Background
: It is known that various subtypes of obesity exist and there has been a growing interest in the various subtypes of obesity, especially in the unique "metabolically healthy but obese" subtype. The purpose of this study was to analyze the features of obese adults without metabolic complications and to provide data which can be used in strategy formation for the effective treatment of obesity.

Methods : A total of 4,561 obese adults with a BMI greater than or equal to 25 kg/m², were recruited from a health promotion center of a university hospital. Sociodemographic and life style information were gathered by self- questionnaire. We classified them into 2 groups - one having no features (metabolically healthy obese; MHO) and the other having 1∼5 features (metabolically unhealthy obese; MUHO) - using the ATP III definition for metabolic syndrome, and used the multiple logistic regression analysis to examine the association between various factors and MHO.

Results : Age and BMI were related with MHO independently. Adjusted odds ratio for the MHO men was 2.17 compared with women (P＜0.001). Adjusted odds ratio for the MHO regular exercise group was 1.66 compared with the no exercise group (P＜0.007). Additionally, those who exercised more had a greater probability of being in the MHO group. Adjusted odds ratio for the MHO in the large income group was 1.88 (P=0.007) compared with those in the small income group. As was seen with exercise, there was a direct relationship between higher income and the probability of being in the MHO group.

Conclusion : Men compared with women, large income compared with small income, and regular exercise compared with no exercise were features of obese adults which increased their probability of being categorized as "metabolically healthy but obese".

Background
: The purpose of this study was to compare the Physical Activity Recall (Stanford 7-days physical activity recall) with the Triaxial accelerometer (RT3) to assess physical activity in young adults.

Methods : Thirty-seven subjects wore the RT3 for 24 hours and then completed the physical activity recall. The Stanford 7-Day Recall records hours of sleep, light-, moderate-, hard- and very hard levels of physical activity.

Results : The total energy expenditure per day for the Stanford 7-day recall and RT3 was 2381.29±594.93 kcal/day and 2232.97±398.32 kcal/day, respectively, and showed high correlation (r=0.821). The activity energy expenditure per day for the Stanford 7-day recall and RT3 was 836.21±290.5 9 kcal/day and 509.83±181.57 kcal/day, respectively, and showed less high but significant correlation (r=0.327). When compared by sex, the total energy expenditure was significantly correlated in men (r=0.572) and the activity energy expenditure in women (r=0.484).

Conclusion : The Stanford 7-day recall and the RT3 was highly correlated in the total energy expenditure and significantly correlated in the activity energy expenditure. Therefore, it may be used reciprocally to assess physical activity.

Background
: Korea is a highly prevalent area of isolated anti-HBc with a rate of 15%, but there is neither vaccination nor management guideline agreed. To know the management for Hepatitis B Vaccination for adults with isolated anti-HBc, we investigated immune response to hepatitis B vaccination in adults with isolated anti-HBc.

Methods : The 23 adults with persistent isolated anti-HBc, who visited a health promotion center from Dec. 1998 to Aug. 1999, were vaccinated with Hepavax^±-B by the standard schedule (0, 1, 6 month) and anti-HBs titers were measured 1 month after 1st and 3rd vaccinations (1, 7 month).

Results : After the 1st vaccination, 18 (78.26%) developed anti-HBs seroconversion. Among them, 4 (17.39%) had titers of 10∼49 mIU/ml, 8 (34.78%) 50∼99 mIU/ml, and 6 (26.09%) more than 100 mIU/ml. All non-responders after the 1st vaccination remained as such even with 3 doses of complete vaccination. The majority of seroconverted group did not show more anti-HBs response with further vaccination.

Conclusion : Since none of adults with isolated anti-HBc had a primary response, which indicated few false positive results. Therefore they should be excluded on vaccination programs in Korea. To differentiate between immunity and occult infections, a single dose of vaccine with a follow-up anti-HBs test is preferable for adults with isolated anti-HBc. If the test shows a seroconversion it would indicate protective immunity, if not, then occult infection may be suspected.

Background
: CRC is an ideal target for population screening because it is a prevalent disease with an identifiable precursor lesion. This study was performed for the purpose of comparing cost-effectiveness of CRC screening strategies.

Methods : The natural history of a simulated cohort of 50- year-old Koreans in the general population was modeled with and without CRC screening until age 80 years. We evaluated 16 different screening strategies with Markov model. Cases of positive screening test results were worked up with a colonoscopy. After polypectomy, colonoscopy was repeated every 3 years. Our main outcome measurements were discounted lifetime costs, life expectancy and incremental cost-effectiveness (CE) ratio, comparing 16 different CRC screening strategies.

Results : In base-case analysis, compliance was assumed to be 60% with the initial screen and 80% with follow-up or surveillance colonoscopy. The non-dominated strategies were colonoscopy every 10 years (COL10), colonoscopy every 5 years (COL5) and colonoscopy every 3 years (COL3). Strategies that only included sigmoidoscopy were generally not regarded as non-dominated strategies, but sigmoidoscopy every 5 years (SIG5) showed similar cost and effects as COL10 while sigmoidoscopy every 3 years (SIG3) had similar results as COL5. Other strategies recommended by the expert panel, such as sigmoidocopy plus colon study every 5 years were less cost-effective than the alternatives.

Conclusion : Colonoscopy is the most cost-effective strategy in Korea for colorectal cancer screening. Unfortunately, the number of physicians skilled enough to perform colonoscopy is not enough to meet the demands of screening for colorectal cancer in average-risk adults. Therefore, we consider alternative strategies such as SIG5 or SIG3.

Background
: Most recent studies have suggested that beer is associated with high risk of mortality and morbidity. The purpose of this study was to investigate how beverage types affected high risk drinking for chronic harm.

Methods : We analyzed data from 1997 Korea's Behavioral Risk Factor Surveillance System Survey collected through telephone interview based on the multi-stage stratified random sampling (N=1,045). According to the WHOs guidelines, we categorized alcohol consumption per day into three risk levels for chronic harm and employed logistic regression analyses by adjusting for confounding factors including the number of beverages consumed, smoking, BMI, stress, and subjective health.

Results : Those who preferred soju were almost three to four times as likely to involve medium or high risk as those who preferred beer. In addition, compared to the beer-preferring drinkers, those who preferred spirits had more than five times of possibility in high risk drinking. However, both of those who preferred makkolli or wine and of those who preferred beer were exposed to high risk drinking to a similar degree.

Conclusion : In Korea, preferred types of alcoholic beverage turned out to be very important factor of high risk drinking behavior. Therefore, we need to encourage drinkers to switch high alcohol to low alcohol content beverages.

Background
: Currently, the high quality of life associated with women's rights is strongly supported and has become an important social issue. As a result, there is an increasing need for studies concerning female sexual function. The objectives of this study was to develop a questionnaire to evaluate sexual function evaluation in Korean women.

Methods : A total of 100 married women, who visited an outpatient clinic of family medicine department of a university hospital in Seoul, were studied. After filling out the self-administered questionnaire, a face-to- face interview was done on all study subjects. The items of this questionnaire were adopted from questionnaires with proven validity and reliability. Factor analysis was done and Crohnbach's alpha was calculated.

Results : The items of this questionnaire were classified into 5 parts: Drive, Excitement, Sexual activity, Satisfaction, and Spouse. The total variance was 51.5%. The total Crohnbach's alpha was 0.82. The internal consistency was high. Study subjects were able to complete this questionnaire within 10 minutes.

Conclusion : The validity and reliability of this female sexual function questionnaire was found to be acceptable. This questionnaire can be utilized as a diagnostic adjunctive tool and feedback for treatment through further studies.

Background
: Korea is an epidemic area of hepatitis B. There are needs for longitudinal study to measure quantity of hepatitis B infection status in Korea. This study was designed to observe natural course of hepatitis B markers in the same person for three years. The objective of this study was to investigate incidence of new infection and persistence of previous infection.

Methods : The study subjects were clients who visited a health examination center in Seoul twice with an interval of three years, from 1995 to 2000. They replied as nonvaccinee on both occasions for hepatitis B by self-administered questionnaire. Hepatitis B markers were measured by radioimmunoassay on all visits. There were 103 subjects with 61 men and 42 women.

Results : The positive rate of hepatitis B surface antigen was 20.4% initially, which changed to 18.5% after three years. The positive rate of hepatitis B surface antibody was 61.2% initially, which increased to 66.0% after three years. The positive rates of hepatitis B surface antibody in men were 63.9% initially and 68.9% after three years, which showed statistically significant trend (p=0.08). The positive rate of hepatitis B core antibody was 89.3%, which remained the same after three years. There was no positive conversion case of hepatitis B surface antigen. The negative conversion rate of hepatitis B surface antigen was 2/63(3.2%). The positive conversion rate of hepatitis B surface antibody was 7/40(17.5%), and negative conversion rate of that was 2/63 (3.2%). The positive conversion rate of hepatitis B core antibody was 3/11(27.3%), and negative conversion rate of that was 3/92(3.3%).

Conclusion : Hepatitis B markers changed in the direction of infection incidence, rather than natural disappearance of markers in nonvacciness. The mechanism was postulated as occurrence of new infection mainly, but the possibility of double infection by variants of hepatitis B virus could not be ruled out. We confirmed that positive rate of hepatitis B marker in males was not only higher cross-sectionally, but also increased higher longitudinally. We suggest a follow-up study of hepatitis B markers to be performed because hepatitis B markers showed dynamic changes. We think the high risk groups of hepatitis B infection have a priority in follow-up studies.

Background
: Ideal Body Weight(IBW) is commonly used to determine obesity levels because of its usefulness as target weight. This study was attempted to evaluate the comparative consistency between standards of determining obesity levels using the BMI and IBW. And the authors here provide a definition of IBW and attempt to suggest a new classification of obesity by IBW.

Methods : The test subjects for the research were 24,816 patients who received treatment at the such Health Promotion Center between May 1, 1996 and December 31, 1999. The comparative consistency between standards of determining obesity levels using the BMI and IBW were analyzed calculating the kappa value.

Results : The IBW from the Broca methods produced a kappa value of 0.668(p<0.001), while the calculation method for IBW recommended by the Japan Obesity Institute produced a kappa value of 0.664(p<0.001). On the other hand, an IBW calculated as 21(kg/m2)X[height(m)]2 (kg) produced the highest value of consistency at a kappa value of 0.911(p<0.001). After calculating IBW as 21(kg/m2)X[height(m)]2 (kg) and comparing the kappa values while adjusting the boundary zone standards, it was found that defining underweight as below 88% IBW and obesity as above 145% produced the highest value of concurrence at a kappa value of 0.935(p<0.001).

Conclusion : The validity and confidence with respect to the definition of IBW and the determination method for obesity as proposed by the authors may be confirmed through the methods high level of consistency [kappa value = 0.935(p<0.001)] with determination methods using the BMI.

Background
: According as people have an increased interest in early detection of disease and health promotion, people who take health examinations are increased. So this study is aimed to survey common problems about health in community and their frequency by way of investigation on diagnosis in health examination data and to evaluate the effects of risk factors on each disease patterns.

Methods : The medical records of the clients who have taken health examinations for the first time from March 1995 to February 2000 at a health examination center of a university hospital in Seoul were reviewed. The category and number of judged diagnosis, sociodemographic factors are compared and analyzed.

Results : The selected medical records accounted to 22,393. The study subjects consist of 11,544(51.6%) male. Mean age is 52.0±105 years(range 16~90). Mean number of judged diagnosis is 4.04±2.13(range 0~9) per one person and female took more diagnosis than male on an average(4.09±2.17 Vs 3.99±20.9). The organic diagnosis(56.4%) is most in total and other diagnosis is 35.7%, functional diagnosis is 7.9%. The common diagnoses are liver disease(7.17%), decreased physical strength(6.68), hyperlipidemia(6.53%), obesity(5.90%), osteoporosis or postmenopausal syndrome(4.72%), need for immunization against viral hepatitis(4.69%), hypertension(4.20%), functional gastrointestinal disease(3.93%). The number of total diagnosis and organic diagnosis is larger in older age, no exercise, female, smoker, no-spouse, lower education(p<0.05). The number of functional diagnosis is larger in female, younger age, non-smoker, lower education(p<0.05). The number of other diagnosis is larger in no exercise, smoker, female, younger age(p<0.05).

Conclusion : According to health examination, total diagnosis and organic diagnosis are influenced by age, exercise, sex, smoking, spouse, education, functional diagnosis is influenced by sex, age, smoking, education and other diagnosis is influenced by exercise, smoking, sex, age.

Background
: Stress can be induced from minor daily life event, and it is widely accepted that this daily minor stress is better predictive factor for relationship between disease and stress. In a number of laboratory studies, investigator reported that perception of stress can be reduced by physical exercise. So in this study, we observed relationship between exercise and stress from minor daily life event, and tried to clarify the effect of exercise on daily stress.

Methods : Volunteer was recruited from health promotion center of one university hospital. and they were doing regular exercise in more than three days per week. Participants completed measures of daily stress inventory and amount of daily exercise for seven days. To compare the daily stress amount between exercise day and no exercise day, we used repeated measures analysis of variance. We used the Wilcoxon sighed-rank test to compare difference of stress in different sex and different trait anxiety group.

Results : There was significant difference in appraisal of daily stress between exercise days and no exercise days. The amount of daily stress was significantly reduced in continuous low level of anxiety group and male by exercise.

Conclusion : Exercise is associated with a reduction of daily stress appraisal from minor life event. And there is different effect of exercise on daily minor stress in the different anxiety level group and different sex group.

Background
: It is reported that abnormal eating behavior is more frequent in the group of weight control than those of no control. Repeated and chronic binge eating behavior has associations with impaired work and social functioning. overconcerns with body shape and wight. The purpose of this study is to investigate the degree of abnormal eating behavior according to weight management, depression level and obesity.

Methods : From June 1999 to July 1999, we collected self-record questionnaire including body mass index(BMI), Back Depression Inventory(BDI), Eating Attitude Test(EAT), from 1292 students of one girl's high school in Seoul. Study subjects were divided by BMI, the set point was 25 ㎏/㎡. EAT score associated with weight control. BMI, BDI. smoking and alcohol was assessed by mul-tiple linear regression. Study subjects were also grouped by the existence of the history of weight management behavoir, then BMI, EAT score and BDI in each subgroups was assessed by t-test.

Results : Obese student were 42, whereas those of BMI under 25 ㎏/㎡ were 1191. BDI score ranging from 5 to 20 were 940, 21 to 63 were 179. The EAT score has significant relevance to the history of weight control, BMI, and BDI score in order. The EAT score and BMI were higher in the subjects who experienced various modes of weight control (48.41±14.47 vs 33.63±12.52 in EAT, 20.34±2.26 vs 18.72±1.89) (p<0.01).

Conclusion : EAT score was associated with weight control, BMI and BDI. EAT score and BMI were higher in weight control samples.

Background
: Because dementia tends to be underdiagnosed. Solomon PR developed a brief neurocognitive screening battery to identify Alzheimer's dementia. The 7-Minute Screen consists of four individual tests (orientation, memory, clock drawing, verbal fluency). It can be rapidly administered and it may be appropriately used in the primary care setting. We attempted to develop a screening tool of dementia based on the 7-Minute Screen at primary care setting in Korea.

Methods : We adapted the 7 Minute Screen to the Korean version of 7 Minute Screen(7 MSK). 7 MS-K and MMSE-K were administered to 61 elderly people who visited the Sungbuk Public Health Center. Inter-rater reliability and test-retest reliability were evaluated.

Results : The 7 MS-K has a sensitivity of 92% and a specificity of 92% for cutoff point of MMSE-K 23/24, Inter-rater reliability and test-retest reliability for the entire battery was very high(both r=1). Mean time of administration was 10 minutes.

Conclusion : 7 MS-K has a reasonable validity, reliability and can be administered in a brief period, and requires no clinical judgement and minimal training. It may be a useful tool for screening dementias in primary care setting.

Background
: Obesity is not only one of the risk factors that affects the prevalence and aggravation of chronic diseases, but is also the cause of social unfitness because slimness has become a standard of beauty. We surveyed on the satisfaction about self body image, the factors which are related to it and weight control behavior of the adolescents in a local area of Korea. Methods : The survey was performed in a high school of Pocheon on August, 1996. Five classes out of 14 classes in 1st and 2nd grade were selected. The body mass index(BMI) was calculated from the measured height and weight. The satisfaction about body image which was estimated by the difference between present body image and wanted body image in 9 graded figures of body image was obtained from the questionnaire. The information about sex, religion, history of being teased about body image, body image of their parents, mean duration of watching TV in a day, body esteem, and binge-eating was obtained from the questionnaire and we evaluated the relationship between all of the above with BMI and body image satisfaction. We also investigated on the interest in education about weight control and efforts made by adolescents from the questionnaire on weight control behavior. Results : Total of224 students participated in this study and only 14.7% of them were satisfied with their body image. 58.9% wanted weight reduction and 26.4% wanted weight gain. They were more dis-satisfied with their body image when they were girls(p<0.01), had the experience of being teased about their body image(p<0.01), had low body esteem(p<0.01), and had high BMI(p<0.01). We could not find statistically significant relationship between body image satisfaction and other factors such as religion, the duration of watching TV in a day, the body image of their parents and binge eating. 64.3% of the subjects tried to control their weight and most(87.5%) tried to lose wight. The selected methods were diet control(65.3%) and exercise(52.1%) and the most preferred method of diet control was skipping meals(45.7%). Conclusion : Most of adolescents were not satisfied with their body image and this dissatisfaction was related to gender, history of being teased about their body image, BMI, and body esteem. Many of them had tried to lose weight and among the methods of weight reduction, there behaviors that were injurious to their health and growth.

Background
: Alternative medicine is defined as a non-orthodox therapeutic practices including chiropractic, acupuncture, herbal medicine, faith spiritual therapy or as all sorts of medical care that do not follow the medical community standards. Patients do not think of modern medicine as the absolute solution to their health problems and they will sometimes ask for complementary therapy and in want of referral to alternative practitioner. We have investigated the primary physician's attitude and behavior towards alternative medicine.

Methods : Randomly selected 770 practitioners, in primary care practice in Seoul, were questioned from July to September in 1996 about the attitude to wards alternative medicine, the reasons and symptoms when referring, and experience in alternative medicine practice.

Results : 150 questionnaires were returned and among them 139 completed one(18.1%) were analyzed. Among 770 doctors, 35(25.2%) have refereed patients to alternative practitioner before and more referrals were made when they worked together closely or had some prior training. The belief of special effect of alternative medicine on certain disease was the first reason to refer. Other reasons were for herbal medicine, acupunture, and chiropractics in the order of sequence. The standard way to learn alternative medicine was to attend seminars available through certain institutions. On referral either chronic pain or musculoskeletal disease were the most chief complaints or main diseases of patients. 15 doctors(10.8%) had some experience in practicing an alternative approach and the patient subjects were more likely to be women, and there was increased tendency to be working with another doctor, and to have been trained for such practice. The items used by alternative practitioners were acupuncture, herbs in the order of sequence.
Conclusions：Alternative medicine is accepted somewhat by primary physicians in Seoul although the rate of referral and practice is lower than 54% compared to 16% in Canada.

Background
: Alcohol use is a major source of health problem. The social and economic costs related to alcohol use are enormous. Thus, alcohol use is a public health issue. Previous studies on alcohol use were based on hospitalized patients(especially alcoholics) or community subjects, but national survey is lacking. In this study, we describe alcohol use among the Koreans.

Methods : Household telephone survey was carried out using multistage stratified random sampling methods from April to May, 1997. Fifteen to sixty-nine year old subjects were randomly selected from household and asked to report type, quantity and frequency of alcoholic beverage consumption.

Results : The prevalences of alcohol drinking during the last month were 64.0% for men, 37.8% for women, and 64.7% for those in their twenties, and it decreased with increasing age. In multivariate logistic regression model, men, the unmarried, those in their twenties, administrative and professional personnel were associated with higher prevalence of alcohol drinking. Proportions of nearly daily drinker were 16.5% for men, 2.2% for women, and more than 20% for those in their forties and over and increased with increasing age. Mean alcohol consumption was 56 grams for men, 12 grams for women. Heavy drinkers, defined as average intake of 30 grams or more per day, were found in 23.4% of men and 2.4% of women. The most widely consumed beverages were soju, beer and makuli. In multivariate logistic regression model, men, the unmarried, those in their twenties, and administrative and professional personnel were highly associated with heavy drinking.

Conclusion : The prevalences of alcohol drinking during the last month was 49.0%. The proportion of heavy drinker was 11.4%. Men, the unmarried, those in their twenties, and administrative and professional personnel were highly associated with heavy drinking. Therefore, efforts should be made to reduce heavy alcohol drinking among the risk groups.

Background
: Blood pressure is normally lower during night times than in day times. But in some people, this nocturnal blood pressure drop is decreased or absent. In essential hypertensives, absence of nocturnal blood pressure drop(the 'nondipping' pattern) has been associated with increased target organ damage and cardiovascular morbidity. Present study was intended to describe the proportion of 'nondippers' among untreated essential hypertensives in Korea and to investigate the influences of independent clinical factors on the nocturnal fall of blood pressure.

Methods : We studied 50 untreated Korean essential hypertensives who underwent 24-hour ambulatory blood pressure monitoring. Subjects with a nocturnal drop in systolic or diastolic blood pressure, or both, 10% were defined as 'dippers', the others as 'nondippers'. Their demographic and clinical characteristics were obtained through medical record and questionnaire. Above characteristics were considered to be independent variables and the dipping status, dependent.

Results : Thirty four percent of essential hypertensives were 'nondippers'. Nocturnal blood pressure drop decreased with reporting of family history of hypertension and higher 24-hour ambulatory mean blood pressure. Previous studies insisted on the influence of age on the dipping status, but in our study, age showed no impact on nocturnal blood pressure drop.

Conclusion : About one third of untreated subjects with essential hypertension were observed to be nondippers. Family history of hypertension and high 24-hour ambulatory mean blood pressure significantly decreased nocturnal blood pressure drop in our study. According to previous studies, above factors might work through affecting the normally decreased sympathetic activity during sleep time. Longitudinal studies of the influence of nondipping on the long term prognosis of hypertension and large scale studies to establish the factors influencing nocturnal blood pressure drop and their mechanisms are further needed.

Background
: The BEPSI(Brief Encounter Psychosocial Instrument) was developed as an instrument for quick assessment of stress in a busy office setting, and well correlated with other stress scales. Bae et al. developed the BEPSI(Korean version)[BEPSI-K] in Korea, which was used broadly in health examination. In this study, we attempted to assess degree of stress and to find stress-related factors amon Koreans by the BEPSI-K.

Methods : A household telephone survey of 1,060 responders was carried out using multistage stratifed random sampling technique from April to May, 1997. The data were collected from 947 subjects who answered all the items of the BEPSI-K.

Results : The reliability of the BEPSI-K was demonstrated (Cronbach's alpha 0.71). The BEPSI-K sore showed left-shifted distribution, and its mean was 1.72. It also was significantly high in the unmarried, those with a low educational level, those with a low income, non-economic group, hypertensie patients, smokers, non-exercisers and drinker. Among 947 subjects, 7.7 percent was high stress according to tercile of the original BEPSI score.

Conclusion : Stress-related factors were marital status, educational level, income level, occupation, exercise, smoking, drinking, and hypertension in Korea.

Background
: Hypothyroidism may be involved in a significant portion of the causes of hypercholesterolemia in Korea. In this study, we determined the frequency of suspected hypothyroidism in hypercholesterolemic patients and compared the frequency of elevated thyrotropin levels among the groups with various total cholesterol levels.

Methods : The study subjects were healthy, asymptomatic people who visited Health Promotion Center of Seoul National University Hospital. We excluded subjects with history of hypertension, DM and hypothyroidism. The study subjects underwent physical examination and filled out a questionnaire on health risk factors. Also blood chemistry and thyroid function test were done.

Results : Among 6479 subjects, 194(2.99%) had elevated(>4.1μIU/ml) thyrotropin levels. Among the hypercholesterolemic(≥240mg/dl) patients(n=868), 40(4.60%) had elevated thyrotropin levels. And there was statistically significant difference between normal cholesterolemic and hypercholesterolemic subjects(P<0.05). Among the patients with total cholesterol above 280mg/dl (n=180), 15(8.33%) had elevated thyrotropin levels. As amount of the total cholesterol increased, the frequency of elevated thyrotropin levels increased(P=0.001). And this result was consistent following adjustment for age, sex, BMI, smoking and drinking status(P<0.01).

Conclusion : Practicing physicians should be aware of the possibility of secondary hypercholesterolemia due to hypothyroidism and keep in mind the importance of evaluating TSH level.

Background
: In order to improve the quality of life of dying patients so that they may die with dignity, they need to receive not only the physical, psychological, social, and spiritual care, but also systematic and continuous care. However, there is no adequate medical service at present. We studied terminal cancer patients' behavior patterns of health care utilization, the problems of caring for the patient, and medical services that bereaved families suggested for terminal cancer patients and their families.

Methods : From 271 patients' families who participated in our hospice program from March 1991 to February 1996, 108 bereaved families whom we could have contacted were interviewed by three student nurses with a structured questionnaire.

Results : The terminal cancer patients received their medical care through admission to hospital(45.4%), outpatient clinic(22.2%), emergency room(16.7%), and oriental medicine(12.0%). But during their terminal phase of the illness, 32.4% of patients never received medical care including oriental medicine, and 28.7% received alternative medicine care such as intake of mushroom and elm tree. 26 bereaved families(24.1%) pointed out the indifference of the medical team as a problem receiving proper hospital care, and 22 bereaved families(20.4%) emphasized emotional strain of their helplessness with the patient's suffering as a problem of caring for the patient at home. Over 90% of bereaved families from their experience suggested needs of continuous care, hospice care, home care, and 24hr telephone service.

Conclusion : There were inappropriate behavior patterns of health care utilization which resulted in large proportion of terminal cancer patients received alternative medicine never receiving proper medical care. Therefore, there is a need to develop the continuous and comprehensive care for terminal cancer patients and their family, such as hospice.

Background
: Korea is known to be endemic area of viral hepatitis B, and 5-6% of population are carriers. Immunization can reduce the spread of hepatitis B infection. Ho-wer, not all people respond to hepatitis B immunsation. 5-15% of primary vacciness fail to be immunized. After revaccination, only 37.5%-44% of the primary failures elicit antibody response. Recent studies have reported that it is effective to inject a double dose vaccina-tion in immunocompromsed patients. In some country, they recommend that neonate whode mother is HBV carrier shoud receive double dose vaccination. This study documented the results of double dose vaccintion only once to nonrsponders toward the HBV immunzation.

Methods : Healthy nonresponders to Hepatitis B immunization were recuited from Sep. 1995 to Aug. 1996. Subjects with their AST/ALT level over 40, or over 65 years old were excluded. They were received 2ml of plasma-derived vaccine(Hepavax-B) intramuscularly in the deltoid muscle. Anti-HBs antibody testing were performend at 1 to 3 months after vaccintion.

Results : 17 healthy nonreponders to Hepatitis B immunization(male 10, female 7) were included. Their mean ages were 47(32 to64). AST/ALT level 20/19(16 to 28/11 to 35), smoking 4.3pys(1 to 7). Seroconversion occured in 13 of them(76.5%).
Conlusions: Nonresponders to Hepatitis B vaccintion respond well to double dose vacci-nation once.

Background
: Recently, according to many studies, variable factors have been known to be associated with physical fitness. The factors such as obesity and inactivity are associated with poor physical fitness, but regular exercise is associated with good physical fitness. In our country, these studies are not yet reported. And so, this study was designed to investigate the factors associated with physical fitness.

Methods : From May 1st, until July 30th 1996, we recruited the 411 subjects who visited the Health Promotion Center at Seoul National University Hospital. Data related to sex, age, exercise, job, cigarette smoking, alcohol consumption were obtained by self-administered Questionnaire. Obesity index was calculated by the percentage of standard body weight. And VO2max were obtained by submaximal bicycle ergometer test. High level exercise group was defined as the persons who had taken exercise more than 3 times a week and 20 minutes per session, and moderate exercise group was defined as the persons who had taken exercise one or two times a week and 20 minutes per session, and sedentary group was defined as the persons who had taken exercise more than 20 minutes less than one time per week.

Results : The subjects were 230 males(56%), total numbers were 411. The results were as follows. Compaired to women and nonexercise group, men and exercise group had high VO₂max(p<0.005). The relationship between VO₂max and age showed negative, and the VO₂max of obese group(obesity index≥120) was greater than that of nonobese group. Any significant relationships between VO₂max job, disease were not found. In multiple regression analysis, significant relationships between VO₂max and age, sex, exercise type, and obesity index were observed(p<0.01).

Conclusion : We concluded that there were significant relationships between VO₂max and obesity index, exercise group.

Background
: Recently in Europe, some epidemiologic studies reported that various physical symptoms and social, psychological wellbeing are related to low blood pressure. But in Korea, none has been studied on symptoms related to low blood pressure yet. In this study, we would like to see if the somatic symptoms and social, psychological wellbeing shown to be related to low SBP is truly associated with it.

Methods : Questionnaire interview was done to the people who have visited Department of family practice in two university hospitals and two health promotion center from April, 1996 to August, 1996. Seven somatic symptoms and Psychosocial Wellbeing Index(PWI) for the evaluation of social, psychological health status were included in the questionnaire. SAS statistics packages was used in statistical precess. We used logistic regression to see the frequency of somatic symptoms related to the systolic blood pressure(SBP) group and the confirmation of confounding variables was done by ANOVA.

Results : Total of 304 completed the questionnaire. Average age was 44 years old and average SBP was 115.4±16.4. 84of them(27.6%)felt that they had a low BP & 69 were women compared to 21 men, being meaningfully more common. 107(35.2%) people answered that they had heard that their blood pressure was low and 66% were from doctors. Only 32(38.1%) of the group who felt of having hypotensive symptoms and 38 of the group who heard of having hypotension actually had SBP of below 100mmHg. Vocation, income, smoking & alcohol history, present illness, marital status were not significant as a confounding variable. SBP of 100 or below group had a less presentation of fatigue & significantly higher PWI than the group of above 100mmHg(p<0.05). The group who felt that they had a low BP had more complaints fatigue, dizziness, palpitation, cold hands and feet and had significantly higher PWI than the group who didn't.

Conclusion : SBP of 100mmHg or below group has more frequent manifestion of fatigue and low level of sociopsycholgiacl health index than the above 100mmHg group. But most of the people who complained of hypotensive symptoms didn't have low blood pressure and a lot of them misunderstand of having low blood pressure and after checking blood pressure by doctors, so great deal of caution is called for when seeing patients.

Background
: With improvement of Medicine, prevalence of acute, infectious disease declined and Incidence of Coronary artery disease increased, in Korea. The causes of this finding are bad lifestyles, for example eating habit, insufficient physical activity and fitness, smoking and these are the major risk factors of chronic disease. Recent data suggest the important effect of physical activity and fitness on prevention of chronic disease. This study will show the frequency of leisure time physical activity and characteristics of people in Seoul according to physical activity.
Method: A modified version of Minnesota Leisure Time Physical Activity Assessment was adminis-tered to the people selected by Randm Digit Dialing, Mitofsky-Waksberg method from May to August, 1995. This report focused on time spent in specific activities during previous month and questions asked included frequency per month of engaging in activities.
Participiants were asked about cigarette smoking, alcohol, blood pressure, age, sex, periodic health examination, education. Responses were differentiated to create four categories of physical activity status ; inactive, regular active, irregular active.

Results : The final response rate was 136 persons(30.8%), for a total 441 persons. Among them, Man was 51 persons(37.5%) and aged 20 years and older. Proportion of people who reported being inactive, irregular active, regular active are 21, 83 and 32 persons. Women were more likely to report being inactive than men. The proportion of people in Seoul who reported an inactive status increased with increasing age, and shorter, less smoker, less drinker. The three most commonly repor-ted physical activities for both men and women are Calisthenics, Walking with pleasure, Climbing stairs.

Conclusion : We studied people in Seoul, selected by Random Digit sampling. The most commonly reported physical activities for both men and women was Calisthenics. The Proportion of people in Seoul reported an active status increased with decresing age and increasing height.

Background
: For control of diseases, the relative importance of prevention and treatment of the disease has become greater day by day and, accordingly. the importance of health education is being emphasized. In conducting health education, we are aware that using mass media exerts a great effect upon the readers in general. However, We seldom find any study on what kind of health in formation the mass media is providing and furthermore. if the if the information provided is fit for reader in general. In this study, we strove to ascertain, through a content analysis, if the daily newspapers reported adequate articles of health information on cancer, on of the most important health problems in this country.

Methods : A prepared analysis table containing 11 different items(evaluation standards) was distributed to a family medicine specialist and internal medicine specialist, and a graduate student in the doctoral course of public health science. they were asked to analyze 143 articles, pertaining to cancer, reported in nine different daily newspaper during the period from January 1992 December 1993. Three different analysis tables, prepared by the three analyzers, were consolidated by each of the 11 items and the consolidated table was analyzed.

Results : As for the items entitled "The contents of article were too professional for the readers(in general) to understand." and "Article contained too difficult terminologies for the readers to understand", 39.2% and 34.3% of the readers gave affirmative answer to the respective question. This meant that more than on third of the readers thought the articles were too difficult to understand. The result of analysis reflects that the headlines accurately reflected the contents of the articles(88.8%) and there were very few academic errors(2.1%). Articles pertaining to high technology were 35.0% of the total and articles including an adequate explanation of the prevention and early diagnosis of cancer were only 34.5% of th total It also indicates that 14%, 2.1%, 20.3%, and 35.7% affirmative answers were given to each of the following four (4) items, respectively: "foreign case was reported as if it were a case in this country". "rare case was reported as if it were a common case", "case in a limited area was inadequately generalized and reported as a common case", and "article was written by using only on viewpoint on a topic which was being criticized." If we consider any on of the above four items as an exaggerated article, 42.7% of the total articles fall into this category. As for the last item, "in total view, the article contributed to the health promotion of the readers", only 53.1% of the articles had a affirmativex answer.

Conclusion : The articles concerning cancer. reported n the daily newspapers in this country, did not provide inaccurate on health. However, many of the articles were determined to be too difficult to understand, or provided exaggerated information, and only about on half of the articles are considered to have contributed to the health promotion of the readers.

Cronbacch's alpha was 0.6438 and with a score over 0.6, the coping score is found to have reliability. Correlation was found between the total score and individual items' scores.(P<0.0001) The R coefficiency between the coping score and the interview score was determined to be 0.5697 also showing correlation.(P<0.0001) The R coefficiency between the coping score and the interview score was determined to be 0.5697 also showing correlation.(P<0.0001) The R coefficiency between the coping score and APGAR score was 0.6410 again showing correlation (P<0.0001) and demonstrating the validity of the coping score.

Background
: Gastrofiberscopy(GFS) is a very important method to detect esophagogastroduodenal lesions which has high sensitivity. Biopsy and other interventions can be done by GFS. Despite of the merits, GFS is quite an uncomfortable procedure for patients. We studied to find discomfort of patients during GFS and to identify predictors for it.
Mothods : We recruited patients taken GFS at outpatient clinic, SNUH, Seoul, from June to July 1994. The patients recorded their discomfort during GFS by visual analogue scale score for 4 items respectively, pain, nausea, dyspnea, and air-fullness. The left end means no pain or discomfort, and the right end means extreme pain or idscomfort. Duration of examination. premedication. insertin method and the results were recorded. The X²test, simple linear regression, and multiple reogression were used. p value ≤ 0.05 was regarded as significant.

Results : 176 patients(mean age 45yr : 53% male) were recruited. The mean(SD) scores were : nausea 5.9(2.4), pain 3.9(2.5), dyspnea 3.7(2.7), air-fullness 3.6(2.8). The younger patients reported more nausea, dyspnea, air-fullness(P<0.05). Female patients reported more nausea than male (p<0.01). Insertion under direct visualization caused more nausea than blind insertion. Decompression of air-filling did not reduce patients' discomfort. Previous GFS exprience, biopsy operation, waiting time at endoscopy room, duration of examinationm education during procedure, bowel preparation, and premedication(IM buscopan, lidocaine gargling) and other characteristics of investigation pool were not associated with the degree of discomfort. The shorter time for insertion(from incisor teeth to upper esophagus), the more nausea was reported. But the association was not significant at p value ≤ 0.05.

Conclusion : The younger patient reported higher degree of discomfort during GFS. Female reported more nausea than male. Insertion under direct visualization caused more nausea than blind insertion. The other procedural and general factors did not show significant association in our finding.

Background
: primary physicians should understand not only the biomedical status but also the functional capacity of their patients. There are Many instruments designed to measure functional status, but none of them are confirmed to be valid and reliable in Korean version. This study was designed to develop Korean version of COOP/WONCA charts which are approved to be reliable and valid through many international studies, and to evaluate their validity and reliability.

Methods : The charts were translated to Korean language and evaluated face validity. The patients who visited family medicine outpatient clinic of one hospital from June to July in 1994 were included in this study. They administered COOP/WONCA Charts and MOS-20 measurement which was also translated. In order to test the validity, the correlation codfficients between the same items of COOP/WONCA Charts and MOS-20 measurement were calculated. Then the convergent and discriminant validity were evaluated via Multitrait-Multimethod approach. To test the reliability. 30 persons who completed the COOP/WONCA Charts readministered the same charts after 1 hour, and 22 persons of them administered again after 1 or 2 weeks when they revisited the clinic. The test-retest correlations and Cronbach's alpha coefficient were calculated.

Results : The average convergent validity correlation between COOP/WONCA Charts and MOS-20 measurement was 0.5232, and ranged from 0.3502 to 0.8714. Most of them met the 5 criteria proposed by Campbell and Fiske. 1-hour-test-retest intraclass correlations ranged from 0/7160-0.9529, and 1 or 2-week-test-retest correlations ranged from 0.3516-0.7250. Cronbach's α coefficient was 0.7937.

Conclusion : Developed Korean version of COOP/WONCA charts are reliable, valid, and useful for quickly measuring patient function in primary care setting. But those items which showed lower convergent validity coeffcients such as physical fitness and social activities should be reevaluated.

Background
: Though there are some women who deliver at hospital that they have not visited for prenatal care, there are only a little knowledge about the reason and effect of such behavior.

Methods : Data were gathered from 121 women who gave birth at Pochun medical center during September 1993 and who met the inclusion criteria by paper-interview and chart reviews. They were composed of 59 controls who received prenatal care at Pochun medical center and 62 cases who did not receive prenatal care at that center.

Results : The most frequent reason for self-changing hospital was patient's desire to deliver at the place near her mother's home(37.2%). Other reasons were mere preference for general hospital(19.4%), self-change due to medical problem(12.9%) and so on. There were no difference in average birth weight, types of delivery, average delivery cost.

Conclusion : Most reasons were not related to medical problems. There were no significant difference between cases and controls in delivery outcome.

Background
: A health questionnaire and feedback system was developed to promote clinical preventive services for people of age 18 or older. This system was designed to recognize common but significant health problems and feedback their risk factors.

Methods : The health questionnaire consists of about 300 items which cover 14 systems and 34 organs/diseases. Certain combinations of the items lead to the three level assessment. This was done through a computer program. Each person who filled up the questionnaire receives those assessments, their interpretations and appropriate management plans via mail. To develop the questionnaire, 26 specialists and family physicians were consulted, and a pilot test on nonhealth persons was performed. The computer assessment algorithm and feedback were also reviewed by 6 specialists. he accuracy of the computer-genarated feedback was evaluated through comparison of the feedback and the physicians' clinical impressions on 527 patients who visited the family practice department in a university hospital.

Results : The study subjects consisted of 227 men and 300 women, and their average age was 40.2 years with the youngest of 18 and oldest of 74. It took 23.4 minutes in average to answer the questionnaire. the questionnaire by the organ system showed moderage reliability (Cronbach's alpha=0.493-0.854), if the organ systems with less than 10 items were excluded. the positive and negative predictive values for 29 organs/diseases were 73.6% and 40.2% respectively. The digestive organs showed the highest positive predictive valuse of more than 90% and the endocrine system and skin showed the lowest ones of less than 60%.

Conclusion : The developed questionnaire and feedback system seems to contribute to the clinical preventive services which is insufficient in Korea.

Background
: Nowadays, since Aquired immunodeficiency syndrome(AIDS) prevailing all of the world has no exact cure yet, the only countermeasure is to guide the masses' steps in the path of awareness through publicity & education. In the first stage, only the high risk group and countries hea the opportunity of infection. But, at the present the way of infection has changed to 'within the general publics' and multiplied among Koreans. Since, it has become important to educate the low risk groups(general publics). We research the general public's knowledge of AIDS.

Methods : A questionnaire was given to two groups; one was composed of the people who visited a hospital for periodic health examinations during one month(April 1993). The other group was composed of people who worked in a government office.

Results : A total of 289 people answered the questionnaire. The rate of response was 90.1%. And the percentage of males was 53.3%, Concerning the question of the latent period, 49.5% had a correct understanding of the fact that AIDS development took more than several years after HIV infection. 52.2% of the subjects of investigation didn't want to visit hospital even though they felt they might have the infection. Among them, 83% said that the reason was the contempt and isolation from society, when they are regarded as AIDS patient. Once guaranted of security, most of them(78.9%) wanted a consultant, especially by phone(36%). Concerning the risk routes of infection, most of them(from 83.1% to 99.0% each items) looked at in the right light. However, concerning the possibility of the infection in daily life, they have some misconception, c.g. mosquitoes(88%), donation of blood(48%0, swimming(36.1%) etc. Only 56% know that condoms can protect from AIDS.

Conclusion : Nearly half of the respondents would not visit a hopital, even though they have recognized their infection with AIDS. Almost all of them duly recognized the importance of sex and blood in AIDS transmission. But, many of them considered AIDS as an acute disease and had misconceptions that it was carried by the donation of blood, mosquitoes. We also find that half of the subjects of investigation didn't acknowledge that condoms could prevent AIDS.

Background
: In 1979, when Family Practice Residency Training Program began, family practice was presented as a solution to a serious national health care problem of maldistribution among physicians, under-emphasis of primary care, and preference of specialists. In 1992, after fourteen years, the current number of graduates of family practice residency training programs is up to 402. At this point, an assessment of whether family practice has indeed had such an effect on the health care system is appropriate. This study was done to assess the satisfaction level of family practice residency program graduates about their present practice, to survey their geographic distribution, and to identify possible factors associated with their current status.

Methods : From July to September of 1992, a questionnaire was sent to 352 graduates of family practice residency programs whose addresses were known among total of 402 graduates. Response rate was 39.8%. The questionnaire contained items concerning type and location of present practice. Possible factors associated with this status was also asked: place of birth, education history, residency training hospital, religion, medical occupation prior to residency training reasons for selecting current practice, and reasons for choosing family practice.
Result: Greater proportion of the respondents are practicing in smaller communities compared to the geographical distribution of physicians in Korea. Rate of "satisfied" or "very satisfied" responses to the profession of medical doctor was 82.4%, to family life 71.6%, and to being a family practice specialist 68.4%. However, only 46.0% of the respondents responded "satisfied" or "very satisfied" with their social life, 45.6% with type of practice, and 35.6% with income. 71.4% of the respondents who trained in non-university hospital setting, 65.5% of respondents with history of medical occupation prior to residency training, and 73.9% of respondents who were married before residency training are in private clinic practice. 60.3% of respondents practice near their residency training program; 59.5% practice near their medical school. The majority of respondents are in practice settings which they desired at the beginning of their residency training. Reasons for selecting their current practice setting were varied. "Comprehensive care", "well suited to primary care", preference for humanistic principles of family medicine, and being useful for missionary or service work were frequently mentioned as reasons for selecting family practice. Other mentioned reasons included the short duration of training and the newness of family practice as a medical specialty. The great majority of graduates(95.0%) practice as family physicians. 48.6% of the respondents work in private clinic setting, 32.9% in hospitals, and 2.1% in other medical specialty fields. 39.3% of the respondents are located in Seoul, 13.6% in large cities, 23.6% in small cities, and 14.3% in rural areas.

Conclusion : Respondents are generally satisfied with their professional and family life, and larger percentage of them are practicing in smaller cities compared with the distribution of physicians in Korea. Location of residency training program and medical school, history of medical occupation prior to residency training, type of practice desired at the beginning of residency training, and time of marriage are related to the type or location of current practice.

Background
: It has been estimated that up to 80% of all illnesses seen in a physician's office is due to psychosocial stress. But, previous instruments of stress measurement cannot assess patient stress rapidly in a busy practice. This study was attempted to develop a new instruments to measure the amount of stress in outpatient clinic setting in Korea

Methods : The data were collected from 387 subjects of 20 years of age and older, living in Seoul and Incheon city. The Questionnaire was composed of the Korean-translated BEPSI(Brief Encounter Psychosocial Instrument), reformed 30-items SRRQ(Social Readjustment Rating Questionnaire), and Lee's 98-items SRRQ.

Results : The reliability of Korean-translated BEPSI is demonstrated(Cronbach's alpha 0.84). The validity is measured through correlation with Lee's 98-items. The correlation coeffciency of translated BEPSI is 0.25 (P<0.01), and of reformed 30-items SRRQ is 0.98(P<0.01).

Conclusion : Korean-translated BEPSI and reformed 30-items SRRQ in Korean are applicable to rapid measurement of stress in outpatient clinic setting.

Background
: Informing patients of their cancer diagnosis is a difficult task for most physicians and is a traumatic event from the patient's point of view. With the remarkable development of medical science, prolongation of life is possible and some cancers are curable. Also, expanding medical technology has enabled nonsurgical physicians to sample tissues for pathologic examination. The doctor's office may become the primary place where the patients are told their cancer diagnosis in the future. Because there is little empirical literature to guide the clinician an how to inform the patients, and in what context to present cancer diagnosis, analysis of the experience of groups of cancer patients may be valuable in gaining a wider view of this issue.

Methods : Forty patients with knowledge on their cancer, undergoing chemotherapy were interviewed to learn how patients were told, their feelings how and where they were told, and the patient's opinion on how other patients should be told in the future.

Results : 45% of forty patients were told by physicians, 30% by family and 25% by accident. 57.5% of patients were told in the hospital room. 30% in the doctor's office and 12.5% in the home. When asked whether they should be told about cancer diagnosis 87.5% of all respondents answered "yes", 12.5% answered "dependent on situation" and none answered "no". When asked who should tell the diagnosis, 80% answered "doctor", and 20% answered "family". When asked who should be informed of the cancer diagnosis first, 62.5% of respondents answered "the family", 22.5% "the patient", 15% "simultaneously".

Conclusion : This study showed that cancer patient should be told the diagnosis and the informant should be the physician. This study also showed that in contrast to western society, the family should be considered in the presentation of cancer diagnosis. In order to achieve active participation of the patient in the treatment of their cancer, the doctor should inform the patients their cancer diagnosis in a hopeful and caring environment with the support of their family.

Background
: In Korean family medicine, 73.3~76.4 percent of three year resident training time is spent in outside rotations with other specialties. But there has been no study which investigated the attitudes of family medicine faculties, residents, and non-family medicine specialists regarding the contents of family medicine resident training rotations, such as whether a family physician should perform Caesarean section, etc. In order to achieve a family medicine program whose content is based on the consensus of family medicine faculties, residents, and nonfamily medicine specialists, we compared the attitudes of these groups toward various components of family medicine resident training in internal medicine, pediatrics, general surgery, obstetrics-gynecology, and psychiatry which account for 68.5% of outside rotations of family medicine resident training programs.

Methods : A questionnaire was sent to 679 family medicine faculties, family medicine residents and non-family medicine specialists in 21 different family medicine centers and related hospitals. Total response rate was 57.6%.

Results : Significantly more numbers of non-family medicine specialists felt that various skills and tasks should not be performed by family physicians. Family medicine residents and family medicine faculties were generally similar to each other in their attitudes toward training in various skills and tasks, but, in some elements of psychiatric training, more family medicine faculties failed to see the need for such training compared with family medicine residents.

Conclusion : In many elements of family medicine resident training, family medicine faculties and nonfamily medicine specialists do not agree. In order to resolve this problem, it is urgent to establish a curriculum, which is agreed upon between by family medicine faculties, residents, and nonfamily medicine specialists who are involved in the training of family medicine residents.

Background
: Bacause head trauma patients can have serious sequelae, head trauma patients should be evaluated quickly by sensitive and specific diagnostic tools. For this reason, the use of brain computed tomographic(CT) scan is increasing. But unnecessary brain CT scans can reasult in increased medical cost and loss of critical time for managment of other fatal injuries. Therefore certain criteria for requesting brain CT scan is needed. This prospective study was attempted to see if the positive brain CT scan can be predicted by the patient's clinical features and, if so, to develop indications for brain CT scan use in Korea.

Methods : The data were collected from 130 subjects who were treated in the emergency room for head trauma and received brain CT scan. The sensitivity, specificity, positive and negative predictive vlaues were calculated the association between each clinical feature and positive CT scan was tested by X²-test and forward stepwise logistic regression. The score system was developed using likelihood ratio, and the cut-off point was estimated in Receiver Operating Characteristic(ROC) curve between sensitivity and false-positive rate.

Results : The percent total of positive CT scan was 30% and the classification of head injuries were Subdural Hematoma(SDH), Epidural Hematoma(EDH), Intracranial Hemorrhage(ICH), Brain contusion, Subarachnoid Hemorrhage(SAH), and traumatic infarction in order of decreasing freaquency. There were significant statistical associations between positive CT scan and loss of consciousness more than 5 minutes, Glasgow coma scale, skull fracture by forward stepwise logistic regression. The cut-off point in this scoring system using likelihood ratio was 12.

Conclusion : The positive CT scan can be predicted by the patient's clinical features in most of cases and the scoring system may help the predictability.

Background
: Chest P-A interpretation is very important because chest P-A is one of the important diagnostic tools in primary care. Primary care physicians often make decision of patient management based on clinical impression and radiologic findings. This study assessed the accuracy of family physicians in interpretationg radiographs taken in the seven family practice offices.

Methods : This study compared the interpretation of family physicians with those of one radiologist on 183 office radiographs using a uniform protocol. Nine family physicians participated in the study along with one radiologist. A total of 183 chest P-Ad were evaluated.

Results : The results were as follows 1) the family physicians' discordancy rate with the radiologist was 19.6% 2) 80% of the discordant films were clinically significant misses of those were read as "normal" by one radiologist 4) only 5% of chest P-As which were read as "normal" by family physicians were read as "abnormal" by radiologist 5) The sensitivity of family physician's interpretation compared with radiologist was 90%, the specificity was 86%, and the positive predictability was 71%.

Conclusion : This result suggest that it is not necessary to consult radiologist for interpretation of Chest PAs which were read as "normal" by family physician, because 95% of Chest PAs which were read as "normal" by family physicians were read as "normal" by radiologist. Radiologically abnormal films may need to be consulted with clinical information. Physicians should take more active role in extending cervical screening corverage.

Background
: The causative effect of cigarette smoking on pulmonary diseases, coronary heart diseases and much variety of cancers is evident. But the rate of cigarette smoking in Korea is increasing and adequate smoking cessation intervention has not been done yet. this clinical trial evaluated the effect of antismoking intervention done by primary care physicians.

Methods : The subjects were 145 smokers who visited SNUH Family Medicine Model Clinic from April to early July, 1991. We randomized subjects by their chart number. We educated all smokers about the adverse effect of cigarette smoking with self-help material and recommended to quit smoking. We reeducated the intervention group every 3rd, 5th and 7th week by face-to-face interview or telephone call. Twelve weeks after the intervention, we attempted to contact every smoker for the number of cigarettes per day currently smoked.

Results : The rates of smoking cessation and reduction for control group and intervention group were 7.7% and 38.5% vs. 19.7% and 47.99%, respectively. They were statistically significant(P<0.05). Statistically significant differences between the case and control groups were in their change of smoking habit in the following subgroups ; greater than 40 years of age, greater than 12 years of education and having diseases associated to smoking.

Conclusion : In conclusion, personal intervention carried out by primary care physicians resulted in significant smoking reduction and cessation. history.

Background
: Patients known as 'difficult' who make doctors get negative fillings can be products of 'difficult' doctor-patient relationship. This study describes the reasons for difficulty, demographic characteristics, and contents of medical care of 'difficult' patients as compared with control patients of nine third-year residents in hospital-based family practice center.

Methods : Fifty-nine difficult patient sample was generated by asking residents to indicate patients whose care they considered difficult. And control sample was generated by random sampling after matching about duty doctor and being registered to Lifetime Health Maintenance Program in department of Family Medicine, Seoul National University Hospital. The control and difficult patient charts were audited and we compared two groups about various medical and demographic characteristics.

Results : Thirty-nine percent of difficult patients were selected due to medical problems and the others were selected due to psychosocial problems. There were no differences in demographic characteristics such as age, sex, marital status, educational level, and number of adults and children in family. Difficult patient group had more chronic problems, psychotropic drug use, provider continuity, and less total duration of care than control group. Two patient groups did not differ significantly in acute problems, chronic medications, samplings, radiological examinations, special tests, referrals, total visits to family practice center, and total duty doctors. After covariance analysis adjusting for total duration of care, significant differences remained between the two groups for chronic problems, psychotropic drug use. Also, after the covariance analysis the differences between difficult patient group and control group in number of acute problems and referrals became significant with the patient group having more acute problems and more referrals.

Conclusion : This study result suggest that residents experience a lots of difficulties in medical work-up and therapeutic plan of certain conditions, and that demographic characteristics and contents of medical care of difficult patients differ from previous studies.

The purpose of this study is to find out the better Body Mass Index for Korean children.
We surveyed 737 students in a primary school in Seoul. Among them, 373 were boys. Using the records of the physical examination done for the children every last 5 years, the data of the children's weights and heights for last 5 years were obtained. From these data, we calculated 6 Body Mass Indices(Quetelet Index, Modified Quetelet Index, Rohrer Index, Ponderal Index, Weight for lenght Index, and Body Surface Area Index). We analysed the trends of indices by age and by sex. The results were as follows ;
1. In boys, Quetelet, Modified Quetelet, and Body Surface Area Indices increased as the age.
The Ponderal Index increased till the second year and then remained unchanged. The change of the Weight for Lenght Index were unnoticeable for the the firs year, but the Index increased for next two years, and then there was no change. The Rohrer Index changed insignificantly all the years.
2. The trends of girls' indices were very similar to those of boys except the Weight for Length Index, which decreased slightly for the second year and increased till the fourth year for girls while never decreased for boys.
3. The Quetelet Index were significantly larger for boys than for girls in the first and second year(p<0.05). The Weight for Lenght Index was significantly larger for girls in the first and the second year, while it was opposite in the third and fourth year(p<0.05). The Body Surface Area Index was significantly larger for girls all the years but the fifth year(p<0.05).

Medical records are important resources in evaluation of residents' clinical perfomance. Medical redcords may be audited by the resident himself (self audit). Self audit is more convenient and effective than peer review in modifing a doctor's clinical behavior. The purpose of this study is to evaluate the validity and reliability of structured self audit protocol for Family Medicine residents. Medical records of the hypertensive patients who visited Seoul National University Hospital Family Practice Center from May to August of 1991 were selected randomly and audited by both the residents themselves and fellows. Validity was evaluated by item by item comparison of audits by residents and fellows using rates calculated by kappa statistics. Reliability was evaluated by item by item comparison of selected charts between three groups of paired residents. The agreement rate of response of the residents and fellows was relatively high (agreement rate=77.1%, kappa=0.5874) and that of groups of paired residents was also high (agreement rate=77.1%, kappa=0.5870). We concluded that this self audit protocol has both good reliability and validity to evaluate medical records of residents in Family Medicine.

In order to elucidate the relationship between low visual acuity and environmental factors including the video display terminal usage among school children, we measured the visual acuity of the 557 elementary school children and analysed the data from questionnaire about life pattern pertaining to video display terminal usage. The results were as follows;
1. There was a tendency of gradual increase of low visual acuity with grade(p<0.01).
2. The low visual acuity in female was higher than that in male. (p<0.01).
3. It is statistically significant that low visual acuity was related with glasses wearing of parents(p<0.05).
4. It is statistically significant that the time of watching TV, computer operation and duration of computer education were related with low visual acuity respectively(p<0.05).
From the above results, we have got a conclusion that low visual acuity was related not only with hereditary factors, but also with environmental factors including the video display terminal usage. So it is conceived that the instructions for proper usage of video display terminal are required for prevention of low visual acuity among school children. And further studies on causal relation between low visual acuity and video display terminal usage are required.

We already know how important the adequate prenatal care is & it's positive effects to birth outcomes. In KOREA, nevertheless, the proportion of pregnant women who receives adequate prenatal care is still low. This study was performed to detect any obstacles in receiving adequate prenatal care. As many as 141 out of 257 women who gave birth at Puchun Sejong hospital from June to July 1990 were selected & paper-interviews with chart reviews were performed.
The results were as follows :
1. Mean age of 145 women was 27.3 years & 82(56.6%) of them were primipara & 63(43.4%) were multipara.
2. The mean number of prenatal visit was 8.1, and the numbers of women who received adequate prenatal care were 65(37.2%), intermediate prenatal care were 55(37.2%), and inadequate prenatal care were 25(17.2%).
3. Adequacy of prenatal care had no effect to birth outcomes.
4. Age group, economic status, educational level, type of health insurance, family structure, previous illness, illness during this pregnancy were not significantly related to adequacy of prenatal care.
5. In multiparous women, the proportion of inadequate prenatal care was higher than primiparas & it's difference was statistically significant.
6. The proportion of inadequate prenatal care was higher in women who had negative attitude to prenatal care than those who had positive attitude, & it's difference was statistically significant.
7. The majority(86.7%) of women who did not received adequate prenatal care said,"I didn't have to, because I had no problem".
We concluded that the education about the significance and the practical method of adequate prenatal care was very important, and it should be especially stressed to multiparas.

The blood pressure level and several selected variables were studied in 485 female adolescents (15 to 18 years of age) for the purpose of knowing the distribution of blood pressure and the factors associated with blood pressure. The level of systolic and diastolic blood pressure did not change with the increase of the age, height and pulse rate. But the level of systolic and diastolic blood pressure elevated with the increase in body weight and variable weight-height ratios. The level of systolic and diastolic blood pressure was not associated with the family history of hypertension and blood type. So this data suggests that for Korean female adolescents, body weight and variable weight-height ratios correlate with blood pressure significantly.

To assess the injection preference of patients and its related factors, 332 patients who visited Yeoncheon Health Center Hospital during the preiod of 16th June through 30th June 1990 were studied by means of questionnaire and review of medical records.
The results were as follows.
1. Of total 332 patients, the proportion of injection preference group was 226(68.1%).
2. The proportion of injection preference group according to disease group was 26(86.7%) in sensorineuro-psychiatric diseases, 49(81.7%) in musculoskeletal diseases, 46(69.7%) in gastrointestinal diseases, 52(65.0%) in respiratory diseases, and 8(47.1%) in cardiovascular diseases.
3. There was a tendency that injection preference was higher in patients who were older, who were low-educated and who had no history of side effect of injection. Age, education level and history of side effect of injection were significantly related to injection preference.(P<0.01)
4. The beliefs that 'Injection makes faster recovery from illness than p.o. medications.','Illness that was not recovered by p.o. medications had better be treated with injection.' and 'Side effect of injection is more dangerous than that of p.o. medications.' were significantly related to injection preference.(P<0.01)
In conclusion, in order to induce the injection preference to favorable direction, health education is necessary to change the patients' beliefs about injection and this effort is more important in patients who are older, who are low-educated, and who have no histroy of side effect of injection.

143 elderly who are staying in nursing home in Gyounggi-do are studied in terms of nutrional evaluation.
1. The proportion of smaller diet is higher in the age of 85 and more than any other age group.
2. The values of measurement of obesity index, BMI, and thickness of mid upperarm are significantly higher in female(P<0.50)
3. The prevalences of anemia according to hemoglobin level are 33.3% in men and 20.9% in female. However hemoglobin level less than 10.0g/dl are observed only in female.
4. Hypocalcemia are identified among 37.3% in male and 50% in female.
5. The levels of phosphorus are not significantly different in terms of age and sex.
6. hypoalbuminemia are identified among 17.6% in men and 27.2% in female.
This difference is statistically significant(P<0.05) and the level of albumin is inversely correlated with age.
7. means of cholesterol level are 184.7 mg/dl in female and 152.1mg/dl in men. The higher level in female may be related with the higher obesity rate.

During 4 weeks (1990.5.21-6.18), ninety-two patients' medical interviews were reviewed after recording by the use of audiovisual system for analysing their terms containing medical meanings. Medical intervews were done at OPD of Department of Family Medicine, Seoul, Seoul National University Hospital.

The results were as follow;
1. Total time of medical interviews was 1,021 minutes.
2. For hundred five words or sentences were presented and used 831 times.
3. Patients used 298 words or sentences 685 times to complain their symptoms.
4. Everyday languages and well-known medical languages were used as meidcally meaning full terms.
5. There were many words or sentences containing similar medical meaning.
6. There were some words containing two or more meanings concomitantly.

Most primary care physicians are faced with continuous health care and this access is accomplished through the telephone because on-call arrangement is the traditional solution to patient care demands outside scheduled hours and provides a means by which the patient may interact with a health care provider at all times of day or night. For this purpose, we have given 24 hour telephone call service at Dept. of Family medicine, Seoul National University Hospital.
We analysed the contents of 108 calls for 5 months(90.5.1~9.30) from the family members who are registered in the same department in terms of age, sex, chief complaint and counselling.

Followings are the result of the study ;
1. A total of 108 calls were received during the study period and an average of 0.7 call day were received.
2. Of the patients who called, 61.8% was female and 38.2% was male.
3. According to patient's age, divided into age groups of 0-19, 20-29, 30-39, 40-49, 50-59 and 60-69year of age, the heighest number of patients were observed in age of 0-19 in male and in age of 30-49 in female.
4. When analysed by the type of caller, call from the patient was 51.4%, that from their relatives was 48.6%.
5. On weekdays, 76 calls were received and none on weekend, 32 calls were distributed throughout the day as follows;
40 calls(37.0%) were received by the physicians during daytime hours of 9AM to 3PM and 68 calls(63.0%) were received on after-hours.
6. The majority of the contents of calls were about the medical problems and diagnoses related to medical problems are recorded in the general categories of the international classification. The most common diagnoses are Gastrointestinal tract and Nervous and sense organ disease.
7. Most calls did not require a face to face visit as judged by the physician. So, of the calls, 44.8% were handled by the physicians with only information.

This study was performed in order to assess the factors influencing pregnant women's behavior in oral iron supplement and to document the reasons to stop oral iron supplement.
The 260 women's data which were collected by chart review and the responses to the prepared questionnaire in Bucheon Se Jong Hospital during 4 months(May, June, July, August) in 1990, were as analyzed.
The results were as follows :
1. The percentage of the women who took oral iron pill was 56.2%.
2. There was significant increase in the oral iron supplement if the pregnant women had higher education or the more income or antenatal care or the knowledge for iron supplement during pregnancy.
3. The most common reason for iron supplement during pregnancy was the knowledge for iron supplement. Then the doctor's advice was the second and the husband's advice was the third.
4. They discontinued iron supplement during pregnancy due to the side effects(32.9%), annoying continuous use(25.7%), forgetting the use(18.6%) and satisfying to herself(5.7%).
5. The mean values of hemoglobin and hematocrit were 11.8gm/dl and 35.3% in adequate supplement group, 11.0gm/dl and 33.3% in inadequate supplement group, and 10.0gm/dl and 30.9% in non-supplement group.