Background
The relationship between clinical as well as subclinical thyroid disease and cardiovascular disease has been reported. Epidemiological evidence is accumulating that vascular risk factors increase the risk of AD. We sought to investigate the relationship between thyroid function and dementia. Methods: We examined patients who were admitted to geriatric ward of one psychiatric hospital in Kyong-Gi. The control group was individuals who underwent check up at a health promotion center of one university hospital in Daejeon. Results: The number of patients with dementia was 110. In the dementia group, there were 12 people with subclinical hyperthyroidism, 6 with subclinical hypothyroidism, and 2 with apparent hypothyroidism. After controlling for education, hypertension, diabetes and total cholesterol, multiple logistic regression yielded the odds ratio for dementia to be significantly higher in the group with low levels of thyroid stimulating hormone compared to the normal group (OR 4.00, 95% confidence interval 1.04∼15.39). Conclusion: We found a significant relationship between dementia and subclinical hyperthyroidism. (J Korean Acad Fam Med 2007;28:173-178)

Background
: Increased abdominal obesity is clearly associated with metabolic diseases and associated with increased risk for atherosclerosis and cardiovascular diseases. But the mechanisms underlying these associations are not completely understood. The aim of this study was to correlate the regional body composition with pulse wave velocity in the overweight and obese women.

Methods : We investigated 104 overweight and obese participants. Regional body composition was distinguished by anthropometry, dual-energy X-ray absorptiometry, and computed tomography (CT). For estimates of arterial stiffness, we measured brachial ankle pulse wave velocity (baPWV). Fasting blood glucose, lipid parameters, CRP, and free fatty acid were measured. Pearson's correlation analysis and multiple regression analysis were conducted to identify the relationship between baPWV and regional body composition.

Results : Average age, fasting blood sugar, HDL-cholesterol, triglyceride, HOMA-IR, abdominal visceral fat area measured by CT, visceral fat area/ subcutaneous fat area (VSR), and visceral fat area/midthigh muscle area (VMR) were all significantly higher in the visceral obesity group than the subcutaneous obesity group. BaPWV was positively correlated with age, blood pressure, triglyceride, waist circumference, waist hip ratio, abdominal visceral fat area measured by CT, and VSR and inversely correlated with thigh subcutaneous fat area. In multiple regression models, after adjustment for confounding factors, baPWV was independently correlated with abdominal visceral fat area measured by CT (R²=0.560, P=0.006).

Conclusion : Abdominal visceral fat area measured by CT was the only measurement positively associated with baPWV which explains the relationship of regional body composition and arterial stiffness.

Background
: Although many studies have focused on the association of hyperuricemia with components of metabolic syndrome, there are only few studies of independent relation between uric acid and metabolic syndrome itself. In this study, we evaluated healthy subjects and assessed the relationship of serum uric acid with metabolic syndrome.

Methods : Between January and February of 2005, we evaluated 164 healthy patients who visited a health evaluation center. Patients were evaluated for metabolic syndrome and risk factors were assessed using a questionaire, blood test and physical examination.

Results : Metabolic risk factors significantly increased as uric acid level markedly increased (P＜0.05). Even after limiting the variables such as age, sex, smoking, exercise, total cholesterol, low-density lipoprotein cholesterol, and LogCRP, the group with metabolic syndrome had markedly increased uric acid levels than those without metabolic syndrome [Odds ratio 1.494 (95% CI, 1.072∼2.084)].

Conclusion : The number of components of metabolic syndrome increased according to serum uric acid level. Uric acid level was significantly higher in metabolic syndrome than normal. Even after considering health behavior variables such as smoking, alcohol status, and exercise, they showed an independent relationship. Further massive prospective studies on whether collecting serum uric acid level can be used as a screening test or predictor of mortality for early metabolic syndrome and cardiovascular disease will be needed.

Background
: Serum γ-GT is one of the biliary enzymes with the only enzymatic activity capable of cleaving extracellular glutathione, thus originating precursor amino acids for the intracellular resynthesis of glutathione. Several population-based studies have shown a strong cross-sectional association between serum γ-GT concentration and cardiovascular risk factors. And prospective studies showed that serum γ-GT concentration had a prognostic impact on cardiovascular mortality. But, the mechanism by which γ-GT is associated with cardiovascular disease is not elucidated. We hypothesized that there was an association between serum γ-GT and ferritin, a marker of oxidative stress. In this study, we investigated the relationship between serum γ-GT and serum ferritin.

Methods : By reviewing the medical records of 288 healthy adults, we determined the serum levels of γ-GT and ferritin according to age, body mass index, systolic blood pressure, diastolic blood pressure, triglycerides, total cholesterol, LDL-cholesterol, fasting blood sugar, hs-CRP, serum ferritin, AST, ALT, uric acid and smoking history. We studied the relationship between the variables by Pearson correlation coefficients and multiple stepwise regression analysis. Mean values of serum γ-GT according to the smoking history were compared using t-test.

Results : Serum γ-GT correlated positively with serum ferritin (r=0.42; P＜0.001). BMI, triglycerides, total cholesterol, fasting blood sugar, AST and ALT also showed statistically significant correlation. Smokers showed significantly higher serum γ-GT. Serum γ-GT correlated with serum ferritin, ALT, current smoking and triglycerides by multiple stepwise regression analysis.

Conclusion : Serum γ-GT correlated positively with serum ferritin.

Background
: Several studies have revealed a relationship between the cognitive decline and several cardiovascular diseases. The relationship between the metabolic syndrome and cognitive function has not been studied yet in Korea. The objective of our study was to determine the relationship between the metabolic syndrome and cognitive function in elders above 50 years old.

Methods : We examined subjects who visited the health promotion center of one college hospital in Seoul. The metabolic syndrome was defined according to the National Cholesterol Education Program guidelines and we categorized the two groups by the presence of the metabolic syndrome. We used the Korean version of Mini Mental State Examination to check the cognitive functions and compared scores between these two groups.

Results : There were a total of 400 subjects (195 men and 205 women). Compared with those without the metabolic syndrome, elders with the metabolic syndrome had lower mean scores in K-MMSE (26.6±2.0-28.2±1.8, P＜0.001). In subcategories of K-MMSE, the average scores of concentration or calculation were lower in the metabolic syndrome group (3.5±1.3) than in the control group (4.3±1.0) and the average scores of delayed recall were lower in those with the metabolic syndrome (1.7±0.9) than the control group (2.2±0.8) (P＜0.001). After controlling for age, sex, education, smoking, alcohol, and body mass index, multiple regression yielded the metabolic syndrome to be independent associated factor in cognitive function (P＜0.001).

Conclusion : We found a significant relationship between decreased cognitive function and the metabolic syndrome. There are needs for prospective study about the possible development of dementia in the metabolic syndrome and probable prevention of dementia when cardiovascular risk factors in those are modulated.

Background
: Recently, thermal therapy such as sauna and sweating room is popular as a health behavior. In patients with heart failure, sauna treatment improves hemodynamic data and clinical symptoms by restoring endothelial function. The purpose of this study was to investigate that sauna bath could decrease pulse wave velocity reflecting vascular function of people in the community.

Methods : A total of 43 volunteers (11 male, 32 female) older than 40 years old were kept in 60℃ dry sauna for 15 to 20 minutes. We measured the brachial-ankle pulse wave velocity (baPWV), blood pressure, heart rate, body weight and body temperature before and, 30 and 60 minutes after sauna bath and assessed the differences of the means of these measurements with repeated measures of ANOVA. Then, we performed multiple regression analysis to find out the factors independently associated with the amount of baPWV change.

Results : The BaPWV and systolic and diastolic blood pressure decreased significantly 30 and 60 minutes after sauna bath comparing to those before (P＜0.001, P=0.003, P=0.011, respectively). Multiple regression analysis showed that baseline baPWV and history of hypercholesterolemia independently influenced on the amount of baPWV change (β=-0.47, P=0.002; β=-0.36, P=0.013, respectively).

Conclusion : We studied the acute reduction of pulse wave velocity after sauna bath in adults over 40 years old. This change was striking in the subjects with faster baseline baPWV. This result suggests that sauna bath can improve vascular function in the high risk group of cardiovascular diseases.

Background
: Sullivan has suggested that higher incidence of coronary heart disease in men and postmenopausal women is due to higher levels of stored iron in these two groups. A few epidemiologic studies in humans have reported the association between iron stores and increased risk of cardiovascular diseases. But there is conflicting evidence regarding the relationship between iron and cardiovascular diseases. The present study evaluated the relationship between ferreting and well established cardiovascular risk factors.

Methods : There were 288 healthy subjects who visited a health promotion center of a general hospital. We collected data by means of self-reported questionnaire and measured height, weight and blood pressure. Serum ferritin, fasting blood glucose, lipid profiles, and C-reactive protein were measured at a fasting state.

Results : Mean serum ferritin values were 150.1±82.2 ng/mL in men and 61.7±38.2 ng/mL in women (P＜0.001). Serum ferritin level in current smoker was higher than in non-smoker (157.6±111.8 ng/mL versus 100.5±64.2 ng/mL, P=0.006). Serum ferritin was significantly and positively correlated with body mass index, systolic blood pressure, diastolic blood pressure, fasting blood glucose, total cholesterol and triglyceride. There was no statistical significance in age, C-reactive protein, high- density lipoprotein cholesterol and low-density lipoprotein cholesterol. In multiple regression analysis, there was association between ferritin and sex (β=-80.333, P＜0.001) and triglycerides (β=0.182, P=0.030).

Conclusion : The serum ferritin level in men is higher than in women in healthy adults. Serum ferritin is positively associated with triglycerides.

Background
: Pulse pressure, a clinical marker of arterial stiffness, is an independent and strong predictor of cardiovascular disease, and reflects aging of arterial system. It is a well known fact that serum IGF-1 level is a parameter of growth hormone (GH) secretion and decreased GH secretion is related to aging. The aim of this study was to find out if there was any correlation between pulse pressure and IGF-1 concentration.

Methods : By reviewing the medical records of a hospital in Korea, healthy 194 men and 180 women were studied. We measured serum IGF-1, triglyceride, total cholesterol, HDL cholesterol concentrations and fasting blood sugar (FBS). Also, anthropometric and blood pressure measurements were performed.

Results : In men, the pulse pressure was positively correlated with age (r=0.29, P＜0.001), systolic blood pressure (SBP) (r=0.70, P＜0.001), diastolic blood pressure (DBP) (r=0.22, P=0.003), and body mass index (BMI) (r= 0.28, P＜0.001) and inversely with IGF-1 levels (r=-0.27, P＜0.001). In women, pulse pressure was positively levels with SBP (r=0.28, P＜0.001), BMI (r=0.27, P＜0.001), triglyceride (r=0.19, p=0.011), total cholesterol (r=0.15, P=0.049) levels, and FBS (r=0.17, P=0.027) and was not correlated with age, DBP, and serum IGF-1 levels. After adjustment for age, BMI, triglyceride, total cholesterol, and FBS, the pulse pressure was independently negatively correlated with serum IGF-1 levels (β=-6.052, P=0.007) in men. The multiple regression analysis showed that serum IGF-1 levels (R²=0.04) was the third most powerful factor influencing the pulse pressure.

Conclusion : There was as independent negative correlation between the pulse pressure and serum IGF-1 levels in healthy men.

Background
: Community-acquired pneumonia is one of the main causes of hospitalization and death, especially in elderly patients. There have been many studies on prognosis for community-acquired pneumonia, but few in Korea. We sought to identify characteristics on admission predicting mortality in elderly patients hospitalized with community-acquired pneumonia and to compare mortality rates by PORT score with PORT study's ones.

Methods : We performed a retrospective study of 267 patients aged 65 years and over admitted with community- acquired pneumonia from January 2000 to December 2002. We reviewed demographic, clinical, laboratory, microbiological and radiologic data and identified independent factors associated with the mortality using logistic regression analysis. We classified patients into risk classes by PORT score and calculated the mortality rate.

Results : Among of 267 patients, 48 (18.0%) died. We identified six independent predictors of mortality; male (OR, 2,496; 95% CI, 1,012∼6,153), lung cancer (OR, 3,409; 95% CI, 1,302∼8,920), general weakness (OR, 5.218; 95% CI, 2,140∼12,718), unable to walk (OR, 9,232; 95% CI, 2,228∼38,257), BUN ≥30 mg/dL (OR, 3,327; 95% CI, 1.072∼10.327), albumin ＜3 g/dL (OR, 3,219; 95% CI, 1,351∼7,670) and pleural effusion (OR, 3.135; 95% CI, 1,052∼9,342). Mortality rates of risk class II-V by PORT score were 6.7%, 9.5%, 30.4% and 34.4%, respectively.

Conclusion : There were factors that were associated with mortality in elderly patients hospitalized with community-acquired pneumonia.

Background
: DHEA is the most abundant steroid hormone secreted from the adrenal cortex and has several roles such as increasing insulin sensitivity, lowering serum lipid, improving obesity, and anti-cancer effects. DHEA levels vary profoundly and levels decline as age increases. But the role of DHEA in the aging process is not yet fully understood. Total antioxidant status(TAS) which provides information of one's antioxidant capacity, also decreases with age. In this study, we investigated the relationship between TAS and serum DHEA-s concentration.

Methods : By reviewing the medical records of 197 healthy adults, we determined the serum levels of DHEA-s and TAS according to BMI, pulse pressure, WBC, hs-CRP, A/G ratio, LDL-cholesterol, triglyceride, ferritin, uric acid and total bilirubin. We studied the relationship between the parameters by Pearson correlation coefficients and multiple regression analysis.

Results : The mean level for TAS and serum DHEA-s was 1.20 mml/L and 177.3 ug/mL, respectively. Serum DHEA-s correlated positively with TAS (r=0.44) and negatively for age (r=-0.44). WBC, triglyceride and uric acid also showed statistically significant correlations. But, according to multiple regression analysis DHEA-s only correlated with TAS and age.

Conclusion : Serum DHEA-s correlates positively with TAS.

Background
: In severity of illness index, there is an acute physiologic and chronic health evaluation (APACHE) scoring system which was modified to APACHE III in 1990. Heart rate variability (HRV) studies for the intensive care unit (ICU) patients provides an indirect but noninvasive probe of autonomic cardiovascular control. Therefore, we intended to find out the relationship between the APACHE III score and the HRV variables in ICU patients.

Methods : We examined 22 patients in medical ICU of one college hospital from April to May of 2003, excluding patients with cardiac disorders, neurologic disorders or surgical diseases. We also examined 22 patients in general wards of family medicine. We checked the APACHE III during the 24 hours of admission, and examined the HRV on the second day of admission and then the total power (TP), normalized low frequency (LFnorm), low frequency/ high frequency ratio (LF/HF ratio) and approximate entropy (ApEn).

Results : The average of TP (msec²) were 538.9±896.7 in ICU patients and 1605.3±3091.8 in patients of general ward. The average APACHE III score was 35.9±18.5 and by Pearson correlation analysis, the correlation coefficient between the APACHE III score and the log (TP) was -0.58 (P=0.005).

Conclusion : We found that the medical ICU patients had more decreased autonomic function than the patients of general ward, and there was a negative correlation with the APACHE III score and the disease severity.

Background
: There is a significant amount of evidence to indicate that some of the changes attributed to aging process can be partially reversed by GH replacement. But the GH replacement for somatopause with functional GH deficiency is still controversial. The aim of this study was to explore whether the short term GH replacement improved physical, emotional and sexual function as well as body composition.

Methods : A total of 31 adults with functional growth hormone deficiency were assigned to receive rhGH with an initial daily dose of 1.05 IU, six times a week. For evaluating physical change a 25-item questionnaire was administered to patients at initial visit and 6 months later. Body composition was determined by bioimpedence analysis at initial visit and 6 months later as well. We compared the changes for each variable using Wilcoxon's rank and Friedman's test.

Results : Serum IGF-1 level at 3 and 6 months were increased significantly by 31% and 43%, respectively, compared to baseline (P＜0.0001). Lean body mass and percent body fat at 6 months of treatment showed a 2.2% increase and a 7.6% decrease with statistical significance. The score of the questionnaire at 6 months of treatment increased significantly in physical changes (P＜0.0005), sexual function (P＜0.001), self perception of physical appearances (P＜0.02), chronic fatigue & immunity (P＜0.03), and vitality (P＜0.05).

Conclusion : Adults with functional growth hormone deficiency showed improvements in not only body composition, but also physical function and appearances and sexual function after 6 months of treatment with rhHGH.

Background
: There is a clinical need for a reference value based on healthy adults in Korea. The aim of this study was to define IGF-1 concentration in healthy Korean adults and to investigate the factors relative to IGF-1 level.

Methods : By reviewing the medical records of a hospital in Korea, healthy 112 men and 109 women aged over 40 years were studied. We determined the serum IGF-1 levels of both groups according to age, sex, health behaviors, lipid profile, bone mineral density, serum albumin, waist circumference, body mass index, total testosterone, and FSH.

Results : IGF-1 had no sexual difference in any age group (258.7±84.3 ng/mL for men, 263.7±86.8 ng/mL for women), but correlated negatively with age (r=-0.43 and -0.35 for men and women, respectively). The mean decline was 49.6 ng/mL and 43.9 ng/mL per 10 years for men and women, respectively. IGF-1 correlated positively with serum albumin, total cholesterol, and bone mineral density of spine and femur neck. The multiple regression analysis showed that the most powerful factors influencing IGF-1 level was serum albumin (R²; 0.13) followed by age, bone mineral density of femur neck, and total cholesterol.

Conclusion : We present a reference value for IGF-1 in healthy Korean adults aged over 40 years. The most powerful factor influencing IGF-1 level was serum albumin.

Background
: Pharmacological stress tests for the diagnosis of GH deficiency are unpleasant, labor intensive and potentially dangerous. Reports on urinary GH measurement for the assessment of GH have been published after highly sensitive immunoassaies were developed. The aim of this study was to determine whether a 24- hour urine GH as an alternative method for GH assessment were reliable in predicting GH deficiency defined by L-dopa stimulation test.

Methods : Thirty women, ages 45 to 67, were studied. L-dopa stimulation tests were performed with an ingestion of 500 mg of L-dopa. Serum GH and IGF-1 were measured by a radioimmunoassay using commercially available reagents and uGH was estimated from the 24-hour urine. Then, the mean and its distribution of uGH values were compared according to the GH status defined by L-dopa stimulation test.

Results : The correlation between the uGH and the peak values after L-dopa stimulation test was significant (r=0.46; P＜0.01). The mean value of uGH in the GH deficiency group was significantly lower than that of the normal group (P＜0.05). But because of the broad overlap of uGH in the two groups uGH showed no good separation GH deficiency from normal group although uGH reflects GH status significantly.

Conclusion : uGH reflects GH status significantly, but because of broad overalp uGH couldn't separate GH deficiency form normal group defined by L-dopa stimulation test.

Background
: Lymphedema is a common condition occurring in over 50% of breast and cervix cancer patients. The pneumatic pump as used in the past is still utilized for the treatment. A complex lymphatic therapy was developed by Dr. Michael Foeldi of Germany in the 1980s, and was widely practiced with good effects. This study was to observe the practical effectiveness in patients receiving such treatment.

Methods : Twenty two patients diagnosed with lymphedema and treated in department of Family Medicine of National Health Insurance Corporation Ilsan Hospital from August 1,2000 to September 30, 2001. They were observed with respect to the frequency of demographic characteristics, and were compared to assess the improvement of clinical symptoms before and after complex lymphatic therapy by independent samples T-test and the degree of edema reduction before and after complex lymphatic therapy by paired samples T-test (P-value<0.05).

Results : Among the 22 subjects I was a male and 21 were females and their mean age was 49.9±9.3. Cervix and breast cancer patients comprised 86.4% among the total. Twenty one cancer patients developed lymphedema after the operation or radiotherapy. Most were in stage 2 or 3 of edema with 81.8%. Relative to the edema onset time, there were 7(33.3%) of less than 1 year, 5(23.8%) from 1 to 3 years and 9 (42.9%) over 3 years. They came to see a lymphedema specialist in 2.9±3.9 years after edema progressed. The degree of lymphedema with 968.4±545.3 ml before the treatment was improved to 337.3±326.8 ml after the of lymphedema with 968.4±545.3 ml before the treatment was improved to 337.3±326.8 ml after the treatment which showed a statistically remarkable 65.0±33.2% effectiveness.

Conclusion : complex lymphatic therapy for the patients of lymphedema presented with a 65% edema reduction in our study. Thus, the therapy for such patients is considered the most effective method up to present.

Background
: In terminal cancer patients, alleviation of suffering is as important as the cure of disease. But their symptoms are often intractable. In such a case, sedation is usually considered to relieve these refractory symptoms. However, the decision to sedate has been an ethical concern to health care worker because of an effect on survival time of cancer patients. The aim of this study was to investigate the use of sedation in terminal cancer patients and its relationship with intractable symptoms.

Methods : One hundred and fifty six patients admitted to National Heath Insurance Corporation Ilsan Hospital, Department of Family Medicine for hospice care from September 2000 to the end of October 2001 were enrolled in the study. Demographic data, clinical symptoms, the use of sedation, the choice of medication, reasons for administration, and frequency were recorded.

Results : There were 81(51.9%) men and 75(48.1%) women. The mean age was 64.6±13.3 years. The primary sites of cancer were stomach 36(23.1%), lung 27(17.3%), and colo-rectal 19(12.2%). Common symptoms were pain, nausea/vomiting, and dyspnea. Among the subjects, 55(35.3%) receive sedation. The drugs used for sedation were lorazepam in 37(67.3%), haloperidol in 21(38.2%), and diazepam in 18(32.7%). Sedation was administered to relieve insomnia in 20(36.4%), agitated delirium in 20(36.4%), severe pain in 9(16.4%), dyspnea in 5(8.0%), and nausea/ vomiting in 1(1.8%)

Conclusion : Among the subjects, 55(35.3%) of 156 terminal cancer patients received sedation. Though most common symptoms were pain and dyspnea, the use of sedation was mostly limited to insomnia and delirium. Therefore, the use of sedation is not yet prevalent in Korea.

Background
: C-reactive protein is an acute phase reactant, which can be increased by either (both) infectious or (and) non-infectious and non-specific reaction of cells and tissue metabolism. Also C-reactive protein is known to have a relationship between changes in lipid and glucose metabolism. In recent studies, the possibility of being a prognostic factor of cardiovascular risk factors and serum C- reactive protein concentration within conventional reference ranges in otherwise normal people has also received little attention. Therefore, in the study, we tried to look for the relationship between C-reactive protein and cardiovascular risk factors of a healthy adult.

Methods : We analyzed the results of the surveys and general chemistries given to 3,548 healthy men and women who have visited the health promotion center in a certain university hospital. We assayed the C-reactive protein by means of rate nephelometry. We omitted the case of 123 people who went over 1mg/dL. We compared C-reactive protein of normal and abnormal range of each risk factor and went through the multiple regression analysis for the factors with significant differences.

Results : When C-reactive protein concentration of normal and abnormal range of cardiovascular risk factors were compared by t-test, there were differences according to age (p<0.001), sex(p<0.001), body mass index (p<0.001), WBC (p<0.001), systolic blood pressure (p<0.001), diastolic pressure (p<0.001), total cholesterol (p<0.01), HDL-cholesterol (p<0.05) and smoking (p<0.001). We could not find any significant difference of triglycerides. After going through multiple regression analysis for the risk factors, which showed a significant difference by t-test, we found out that the C-reactive protein increased as cholestrol (p<0.01), body mass index (p<0.01) and WBC (p<0.001) increased. As for HDL-cholesterol (p<0.001), the C-reactive protein increased as it decreased. Age, sex, smoking history, systolic blood pressure, and diastolic blood pressure did not show significant relationship we were looking for.

Conclusion : C-reactive protein was not related to age, smoking history, blood pressure, and triglycerides among cardiovascular risk factors, bot was related to body mass index, cholesterol, HDL-cholesterol and WBC. This relationship indicated that even if the C-reactive protein was in normal range a person with C-reactive protein should be aware of the risk involved for cardiovascular diseases.

Background
: Family doctor registration program was proposed several years ago and is still in discussion. The success of this program depends on attitude and acceptibility of people. This study was done to describe the attitudes of the people to the family doctor registration program.

Methods : We interviewed 657 adults who lived in Seoul, Bundang, Ilsan and Pyungchon with a preformed questionnaire. The questionnaire was pretested by five family doctor and trainee.

Results : About half of the respondents were favorable for family doctor registration program. The most importantly considered benefits of the program were continuity of care, telephone consultation and management of chronic disease. The most seriously considered drawbacks of the program were only single doctor available cost, and restriction of medical services. Over half of the respondents preferred internists as their treating doctor and family physician, pediatrician followed. About half of the respondents opposed on the fact that the family doctor was restricted to clinic-based practice. Half of the respondents intended to participate in the program and the rate of intention to participate in the family doctor registration program was related to their household income and favorable attitude to wards the program and marginally related to the number in a household, haring a regular doctor, their interest in health. The demographic variables did not influence intention to participate in the program.

Conclusion : Half of the respondents agreed to participate in the family doctor registration program, but others were negative to the principles of the program and cost, sharing.

Background
: As patients can go to specialists and family doctors do not have gate-keeping role, doctor-shopping is very popular in Korea. The introduction of family doctor registration program is proposed several years ago, and the debate is still being done about that issue. This study is to show the possession rate of regular doctor and to investigate the factors associated with it.

Methods : We interviewed 657 adults of Seoul, Bundang, Ilsan and Pyungchon with preformed questionnaire which included the questions about regular doctor and attitudes to the family doctor registration program. Respondents were sampled according to the age structure and population distribution of the cities.

Results : About half of the respondents had regular doctor. Internists were regular doctors of nearly half of the respondents and pediatricians 30.6%, oriental doctors 5.6%, general surgeon 4.4%, and family doctors 3.8%. About half of the regular doctors worked in primary clinic and 48.2% in hospitals. The most important reason choosing regular doctor was distance to the medical facilities. The most frequently provided service by regular doctor was vaccination (57.1%), the least was home visit (2.9%). Factors associated with the possession of regular doctors were residence area, sex of respondents, level of income and education.

Conclusion : Nearly half of the respondents had regular doctors and half of the regular doctors were internists and worked in primary clinics. The area of residence, sex, income level, level of education, and interest for health were related with the possession of regular doctor.

Background
: Recent advances have been made in the treatment of acute stroke, but the effectiveness of the new therapies is highly time dependent. Patients with acute stroke often arrive at the hospital too late to receive the maximum benefit from these new stroke therapies. Efforts to reduce delay time of therapy for acute stroke may be more effective if the factors that delay hospital arrival are identified and targeted for specific intervention. So we studied about reason of delay of hospital presentation in patients with acute stroke.

Methods : The 85 acute stroke patients group who admitted to the Young-dong severance hospital from April to August 1999 were enrolled in this study. We collected clinical data from the medical record, including demographic characteristics, date and time of symptom onset, date and time of presentation to the hospital, medical history, and symptoms at stroke onset. And informants about stroke, method of transportation, the patient's interpretation of the symptoms were interviewed. We defined early arrival as within 3 hours of awareness of symptoms.

Results : The 85 patients were interviewed, early arrival were more likely to arrive by ambulance (P<0.001), admit via emergency department(p=0.001), interpret their symptoms as a stroke(P=0.005) and use readings as a informants about stroke(P=0.027) than late arrivals. Also they were younger than late arrivals(P=0.027). Main reason of delay of hospital presentation was because they expect spontaneous improvement(43%), mistake as other disease(23.3%), arrive via other medical institute(20%).

Conclusion : Late arrivals expected spontaneous improvement, misinterpreted their symptoms as those of other disease and didn't choose proper medical institute for acute management. Considerable education is needed to increase the knowledge about stroke and proper acute management.

Background
: Medical decisions concerning the prolongation of life. the right to die and euthanasia are among the most extensively discussed issues within medicine and law today. The purpose of this study was to evaluate the attitudes of medical of students and housestaff toward euthanasia.

Methods : From July 15 to september 15 of the 1998, the responses of 180 medical students and 132 housestaff to a self-adbministered questionnaire were analyzed to identify attitudes toward euthanasia. Over 312 respondents about attitudes toward euthanasia, the analysis of differences between proportions was made by the Chi-square test.

Results : About 69.9% of the respondents thought euthanasia should be legalized. The findings suggest that Buddhists (77.5%) and non-religious groups (88.1%) tend to support euthanasia more than Christians. Futhermore, medical students (74.4%) support euthanasia more than housestaffs(63.6%), male(75.1%) more often than female(57.9%). about 73.1% of the respondents said that active euthanasia is not justifiable, and 79.2% said that they do not like performing active euthanasia. In respect to passive euthanasia, 69.0% said that it is not ethically justifiable, but 63.0% would perform this as if it were legal. Housestaffs of internal medicine (76.9%) were more willing to do euthanasia than pediatrics (70.0%), surgery (63.6%), family practice (53.8%) and Ob/Gyn(33.3%).

Conclusion : Respondents have positive attitudes toward legalization of euthanasia.. Most considered that passive euthanasia is not morally justifiable. But if it were legalized, they would still be disturbed by active euthanasia. The opinions of physician and medical students directly affect patient care and their attitudes must be considered if clear plicies are to be developed concerning euthanasia.

Background
: Falls in the elderly can lead to disability, hospitalizations, and premature death. Even if the fall does not cause significant injury, it may lead to fear of falling, loss of self-confidence and restriction of ambulation. Thus, we conducted this study to examine the risk factors of falls in the elderly.

Methods : The study population consisted of 70 persons, older than 65 years. Subjects were subdivided into 3 groups according to their experience of falls, during the past 2 year period. Among them, 30 persons had no previous experience, 20 had one fall, and 20 more than one fall. Age, past history, situations surrounding falls, MMSE-K, GDS-short form, ADL, IADL, Mini Nutritional assessment (MNA) were reviewed, and the Get up and go test, evaluation of orthostatic hypotension and hearing were done. T-test, chi-square, ANOVA, logistic regression test using the SAS program was performed.

Results : The mean age of the participants was 75.4 years with 62.9% males. The factors associated with falling were age (P=0.01), scores of MNA (P=0.04), Get up and go test (P=0.004), past history (P=0.01), MMSE-K (P=0.02), GDS-short from(P=0.001), ADL (P=0.003) and IADL (P=0.002). Those in the group who fell once occured mostly while doing a riskful task, while those who fell more than once happened mostly during positional change (P<0.0001). Independent predictors of falls were get up and go test results and GDS-short from scores.

Conclusion : The independent predictors of falls were Get up and go test results and Geriatric Depression Scale scores.

Background
: Recently live blood analysis was populated in korean society. So we evaluated clinical utility of Live blood analysis, as compared the Live blood analysis result of patients who have confirmed diagnosis of disease with that of controls who have no known health problems.

Methods : We carried out Live blood analysis to patients(n=30) who was entered to an admission in Yongdong severance hospital from February 2000 to March 2000 and to controls (n=30) who worked in that hospital at same time. We examined 3 abnormal finding; rouleau formation, spicule, protoplast, which were often observed in Live blood analysis.

Results : At comparison of parient group and control grup, rouleau formation was observed in 27 patients except 3 partients and it was observed in all 30 controls. Spicule was observed 2 in 9 partients except 1 patients and it was observed in all 30 controls. Protoplast was observed in 16 patients and 13 controls. There was no difference between patients and controls in observing 3 abnormal fingding.

Conclusion : We conclude that Live blood analysis may have no clinical significance.

Background
: The prevalence of hepatitis C in blood donors have been reported to be 1.5% to 2.0% and 85-90% of post-transfusion hepatitis patients show anti-HCV positive results. Most agree that hepatitis C is readily spread by way of contact with blood, but a discernible history of parenteral exposure is identified in only 40% to 50% of cases. Thus other possible nonparenteral routes of transmission such as vertical, sexual and intrafamilial contact transmission need to be explored. In this study, we investigated the clincial characteristics of anti-HCV but also by HCV-PCR to explore the possibility of HCV infection through nonparenteral household contact.

Methods : Past history, physical examination, liver function tests, HCV-PCR, hepatitis B viral markers, abdominal ultrasonography and liver biopsy were done in 161 anti-HCV seropositives from May, 1991 to August, 1996. Of the 161 seropositives, 42 seropositives' family members, 98 subjects, were available for investigation by anti-HCV, HCV-PCR and liver function teste to doc-ument intrafamilial HCV infection; thier respective relationships to the index seropositive were noted.

Results : The 161 anti-HCV seropostives were classified as follows: 34 in the carrier group(21.1%). 41 in the acute hepatitis group(25.5%), 32 in the chronic hepatitis griyo(19.9%), 24 in the liver cirrhosis group(14.9%) and 30 in the hepatoma group(18.6%). The positive rates of HCV-PCR were 55.2% in total, 46.1% in the carrier group, 55.0% in the acute hepatitis group, 76.4% in the chronic hepatitis group, 40.0% in the liver cirrhosis group, and 42.8% in the hepatoma group. The 98 family members were all anti-HCV seronegative. The positive rates of HCV-PCR in these family members were 10.2% in total, 7.1% in spouses, 28.6% in siblings, and 8.3% in children.

Conclusion : Anti-HCV seropositives were in various clinical states of liver disease due to HCV infecton. Although none of the family members showed anti-HCV positive results, HCV-PCR was positive in 10.2% of the family members indicating the need to perform HCV-PCR to detect HCV infection.

Background
: Means to measure death anxiety, death depression and sense of symbolic immortality with approved validity and reliability does not yet exist in Korea.

Methods : Existing English questionnaires such as Templer Death Anxiety Scale (TDAS), Death Depression Scale (DDS), Sense of Symbolic Immortaligy Scale (SSIS) were translated into Korean by 5 translators, and then reviewed by 3 non-participants of translation for collegial summary and this summary was counter-translated again by another 2 non-participants. Another 3 non-participants of translation and counter-translation were chosen to examine the two sentences of each item. Then reexamination was done by retranslating and counter-translating the parts with errors. After pretest on ordinary people. The completed questionnaires were given to medical students, residents and nurses of a university hospital. Pastors and missionaries were selected as comparison group.

Results : Kuder-Richardson or Cronbach-α that represent internal consistency of TDAS, DDS and SSIs was 0.69, 0.84 and 0.78. The three sentences that lowered internal consistency of SSIS was deleted. BDI and DDS showed a positive correlation (0.32, P=0.02), suggesting proved construct validity. Correlation coefficient that proves construct validity of TDAS and DDS was 0.54 (P<0.01), of SSIS and TDAS -0.23(P=0.04), of SSIS and DDS -0.29(P=0.01). The TDAS and DDS(P<0.01), DDS and BDI(P=0.02) have shown a positive correlation were shown. There was significant difference in the score of SSIS(P<0.01). The same results in cases where the 3 sentences was deleted.

Conclusion : Korean versions of TDAS, DDS and SSIS were reliable and valid.

Background
: This study was intended to look into the characteristics and problems when FACES III are used as tools to evaluate family function of adolescents.

Methods : From May to June1996, self-reported questionnaires for FACES III were conducted on 2,430 middle school and high school students(males:1,190, female:1,240) in Seoul and Yangpyung, Kyunggi-Do. There were eight schools(four middle school, four high school) in Seoul and two schools(one middle school, one high school) in Yangpyung, Kyunggi-Do in this study. Also, education level of parents, occupational status of parents, family types(extended/nuclear), number of family member and numbers of siblings were assessed.

Results : The mean values of adaptability were significantly higher in Seoul students, in females, and in nuclear families. The mean values were higher in single sibling than two or more and in parents with higher education. The mean values of cohesion were significantly higher in Seoul students, in middle school students and in family members of 5 and under. The mean values were higher in those without a sibiling and in those with above college education. In stepwise regression analysis, educational level of parents, gender, area, occupational status of mother and grade were associated significantly with the mean values of adaptability and educational level of mother and grade were associated significantly with the mean values of adaptability and educational level of parents, grade and numbers of siblings were significantly associated with the mean values of cohesion.

Conclusion : We consider that there are problems in deciding the cut-off point and in the questionnaires of survey when the FACES III is used as a tool for evaluating family function of adolescents. Trials of combining other tools of family function or consideration of lower concepts are needed in other to be applicable to the individual conversation and clinical surroundings.

Background
: Computer can in many ways improve the quality and efficacy of medical care. The purpose of this study was to perform a comprehensive survey of present computer use and investigate the factors affecting computer use by family physicians.

Methods : 1250 family physicians were surveyed by mail from May to August, 1999. The survey protocol included demographic characteristics, opinions on computer use in medicine, present computer usages and wanted applications in the future.

Results : Of the 306 responses received, 291 responses were analysed, 91.4% replied that they used computers in the medical field, and 58.1% said they used computers during medical interview. Factors preventing computer use in medicine were cost(33%), time(16%), insufficient information(14%), the doctor-patient relationship(12%) and no perceived need(6%). While 46% of the responders who used computers in the medical field cited fellow doctors for their interest in computer use in the medical field, only 6.2% answered that medical societies or associations had promoted their interest. Present usage of computers included word processing. online communication, internet, medical insurance billing, in descending order. Factors affecting the present degree of computer use that were statistically significant, were the computer system used, factors preventing computer use and the preset form of practice.

Conclusion : Although, most family physicians use computers in the medical field, its use is still limited to a few areas.

Background
: Life expectancy is ever increasing due to medical advancements, but cancer death rate is also increased. Quality of life is an important issue in cancer patients. Despite developments of early diagnosis and treatments for cancer, the medical costs is increasing due to extended survival against cancer and the absolute numbers of terminal cancer patients. We assessed the medical costs and quality of life in terminal cancer patients by the types of medical facilities, which would contribute to effective management.
Method: A total 159 patients (males 70, females 89) with terminal cancer patients who were treated and died in various types of medical facilities(home hospice, charity hospital hospice unit, university hospital hospice unit, university hospital non-hospice unit) between November 1, 1997 and January 31, 1999 were included in the study. After the confirmation that the demographic factors correlated with factors of quality of life, the differences in the medical costs and quality of life(pain, depression, ADLs, family APGAR score) during the last 1 week of life in the various types of medical facilities analyzed by multi-way ANOVA with interaction of the significant demographic factors.

Results : The mean cost of types of medical facilities during the last week of patients as 65,332.5 won in charity hospital hospice unit, 105,165.5 won in home hospice, 702,083.4 won in university hospital hospice unit, and 1,037,358.6 won in university hospital non-hospice unit. The difference between free hospital hospice unit and home hospice in medical costs as not statistically significant, but the difference among charity hospital hospice unit and home hospice, university hospital hospice unit, and university hospital non-hospice unit as significant (p<0.001). The demographical factors of quality of life in terms of pain, depression, ADLs, and family APGAR score were compared among various facilities. The ADL score of home hospice was 8.2±3.3, which was lower than free hospital hospice unit and university hospital hospice unit(p<0.05). The mean pain score of home hospice as 1.7±1.7 and that of university hospital hospice as 1.2±1.2, and pain scores of home hospice were lower than free hospital hospice unit, and pain scores of university hospital hospice were lower than free hospital hospice unit and university hospital non-hospice unit(p<0.05). In depressions categorical scale of home hospice the score was 4.8±1.3, which was higher than those of free hospital hospice unit and university hospital non-hispice unit(p<0.05), signifying less depression. The family APGAR score was statistically insignificant among various types of medical facilities.

Conclusion : The cost of hospice care is less than the non-hospice care. We found that the patients of home hospice experienced less pain and depression even with low ADLs, and increased the quality of life in both psychological and physical aspects.

Background
: As childhood-onset obesity has been known to have a poor prognosis, and its prevalence is rapidly increasing, many children and adolescents are becoming concerned about obesity and try various weight control methods. This study assessed the experience and behaviors of weight control in obese adolescents.

Methods : A total of 732 among 840 obese students from 28 schools in Seoul metropolitan area were assessed with a self-administered questionnaire.

Results : Middle school students showed the highest trial rate of weight control. Elementary and high school girls showed significantly higher trial rates of weight control than boys(p<0.05). The methods more frequently used were physical exercise, and diet, drugs and other methods, and visits to obesity clinics in than order. Elementary school girls most frequently tried physical exercise while high school girls went on a diet more frequently. All groups of girls were dieting significantly more often than boys(p<0.05). High school girls were the most frequent users of drugs and other methods while elementary school boys and middle schoolgirls visited obesity clinics most frequently. Unhealthy weight control methods observed were monodiet(2.7%), fasting(1.9%), dieting pills(1.4%), and vomiting(0.1%). The mean number of weight control methods was decreased with increasing age. The possibility of overall weight control was significantly higher in girls, having higher weight dissatisfaction levels. The possibility of physical exercise was significantly higher in younger ages, having mother with a career and a family history of obesity. The possibility of dieting was significantly higher in girls, older ages, having higher obesity index. The possibility of using drugs and other methods was significantly higher if they had higher weight dissatisfaction levels and a family history of obesity. The possibility of visiting obesity clinics was significantly higher if they had higher obesity index.

Conclusion : Although, exercise and diet were frequently chosen by obese adolescents for weight control, the number unhealthy methods chosen were found to be higher and physical exercise decreased wit increasing age. Therefore, an appropriate weight control program that is not detrimental to normal growth and development is called for in early adolescence.

Background
: Compliance, defined as the extent to how a person's behavior concedes with medical prescription or advice, has great influence on the treatment. Compliance can be a problem when dealing with chronic medical disorder requiring lifestyle changes and long term treatment. Elderly patients are thought to have more difficulty following prescription because they are generally prescribed more medication, and have more chronic disease. Thus we conducted this study to exam the medication compliance, and the factors associated with compliance in elderly patients.

Methods : The study population consisted of 60 patients (men 31,women 29), older than 60years, who visited a geriatric center geriatric center in a university hospital in September 1, 1998 for one week. We used morisky's self-reported questionnaire which consisted of 4 questions by telephone interview to figure out compliance, and asked 11 questions that may influence compliance, and then collected data - sex, age, number of medication, complexity of prescription, physician number, follow-up days etc. by medical records. We defined compliance as given positing answers to all of the four questions. We analyzed the correlation between compliance and associated factors with x2- test.

Results : Twenty one patients(35%) of the 60 patients were non-compliant. The factors associated with medication compliance were knowledgement of the disease (p=0.020), satisfaction with physician(p=0.012),explanation from physician (p=0
050), number of physician (p=0.024), number of dedication (p=0007), complexity of prescription (p=0.002). But there was no relationship between medication compliance and sea, age, education, perceived seriousness of illness, perceived efficacy of treatment, family support, physical disability, treatment duration, adverse effect, and follow-up days.

Conclusion : Thirty five percent of the subjects were non-compliant. In the factors associated with compliance, the doctor/patient factors as satisfaction with physician, number of physician, number of medication, complexity of prescription have more correlation than patient/disease factor Therefore, we emphasize the role of doctor for improving medical compliance.

Background
: There has been no systematic investigation of the necessary core procedures in primary care in Korea. The purpose of this study is to examine the core procedures necessary in primary care and to have the results reflected in residency programs.

Methods : A mail survey was conducted from May 2, to August 20, 1997 among 478 physicians who qualified as a family physician specialist since 1989. The contents of the questionnaire included 1) sex, age, location and size of the hospital 2) of the 93 procedures that should be taught during residency programs as suggested by the [American Academy of Family Physicians] and the [Korean Academy of Family Physicians] a) procedures taught in residency programs, b) procedures performed by practicing family physicians, and, c) procedures considered as necessary in primary care.

Results : 1) Of the 93 procedures, 78 were taught in residency programs, 35 were performed by practicing family physicians, and 77 were considered necessary in primary care. 2) All of the 35 procedures performed by family physicians were taught in the residency programs. Of the 77 procedures considered necessary in primary care, 71 were taught but the remaining 6 were infrequently taught. 3) 7 procedures were taught but were considered unnecessary ; Procedures taught but not actually performed amount-ed to a total of 43. 4) 42 procedures were considered necessary but not performed. 5) More procedures were performed by male doctors(p<0.05). Surgical procedures were performed more often in regional hospitals than those in Seoul and in the larger cities(p<0.05), and more were performed in private practice(p<0.05).

Conclusion : Although almost all of the procedures considered necessary in primary care were taught in residency programs, many procedures were not being performed in current medical practice. We suggest that it would be more effective to intensively train the core procedures than to provide exposure to a wide array of procedures. As the procedures performed were found to vary in relation to sex, location and size of the attending hospital, it would be desirable for training programs to accommodate individual needs, giving residents access to specific procedures needed for their future.

Background
: Despite widespread recognition of the hazardous health effects of smoking, adolescent smoking continues increase, emerging as a public health problem. However few studies have focused on smoking cessation programs for adolescent smokers. The purpose of this study was to measure the short-term effects of adolescent smoking cessation program performed by the Seoul School Health Center.

Methods : Four hundred and twenty adolescent smokers referred from their schools form March to December of 1996 were assessed before and immediately after the program with a self-questionnaire. The data acquired from these 420 students was analyzed.

Results : Males were found to have a higher rate of daily smoking as compared with females. Middle school students had an earlier starting age than those of high school students. About 70% of the students had tried to stop smoking and about 1/3 had a high level of self-efficacy in stop smoking. More than 80% of the students were current alcohol drinkers and 10% ever had experience with other drugs. Many showed poor academic performance and low degree of satisfaction with their schools. More than 50% had experienced punishment at school. Middle and high economic status were more common than low status, 73.3% had smokers in their families and 43.3% showed severe dysfunction in family APGAR. Smoking cessation rate immediately after the program was 37.4%, highest in female high school students and lowest in male high school students. Factors shown to be significantly associated with smoking cessation in males were school age, FTQ scores, presence of peer smokers, smoking and alcohol status, self-efficacy in stop smoking and degree of satisfaction with their schools. School age, presence of peer smokers, smoking and other drug use status, self-efficacy in stop smoking, academic performance, degree of satisfaction with their school, experience of runaway from home, economic status and presence of smokers in their families were significant factors in females. Stepwise logistic regression showed that current alcohol users were less likely to succeed in smoking cessation and those with a higher level of self-efficacy in stop smoking were more likely to succeed in males. In females, high school students with higher economic status were more likely to succeed while those with smokers in their families or experience of runaway from home were less likely to succeed.

Conclusion : To promote smoking cessation, specified and risk-based approaches are considered to encourage the motivation of adolescent smokers. For more effectiveness, programs will need to comprehensively include the school, the family, peers, alcohol and other drug issues as well as smoking problem itself.

Background
: Although childhood obesity is an increasing public health problem in our society and a number of regimens have been developed and distributed for the treatment of adult obesity, few studies have focused on therapeutic programs for obese children. The objective of this study was to develop and measure the effects of an OPD-based childhood obesity control program.

Methods : The OPD-based childhood obesity control program was developed by reviewing the preexisting literature and consulting specialists. It was applied to the 4-6th grade obese(obesity index≥30%) children. The effects of intervention were assessed by the changes in obesity-related behavior, caloric and nutrient intake and exercise amount. The effects in the OPD-based group(group I) were also compared with the school-based group(group II)and the no intervention group(group III).

Results : The OPD-based program was developed based on behavioral modification principles such as self monitoring, stimulus control, positive reinforcement, social support, cognitive change and behavioral contracts and contained diet and exercise therapy. The developed program was applied to 34 pairs(child and mother) in the treatment group of which 21 pairs completed the basic sessions and 17 pairs completed the additional follow up session. Significant changes, decreases in obesity index were observed in the OPD-based group. No significant changes were found in the school-based group whereas increased degrees of obesity were found in the no intervention group. Obesity related behavior scores were significantly increased in both the OPD- and school-based groups. The children in both the OPD-based group showed significant decrease in dietary intake and increase in exercise amount.

Conclusion : Although it was a short-term treatment result, the OPD-based program was more effective than the school-based program in childhood obesity control. We suggest that a control program of comparable intensity and individualization as ours is required, for effective childhood obesity control.

Background
: The prevalence of adolescent obesity is so rapidly increasing in Korea that there are concerns not only for increased risk of adult obesity in the future, but also for psychosocial problems in this period. This study is to find out the psychosocial correlates of adolescent obesity such as demographic characteristics, concerns about body image and weight, self-esteem, depression, and the locus of control for obesity.

Methods : A total of 963(obesity, 433 ; normal weight, 530) among 8,209 students from schools that underwent survey of physical examination in Seoul were assessed with a self-administered questionnaire.

Results : There were statistically significant differences between the obese group(OG) and the normal weight group(NWG) in family structure(p<0.05) and economic status(p<0.01). Adolescents in a extended family were more frequent in the OG(14.3%), than in th NWG(9.4%). Those in the high economic status were less frequent in the OG(15.3%) than in the NWG(23.8%). Although almost all obese adolescents considered that they were fat, normal weight students did not view themselves as they really were(p<0.001). That is, 57.5% of the NWG thought that they were either fat of thin instead. The majority of the OG was not satisfied with(86.4%) and worried(88.0%) about their weight(p<0.001), and these aspects were more remarkable in women(p<0.001). The total self-seteem score in the OG was higher(p<0.001) than the NWG, and the depression score was lower in the OG than the NWG(p<0.001). Higher scores for powerful others and chance in th OG than those in NWG were shown(p<0.001). The psychosocial aspects which were highly associated with obesity were self-esteem in peers(odds ratio=1.547) and school(odds ratio=2.041), and powerful others(odds ratio=2.181) and chance(odds ratio=2.367) locus of control for obesity, and less probable characterisrics were depression(odds ratio=0.723) and high economic status(odds ratio=0.498).

Conclusion : Obese adolescents neither had low self-esteem nor were they depressive to the contrary of belief in the general public. Since they were not satisfied with and worried about their body weight, however, there is a need to change our misconception of obese people who may risk unhealthy weight reduction. Further studies using various insrtuments and reinforcing internality for management of obesity would be needed to deeply understand the psychosocial correlates of obesity.

Background
: Medical dispute is increasing and its effect on society is serious, but reasonable settlement system is absent. Nevertheless patients and families choose medical dispute. But there is little research on patients and their families who choose to settle by medical dispute. Therefore this study examines the impact of medical malpractice to patients and their families and their reasons for choosing medical dispute after mishap.

Methods : Data were collected from 234 subjects who inquired of Medical Malpractice Family Association about malpractice suit. Questionnaire was composed of demographic characteristics, characteristics of hospital, characteristics of medical malpractice, degree of satisfaction with explanation and attitude of the treating doctor, effect of medical malpractice on patients' life and reasons that patients and their families choose to settle by medical dispute. Factor analysis with varimax rotation was carried out to reduce the reasons to a smaller number of clearly interpretable factors. Multiple regression analysis was carried out to identify the variables relevant to these main themes.

Results : Degree of satisfaction with doctor's explanation and attitude was less than 10%. Over 60% of respondents stated that medical malpractice seriously affected their lives. Four main themes emerged from the factor analysis of reasons for dispute which includes dissatisfaction with doctor's attitude, wanting to prevent similar incident in the future, call to account, and compensation. The relative importance in the order of frequency was wanting to prevent similar incident in the future, dissatisfaction with doctor's attitude, call to account, followed by compensation. Multiple regression analysis was used to identify the variables relevant to these four main themes. Clinical specialty group and degree of satisfaction on attitude were significantly associated with the dissatisfaction with doctor's attitude. Clinical specialty group, patient's condition, effect of medical malpractice on life and degree of satisfaction on attitude were significantly associated with the call to account. Academic career, clinical speciality group, patient's condition, effect of medical malpractice on life and degree of satisfaction on attitude were significantly associated with the compensation.

Conclusion : From the above results, the reasons patients and their families choose to settle by medical dispute were diverse and associated with demographic characteristics, doctor's attitude, effect of mishap on life, et. al.

Background
: Despite the declining tendency of the prevalence of tuberculosis in Korea, pulmonary tuberculosis is still considered to be such an important disease in Korea that tuberculosis of patients have been screened by mass miniature radiography(MMR). Although the prevalence of tuberculosis increases with age, screening of it has been done on students and young workers. There hasn't been any study about the prevalence of tuberculosis in adolescents recently.

Methods : MMR were performed on high school freshmen in Seoul from March to September, 1995. Patients with abnormal MMR were further evaluated on history taking and standard chest X-ray, Their results were classified as normal, active tuberculosis, activity-undetermined tuberculosis, healed tuberculosis, and other diseases. The prevalence of active tuberculosis by this screening method was estimated.

Results : Among 194,102 high school freshmen, 388 were suspected to have pulmonary tuberculosis by MMR. The prevalence of tuberculosis in high school freshmen in Seoul was 0.20%, male 0.18%, female 0.23% by MMR respectively, There was significant difference between the prevalences of both sexes. History taking and standard X-ray was taken for 94 students and among them 68 students were found to have active tuberculosis(72.3%), 14 normal(14.9%), 3 other diseases(3.2%), 9 healed or activity-undetermined tuberculosis(9.6%). Newly-diagnosed patients in active tuberculosis were 59(82.9%). There were family history in 31 out of 94 students(33.0%) and 29 out of 68 students(37.1%) with active pulmonary tuberculosis had family history of tuberculosis.

Conclusion : The prevalence of pulmonary tuberculosis in high school freshmen in Seoul was 0.20% by MMR. Positive predictive value of MMR was 72.3% in follow-up students by standard chest X-ray. Therefore estimated prevalence of active pulmonary tuberculosis by standard chest X-ray after MMR was 0.14%.

Background
: The purpose of this study was to figure out the prevalence of smoking, alcohol and other drug abuse and the relationships among them.

Methods : In July 1996, a total of 4,438 school adolescents randomly sampled from 6 schools(2 middle schools, 2 general high schools, 2 vocational high schools) in Seoul were assessed with a self-completing questionnaire pertaining to smoking, alcohol and other drug(sedatives, stimulants, inhalants) use.

Results : The current smoking rate of the study subjects in the study was 17.1%(male: 27.5%, female: 8.3%) and the current alcohol drinking rate was 29.4%(male: 34.0%, female: 25.4%). The experience rate of sedatives and stimulants was 4.0%(male: 4.7%, female: 4.4%) and 12.1%(male: 7.0%, female: 16.6%), respectively. The experience rate of glue, butane gas and other volatile solvents was 1.3%(male: 2.5%, female: 0.4%), 0.8%(male: 2.0%, female: 0.2%) and 1.0%(male: 1.4%, female: 0.6%), respectively. Current alcohol drinking as well as smoking was increased with age, higher in males than females, higher in vocational high school students than general high school students. The experience rate of stimulants was higher in females than males but the experience rate of inhalants(glue, butane gas, organic solvents) was higher in males than females. The younger the age of the study subject, the earlier the starting age of smoking and alcohol drinking. Smoking, alcohol and other drug use status was highly associated with one another.

Conclusion : The most commonly used drugs by the study subjects were alcohol, cigarettes, stimulants, sedatives and inhalants in this order. Higher experience rate was seen in vocational high school students than general high school students.

Background
: Recently preventive clinical care has been proved important to the health. A number of recommendations or programs for preventive health services have been developed. The government made laws for health promotion of the people and for medical check-up for the insured in the district medical insurance association, who had been alienated from reimbursement for periodic health examination. As a result, above 95% of Korean people could took the periodic health check-up by this legislation. According to the national data, however, about 20% of the insured participated in the health screening program which was carried for the first time by the district medical insurance association in 1995. The reason that the compliance of health screening program was much lower than expected has not been clear yet. The purpose of this study is to define the facors affecting on the compliance of the health screening program.

Methods : Two hundreds of compliers and as many non-compliers of the health screening program was selected by the stratified sampling in one district medical insurance association which consisted of one town and eight township within the National Capital region. The telephone survey was performed from June 1 to 15 in 1996. The questionnaire was framed by health belief model with other demographic data. The data was analyzed by chisquare test, wilcoxon rank sums test, and logistic regression for the comparison of the characteristics between compliers and non-compliers.

Results : There was no difference of demographic data and medical history of chronic disease between compliers and non-compliers. 73.3% of the subjects knew they had been the expectant examinee of the health examination, and among them, 68% took the health examination. However, 53% of non-compliers did not know that they had been the expectant examinee. The most common reason that non-compliers didn't took the health examination was "they didn't know"(43.5%). Among 73 families of compliers which had more than 2 expectant examinees of the health screening program, 44 families(60.3%) had more complier other than study subjects. In contrast, among 74 families of non-compliers, only 7 famiies(9.5%) had more complier other than study subjects. Compliers showed lower reliability of the health screening program than non-compliers. Non-compliers had more perception about the severity of the target disease for the examination and had more confidence about self health status than compliers. There was no difference of the answer about the benefit of the health examination, perceived susceptibility about target disease, sue to action, and perceived barriers. The odds ratio of compliance of other family member was 21.2, perceived severity, 0.70, and cue to action, 1.36.

Conclusion : The main reason of low compliance of health screening program for the insured in the district medical insurance association was lack of public information. By the fact that non-compliers had more perception about the severity of the target disease and there was no difference of perceived benefit of the health examination between two groups, public information should be focused on the benefit and efficacy of periodic health of the health examination between two groups, public information should be focused on the benefit and efficacy of periodic health check-up than severity and susceptibility of target disease. Because the health screening program on study subjects was carried for the firt time, only compliers had experience of the examination. The fact that compliers relied on the examination less than non-compliers meant that the examinees was satisfied much less than expected. Therefore, further study of the expectation of the examinees about the health examination is expected.

Background
: HBsAg carriers are 6-12% of population in Korea. The patients' knowledge on hepatitis B and regular follow-up tests are important, because HBsAg carriers have infectivity and the disease may progress without symptoms. We surveyed their knowledge on the hepatitis B and the frequency of follow-up blood test and sonogram.

Methods : From March 1993 through September 1994, 630 patients who were diagnosed as HBsAg positive and Anti-HBs negative in a health promotion center of college hospital were surveyed by mailing questionnaire. The questionnaire included the result of HBV viral marker test, transmission routes, complications, and prevention methods of Hepatitis B, frequency of follow-up test, and doctor's recommendation.

Results : Of the 490 questionnaires excluded the 140 questionaires returned due to wrong address, 100 were answered, making the reply rate 20.4%. As for the result of HBV marker test, 64% answered their HBV marker as HBsAg positive, 10% answered HBsAg negative, and 26% answered 'I don't know'. 65% answered that they are HBV carrier. As for the mode of transmission, 59% answered that HBV is transmitted by blood, 57% form carrier mother at birth, 29% by sexual intercourse. 76% of responders know that vaccination is needed for preventing vertical transmission. When making score on their knowledge, significant differences were showed according to education, income and doctor's recommendation about regular follow-up test. The number of persons who took regular blood test every 6 to 12 months were 56(56%), and the number of persons who took regular abdominal ultrasonogram were 39(39%). The number of patients who were recommended regular follow-up by doctor was 76%. In this group, 51 persons(67.0%) took regular blood test and 35 persons(35%) took regular sonogram so this frequency is significantly higher than the other group(each 20.8%, 16.7%).

Conclusion : The knowledge on hepatitis B in HBsAg positive patients is relatively low and the frequency of regular follow-up test is significantly higher in the group who took doctor's recommendation. So it is very important that HBsAg carriers must be educated about the infectivity, preventive methods, and regular follow-up for early detection of complication like hepatocellular cancer.

Background
: Family physicians help the patients to be adapted to a new life cycle with anticipatory guidance. But the later life of empty nest stage seems to be the most stressful since during this time is made preparation of his/her own death. Anticipatory guidance in later life for death is not encouraged because after death, the patient no longer exists.

Methods : From August 1, 1995 to August 31,1995, we gathered the data by the means of questionnaire to persons aged over 60 who visited the department of family medicine and geriatric center in Yong-dong Severance Hospital. The questionnaire was consisted of demographic factors, attitude toward death, fear of death, preparation of death in aspect of his/her own and also in his/her family.

Results : The total 104 subjects responded to the questionnaire, consisting of 58 males and 46 females. To the question asking the attitude toward death, 71(67.6%)answered death as a spiritually new life, 39(37.1%)as an end of life and 11(10.5%)as just and event in life. 75(72.1%)persons insisted the need of preparation of death, and the content of the preparation were consideration of the family 35(33.3%), preparation of mind 34(32.4%), devotion to religion 33(31.4%), arrangement of fortune 19(18.1%). The answer about the fear of death was 42(40.0%)and the reasons for fear were pain of death26(24.8%), separation from the family 19(18.1%), uncertainty of the nature after death 17(16.2%), suffering of the family 10(9.5%)in rank order. The contents of preparation of death as family were being together with dying person 57(45.7%), evangelizm 32(30.5%), helping arrangement of life 30(28.6%), and the answer about fear of death of family were pain of death 40(37.1%), regret 31(26.5%), lack of preparation of after death 22(21.1%), loneliness after separation 14(13.3%).

Conclusion : Family physicians should recognize death as one of the life cycles because the most persons insist of the need of preparation of death. So family physician can help the the patient prone to death by anticipatory guidance with stimulation of performance of developmental tasks.