermographic examination of both knee joints were assessed.

Results : Among the twenty patients who have been examined, 15 patients were to have shown radiographic abnormality; on the other hand, 14 patients showed thermographic abnormality. Seventeen patients showed clinical manifestations of osteoarthritis. Twelve patients, among those who had clinical osteoarthritis, were shown to have osteoarthritis in both image studies, i,e. radiographic and thermographic abnormalities. All patients who had not shown clinical osteoarthritis, were normal on both image studies. The sensitivity and specificity of thermography in diagnosing osteoarthritis were 80% and 80%, respectively (P<0.05).

Conclusion : Hot spots or asymmetric distribution in the knee joint area of osteoarthritis patients were in thermographic examination. Thermography has shown efficacy in the evaluation of osteoarthritis.

Background
: It is well known that Korea is one of the endemic areas for viral hepatitis B and those who are positive for HBsAg has been reported to be about 5-10% in Korea. Since the 1980's, research and population education for prevention and vaccination for hepatitis B were implemented in Korea. Therefore, we predicted that the positive rates of HBsAg and Anti-HBs have changed since then. Young adults are considered to be the main candidates for hepatitis B vaccination, and the change in the rate of prevalence of HBsAg and Anti-HBs has been investigated in this study.

Methods : We surveyed 1760 freshmen who were positive for HBsAg and Anti-HBs who were in 1998. HBsAg and Anti-HBs was tested by RPHA/PHA.

Results : 3760 students included 2780 males and 980 females(mean age 19.44 years). Among them, 128(3.4%) was positive for HBsAg and 2488(66.2%) was positive for Anti-HBs. The positive rate of HBsAg was 105(3.8%) and that of Anti-HBs was 1797(64.7%) among 2780 male students. The positive rate of HBsAg was 23(2.3%) and that of Anti-HBs was 691(70.5%) among 980 female students.

Conclusion : As compared with previous prevalence studies of HBsAg and Anti-HBs, the positive rate of HBsAg was decreased and that of Anti-HBs was increased. The researchers hope that farther study is necessary using wider range of subjects.

Background
: The expansion and strengthening of primary care is approved as the only method to revise the ineffective health care system in Korea. In such a system, we intended to analyze the functional and regional distribution of specialists by investigating and classifying the hospitals where residents who completed their training in a university hospital located in Seoul for seven years are working and by acquiring the distribution of the subjects who are practicing as primary care physicians by year, specialties and location.

Methods : We selected 384 specialists, all of whom were trained as residents at a university hospital located in Seoul from 1987 to 1993. The hospitals they worked at were classified as primary, secondary and tertiary care hospitals according to the classification in the health care administration. The location of primary care hospitals among them was plotted on two maps; one of Seoul, the other of Korea.

Results : The number of females in the subjects was 68(17.%) and that of males 316(82.3%). The number of practitioners was 156(40.6%) and that of specialists working at the secondary care hospitals was 55(14.3%), and 147 specialists were working at the tertiary care hospitals(38.3%). With regard to the percentage of practitioners, dermatologic specialists presented with 60%, and relatively high group included obstetrics & gynecology(59.2%), family medicine(54.5%), plastic surgery(52.6%), otolaryngology(52.0%), pediatrics(51.7%), and orthopedics(48.6%). In tertiary care hospitals, chest surgery showed 72.7% as highest. Radiologic oncology presented with 66.7% and anatomical pathology with 66.7%. As to the location of primary care hospitals, 41.0% were in Seoul and 38.5% in Kyungkido. And the rest of the 20.5% were located in other areas of Koreas.

Conclusion : Considering the results of the study that show a great number of specialists are actually practicing as primary care physicians after their specialists' training, the present training system of spe-cialists needs to be revised and controlled in structure.

Background
: In order to provide basic data which are necessary for the standard reference of residency training program in family medicine, we analysed of family practice residency program in Korea(the core curriculum) which has 313 items - diseases and problems - proposed by the Korean Academy of Family Medicine.

Methods : Each item of the core curriculum of family practice residency program in Korea was sorted according to ICD-10. They were the most compared to common 100 diseases and clinical cases in family medicine department of a tertiary hospital in one year. The most common 100 diseases were listed according to ICD-10, also. But some items which were difficult to sort were excluded. Eighty eight types of diseases were sorted. Clinical data of a tertiary hospital included 9138 cases.

Results : Comparing to clinical cases of a tertiary hospital, the core curriculum includes 93.2% cases of family medicine department of a tertiary hospital. Among the 17 fields of the core curriculum, 12 fields were found in about 50% or more among cases of the clinic and 5 fields were in less than 50%.
Among 88 diseases, the core curriculum includes 78 diseases. 10 diseases were excluded. In the most common 100 diseases, 12 diseases were related to trauma and the core curriculum did not include them.

Conclusion : Generally the core curriculum included highly prevalent diseases, but did not include some diseases which is important. Revision to make up for the weak points in the current core curriculum may be necessary.

Background
: The immune system is controlled by a complex network of regulatory mechanisms which include neurologic and psychological factors. Previous studies of psychopathological population and population challenged by significant life events have shown that high levels of anxiety and depression are associated with impaired cellular immunity. However, less is known about the psychoimmunological relevance of family function with the immune function in healthy population. The aim of the present study was to investigate the presence and direction of relationship between family function and cellular immunity.

Methods : Design : Cross sectional, observational study. Participants : 41 healthy adult males from a family medicine ambulatory care unit in a tertiary hospital completed a series of psychometric instruments that include the Family APGAR(Adaptation, Partnership, Growth, Affection, and Resolve), FACES III. In parallel, lymphocyte subset assay, lymphocyte proliferative responses to the mitogen concanavalin(ConA), interleukin 1-beta, interleukin-2 was analysed to assess cell-mediated immune function.

Results : Family adaptability was inversely correlated with total T cell, B cell counts, helper T cell(T₄) and lymphocyte proliferative response to low dose mitogen Con A(p<0.05). Family cohesion was inversely correlated with suppressor T cell(T8)(p<0.05). In the lymphocyte proliferative response to low dose Con A stimulation, the extreme family showed the highest response compared to midrange and healthy family(p<0.05). Relative to moderately dysfucntional family, severe dysfucntional family and healthy family had significantly higher lymphocyte proliferative responses to the high dose Con A(p<0.05).

Conclusion : We suggest that family function could be related with immune function and it may impact on health and susceptibility to illness in healthy adult males. Further studies are required to elucidate the direction of relationship of family function and cellular immunity and the psychosocial mechanisms involved in the immune system.

Background
: Many of the major life events that appear to affect biologic system and health occur within the context of the family and can have a profound psychosocial and biologic impact on family memebers. So, the present study attempted to exmins the relati-ons of family function with stressful life events, depression, and physial and psychological symptoms reported by partients.

Methods : Design : Cross sectional, observational study. Participants : 41 healthy adult males from a family medicine ambulatory care unit in a tertiary hospital located in Guro completed a series of psychometric instruments that include the Family APGAR(Adaptation, Parnership, Grorwth, Affection, and Resolve< FACESIII(Family Adaptability and Cohesion Evaluation Scale), Modified 46-item Stressful Life Events Scale, Lee's 98-items Stressful Life Event Scale, Korean version of BEPSI(Brief Encounter Psychosocial Instrument) and BDI(Beck's Depression Inventory Scale).

Results : Family APGAR was negatively correlated with stress related life event(both in total negative events -0.30, -0.37, respectively ; p<0.05) and BEPSI(0.56, p<0.0001). No significant correlation could be found between family function and positive life events. Family APGAR also revealed significant negative correlation with BDI(-0.61;p<0.0001). Among the three family types, severe dysfunctional family demonstrated highest level of stressful life events, score, perceived stress, and depression(p<0.05).

Conclusion : The higher the assessment of the family functions(Family APGAR), the lower the level of stressful life events, perceived stress and depression. There, knowledge of the family function, stress, and coping could useful to family physicians in the whole person approach of their patients.

Background
: This study intends to clear that the current cost reimbursement system of Korean medical insurance of health care.

Methods : By using insured medical record of Federation of Korean Medical Insurance Societies used in the demand tendency research of the type of services from feburary 1st to 28th of the year 1990, authors analyze the characteristic of components of charges per case in the type of health care facilities.

Results : The charge per case in the out-patinet care of primary health care facility is 13,498 won, which is 54.6% by comparison with the secondary health care facility and 30.7% by comparison with the tertiary health care facility. Among these charges the amount facility and 71.8% in the secondary and 67.5% in the tertiary. Consequently, the services in the primary care are chiefly composed with the medical examinations and oral drugs. In addition to this point the author also finds that the charge per case in 3.5 times, the cost for oral drugs is 5.6 times larger than those of primary care, and therefore tertiary health care facility conduct various diagnostic examinations and prescript more expensive.

Conclusion : There is a difference of basic medical cost ratio between primary, secon-dary and tertiary health care facility. These points can be lead to the presumption that the diseases under the structure of current medical insurance are overlapped irrespective of the characterisitcs of the type of health care facilites, and this is profitable to the tertiary health care facilities which can conduct various types of services. In conclusion, the frame a policy is needed to encourage primary care which are nothing but simple structure of charges.

Background
: Rapid progress in medical science and technology has lengthened the average span of life in general population and accelerated the increase in the elderly. This gave rise to the expansion of chronic degenerative disease in the elderly, and then led to an increase in the utilization rate of health care facility and medical fee in sequence.

Methods : In order to grope for an effective control program of chronic degenerative disease and to find out the characteristics of disease structure and uilization patterns of health care fa-cility in the elderly, the author analysed the 6,072,196 cases of insured medical record of Federa-tion of Korean Medical Insurance Societies from January 1st to December 31st of the year 1991.

Results : Essential hypertension(5.94%) is the most common disease in the elderly. And what follows are gastritis and duodenitis(4.29%), acute bronchitis and bronchiolitis(3.68%), acute upper respiratory infection of multiple or unspecified site(3.47%) and diabetes mellitus(3.21%). Twenty most frequent diseases constitute the top 50.27% and one hundred constitute over 85% of all frequency of health care facility utilization. There are different patterns of diseases be-tween two sexes. Pulmonary tuberculosis, chronic liver disease and cirrhosis, malignant neo-plasm of stomach, chronic obstructive pulmonary disease, occlusion of cerebral arteries, sprains and strains of knee and leg, malignant neoplasm of trachea, bronchus and lung, other open wound of head, erythematosquamous dermatosis are more than 1.5 times higher in male by the standardized frequency ratio. There is a significant dissimilarity of disease structure between primary and other types of health care facility, which presents the point of reinforcement in pri-mary care. The author has also noted elderly patients prefer secondary or tertiary health care facility in case of essential hypertension, diabetes mellitus, pulmonary tuberculosis, health failure, duodenal ulcer, chronic liver disease and cirrhosis, funtional gastrointestinal disorder, hyperte-nsive heart disease and chronic obstructive pulmonary disease which seems to be not so critical in most cases.

Conclusion : Patients of chronic degenerative disease tend to pursue the high quality of medical care and irregularly utilize health care delivery system.

Background
: Obesity itself is independent risk factor of cardiovascular diseases but recent studies have demonstrated that regional fat distribution rather than obesity itself is a risk factor for cardiovas-cular diseases. The aim of this study was to analyze the relationship of obesity and increased waist-hip ratio to other risk factors for cardiovascular diseases(blood pressure, fasting blood sugar, serum lipids and lipoproteins).

Methods : The study was conducted in 382 subjects(make 197, female 185) who visited a periodic health examination center in a tertiary hospital from Aug 1th to 31th of the year of 1995. Subjects were checked sex, age, height, weight, waist, circumference, hip circumference, blood pressure, fasting blood sugar, serum total cholesterol, triglycerides, HDL-cholesterol and LDL-cholesterol. Overall obe-sity was measured by BMI(body mass index) and abdominal obesity evaluated by waist-to-hip ratio (WHR) and Conicity index. Subjects were divided into 4 groups according to their BMI(<25.0≥25.0) and WHR(male<0.91, ≥0.91/female<0.85, ≥0.85)

Results : Higher mean value of total cholesterol was found in abdominal obesity and normal weight with increased WHR than groups with normal WHR in male. In female, the mean value triglycerides in normal or underweight with increased WHR was significantly higher than in normal higher and than of HDL-cholesterol was lower than gluteofemoral type obesity. Conicity index was significantly positively correlated with BMI, WHR in both sexes. A significant positive correlation emerged between Conicity index and age, systolic blood pressure, fasting blood sugar, total cholesterol and a significant negative correlation emerge between Conicity index and HDL-cholesterol in male. In female, a signifi-cant positive correlation was founded between Conicity index and age, blood pressure, fasting blood sugar, total cholesterol, triglycerides and a significant negative correlation with HDL-cholesterol.

Conclusion : Obesity and increased WHR is associated with rick fators of cardiovascular diseases and WHR and Conicity index is useful in measuring abdominal obesity. So, the author suggest incorpo-rtate measurement of BMI and WHR, Conicity index into the routine. examinations of obese patients to enhance the evaluation of health risk.

Background
: It is current trend that health promotion and disease prevention are important target to the health seeking people. The health promotion is very closely related wit lifestyles which can be modified. Physician's role nowadays would be advocating health lifestyle for their patients, but many physicians in busy practice are reluctant to do so. If brief counselling requiring minimum time can be effective in changing poor lifestyle factor, it is of great help in preventive ptactice among primary care physicians.

Methods : During three months of period from 3 April 1995 to 30 June 1995, patients attending the health examination center in two hospitals was randomly assigned to control group and interven-tion group. Intervention group were advised to modify their poor lifestyles trough three to five minute brief counselling, given health related leaflets. Data for follow up questionnaire were obtained from 100 patients by the end of 1st month and 77 patients by the end of 3rd month.

Results : Intervention group had shown significantly increased mean score in exercise, seatbelt use, nutrition and weight control, smoking, drinking, behavior, overall health score one month later. Control group had shown significantly increased mean score in exercise only one month later. Interve-ntion group showed better behavior change than control group in the aspect of overall health score, nutrition and weight control significantly by the end of one month. Intervention group had shown significantly increased mean score in exercise, seatbelt use, nutrition and weight control, smoking, drinking behavior, overall health score three month later. Control group had shown significantly increased mean score in overall health score and exercise three month later. Intervention group showed better behavior change than control group in smoking nutrition and weight control, overall health score significantly by the end of three month.

Conclusion : The results show that doctor's brief counselling modifying poor lifestyles for their patients was effective and thus primary care physicians should play a key role in counselling and encouraging their patients having desirable habits.

Background
: The adequate and appropriate pain control for the terminal cancer patients which should have heen given is not simple matters to be accomplished. Because there was not enough accumulated experiences for the most of medical doctors through their residency training and they are not comfortable to give analgesics to terminally illed patients, particularly narcotics.
Therefore the author attempt to make actual method to use in paractive with analyzing the requirement of analgesics, the method how th give analgesics, the side reaction from narcotic analgesics and the cahracteristics of terminally illed cancer patients in order to make a suggest how th approach to the terminally illed patients, particularly narcotics.
Therefore the author attempt to make actual method to use in paractive with analyzing the requirement of analgesics, the method how th give analgesics, the side reaction from narcotic analgesics and the cahracteristics of terminally illed cancer patients in order to make a suggest how th approach to the terminally illed patient successfully.

Methods : A retrospective chart audit of analgesic type and amount was performed on the medical records of 100 terminal cancer patients who had been expired in the Holy Welfare Hospital from July 1991 through August 1993. Different typers and amounts of analgesics were converted to a common standard, and oral morphine equivalent(OME) relative to 1mg of oral morphine. Descriptive statistics were used to characterize patient analgesic use during the last 30 days and the last 5 days of life. Associations between analgesic use and select patient characteristics(age, sex, cancer site, metastasis, family life cycle, family type and pain intersity at the last 5 days of life) were explored.

Results : 1. The number of patients was 110, male, 60 cases(54.5%) and the female was 50 cases(45.5%) respectively.
2. 90% of 110 subjects had required analgesics to given at some time during terminal care. The 11 patients did not need any analgesics at all, 2 other patients did not need any analgesics during the last 5 days of life. However, 84.5% out of the all patients received narcotic analgesics at some time during the terminal course.
3. Most of the patients in this study used the long-acting form of oral morphine in regular basis and talwin was most frequently given alalgesics on an as-needed-basis. 61.7% of 99 subjects had been received analgesics by mouth during the last 30 days to the end of life and during the last 4 days, the requirement of pain killer by mouth had been decreased markedly to 54.6%. Parenteral and rectal route were prefered route of drug admistration as reach to the end of life.
4. The range of mean daily analgesics used was between 17.3 and 397.5 OMEs. The proportion of patients using analgesics increased while reach to death. The mean of daily requirement of analgesics longer than a month in duration was 73.6%mg(OME1) and the median was 58.0mg OMEs. During the last 5 days of life, the mean daily analgesic requirement was 79.5mg(OME2) and the midian was 61.5 OMEs. There was significant difference between OME1 and OME2(P<0.05).
5. OME2 was positively related with pain intensity at the last 5 days(P<0.05)/
6. OME2 was inversely related to age(r=-0.2978, P<0.01).
7. There were no statistically significant difference in OME2 by sex, staging, bone metastasis, family life cycle and family type.

Conclusion : The most of all terminally illed cancer patients acquired analgesics to take care of their terminal stage of life although there was some individual differences in the requirement of pain medication. Large and enormous doses of analgesics may sometimes be required to control cancer pain. To control apin properly was the one of important method th take care of terminally illed patient as breaking vicious cycle to pain-fear to death-depression, and preventing anxiety, hopelessness and give up dignity as a human being.
The side reactions from the analgesics ware not prominent as to avoid to give medication and those could be ignored.

Background
: To prepare the basic educational data for primary care physicain who work to maintain and enhance the health of people in community. The authors carried on disease frequency analysis in medical Insurance in Korea.

Methods : To clarify the frequency of reasons which made people to use health delivery system in Korea, the authors has made descriptive study with 113,244,548 cases of actual visits to the health delivery system of Korean medical insurance from January 1st to December 31st of the year 1991. The objectives of this study are 100,000 random sampling cases of medical visits among 113,244,548 actual cases of those.

Results : 1. Females(54.5%) have made more frequent medical visits to the health care system than males(45.5%) 2. The frequent diagnoses are acute upper respiratory infection of multiple or unspecified site, acute bronchitis&bronchiolitis, acute nasopharyngitis, acute tonsilitis and acute pharyngitis in order. 3. There is a significant dissimilarity of disease pattern between the in-parient and out-patient group. Among the upper twenty frequent disease, only five disease are concord between the two groups. 4. There are higher prevalence of respiratory infections in the first and second decade, genitourinary infections in the third and forth decade, gastrointestinal diseases in the fifth and sixth decade and then hypertension above the seventh decade.

Conclusion : 53.3% of all visits to health care system were upper twenty frequent diseases. The people who have acute, transient problems made more frequent visits to the primary health care system than to the secondary or tertiary of those. It is needed to encourge primary health care system.

Background
: The aim of this study is to clarify the possibility of using the analysis of the avoidable mortality as a tool to check the quality of medical care.

Methods : The Causes of 2,202 deaths in the period of 1984~1994 were classified into avoidable causes and unavoidable causes, and then avoidable causes of death were grouped into the perventable causes, the treatable causes, and the treatable and preventable causes according to Rutstein's classification

Results : The avoidable causes among total mortality rate has been declined significantly in 11 years and the treatable causes of death declined more than the avoidable causes. The mortality rate increased in the avoidable causes of death, such as neoplasm in liver and other diseases of liver in men, hypertensive disease with vascular complications of heart and brain in women.

Conclusion : This study revealed that the mortality of neoplasms and chronic degenerative disease were not decreased in spite of developments of modern medical care. The avoidable mortality pattern of this study may reflect unbalanced development of medical care. This study have limited significance because the population observed in this study belong to partial population in health care system.

Background
: In Korea, tertiary medical care almost totally provided by the university hospitals, which makes the university hospital acting as community-health care centers only. Moreover, the tertiary care hospitals became difficult to performer but also differentiation of specialty in the care are restricted by overloaded patient care in the tertiary care hospital. The purpose of this study is to analyse the functions of tertiary care hospital within the health care delivery system in order to check it university hospital plays its role properly as it should be.

Methods : The authors have selected the patients visited, the doctors trained as residents, the medical students, and the jouranls reported in Guro hospital from Sep. 1983 to Feb. 1992, which were analyzed into the aspects of the care, medical research, medical education and community support. We identified the numbers of the patients and their adresses, disease entities of the patients as the ICD-9 three-digit categories and found out the physician's offices who trained in Guro hospital.

Results : The total number of the patient are 1,548,188 persons(inpatient care) and 2,687,330 persons(outpatient care). The internal medicine is the most. (In patients ; 16.15%, out patient ; 23.16%) The frequency of the disease for 10 years is as follows in descending sequence ; unspecified anemia, essential hypertension, organism unspecified pneumonia, enterocolitis, anemia by complicating pregnancy and childbirth, adult-onset type diabetes mellitus, hypertrophy of tonsils and adenoids, unspecified fetal distress, Caesarean delivery, liver cirrhosis. The number of the papers reported in the each department are 1,407 cases(clinical review 96.0%, experimental reports 4.0%). The number of educated medical students is 1.139 and trained residents are 144 persons. In 144 trained doctors, approximately 28.5% worked in tertiary care hospitals and the remainders are belonged to the primary and secondary health care facilities.

Conclusion : Although the Korea University Guro hospital has been doing well as a tertiary care hospital in the care of the patients, there are many problems in the aspects of the research, medical education and patient care yet.

Background
: Hepatitis C Virus(HCV) infection is known as one of the most important causes of liver diseases such as post-transfusion hepatitis, sporadic hepatitis, liver cirrhosis and hepatocellular carcinoma. The prevalence of antibody to Hepatitis C Virus(anti-HCV) among blood donors was about 0.3-1.5% by first generation enzyme immunoassay(EIA). Second gengration anti-HCV among Korean adults and identify the route of HCV transmission.

Methods : Serum samples from 5,718 adults who visited Korea University Hospital Health Care Center were tested for second generation anti-HCV EIA, serum ALT(alanine aminotranferase), HBsAg, anti-HBs and anti-HBc. Questionnaires including presumptive risk factors of HCV were obtained from 47 anti-HCV positive cases, and those results were compared to the results from 137 anti-HCV negative cases.

Results : The overall prevalence of anti-HCV was 1.6%(89/5,718). The prevalence of anti-HCV increased with aging significantly(P<0.01). The prevalence of anti-HCV in elevated(ALT>40IU/L) serum ALT cases was significantly higher than in normal(ALT≤40IU/L) cases(5.4% vs 1.1% P<0.01). Anti-HCV status was associated with history of transfusion significantly(P<0.05), but the following factors such as operation history, family history of liver diseases, history of sexually transmitted disease, alcohol intake and history of acupuncture or tatooing were not associated with status of anti-HCV.

Conclusion : Prevalence of anti-HCV among Korea adults was 1.8%. Age matched prevalence of anti-HCV in Korean adults was higher than the other countries in North Europe or North America, but similar to that of Spain or Japan. Prevalence of anti-HCV was increased with aging. To elucidate the meaning of anti-HCV positivity in this, futher sutdy is needed

Background
: It is well known that the ultrasonographic test is one of most commonly performed diagnostic tool nowadays. Also the fatty liver is one of the most frequent finding by this abdominal ultrasonographic examination. The purpose of this study is to determine the significance of this fatty liver and the possibility of application of ultrasonography to make diagrosis and follow up clinical course of fatty liver.

Methods : Obesity index, liver function tests, blood lipids, clinical features, related factors and age and sex distribution were analyzed with 237 fatty liver cases those were diagnosed by ultrasonography for the health care examination at Guro Hospital Korea University from April 1992 to March 1993. Fatty liver cases were classified according to Mittelstaedt's classification to group I(mild) an group II(moderate to severe). In this study, patients who were confirmed as hepatitis B or C were excluded.

Results : Fatigue(21.5%), indigestion(9.9%), epigastric pain(9.4%) were frequent complaints and asymptomatic was 54.1% in group I. In other hand, fatigue(28.6%), indigestion(14.3%), epigastric pain(8.9%) were prominent subjective finding and asymptomatic were only 39.3% is group II. The obesity index was statistically higher in group II than group I. And aspartate aminotransferase, alanine aminotransferase, ν-glutamyltranspeptidase, alkaline phosphatase were significantly higher in group II than in group I. Total cholesterol and triglyceride in group II were significantly elevated than group I.

Conclusion : The fatty liver cases classified by ultrasonographic finding revealed statistically significant differences in several biologic markers as indicated the above results. The author concluded that group II fatty liver needs more close and more frequent clinical traces individually as they have well known risk factors than group I.

Background
: It is expected that Korea Medical Insurance and Health Care Delivery System made change the contents of inpatients in Family Medicine and increased the role of Family Mediine in primary care. We have tried to prove the above hypothesis by comparative study on the inpatient related seeral factors in the year of 1998 and 1991.

Methods : We examined the medical records of the patients who were hospitalized to the department of Family Medicine, Korea University Kuro Hospital from January 1. 1998 through December 31, 1988 and January 1, 1991 through December 31, 1991. We analyzed the number of patients, age, sex, living district, the length of stay, the route of admission, condition at the time of discharge, and diagnosis.

Results : A total of 95 patients were hospitalized in 1988 and those of 183 patients in 1991. The increased rate of total numbers of hospitalized patients was 92.6%. There were no significant difference in age, sex, living district distribution in between those study groups. The length of stay was increased from 5.8±3.8 days to 13.3±8.2 days. In the route of admission, the patients via out patient department was decreased from 97.8% to 91.8% and those via emergency room was increased from 2.2% to 8.2%. In patient's condition at the time of discharge, improved state was increased from 38.9% to 66.7% and unimproved state was decreased from 49.5% to 16.9%. In 1988, the most common diagnosis was chronic hepatitis of 14 cases(14.7%) and the next was neurotic disorder of 8 cases (8.4%). In 1991, the most common diagnosis was diabetes mellitus of 20 cases(11.0%) and the next was acute and subacute necrosis of liver of 12 case(6.6%).

Conclusion : It is concluded that these changes were induced by increased hospitalization for treatment compared to decreased hospitalization for diagnosis due to decreased the amount of money that patient has to pay from their own pocket besides medical insurance coverage. Also, it is believed that the increased role of family medical insurance coverage. Also, it is believed that the increased role of family medicine in primary care affected these changes.

Background
: It is well accepted fact that the obesity is an important factor for many disease such as chronic debilitating illness including hypertension and so on. It has been the main focus of disease prevention adn health promotion in our medical field because of westernizing daily life practice in Korea. Many investigators had been reported the relation between obesity and hypertension. However there has little study been done about any relationship between Body Mass Index (BMI) and blood pressure. The purpose of this study focused on the relation of aging process, blood pressure and BMI.

Methods : The author analysed systolic and diastolic blood pressure and BMI by age variables with 911 people who came to Korea University Guro Hospital for periodic health exam from January 1, 1985 to June 40, 1991.

Results : The systolic and diastolic blood pressure are significantly (P<0.05) higher in BMI grade I and II compare to grade 0 in men regardless of age variable. In other hand systolic blood pressure in significantly (P<0.05) higher in BMI grade I than grade 0 and diastolic pressure is also higher (P<0.05) in grade I and II than grado 0 in women. The correlations of these variable are r=0.29 in systolic blood pressure and age, r=0.26 in systolic blood pressure and BMI, r=0.18 in diastolic blood pressure and age, and r=0.29 in diastolic blood pressure and BMI. The author analyzed the contribution of age and BMI to blood pressure. The result showed that age can explain 8.24% to systolic blood pressure and BMI can explain 8.61% to diastolic blood pressure.

Conclusion : In this study with the relationship of obesity and blood pressure(systolic and diastolic), the author can make conclusion that age variable has significantly correlation with systolic blood pressure and BMI showed positive relationship with diastolic blood pressure. The author propose that there is a lot of room for further study to make clear the point if there is and possibility of positive effect on diastolic blood pressure with reducing body weight in the obese diastolic hypertensive patients.

Background
: There has been marked increased interest in health promotion and disease prevention recently. An important aspect of health promotion is the lifestyle factors that can be modified. Because good health habits can positively affect the length and quality of life. Modern physicians' role nowadays would be advocating healthy lifestyle for their patient as the teacher and counselor, and model. However, if doctors do not act healthy behavior seriously, patients will not practice healthy behaviors which was taught by their doctors. The purpose of this study is comparing the physicians' behaviors with those of control group.

Methods : Physicians group was consisted of 77 residents, 9 instructing physicians and 66 practitioners. And the control group was 126 persons who visit to a health counseling department from May, 1992 to July, 1992, and 81 persons who work for the City Hall and some employers of a hotel. Data were obtained by a self-administered questionnaire including 12 items.

Results : Physicians had better healthy behaviors than control group in the aspect of nutrition, smoking, toxin, alcohol drinking, seatbelt, career satisfaction, and relationship of family and friends, but less in sleep, career satisfaction, and relationship of family and friends, but less in sleep. Male physicians had better behaviors than male control group in nutrition, smoking, toxin, alcohol drinking, seatbelt, career satisfaction, personality, and relationship of family and friends, but less in sleep. Female physicians had better habits than female control group in nutrition and seatbelt, but less in sleep.

Conclusion : In comparing physicians' health behaviors with those of control group there is no marked consistent difference, which means that physicians act inadequate role model. Therefore physicians more concern and effort to promote healthy behaviors.

Background
: The primary practitioners have been lift their position from their primary care fields more and more recently. The quiet few of primary care practitioners are blaming present Korean medical insurance policy for declining their practice. This study was planned to find out the possible reasons for deduction from medical insurance which primary care practitioners wanted to be paid for their effort, and the influence from "unreasonable deduction" to their practice if there is any.

Methods : A 14-item self-administered survey questionnaire was designed, and mailed to randomly selected 500 primary practitioners. Their main practice fields were internal medicine, pediatrics, family medicine, and general practitioner.

Results : 37(7.47%) out of 500 were responded to our survey. 75% responders experienced insurance premium deduction. The half of responders had argued against the deduction, and 72.2% of those were received the premium back. And 71.5% of responders demanded the readjustment of insurance deduction policy.

Conclusion : Even though there may be many biases exist in this study, the author have to call conclusion that current medical insurance in Korea may need to be changed in many aspects of that policy. Because the reason of deduction for the primary care physician's fee were unclear and those deduction could interfere the patients-doctors relationship and primary care practice.

Background
: Low birth weight is the most important determinant of the chances of the newborn to survive and to experience healthy growth and development. Pregnancy can be seen as a time when the family's boundaries are shifting(or are failing to shift) to accommodate a new member. According to the circumplex model, one would hypothesize that families at either extreme of cohesion or adaptability would not do well at navigating the transition of pregnancy and the birth of a child, Therefore we carried out this study to determine the effects of family functioning on infant birth weight(IBW).

Methods : The mother's perception of family function was assessed with FACES Ⅲ and collects sociodemographic data. Randomly selected mothers in Korea University obstetric clinics, while they are in 28 to 36 weeks of their gestational period were invited to participate this prospective study from June through August 1991. Listwise deletion on any one variable reduced the sample to 120 mother-infant pairs. IEW and other variables affecting IBW were compared by family function type.

Results : IBW is positively related with gestational age(r=0.361) and weight gain during pregnancy(r=0.267) and negatively associated with highest systolic blood pressure(r=-0.240) and age of pregnant women(r=-0.180). 15% of family was considered to be dysfunctional. There were no statistically significant difference in this analysis between sociodemographic determinants(educational level, occupation, religion, income, et al) and biomedical characteristics(gestational age, prepregnancy weight and weight gain during pregnancy, highest systolic blood pressure) of functional and dysfunctional families, IBW from women with dysfunctional family significantly smaller than from whose mother with healthy functional families(p<0.05).

Conclusion : Maternal anxiety and stress or social support have been to be related to the outcome of pregnancy, as understanding of the contribution of the family system to pregnancy outcome increases, it should be possible to intervene early in pregnancy to modify risk factors associated with family systems, the major goal of this research is to generate information that can improve the outcome of pregnancy.

Background
: In recent years, the incidences of atherosclerosis is increased among Korean because of socioeconomic and diet change. And it is known that many biochemical markers for atherosclerosis including serum total cholesterol, triglyceride, LDL-cholesterol and HDL-cholesterol are exist. Among these markers, serum total cholesterol is most basal parameter for screening the risk of atherosclerotic coronary heart disease. In order to determine the cut off value of serum total cholesterol for risk of atherosclerosis in Korean people, we carried out this study.

Methods : Data were gathered from 679 adults over 20yrs-old who were evaluated for general check-up during period from June 1990 to May 1991. Except 383 abnormal groups on physical examination and laboratory study, 296 healthy groups was analyzed and evaluated. Serum total cholesterol, LDL-cholesterol, triglyceride level was distributed with age, and serum total cholesterol was utilized for cut-off point.

Results : The serum total cholesterol and LDL-cholesterol were increased with age in both sex, and triglyceride was increased with age in woman but in men. There were no relation-ship between HDL-cholesterol and age. There was no significant difference of serum total cholesterol by sex. The cut-off point of total cholesterol for moderate risk was 186mg/dl at 3rd decade, 202mg/dl at 4th decade, and 205mg/dl at 5th decade, and 223mg/dl at 6th decade, and 249mg/dl at 7th decade. Also the cut-off points of total cholesterol for high risk were 202mg/dl at 3rd decade, 223mg/dl at 4th decade, 229mg/dl at 5th decade, 236mg/dl at 6th decade and 260mg/dl at 7th decade.

Conclusion : Results of this study may be not sufficient to apply on all Korean adults because this study group was limited and small. But we tried for cut-off value of serum total cholesterol for risk group of atherosclerosis. And, further study and effort for reducing the risk of atherosclerosis should be evaluated.

Background
: Chronic liver dysfunction, especially fatty liver and chronic hepatitis, is a common problem in primary care. In such case, physicians diagnosed the liver disease through the history and physical examination, blood chemistry, hepatitis viral markers, and radiologic study. We carried out this study to determine the clinical association between noninvasive diagnostic methods and liver biopsy.

Methods : Age and sex distribution, blood chemistry, hepatitis viral markers, sonographic finding and pathologic diagnosis were evaluated in 93 patients with chronically abnormal liver function test who were admitted for liver biopsy to Guro Hospital Korea University form July 1990 to June 1991.

Results : The AST level, 140.7 U/L and ALT level, 227.6 U/L in chronic hepatitis group were more elevated with statistical significance than 90.8 U/L, 98.1 U/L in fatty liver group(p<0.05). But the AST/ALT ratio, 1.14 in fatty liver group was more elevated with statistical significance than 0.74 in chronic hepatitis group(p<0.01). At pathologic diagnosis compared with sonographic finding, diagnosis accuracy of fatty liver was 52.5% and chronic hepatitis was 42.4%. Normal finding on sonography in fatty liver group or chronic hepatitis group by pathologic diagnosis were 44.0%.

Conclusion : The blood chemistry including AST, ALT, AST/ALT ratio, γ-GTP and hepatitis viral markers, sonography all are available diagnostic method in the chronic liver dysfunction. But we should be considering that liver biopsy was needed for more accurate diagnosis of liver disease.

An every 8 to 12 hrs shift work is widely accepted in our society because of its economic efficacy which influences many aspects of physical, social, and psychological health. It is well know that the shift work affects physical disorders, such as peptic ulcer, rheumatoid arthritis, functional gastrointestinal disorders, awakeness and sleep disturbances, irregular menstruation, eating problems, and ischemic heart diseases etc. But there is not many investigations about psychological effects of shift work. In order to evaluate psychological effects of shiftwork, authors have surveyed day and shift workers. The Symptom Checklist-90-Revision-Somatization, Obsessive-compulsive, Interpersonal sensitivity, Depression, Anxiety, Hostility, Phobic anxiety, Paranoid ideation, Psychotism-was applied to 271 nurses, including 185 shift and 86 day workers, in a university, hospital, form July 30, 1990 to August 4, 1990.
The results were as follows.
1. The scores in Obsessive-compulsive, Interpersonal sensitivity, Depression, and Paranoid ideation of shift workers worked more than 4 times of night work during the last week were higher than those of day workers, significantly(p<0.05).
2. In the shift workers, the scores in Obsessive-compulsive, Interpersonal sensitivity, Depression, Anxiety, Paranoid ideation and Psychoticism of shift workers worked more than 4 times of night work during the last week, Obsessive-compulsive, Hostility and Paranoid ideation of shift workers worked 3 times of night work, Hostility of shift workers 2 times of night work, were significantly higher than those of non-night workers(p<0.05).
3. Although correlation coefficients were low between the frequency of night work and symptoms dimension in the shift workers, Obsessive-compulsive, Depression, Hostility and Paranoid ideation were correlated significantly to frequency of night work(p<0.05).
4. Results of 9 symptoms between shift workers and day workers were not different(p<0.05).
5. Three global indicies-Global Severity Index, Positive Symptom Total, Positive Symptom Distress Index-between shift and day workers were not different, too(p<0.05).
6. Several symptom dimensions were different according to marital and religious status in this study. Scores in Obsessive-compulsive, Depression, Hostility and Positive Symptom Total of unmarried group showed higher scores than those of married group, and obsessive-compulsive, Depression and Hostility of infidel group higher than those of having religion group. But the status of marriage and religion were not different in the compared groups-day workers and shift workers worked more than 4 times of night work during the last week, non-night workers and night workers worked 2,3 or 4 times of night work during the last week, respectively-in this study(p<0.05).
7. Scores of all symptom dimensions were not affected by such as age, duration of employment, mean work time per day, position-head nurse and nurse, work place, education and daily travel time to work. And scores of all symptom dimensions also were not affected by work types when questionnaire survey was recorded at that times-day work of day workers, day, evening and night work of shift workers(p<0.05).

From the above results, shift work, especially night work affects the developments of psychological symptoms.

This study was planned to evaluate the actual circumstances of induced abortion in urban and rural area, and figure out the way how to reduce the frequency of induced abortion that causes many complication and danger if there is any.
Questionnaire survey was done for five months from January to May 1990. The objective of study was married women who visit to Family Medicine, Guro Hospital, and Yoju Hospital, the Korea University. Total repondents was 100 persons : 53 were living in rural area and 47 persons were living in urban area. SAS program was used for analysis of this study and the result was following;
1. Sixty-six women experienced induced abortion, 38(57.6%) of them were living in urban and 28(42.4%) in rural area.
2. Mean frequency of induced abortion was 1.57(2.19 in urban, 1.02 in rural) and significantly higher in urban are than in rural area(P<0.01).
3. The reason for induced abortion : Because they did not want any more children 27(44.3%), was the most common cause, control the interval between siblings 11(18.0%), was the next and conception before marriage lock 10(16.4%), economic reason 7(11.5%), health problem 5(8.2%) in urban and so on. The other hand, did not want any more children 22(52.3%), health problem 9(21.4%), control the interval between sibling 7(16.7%), economic reason 3(7.2%), afraid of female baby 1(2.4%) in rural in order were the reason of induced abortion.
The most common reason of induced abortion was they who experienced induced abortion did not want any more children.
4. Among 105 induced abortions, contraceptions were not performed in 76 cases(72.4%), contraceptions were perfomed in 29 cases(27.6%).
5. There was no difference in the number of children, method of contraception, school education level between women living in urban area and in rural area.
6. All ten respondents who had induced abortion due to pregnancy before marriage were living urban area.
7. The method of induced abortion were dilatation and curettage in 102 cases(98.0%) and 3 cases(2%) were with certain herb medication, drug injection, pitocin induction at 3rd trimester, and so on.
8. Dilatation and curettage were done most in 1st trimester, but 17 cases(7.6%) were done in 2nd trimester.
9. The sources of education for contraception were personel of health center in 30 cases(42.3%), neighborhoods and lay person in 17cases(23.9%), books 11cases(15.5%), physician in 10 cases(14.1%) and the others in 3 cases(4.2%).
10. The methods of contraception were tubal ligation in 28 cases(41.8%), condom in 12 cases(17.9%), loop 1 case(14.0%), vasectomy 7 cases(10.4%), rhythm method 4 cases(6.0%), orall pill 3 cases(4.5%), and the others 3 cases(4.5%).

It is a recent trend that the birth and mortality rates have been decreased and average life span prolonged in proportion to the socioeconomic and scientific advances.
More and more people live to a ripe old age, consequently elderly patients are steadily increasing.
This tendency is more remarkable in the rural areas where there is much drift of population comprizing the young and the matured.
This study purported to make a comparative investigation of the diseases among geriatric population in rural and urban areas.
Based uppon ICD-9 (International Classification of Diseases), the author made a comparative study of all senior citizens beyond the age of 65 who were hospitalized to the Korea University hospitals at Kuro, an industrial city, and at Yoju, a rural town, from July 1986 to June 1989. The trends of population at the two places for the four years were investigated at the same time.
As a result, the following differences were noticed between two areas.
First, the increase rate of old population 65 years of age and over in the percentage of total population in the rural area far surpassed that in the urban industrial area, and so did the number of aged inpatients in the rural area accordingly.
Second, although there was little difference in the average number of geriatric diseases per inpatient, that of the industrial city being 2.4 and that of the rural town 2.1, the characteristic of each elderly patient were in general multiple nature.
Third, the industrial area abounded mostly with cardiovascular system disease, malignancy, GI tract diseases, endocrine system diseases. In particular, hypertension, D.M., lung cancer and etc. were more predominant in the industrial city. On the other hand, while the rural area also tended to give rise to cardiovascular diseases, GI tract idseases, respiratory system diseases, and infection, the rural town outnumbered the industrial city in the cases of COPD, spondylosis and arthropathy, tuberculosis, heart failure, drug intoxication, etc. (P<0.05).
Fourth, granting that there are these differences between the two areas, what was commonly shared by them was the marked tendency of more and more people reaching a great age, with the inevitable result of increasing geriatric inpatients. Besides, despite some differences in the order of predominant diseases, geriatric diseases of both areas were similar on the whole in that they were mostly characterized by slow and chronic processes.

The suicide with using drugs is becoming a serious social problem. There have been many general studies of suicides, but the studies the suicide with using drugs in the rural areas have not been done well, Especially, in the rural areas agricultural chemicals which can be taken easily are the main ways to attempt suicide. So, the authors studied this phenomenon and analyzed it.
We analyzed the 118 people who attempted suicide with drugs. These are some of the patients who visited Yeo Ju Hospital emergency room from March, 1987 to February, 1989. The results were as follows:
1) Considering the people who attempted suicide by drugs, the ratio of male to female was 1 to 1(male : 59, female : 59), the age distribution rate of both sex between 30 and 39 years old was 24.6%, and that of between 20 and 29 years old was 23.7%, and the age distribution of men was even while the rate of women between 20 and 29 years old was 30.5%, and between 30 and 39 years old was 30.5%.
2) Seasonally, 30.5% of suicides ware attempted in spring, 26.3% in summer, 22.9% in autumn, and 20.3% in winter.
3) 66.1% of men and 54.2% of women used agricultural chemicals, and they also used rodenticide, tranquilizer, hypnotic, glacial acetic acid, etc.
4) For men, 50% of suicides were motivated by home disords, among which 92.3% were the discords between the family except wives, and other motives of suicides were pessimism of himself, failure of business, conflicts with coworkers, etc. For women, 61.9% of the motives of herself, violences of husbands were one of those motives.
5) 61.8% of the who attempted suicides were farmers and some of them were office workers, merchants, students, etc. And 47.4% of them were Buddists, 15.4% Christians, and 3.8% Catholics, and the rest of them have not any religion.
6) 32.5% of them graduated from high school, and 27.3% middle school.
7) 50% of them attempted suicide between 18 and 24 O'clock, and 89.2% of them attempted suicide at their homes.
8) All of those who answered to a questionary did not leave testament, and 82.3% of them did not give any hint to commit suicide.
9) In the process of management, 62.1% of them were hospitalized, among which 60% left the hospital voluntarily, 37% left the hospital after being healthy, 3% died, 27.9% left voluntarily at the emergency room and 6.3% moved to the other hospital.