Background
Most patients feel uneasy about visiting a clinic and thus the trust on their physicians can be affected by the physicians´ attire, attitude and greeting. We aimed to investigate the difference between patients´ and physicians´ preferences to attires and greetings in clinics. Methods: We conducted a questionnaire survey on 394 outpatients in a university hospital and on 169 doctors from five university hospitals. We questioned to the outpatients about their preference for physicians´ dress style, how to address them and the method of greeting. We also questioned to the doctors about their own attire, attitude and etiquette. Results: The patients preferred to be called 'OOO Nim' (54.0%), 'OOO Ssi' (29.2%), 'Hwanjabun' (16.2%) and 'Sunsaengnim' (2.5%). However, the physicians were used to calling patients 'Hwanjabun' (39.2%), 'OOO Nim' (29.6%), 'OOO Ssi' (24.5%) and 'Sunsaengnim' (1.2%) (P＜0.001). Both the patients and the physicians preferred physicians′to wear white-gown (70.3% vs 78.7%) in a medical office. Inside the gown, a shirt and a necktie (66.2% vs 71.6%) were favored in both groups. Compared to the patients, the physicians thought that their attitude (23.1% vs 45.6%) and their attire (49.7% vs 55.6%) had a great effect on their professionalism. Conclusion: We found that the patients wanted to be called 'OOO Nim', but 'Hwanjabun' was most commonly used by the physicians. Both the patients and the physicians preferred white-gown. We also found that the physicians′ attire and attitude were strongly associated with their professionalism. (J Korean Acad Fam Med 2008;29:349-353)

Background
: Prolongation of the QTc interval is a risk factor for ventricular tachycardia, ventricular fibrillation, especially torsades de pointes, and sudden death. It is associated with increasing age, female sex, some of antiarrhythmic drugs, tricyclic antidepressants, and conditions such as hypokalemia, hypothermia, subarachnoid hemorrhage, congenital long QT syndrome. Earlier studies reported lengthening of the QTc interval with increasing body mass index (BMI) and intra-abdominal fat. But no such reports exist in Korea. Therefore, we determined the relationship between BMI and the QTc interval.

Methods : The study population consisted of 372 persons who undertook periodic health examination in a university hospital between September and December 1998. BMI and standard 12-lead electrocardiogram were measured in all subjects. Excluding 4 patients who ha arrhythmia where QTc interval could not be calculated, the QT interval was measured in the electrocardiogram of 368 subjects. The QT interval was measured in the leads that showed the longest interval for three consecutive beats and then were averaged. Correlation between the calculated QTc interval and BMI was examined. The QTc interval difference according to sex and obesity was also analyzed.

Results : Among 368 subjects, there were 197 men (54%) and 171 women (46%). The mean ages were 44.5 years for men and 47.6 for women, The BMI was 23.8±3.13 (mean±SD). Obese subjects with BMI above 27kg/m² totalled 61 917%), including 31 men and 30 women, The QTc interval was 399±25 msec (mean±SD), and the subjects showed prolonged QTc intervals of 24 (12 men and 12 women). There was a statistically significant correlation between BMI and QTc interval (r=0.135, P=0.0094), and the obese subjects were found to have a longer QTc interval than the nonobese controls. Women also had a longer QTc interval than men.

Conclusion : There was a significant correlation between BMI and QTc interval, and longer QTc interval was observed in obese patients. The QTc interval should be considered when analyzing electrocardiogram of obese patients.

Background
: Cervical cancer is the second most commonly diagnosed cancers in women and is responsible for about 14 percent of all female cancer found in Korean women. Early detection is very important because the likelihood of a complete cure is greater, and among the early screening tools to detect cervical cancers, a Pap smear is most widely used. It has the clinical significance to follow-up patients whose results are classified a class II in their Pap smear. Therefore we tried to find the factors associated with follow-up in class II patients.

Methods : On Pap smear practiced from Jan. 1, 2000 to Dec. 31 in a university Hospital, 159 patients Pap smear results were categorized as class II, and among the 159 patients, we were able to collect data from 107 patients who voluntarily answered a phone survey. The categories in the survey were the followings: follow-up for the Pap smear, age, age of marriage, presence of menopause, age of menopause, occupation, family history of chronic diseases or cancers, educational level, presence of concomittant diseases, income, average hospital visit frequency in a year, belief of general health, and reason for doing follow-up and reason for not doing it.

Results : Among 107 patients, only 62 patients(57.9 percent) did follow-up for their Pap smear results. The reason were doctors follow-up recommendation for Pap smear results and regular health check-up, and the two main reasons not doing follow-up were nonexistence of further symptom and financial distress. In a single variable analysis, the higher educational level, individual income, and hospital visit frequency, the more people had follow-up. But in multiple logistic analysis, only individual income was statistically significant.

Conclusion : The follow-up rate was as low as 57.9 percent, and the reasons why they did not follow up were mainly the lack of understanding about the clinical significance II result on the Pap smear. Therefore, an advertisement and public education programs to general public about cervical cancer will make more patients follow up their result on the Pap smear, especially to the low income and low education class people.

Background
: 　Antibiotics are often indiscriminately prescribed for respiratory tract infections. This study was conducted to describe the prescription pattern of family physicians for respiratory tract infections.

Methods : In each clinic of 50 representative family practitioners, about 20 consecutive patients with diagnosis of respiratory tract infection were enrolled into the study. The data were collected by questionnaire to physicians just after patient interview.

Results : The number of study subjects was 1020, of which 55.7% was less than 15 year old. Antibiotics were prescribed to 73.9% of total subjects. According to diagnosis, the antibiotic prescription rate was 51.5% in common cold, 86.0% in pharyngitis, 88.6% in bronchitis, 98.9% in sinusitis, and 100% in otitis media. In common cold, the factors which significantly increased the antibiotic prescription were 1)patient age less than 15 year old (OR=1.70, CI= 1.06-2.73), 2)more than two visits during the same episode(OR=1.95, CI=1.27-2.99), 3)yellow and thick rhinorrhea(OR=2.22, CI=1.16-4.25), 4)yellow and thick sputum(OR=3.31, CI=1.34-8.19), and 5)throat injection(OR=2.50, CI=1.42-4.39). Among patients to whom antibiotics were prescribed, 48.7% of patients were given the antibiotics by intramuscular injection. The most frequently prescribed antibiotics were penicillin and macroride among per-oral medicine and ribostamycin and lincomycin among intramuscular medicine. The reason for antibiotic prescription were 1)possibility of bacterial infection(43.4%), 2)prevention of bacterial complication(23.7%), and 3)definite evidence of bacterial infection(22.5%).

Conclusion : Family practitioners prescribe antibiotics indiscriminately for the respiratory tract infection. The prescription was influenced by patient's age, number of clinic-visit, and clinical symptoms and signs.

Background
: The objective confirmation of subjective symptom of patient is important in the primary care consisted largely by functional disorders of which mechanism could not explain the symptoms clearly. Definite diagnostic method is not established yet for the functional disorders densptie the fact that various investigations have been done. So, we tried to reveal the relationship between the value of indicator drop(ID) from electroacupunctrure point accordint to Voll and the clinical diagnosis and subjective symptom by using noninvasive electroacupuncture diagnosis according to Voll.

Methods : Among the patients of three university level hospitals health care centers from April to June 1997, consenting 203 persons were enrolled .Various laboratory finding and ID from EAV were measured by double blind test methods. In parallel, subjective symptoms were classified by each organ. Validity was tested by the relationship between the gastrofiberscopy finding and the stomach control measurement point ID.

Results : There were statistically significant ID increases in the CMPs of endocrine, lung, circulation system, gastrointestinal system, kidney and bladder compared to a laboratory findings or subjective symptom by the comparison between the variables of the assessed clinical or laboratory findings and organ specific CMP score. Especially, the ID increase of stomach shows 79.3%-90.9% positive predictive value to positive findings of gastrofiberscopy when gastrofiberscopy is definded to confirmation test of gastritis, gastric ulcer and duodenal ulcer.

Conclusion : Our results show that the noninvasive electrodiagnostic method result by measuring EAV of organ system is related statistically to subjective symptoms and laboratory findings. Also they show that it could be useful tool as a clinical diagnostic method. We suggest that further study is needed to reveal organ specific sensitivity, specificity, positive and negative predictive value by using confirmation method of organ specific disease.

Background
: Scientific journal have, at least, some agreement about the study method especially demographic classification to reconfirm by others. In the geriatric field, there are two special problems regarding age classification. One of them is the standardization of age interval. Second problem is policy development regarding the data collection beyond 85, because of increasing average life expectancy. Thus, authors examine whether there was consistency in age classification in the aging research for policy development.

Methods : Authors analyzed the articles that appeared in two journals is "The Journal of American Geriatrics Society" and "The Journal of gerontology" over recent 5-year period(1990-1994).
Since not all research focused on older people, we needed to develop inclusion criteria. Fist, research samples should be human. Second, the age of 65 years of above must be included in the study groups. Third, age groups must be consecutive categories more than two, not discrete ones. One hundred eight hour articles meet the inclusion criteria.

Results : Regular interval system for age classification is adopted in ninety nine papers, while eighty five papers used irregular intervals. Overall, only 84 cases of studies used age 65 as a guideline of age grouping. Eighty four articles cut off their age grouping before 85 meaning that their classification dose not include the age group of the oldest old.

Conclusion : Usually the geriatric population is categorized as age 65 or above in Western country. This conventional breaking point conflicts with an age grouping defined by decades. Many authors still prefer to class age by decade, providing useful age group comparison ; from the young to the old by decade, that does not differentiate clearly age 65.
The results of cutting off age grouping before 85 in many articles will make a problem on reconfirm procedure in the future. So it is necessary to extend the age classification to include the oldest old, above 85.(KJFM 1996L17 : 554~569)

Background
: Among a number of social habits, smoking is an important factor of human health to prevent related disease morbidity and death. It is essential for family physicians to participate in this subject considering the influence of smoking on life pattern or one's behavior as well as smoking itself, physician should keep above aspects in mind through smoking consultation session. therefore, this report is to elaborate the correlations between smoking and the other health activities.
Method: The survey was performed to those who had their health examined at an university hospital and a general hospital during the period between April and May, 1995. Smoking group(male:141, female:14, total:155) and nonsmoking group(male:141, female:18, total:159) were rando-mly selected among those who had answered to the survery(total:650). The questionnaire of the survey consisted of 12 categories and 25 questions to evaluate health score graded 0 point to 4 point according to interpreted version of Wilosn's FANTASTIC Lifestyle Assessment.
Result: The health score of smoking group was lower than that of nonsmoking group in terms of alcohol, exercise, toxin, stress and personality. Nevertheless, the grade between 2 groups was family and friends. Total score of smoking group(68.2 out of 100). The longer the period of smoking was and the more cigarettes one smoked, the lower total health point he had. The onset of smoking, however, is insignifa-ntly related to the health status.

Conclusion : This report shows that concerning the relationship between smoking and other health behaviours, physician must take not only tratment of disease and smoking, but other health behaviours into consideration.

Background
: Doubtlessly the incidence of cancer has increased. As the technology for diagnosis of cancer improves, the possibility of early diagnosis of cancer has increased, and the primary physicians experience many chances to tell their patients about the diagnoses of cancer. Despite the increasing number of ethical dilemmas that the primary physicians have to face, the medical schools do not offer enough moral educations. Instread, many primary phsicians have to depend only on their personal experiences in dealing their inevitable dilemma. Moreover, as the patients are more conscious of their rights as patients, and the conversations between the patients and doctors decrease, it is discove-red that the patients are found to have unsatisfactory feelings toward the medical doctors who do not tell their patients about the diagnosis of their disease and do not explain the procedures on the treatment of the disease. Considering the fact that patients have the right to decide on their own, and that the doctors have to help the untreatable cancer patients to cope with their remaining life, this research is conducted to establish a principle for doctors in telling the diagnosis of cancer based on the comparative study between the cancer patients and the non-cancer patients' experience in hearing about the diagnosis of cancer.
Method: In this study, the 40 non-cancer patients and 36 cancer patients were selected randomly as sample pupulation, from patients who were admitted to the Korea University Hospital between May 1 and May 31, 1994.

Results : 88.9% of cancer patients were told about the diagnosis of their disease by the doctors, 92.5% of non-cancer patients have answered that they want to know the diagnosis if they would develop cancer, 70% and 77.8% of non-cancer patients and cancer patients, respectively, have answe-red that they believe that the patient should know the diagnosis of cancer if a member of their family happens to develop cancer. 82.5% of non-cancer patients and 77.8% of cancer patients have answered that they wanted to be notified by their doctors. And, 37.5% of non-cancer patients and 55.6% of cancer patients have answered that both patients and their families should be told about the diagnosis of cancer at the same time. For their reason, 56.7% of the interviewee gave answered that it is because knosing the diagnosis of cancer would help the teatment of the disease.

Conclusion : The results of this study revealed that the doctors should that the doctors should tell the diagnoses of cancer to their patients, as a principle, and the doctors should bestow psychological comfort and hope to their patients. The patients also want to be told about the treatment procedures and the prognosis of their cancer. The principle on telling the diagnosis of cancer to the patient should be based on its beeficial effects. An exquisite exploration of the patient should be conducted before deciding to tell the diagnosis of cancer, I.e. the personality of the patient, educational and emotional status, support of the family, etc. Hence, the customary pracitce of alienating the patients in decision making procedures during the coures of diagnosis and treatment should be subjugated, and the patients should be informed about their diagnoses of cancer.

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

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

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

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

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