Background
Serum gamma-glutamyltransferase (GGT) was reported to be associated with type 2 diabetes, many cardiovascular disease risk factors, and individual components of metabolic syndrome. We performed a cross-sectional study to elucidate the relations between GGT and impaired fasting glucose (IFG). Methods: The subject of this study included 693 adults (males 272, females 421) aged 45 years or over who have lived in Chuncheon, suburban small-sized city. IFG was defined by an elevated fasting plasma glucose (FPG) concentration (≥100 and < 126 mg/dl). Results: The risk of IFG appeared to increase with increasing levels of serum GGT even after adjusting for other covariates, such as body mass index and inflammatory markers among men only: Adjusted odds ratios of IFG across GGT categories (<25th, <50th, <75th and ≥75th) were 1.0, 0.56, 1.57, 2.79. (p-value for trend 0.022). In women, the association between the risk of IFG and GGT was not statistically significant. Conclusion: This study suggests that elevated level of GGT within the normal range is a independent predictor of impaired fasting glucose in middle-ages or older men but not in women.

Background
: To estimate the prevalence of the metabolic syndrome in Chuncheon city in those ages 45 and over and to evaluate the association between risk factors and the risk of the metabolic syndrome.

Methods : The subject of this study included 662 adults (males 276, females 386) aged 45 years or over who lived in Chuncheon city. The metabolic syndrome was defined as having 3 or more conditions including abdominal obesity, high blood pressure, low HDL cholesterol, high triglyceride, and high fasting glucose. The association between the metabolic syndrome and its life-style related factors, such as smoking, exercise, and drinking, was examined, using multiple logistic regression.

Results : The prevalence of the metabolic syndrome from ATP III criteria was 30.1% in men, and 37.9% in women. The prevalence increased with age in women. In men, however, the prevalence increased to 55∼64 age group and then it gradually decreased. The prevalence of the metabolic syndrome from Asia-Pacific criteria was 48.2% in men, and 46.6% in women. The prevalence increased with age in men and decreased in women. The highest prevalence among the individual components of diagnostic criteria of the metabolic syndrome in men was hypertension, followed by abdominal obesity, hypertriglyceridemia, low HDL-cholesterolemia, and high fasting blood glucose. And in women, it was abdominal obesity, followed by hypertension, low HDL cholesterolemia, hypertriglyceridemia, and high fasting blood glucose. After adjusting for potential covariates, current smoker was 1.93 times at a greater risk for the metabolic syndrome than non-smokers (95% confidence interval 1.06∼3.51).

Conclusion : The prevalence of the metabolic syndrome was higher than previously reported in Korea. Further studies are strongly needed to elucidate the factors which are related to the syndrome and to develop effective prevention guidelines, especially among the elderly.

Background
: One method for achieving medical practice to be more evident, especially in the field of primary care, is to encourage the use of clinical guidelines. If development of guidelines is difficult because of time and cost, an evidence based foreign guidelines can be selected and translated into Korean for application.

Methods : A team was formed, consisting of 11 family physician experts on evidence based medicine and clinical practice guidelines. We selected six respiratory diseases requiring clinical guidelines because of variability in practice. We searched several clinical practice guideline databases and selected one guideline according to currency, scope of guideline, whether it was evidence based, and its feasibility in the field of primay care. We translated selected guideline's full-texts or summaries which were done by authorized organization into Korean.

Results : The selected respiratory diseases were chronic obstructive pulmonary disease, asthma, pneumonia, sinusitis, rhinitis, and influenza. According to criterion, we selected GOLD (Global Initiative for Chronic Obstructive Lung Disease) for chronic obstructive lung disease, GINA (Global initiative for asthma) for asthma, CDC (Center for disease control) guideline for influenza, IDSA (Infectious Diseases Society of America) guideline for pneumonia, AAP (American Academy of Pediatrics) guideline for sinusitis, and JCAAI (Joint Council of Allergy, Asthma and Immunology) for rhinitis.

Conclusion : We selected six common respiratory diseases and the most appropriate evidence based guidelines for those particular diseases.

Background
: Increased WBC counts have been associated with different components of metabolic syndrome (MS), accompanied by clustering of a number of risk factors for CHD. Because most individuals have one or more of the risk factors for CHD or a cluster of MS symptoms, it may not be appropriate to look only at isolated components. Therefore, the aim of the present study was to examine the association of WBC counts with clustered features of MS in Korean adults.

Methods : The subject of this study included 593 adults (males 344, females 249) aged 20 years or older. Among the subjects, we excluded those who did not have records of physical parameters and blood test results and those who did not complete the questionnaire. We also excluded acutely ill patients. Logistic regression analyses were used to evaluate the association between WBC counts and features of the MS, with an adjustment for age, smoking and alcohol consumption.

Results : The relative risks for obesity, hypertension, hypercholesterolemia, low HDL cholesterol levels, hypertriglyceridemia, high fasting plasma glucose levels and hyperuricemia compared with WBC counts ＜5.2~10³ cells/μl, increased as WBC counts increased. The relative risks for the presence of ≥1, ≥2, ≥3, ≥4 features of the MS also increased as WBC counts increased.

Conclusion : An increased, albeit normal, WBC counts associates with the cluster of MS of the so-called "insulin resistance syndrome" and suggest that an increased WBC counts may be yet another feature of this syndrome.

Background
: The hemoglobin is a basic tool in diagnosing anemia. Not many studies compared hemoglobin between non-smokers and smokers in Korea and they did not differentiate hemoglobin between males and females. This study was conducted to show the difference of hemoglobin between non-smokers and smokers in male population and factors affecting hemoglobin.

Methods : We gathered 313 men who underwent periodic health examination from May to July 2001 in a general hospital. The relationship between cigarette smoking and hemoglobin concentration was examined by comparing the means of hemoglobin between two groups and through multiple regression analysis.

Results : The mean of hemoglobin was significantly higher in smokers than in non-smokers, especially in smokers with more than 1 pack per day. The factors that influence the hemoglobin level were age, the amount per day, and the total amount they smoked in the past(pack-year). Daily cigarette smoking seemed to cause a general upward shift of hemoglobin distribution curve, while age and pack-year on the opposite.

Conclusion : The study suggests that hemoglobin cutoff values should be adjusted for smokers and one must consider the patient's age to compensate for masking effect of smoking and aging on detection of anemia.

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
: The positive effects of hormone replacement therapy (HRT) on the skeleton in postmenopausal women are well defined. However, the effects of vitamin D supplementation on BMD in postmenopausal women are controversial. But many women, who are contraindicated to HRT or afraid of side effects of HRT or are already on HRT regimen, take calcium plus vitamin D supplement for prevention of osteoporosis. Therefore, this study was designed to examine the effect of vitamin D supplementation on BMD in postmenopausal women and to determine whether vitamin D supplementation can give additional benefit to HRP.

Methods : Subjects were 109 postmenopausal women out of total 213, who visited the Sacred Heart Hostpital, Chuncheon and had followed up BMD study one year after during January, 1996 to May, 1999. The study group was as follows : No treatment (n=31) ; Vit D (n=11) ; HRT (n=50) ; HRT+Vit D (n=17). We compared and analyzed the changes of BMD in the region of lumbar spine (L2-4) and femur (femoral neck, trochanter, Ward's triangle). SPSSWIN 7.5 was used for statistical procedure.

Results : Subject had a mean age of 54.4±5.7 years, mean menopausal age of 48.4±2.4 years, mean postmenopausal duration of 6.1±4.1 years, and mean body mass index of 24.1±2.8 kg/m2. No correlation was observed between general characteristics (age, menopausal age, postmenopausal duration, and body mass index) and changing rate of BMD. Lumbar BMD had increased by 1.83% in the Vit D group, by 1.95% in the HRT group and by 3.15% in the HRT+Vit D group, whereas it had decreased by 1.99% in the no treatment group. The increase of femoral neck BMD in the Vit D group was 1.5%, in the HRT group 0.66%, and in the HRT+Vit D group 2.09%, but the loss in the no treatment group was 1.65%. The changes of trochanteric BMD were as follows: No treatment group(-2.49%), Vit D group (0.04%), HRT group (1.48%), and HRT+Vit D group (-4.09%), Vit D group (1.17%), HRT group (-0.01%), HRT+Vit D group (0.16%). In the Vit D group, except for the trochanteric area (P<0.05), there was a significant increase in BMD of L2-4, femoral neck, and Ward's triangle (P<0.05) whereas in the HRT group and HRT+Vit D group significant increases were observed in all areas (P<0.05). But there was no significance among Vit D group, HTR group and HRT+Vit D group.

Conclusion : This study confirmed the beneficail effect of HRT on lumbar and femoral BMD. It also showed that low dose Vitamin D supplementation had effect in the prevention of osteoporosis in postmenopausal women, In the HRT+Vit D group. BMD had increaed more than HRT alone, but does not give benefit additional to that of HRT alone.

Background
: Osteoporosis after menopause is known as a disease that needs preventive measures before medical treatment. Many patients, however, do not undergo hormone therapy to prevent it. This paper investigates some obstacles to hormone replacement therapy (HRT).

Methods : A total of 85 menopausal women who underwent bone-mineralodensitometry (BMD) examination at Chuncheon Sungshim Hosptal Health Care Clinic from May, 1995 to April, 1997 were the subjects of our study. We interviewed them by telephone, examined their medical records including their BMD results. We also examined what the obstacles were for them to receive HRT for osteoporosis.

Results : The average age of the subjects was 55.8 years. Only 40 women(47%) replied that they knew beforehand the purpose of the BMD examination. The rest of the subjects replied that they simply went through the examination because it was inclusive to health items. Those who had heard of HRT for osteoporosis were only 43 people because(50.1%), and those who did not currently receive HRT amounted to 32 (74.4%). The reasons why they do not undergo the therapy were fear of cancer, no symptoms related to osteoporosis, financial difficulty, and weight gain. Among the 32 subjects, only 1 person replied that she would not receive the HRT even if the above obstacles were removed. Therefore , it seems that most of out subjects would receive HRT if such obstacles removed. Those who were currently receiving HRT were 11people(12.9%). According to the open questionnaire, many of them replied that they do not feel any inconvenience while receiving the HRT, but some of them complained of epigastric pain, dysmenorrhea, or mastalgia. They replied that after the HRT they felt no arthralgia and felt far better in body and mind than before treatment. All the 11 people replied that they will continue to receive the HRT.

Conclusion : The main reason why so few people received HRT for osteoporosis proved to be the lack of knowledge of the therapy. Even those who had heard of HRT complained about the negative aspects, which in fact can be overcome, and as a result a considerable number of them do not receiver HRT. Therefore we conclude that in order to increase the number of patients who will undergo HRT for osteoporosis after menopause we need to strengthen education about the merits of this therapy rather than just performing BMD examination.

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.

Background
: The national health care system where primay care health service functions properly, provide better medical outcomes in individual health service as well as national health policy. This is quasi experimentally designed, prospective study for the purpose of developing a model of primary health service in Korea. We provided Family Registration Program reinforcing primary health care for 1 year in order to assess medical outcomes and verify the benefit of the program.

Methods : Three board certified family physician assigned to 263 families, 1057 people provide 6 items of medical service reinforcing accesibility, comprehensiveness, continuity, accountability for 1 year. After the program the use of the medical services was reviewed by the medical records, to assess the quality of care during the program two self reporting questionnaire surveys was perfor-med by Continuity, Comprehensiveness, Personal relationship Questionnaire(CCPQ) before and after the program. Another self reporting questionnaire survey was also performed to assess the factors relating the use of the program.

Results : Over the seventy percents of families utilized at least one service item, most frequently using service item was medical service in outpatient department, total number of visit was 695 by 161 people in 102 families. The number of beeper call was 226, 75.3 per a family physician. The reason of beeper call were medical problem(59.7%), services to inform laboratory result(25.9%), and appointment for medical service(13.7%). The scores of CCPQ before and after program were 6.48±1.48 and 8.66±1.76, which meant that better quality of medical service was provided during the program. The reason for under-utilization of the program were 'No health program'(52.9%), 'Not Familiar with how to use the program' (34.3%), 'Felt sorry to call'(20.6%), which meant many families misunderstood the program. Over the seventy percents families had visited other physicians' offices during the program by the reasons of 'Near home' (56.7%), 'Already have a regular doctor'(26.9%). Sixty eight percents families satisied the program and 88.1% of families willed to participate in the re-registraion program.

Conclusion : By the fact that most of families registered were satisfied with familiy registration program, we conclude that this program provided quality care and could be settled in our medical system, but still remains a lot of efforts to make to have such a program known to public and utilized by many people.

Background
: Pain is the most common complaint in hospitalized terminal cancer patients, therefore, controlling the pain is important problem. The studies showed that 33%~60% of patients with advanced cancer were alert during the last 24 hours of life, and the majority of patients were able to continue oral medication until death. The study look at the analysis of analgesic use, both oral and parenteral, in hospitalized terminal cancer patients.

Methods : A retrospective chart review of analgesic type and amount was performed on the medical records of 194 hospitalized terminal cancer patients who had died in Yong Dong Serverance Hospital during the period of January 1, 1993 to December 31, 1994. Different types and amounts of analgesic were converted to a common standard : an oral morphine equivalant(OME) relative to 1mg of oral morphine. Associations between analgesic used and selected patient characteristics(age, sex, cancer site, pain, diet, mental status, and types, amount, and adminstration route of analgesic) were explored.

Results : The mean age f patients was 60.44±14.26 years. The total number of patients was 194, male, 132 cases(68%) and the female, 62 cases(32%). The frequent cancer site was liver(29.4%), lung(19.1%), stomach(17.0%), in order. There was no descriptive statistical significance between dosages of analgesic and age, sex, and cancer site. 93 patients(47.9%) were well oriented 24 hours prior to death, 54 patients(27.8%) 6 hours prior to death, and 17 cases(8.8%) 1 hour prior to death. 152 out of 194 patients(59.3%) complained pain, and 115 out of 152 patients were treated with analgesic to relieve pain. 86 out of 115 patients were able to continue on oral medication. 59 cases(51.3%) were given regularlly, 32 cases(27.8%) p.r.n.(pro re nata), and 24 cases(20.9%) regularlly and p.r.n.. 20 cases(17.4%) were took oral medication only, 71 cases(61.7%) were given parenteral injection. 72 out of 93 patients(77.4%) with an alert mental status had required analgesics during the last 24 hours prior to death, and 31 cases(43.1%) were given oral medication, and 56 cases(77.8%) were given parenteral injection, also 24 hours prior to death.

Conclusion : In this study, 152 out of total 194 patients(78.4%) complained pain before die of cancer. 115 patients(75.7%) were given anagesics to control pain and order, 83 patients(72.2%) were received regular analgesic prescritpion. Parenteral injection analgesics were much more frequen-tly used than oral medication to control pain in hospitalized terminal cancer patients, even through the cases of patients were able to take oral medication and had an alert mental status during the 24 hours before death.

Background
: Improving quality of care by increasing continuity, comprehensiveness, and personal relationship of care is one of the important concepts in family medicine. A self-report questionnaire was designed to assess the improvement in quality of care from the above 3 aspects of care

Methods : 27 questions about the 3 concepts were designed by 5 family physicians and were given to 8 other family physicians and 13 residents to evaluate whether each question meant what it was originally intended to mean. or not. It there was a consistency more than 50% between the testees and the developers, those questions were considered to have content validity and were pilot-tested to decide whether they had internal consistency among questions of the same concept or not. Finally were given the chosen questions to patients visiting family medicin clinics of 3 university hospitals. Comparison was made between the new patient group and the old patient group to evaluate whether there were any differences as expected or not.

Results : 24 questions were considered to have content validity among the original 27 questions. Finally were chosen 21 questions with internal consistency consisting of 4 continuity items (a=0.795), 9 comprehensiveness items (a=0.700) and 9 personal relationship items (a=0.616). The scores of total, continuity, comprehensiveness and personal relationship in the old patient group were significantly higher statistically (P<0.01) than those of the new patient group.

Conclusion : our questionnaire could be used to assess the quality of care indirectly in family practice which has a goal of increasing continuity, comprehensiveness and personal relationship in care.

Background
: Increasing juvenile delinquency has developed as a social problem and adolescent in tis characteristics has tendency not to exposure their problems to physician. For early detection and anticipatory guidance of juvenile delinquency by finding predictive factors of delinquency, we are intended to investigate into the correlation between juvenile delinquency and predictive factors of juvenile delinquency.

Methods : A self-reported questionnaire survey was conducted on 1,266 high school students in Kangnam-Ku, Seoul, from March to May 1994. We made statistical analysis of the family APGAR score, demographic data and delinquency score by means of correlation and multiple regression.
Demographic factors include age, sex, family income, deucational status of parents, and pocket money indicating family background and examination rank indicating their achievement in school.

Results : The factors significantly associated with juvenile delinquency score were pocket money (r=0.508), age(r=0.428), family APGAR score(r=0.367), and examination rank(r=0.281) and R² was 0.44 Compared with female students, male students were significantly high in delinquency score.

Conclusion : Tendency of juvenile delinquency was significantly high in male students, and was related with age, much pocket money, low family APGAR score, low exmination rank in this study.

Background
: An obese child had a high risk for becoming an obese adult and many obese children have disorder similar to obese adults. In addition, obese adolescence is refractory to trerapy due to not hypetrophy of adipocyte but hyperplasia of that. So in obesity, prevention at childhood is the best choice of treatment. Factors that affect the childhood obesity are classified into genetic and environmental factors. Familial tendency or aggregation that includes the both sides of these factors is well known. The purpose of this study is to observe the relationship between child obesity and parents' obesity.

Methods : In 332 boys, 316 girls at 10-11 years old of elementary school in seoul, height and weight was measured in April, 1994. Their parents' height, weight and demographic datas were collected by using the self-recorded home questionnaire. Obesity is evaluated by body mass index(BMI=kg/m²). In children, BMI≥85 percentile was defined as obese group and 25-75 percentile was defined as normal weight group. In parents, BMI≥85 percentile was obese group and ≤85 percentile was non-obese group.

Results : Mothers' BMI was significantly(P<0.05) higher in child obese group than child normal-weight group. In child obese group, children's BMI correlated closely with their mothers' BMI(r=0.23, P<0.05). Children with obese mothers were about twice as likely to be obese than children of non-obese mothers state of each parent was significantly(P<0.01) different.

Conclusion : In child obese group, children's BMI was related more closely with mothers' BMI than the fathers'. Maternal obesity can be one of the risk factors for child obesity.

Background
: The experience of chronic illness affects families in profound ways and how well the family adapts to chronic illness can influence the course of the illness. The purpose of this study is to analyze the factors correlated with the family's coping and the reaction phase to chronic illness, and then to suggest the basis of model for the family-oriented family medicine.

Methods : Total 211 patients and their family was reviewed to investigate the correlating factors between the family's coping, the reaction phase and the chronic illness by the questionnares on which the followings were included : the score of a family's coping with chronic illness, family APGAR, family stress(by Holmes's SRRS), the reaction phase, the duration of chief complaints, demographic factors, etc. The results were analyzed by the descriptive, comparative and multiple regression statistics with DBSTAT and SPSS/PC+4.0 computer program.

Results : The completed subjects was 203 cases of which the mean age was 47.6±15.8 years old. The mean of the duration of chief complaints was 4.3±2.7 years. The mean score of family's coping was 11.3±2.9 points, and the above 11 points was 67.0%, 5 to 10 points was 28.6%, the below 4 points was 4.4%. The distribution of families on the each reaction phase to chronic illness was followings : 1) Denial phase : 3.5%, 2) Fear phase : 17.7%, 3) Guilty phase : 7.9%, 4) Anger phase : 9.3%, 5) Depression phase : 22.7%, 6) Acceptance phase : 38.9%. The factors correlated with the score of family's coping to chronic illness was family APGAR and family stress(r=0.26). Other associated factors was followings : religion, education, economy, reaction phase, the family's coping experience of past ilness(P<0.05). The factors correlated with the family's reaction phase to chronic illness was patient'sage and the duration of chief complaints (r=0.15). And the other associated factors was the number of admission, the score of family's coping and stress, the family's experience to past illness(P<0.05). For only all of the 1st admission patients, their families on denial and fear phase was 80.0%, 83.4% within 2 years. Depression phase was 76.9% within 5 years. Acceptance phase was 75.0% within 7 years(P<0.05)

Conclusion : The score of family's coping with chronic illness was correlated with the family's APGAR and family's stress. The family's reaction phase to chronic illness was correlated with the pamily's stress. The family's reaction phase to chronic illness was correlated with the patient's age and the duration of chief complaints. Further study of the factors and reaching times of family's reaction phase to chronic illness were needed.

Background
: Inspite of the significance of early detection for glaucoma, the majrity of primary care physician does not mesure intraocular pressure in their setting due to limitation of technique for conventional tonometry. The purpose of this study was to compare the effectiveness of noncontact tonometry(NCT) using the air-puff noncontact tonometer(CT-50, Topcon, Ltd, Japan) with that of conventional tonometry using the Goldmann applanation tonometer as a screening tool for glaucoma.

Methods : Intraocular pressure was measured by a technician using the air-puff NCT 3 times and by a skillful ophthalmologist using the Goldmann applanation tonometry once in both eyes of 153 patients who visited eye clinic from June, 1993 to July. 1993.

Results : Air-puff NCT correctly identified 12 of the 13 eyes with an intraocular pressure above 21mmHg measured by Goldmann applanation tonometry for a sensitivity of 92.3%, and 267 of the 268 eyes with an intraocular pressure less than 21mmHg for a specificity of 91.1%. The two methods of intraocular pressure measurement yielded similar pressure readings. The correlation coefficinet is 0.91(Y=0.80X +1.81).

Conclusion : Air-puff NCT is an easy, safe, and practical method of intraocular pressure measurement. So we suppose that air-puff NCT can availably be used in primary care setting to detect glaucoma.

Background
: As a dramatic shift is occurring the demographics of Korean society, especially in the proportion of individuals over the age 65, there is a great concern to the disease commonly developed in the aged including pneumonia. Pneumonia is a major cause of death for the elderly. Clinical symptoms and signs of pneumonia in the elderly are often muted. Timely, accurate diagnosis and therapy depend on recognition of atypical manifestations of pneumonia in the elderly. The goals of this study were to describe atypical clinical manifestation of pneumonia in the elderly and to analyze the predictors associated with mortality.

Methods : The records were retrospectively reviewed of randomized patients older than 65 years with a diagnosis of pneumonia who were admitted to Yonsei Medical Center from January, 1990 to June, 1992 and were compared to the those of younger-aged groups with pneumonia who were admitted to Yonsei Medical Center at the same period of time.

Results : In the elderly, pneumonia is associated with considerable mortality, 28.3%. More atypical clinical symptoms and signs were presented in the elderly, comparing to those of the younger control group. Cough, sputum and fever were less frequently presented in the elderly. Patients with preexisting chronic lung disease, tachypnea, tachycardia or without temperature elevation were associated with mortality. The most commonly identified pathogen was gram-negative bacilli and there were no difference of chest X-ray pattern and therapeutic regimens between the elderly and control groups.

Conclusion : Pneumonia in the elderly is a serious condition with high mortality. Because of atypical and subtle clinical manifestations of pneumonia in the elderly, a high index of suspicion will induce the physician to diagnose and treat pneumonia timely and properly.