Background
: Korea is an endemic area of viral hepatitis B with a rate of 5~10% carrier state. Therefore, hepatitis B vaccination is performed nationwide. But 5~15% of health individuals fail to respond adequately to the vaccine and an approved guideline for the nonresponders has not been developed yet. This study is designed to identify risk factors for those who lack anti-HBs after hepatitis B vaccination and to document the results of a double-dose revaccination in such nonresponders to the primary vaccination.

Methods : From Feb. 1996 to Aug. 1997, we assessed 51 healthy subjects(HBs Ag negative, anti-HBs negative, anti-HBs negative and a normal LFT). All subjects were vaccinated with Hepavax-B® 1.0ml, 24 by a rapid schedule(0, 1, and 2 months) and and 27 by a standard schedule(0, 1, and 6 months). Anti-HBs titers were evaluated 3 months after the third vaccine and assessed the nonresponders(anti-HBsTiter < 2mIU/ml) and the hyporesponders(2~10 mIU/ml). All 13 nonresponders were revaccinated with 2 ml of Hepavax-B 3 months after the primary vaccination. Anti-HBs titers were evaluated 1 month later.

Results : The difference in age(p<0.01) and smoking amount(p<0.05) between the responders andhe hypo and the nonresponders were statistically significant. There were more males and higher body mass index in the hypo and the nonresponders but not statistically significant. The seroconversion rate after the double-dose vaccination was 92.3%(12/13) with an average titer of 58.08 mIU/ml(1~132.4 mIU/ml).

Conclusion : Increase in age and smoking amount were the risk factors of the nonresponders after the primary vaccination. Most of the hypo and the nonresponders to the primary vaccination responded adequately to the double-dose revaccination.

Background
: Research is essential for the development of family medicine as a professional field in primary care, Since information is available through the articles in the Journals of Family Medicine which contain subjects such as disease mechanism, pathophysiology, drug or new treatment method, and it is necessary to evaluate the contribution of recent researches in this field. The paper is intended to evaluate the current status of the quality of papers published in the Journal of the Korea Academy of Family Medicine (below JKAFM) and provide statistical data & direction of studies in the future.

Methods : 1218 articles in 185 editions of JKAFM were analyzed among 188 editions published from Nov.1980 to Dec. 1996. The papers were classified into Case Report, Original Article, Review Article by the type of papers, and then categorized into descriptive studies, analytic studies, and clinical trials by its methodology. In each category, the papers were stratified by the topic. Also, the analysis was conducted according to the authors, research subjects, sampling methods and the statistical methods, and observed the changes each year through 1980s to 1990s.

Results : The portion of original articles has increased from 18.6% in 1980s to 73.9% in 1990s. In terms of research methodology, the portions of analytical studies and clinical trials occupy 28.8% and 2.1% in 1990's respectively, compared with those of 1.8% and 0.6% in 1980's. When the papers were stratified by study topics, topics on family medicine showed the highest of 34.9% of the total. According to the detailed stratification, the principle of family medicine recorded 24.2%. In terms of sampling method, 89% and above was from the clinical data when current data were used, and 69.1% was by questionnaires when the data were newly collected. The most of the study subjects were outpatients of family medicine departments. The portion of papers in which the statistical analysis was not included was 29.9% in 1980s which decreased to 15.7% in 1990s. In terms of the statistical analysis methodology, the Chi-square test was the most frequently used(26.2%), followed by Descriptive(19.6%), t-test(18.2%) and ANOVA(8.7%) were the next.

Conclusion : The academic performance of family medicine can be most effectively measured by the analysis of the journals on family medicine. According to the analysis, the papers based on clinical activity is increasing in recent years with substantial contribution, which means that the field of family medicine has found its own position in medical science and is developing actively. In terms of study methodology, the portion of analysis study is getting larger, and the various method are being tried. The application of statistical methods is being developed in its quality and quantity. It should be noted that research on family medicine should provide the basis for new knowledge and promote public health by the integrated and intensive efforts.

Background
: It is well known fact that smoking is hazardous and fatal to health. Recently, physician's counselling about smoking cessation is carried out sucessfully and its importance is emerging. If phsicians can easily identify the current smoking status of the patient, the frequency of counselling will increase dramatically. This study evaluated the effect of including smoking status as a vital sign on the frequency of physician discussions with patients about smoking and physicians advice to quit smoking. Its purpose is to utilize this to practical practice.

Methods : From September 1 to October 31 in 1995, we analyzed 99 first-visit male patients(over age 20) who finished questionnaires which is composed of 7 questions during visiting family practice clinic in Ewha Womans University Mokdong Hospital in Seoul. Simple institutional change in clinical practice involved training the nurse how to use progress notepaper with a vital sign stamp that included smoking status(current, former, of never) along with the traditional visit signs from October, 1 1995 to October, 31, 1995 and just the traditional vital sign(blood pressure, body temperature, pulse rate) from September, 1, 1995 to September, 30, 1995. The contents of the survey were questions about whether the patient smoked, whether the patient was asked about smoking status by a doctor and, for smokers, whether they were urged to quit smoking.

Results : From September 1, 1995 to September 30, 1995, 52 patients participated and from October 1, 1995 to October 31, 1995, 47 patients did and the current smokers were 30 and 34 patients respectively. After expansion of the vital signs, patients were much more likely to report inquiries about their smoking status on the day of a clinic visit(an increase from approximately 53.3% at baseline to 82.4% at intervention ; P<0.05). The vital sign intervention was associated with significant increase in the percentage of smokers who reported that their clinician advised them to quit smoking (from approximately 36.7% at baseline to 61.7% during the intervention ; P<0.05). Age, age at which smoking was started, the number of cigarettes currently being smoked daily and number of previous quit attempts were not statistically significant.

Conclusion : Expanding the vital signs to include smoking status was associated with a dramatic increase in the rate of identifying patients who smoke and of intervening to encourage and assist smoking cessation. This simple, low-cost intervention may effectively prompt family physicians to inquire about use of tobacco and offer recommendations to smokers.