Background
: With the increased use of computers in medical fields, we can consider introducing computer-mediated communication into the area of patient care such as medical counseling and education. But little was known about what problems can be counseled, what is the main direction of counseling, and what difficulties are met during the computer mediated counseling. So we conducted this study.

Methods : Medical counseling using a method of questioning / answering through a computer mediated communication system was carried out from May 1991, to October 1991. And we analyzed the contents of questions and answers.

Results : Health problems of musculoskeletal system, skin and ear / nose / throat system were most common questions. Many questioners wanted to know treatment principles, prognosis, and preventive methods for health problems, which were previously diagnosed.

Conclusion : The contents of counseling were slightly different from the contents of counseling at doctor's office or counseling through telephone call. So we can use computer mediated communication system for the purpose of supplementing the other of medical counseling.

Background
: It is important for family physician to detect alcohol dependence in its early stage for prevention and treatment of alcohol dependence. But it is difficult to diagnose effectively in primary care because that concept and diagnostic criteria of this illness is ambiguous. Therefore we carried out this study to find the method to evaluate alcohol dependence effectively for primary care physician.

Methods : Patients who were admitted were administered MAST & KAST Yong-In Mental Hospital for an alcohol-related problem. The subject's age, sex, time drinking & time sober were noted from individual interview. Blood samples for the lab investigation were taken at time of admission, and γ-GTP, SGOT & MCV were performed. The data were analyzed & evaluated.

Results : The correlation was found between the MAST score and the KAST score(r=0.78, P<0.01). No correlation was found between the MAST score, the KAST score and duration of drinking behaviors. When biochemical measures of alcoholism, such as γ-GTP was compared to psychological measure of alcoholism(MAST, KAST score), no correlation was found.

Conclusion : Diagnostic approaches of alcohol dependence have undergone separating between physiological & psychosocial effects of alcohol dependence and now emphasized to integrate these two parts. In this study the scores of MAST & KAST which represent the severity of alcohol related problems are not significantly related to cellular toxic effects of alcohol reflected by γ-GTP, SGOT & MCV. These results mean that for effective diagnosis of alcohol dependence it must be used complementally these two test instruments.

Background
: The clinical content of family medicine, still an evolutionary process is very important in education and research in family practice. We carried out this study to analyze the clinical contents of primary care at Keimyung University Family Medicine Clinic.

Methods : In order to assess the contents of primary health care, we collected data from University-Based family practice clinics by chart review from June 1990 to July 1990. We used the ICPC coding system to classify the collected date.

Results : The total number of patients was 2981 of whom 1330 were male(44.6%) and 1651 were female(55.4%). The total number of reason for encounter(RFEs) was 4438. The average RFE per patient was 1.48. Among them cough, stomachache, rhinorrhea, for GI medication and headache ranked as most common. They could be classified to have 205 kinds of different diagnoses. The most common 20 diseases were 69.1% of the total. The disease systems were digestive system (30.9%), respiratory system(25.0%), neuromuscular system(16.5%) and circulatory system(7.2%) as per frequency. The diagnostic tests were 45 in number. The referral rate to other specialties was 9.0%, of which there were IM(25.4%), OB&GY(16.6%), OS(14.0%), Neurology(13.6%), GS(9.6%), Psychiatry(7.0%) and Urology(6.2%).

Conclusion : ICPC coding according to visiting purposes, demand for therapy, and health problems appeared to be very easy for primary care physicians to use.

Background
: Recent studies reported that doctors of different specialty use different diagnostic and therapeutic methods to the same clinical conditions.
Though this difference has significant influence on the quality and cost of medical care, study about this problem was never been done in Korea.

Methods : The diagnostic methods of third year residents in family practice(N=6) and internal medicine(N=6) were compared with respect to "functional gastrointestinal disorder(FGID)", common ambulatory patient problem. One "standardized patient" was presented.

Results : Analysis of the recorded interviews showed that family practice residents took more medical history(p<0.05), ordered more laboratory investigations(p<0.05). There was no difference in the selection of physical examination items. There was difference in the diagnosis reached by these two groups. Six family practice residents diagnosed FGID. In an analysis of the "commonness" of questions asked by internal medicine residents and family practice residents, it was found that internal medicine residents used more common questions.

Conclusion : There were some significant differences in diagnostic and therapeutic strategies between internal medicine and family medicine residents. These findings have implications for the future training of primary care physicians.

Background
: The obese patients has increased recently in Korea due to excessive energy intake and decreased physical activity. To assess the health implications of obesity, we investigated the complications associated with obesity.

Methods : We gathered case and control groups among persons who has taken medical examination from June 1991 to October 1991 at Asan Medical Center. In our study, 320 incident cases of obesity and the equal numbers of control matched by age and sex were investigated.

Results : In both sexes, systolic and diastolic blood pressure, total cholesterol, triglyceride, TC/HDL-C, uric acid and hemoglobin level in obese group revealed significantly higher than those in control group. HDL-cholesterol level in obese group revealed significantly lower than that in control group. The differences of blood sugar and LDL-cholesterol level in two groups were not significant. In male subjects, the prevalence’s of hypertension, hypertriglyceridemia, low HDL-cholesterol, polycythemia, elevated AST, elevated ALT, elevated γ-GT and fatty liver among obese group are significantly higher than those in control groups. In female subjects, the prevalence of hypertension, hypercholesterolemia, hypertriglyceridemia, low HDL-cholesterol, elevated AST, elevated ALT, fatty liver, and gall stone among obese group are significantly higher than those in control group.

Conclusion : The major diseases associated with obesity are hypertension, hyperlipidemia, fatty liver, and gall stone. physicians should take more active role in prevention of obesity.

Background
: During recent years, for the purpose of evaluating the health related behaviors, many instruments especially such as health risk appraisal l(HRA) questionnaire were developed. The HRA questionnaire needs reliability for generalized usage. This study evaluated the reliability of Health Risk Appraisals(HRA) questionnaire in SNUH lifetime health monitoring program (LHMP) with test-retest method. This questionnaire evaluates individual's health risk factors and is composed of 23 items(18 optional types, 2 descriptive types, 3 mixed types).

Methods : A total of 140 selected adults aged 20 to 67 years registered in SNUH LHMP completed an HRA questionnaire on two occasions 2 to 6 weeks apart. Test-retest reliability was assessed by agreement index in optional and descriptive type, and kappa index in optional type. Moreover, non-response rate was obtained for each respondent and each question.

Results : The average of non-response rate was 0.10 by each respondent and 0.14 by each question. The range of test-retest reliability of responses to the questionnaire(by each respondent) was 1.00-0.57 by agreement index. The range of test-retest reliability (by each question) was 1.00-0.51 (unchangeable group) and 0.95-0.38 (changeable group) in optional type by kappa index, 0.88-0.16 in descriptive type by agreement index. Respondents generally gave consistent responses over 'fair' level in all items of optional type by kappa index, but relatively less consistent responses in descriptive type by agreement index.

Conclusion : The reliability of HRA questionnaire in SNUH lifetime health monitoring program (LHMP) was above fair level. and we can use this HRA questionnaire generally for evaluating the health related behaviors.

Background
: Health status is affected by various factors-dietary habits, life style, local difference etc. The prevalence of cardiovascular disorder is increasing in Korea. Serum cholesterol level, blood sugar level, body fatness are closely related to cardiovascular disorder. We performed comparative studies of the results of periodic health examinations in insured adults of different areas.

Methods : Of the results of periodic health examination of insured adults, 3,305 subjects were gathered. 935 subjects were residents of Seoul and 2,370 subjects were residents of Chungjoo. All the subjects' serum cholesterol level, fasting blood sugar level, arterial blood pressure, and body mass index were analyzed statistically.

Results : Serum cholesterol level(Seoul : 207.66mg/dL, Chungjoo : 202.60mg/dl ; P<0.01) and fasting blood sugar level(Seoul : 92.77mg/dL, Chungjoo : 90.16mg/dL ; P<0.01) were statistically different between two areas, but arterial blood pressure and body mass index had no statistical differences. The prevalence of abnormal findings was no statistically different between two areas.

Conclusion : Geographic differences affected above mentioned index values were noted. We did not consider specific environmental factors, such as diet habit, physical activity and individual concern about health. But this study will be a supportive data for future studies of health maintenance factors in Korean.