Background
: Bacause head trauma patients can have serious sequelae, head trauma patients should be evaluated quickly by sensitive and specific diagnostic tools. For this reason, the use of brain computed tomographic(CT) scan is increasing. But unnecessary brain CT scans can reasult in increased medical cost and loss of critical time for managment of other fatal injuries. Therefore certain criteria for requesting brain CT scan is needed. This prospective study was attempted to see if the positive brain CT scan can be predicted by the patient's clinical features and, if so, to develop indications for brain CT scan use in Korea.

Methods : The data were collected from 130 subjects who were treated in the emergency room for head trauma and received brain CT scan. The sensitivity, specificity, positive and negative predictive vlaues were calculated the association between each clinical feature and positive CT scan was tested by X²-test and forward stepwise logistic regression. The score system was developed using likelihood ratio, and the cut-off point was estimated in Receiver Operating Characteristic(ROC) curve between sensitivity and false-positive rate.

Results : The percent total of positive CT scan was 30% and the classification of head injuries were Subdural Hematoma(SDH), Epidural Hematoma(EDH), Intracranial Hemorrhage(ICH), Brain contusion, Subarachnoid Hemorrhage(SAH), and traumatic infarction in order of decreasing freaquency. There were significant statistical associations between positive CT scan and loss of consciousness more than 5 minutes, Glasgow coma scale, skull fracture by forward stepwise logistic regression. The cut-off point in this scoring system using likelihood ratio was 12.

Conclusion : The positive CT scan can be predicted by the patient's clinical features in most of cases and the scoring system may help the predictability.

Background
: Physician's role to reduce smoking-related mortality and morbidity is receiving increased attention. But many physicians in busy practice are reluctant to do smoking cessation counseling because of time pressure and lack of belief in efficacy. If brief counseling requiring minimum time can be effective in motivating smoking patients, it is of great help in preventive practice of primary care physician.

Methods : Cigarette-smoking male patients in university hospital family practice were randomly assigned to either a control group receiving routine care or an intervention group receiving. In addition to routine care, 3-munites brief smoking cessation counseling from their physician. Both groups were followed up with telephone interview at 3 months. Counseling were individualized according to the patient's health problem and physician's own style and consisted of smoking history, hazards of smoking and benefit of quitting, emphasis of cold-turkdy method, and searching for motivation based on the patients' life style.

Results : Fifty-seven patients from intervention group and sixty-nine patients from control group were interviewed. 74% of intervention group and 74% of control group attempted to quit. Quit rate for some duration was 49% in intervention group and 42% in control group. Two patients from intervention group and 5 patients from control group were non-smokers at interview. All the difference between two groups was not significant statistically. Characteristics such as age and baseline smoking status of smokers and non-smokers were similar to each other.

Conclusion : Brief smoking cessation counseling in this study showed negative results. Development of smoking counseling skills and other effective strategy are required.

Background
: Gallstone disease is most common biliary disease, which prevalence and location has different demographic characteristics by its composition. Not all persons with gallstones have clinical manifestation, but most studies in the Korea have been based only on cases of gallstones that were identified clinically. An investigation based on clinical cases may result in an underestimation of the prevalence of GSD. Therefore we carried out this study to determine the Korean prevalence of cholelithiasis and related socioeconomic risk factors.

Methods : 4,395 cases whish were visited at General health screening center of Asan medical center during 9month-period from June, 1990 to March, 1991 were surveyed by abdominal USG. We divided patients into gallstone disease group and normal subject group, which former are defined by gallstone positive or postcholecystectomy due to gallstone. We assessed the sex and age related prevalence and location specific characteristic of gallstones. Age and sex distribution and demographic factor were evaluated in both groups.

Results : We experienced 165 cases of GSD in 4,395 cases examined(139 cases of Gallstone, 27 cases of postcholecystectomy). Total age adjusted prevalence is 3.43%, 3.70%(95% CI 3.14~4.26) of female is significantly higher than 2.08%(95% CI 1.66~2.50)of male. The prevalence of GSD increased along with the increasing age with a significant linear trend. GB stone is most common location and relative frequency is 92.08%. Comparison with normal group, obesity is significantly higher in GSD group (P<0.05).

Conclusion : Age adjusted prevalence of GSD in Korea is suspected which 2.08% of male and 3.70% of female.

Background
: Through the examination on the actual smoking condition of high school student with the family factors, the relationship between the problems of family APGAR and smoking, psychological influence by smoking and articles of newspaper and public opinion on smoking, this study tried to provide helpful materials which can be used to make education plans to let them stop smoking.

Methods : To make survey, authors selected 505 junior and senior students (male: 222, female: 283) from four high schools, of which two(a girls' and a boys') are located in Seoul and the rest in the country.

Results : Among the surveyed students, 38.7 of boys and 12.0% of girls smoke habitually. About the motives of smoking, 34.1% start smoking through the inducement of their friends, 30.0% curiosity and 27.0% stress. About the age when first smoked, 20.3% responded that they start smoking before 13 years old, 24.8% at the age of fourteen, 25.4% at fifteen, 13.7% at sixteen, 9.3% at seventeen and 6.2% at eighteen, which showed that the earlier their first smoking experience, the higher the rate of tendency sticking to habitual smoking. The 18.3% of smoking students and 1.8% of non-smoking ones experienced addicting drug. In addition, 93.0% of smoking group and 27.2% of non-smoking one experienced drinking. When it comes to the family factors in smoking, religion of family member did not make any noticeable statistical differences. The higher the average family income, the higher the rate of smoking. The students whose parents have a do-as-you-2like-it attitude of education showed higher rate of smoking that those of democratic one. In particular, students who had habitually smoking family members recorded comparatively high smoking rate. The average family APGAR score was 5.7. The 15.0% of students had severely dysfunctional family 37.8% moderate and 35.6% healthy functional family, of which severely dysfunctional group showed high smoking rate.

Conclusion : Severely dysfunctional family group showed high smoking rate and a variety of family factors influenced on the adolescent smoking. Since smoking has serious influence on their physical and psychological status, the early stage education to help them stop smoking and the recovery from family dysfunction are thought to be very important.

Background
: By reacting to external stress properly, the human body survives with preservation of homeostasis. But these homeostatic adaptive control systems may be impaired by chronic stress, and readjust to a new abnormal state. After the disappearance of stress, this abnormal readjusted state may persist. Stressors, which change homeostasis, cause various kinds of alteration of psychophysiological phenomena. One of these is muscle tension of our body. Thereupon, comparing basal frontals muscle tension, authors studied persons suffering from tension headache and migraine headache and normal persons in order to facilitate the treatment and diagnosis of the disorders.

Methods : Participants were selected from employees and outpatients in the department of family medicine at St. Mary's hospital, students of Catholic university medical college with a questionnaire about headache. But those suspicious of having organic causes of headache were excluded. Three groups were studied-tension headache, migraine headache and control. The basal frontalis muscle tension was measured by using surface electromyographic biofeedback equipment (model BIOLAB, Autogenic Cyborg)

Results : The basal mean EMG level of the tension headache group was the highest (2.34μV), next was migraine headache group (1.05μV) and the lowest in controls (0.78μV). Differences among the three groups were statistically significant(P<0.0001). The difference in the mean EMG level between tension headache and migraine headache groups was significantly different, and the difference between tension headache and control groups was also significant. However the difference between tension headache and migraine headache groups was significantly different, and the difference between tension headache and control groups was also significant. However the difference between migraine headache group and the control group did not significantly differ in the mean EMG level. Disease type contributed most to the variation in surface EMG levels. The usual factors which affect basal EMG levels such as sex and age etc did not significantly change EMG levels.

Conclusion : The basal mean EMG levels are significantly different between the two headache groups. Even though basal EMG level can vary by examiner, if repeated basal mean EMG levels are ascertained by the same examiner, basal mean EMG levels can be used as an adjunctive diagnostic tool The basal EMG level of the control group can be used as a reference value in treatment of patients with high muscle tension.

Background
: Screening test is one of the most important tools of periodic health examination for health promotion and disease prevention. To achieve effective health screening, diseases which require early detection and treatment need to be targeted. These target diseases should be selected with respect to age and sex. Also, screening tests with efficacy in early detection and safety should be selected.

Methods : We reviewed health risk appraisal results, medical charts and screening test results of 2177 adults who visited Seoul National University Hospital Lifetime Health Maintenance Program from February to December in 1991.
We selected 1011 subjects who were asymptomatic adults.

Results : There were high positive rates in liver ultrasonography(27.3%), blood pressure measurement (14.5%) and urine analysis (12.7%), hemoglobin (9.6%), and serum cholesterol test (8.8%). In males, positive rates in chest X-ray, upper G. I series and sGPT test were more than twice those of females. But in females, positive rates of abnormality of hemoglobin, hematocrit and urine analysis test were greater than twice those of males.
The detection rates of target diseases were 18.6% overall, 17.9% in males, and 9.0% in females. hypercholesterolemia (5.2%) and hypertension (4.1%) were found to have the highest detection rates among target diseases and accounted for 51% of the total detection cases. Detection rate of liver diseases was higher in males (6.3%) than in females (1.3%), but detection rate of iron deficiency anemia (IDA) in females (3.4%) was higher than in males (0.4%).
Males and females in the 5th and 6th decades had higher detection rates than other groups.
Among males, higher detection rates of liver diseases were seen in the 3rd and 4th decades: hypercholesterolemia, hypertension, and liver diseases in the group older than 40years.
Among females, higher detection rates of IDA, hypercholesterolemia, and hypertension were seen in the 5th decade : only IDA in the 3rd and 4th decades. Females in older than 50 years of age had higher detection rates of hypercholesterolemia, hypertension, and liver diseases.

Conclusion : We detected target diseases in 18.6% of asymptomatic adults by screening tests. Males and females in the 5th and 6th decades had higher detection rates than other groups. Detected target diseases revealed different detection rates according to age and sex

Background
: This study was performed to examine the weak point in EKG reading of family practice residents.

Methods : The data was abstained from comparative analysis between EKG readings of six residents of family medicine and that of one cardiologist.

Results : The EKG readings of rhythm, rate, axis, PR interval, QT interval, amplitude of P wave, and tall T were relatively correct and accordance rates were more than 90 percent. The accordance rates of the EKG reading of diphasity and notching of P wave, fibrillatory P, S₁+R5>35mm of QRS complex, inversion of T wave, elevation of ST segment were about ranged from 70 to 80 percent. The accordance rates of the EKG reading of inversion of P wave, QRS interval, R in V₃<3mm, Q wave, T₁>R6 of T wave, flat T, depression of ST segment were below 70 percent.

Conclusion : Family practice resident's weak points on EKG reading were mainly on the interpretation of inversion of P wave, QRS interval, R in V₃<3mm, Q wave, T₁>R6 of T wave, flat T, depression of ST segment. Hence, More emphasis should be put on the interpretation of these components of EKG.

Background
: This survey was investigated the actual situations and an attitude of continuing medical service with private or family usual medical provider for that serves basic data to family practice. The family physician, provide continuous and comprehensive care for the individual and family, was insufficient in Korea.

Methods : A questionnaire survey was conducted with the answered 342 persons which were randomly selected to local residents in Daerimdong, which were many hospitals, universal hospital and local clinics in Seoul, from Aug. 1, to Aug. 31, 1992.

Results : The rate of respondents who have the usual medical provider was 34.2%, family usual medical provider among subject was 70.1%. The rate of respondents who have the idea of necessity for usual medical provider was 89.8%. Confidence of usual medical provider was most common reason in group that have usual medical provider. The group that haven't usual medical provider was to make inquires at any time. Favorable pictures of usual medical provider was confidence, specialty, kindness, in order. The 70.2% in group that haven't usual medical provider visited to pharmacy when disease arises.

Conclusion : There were many medical specialists but most peoples desire to produce a great number of family physician who continuous and comprehensive health care or treatment for family.

Background
: Since July 1989, nationwide medical insurance system and new health care delivery system made the role of family medicine more important, and then Family Medicine Clinics were opened in many university hospitals.

Methods : So this study was conducted to investigate the recognition of the role of family medicine by several apartment inhabitants for a month. December 1990. Study method was questionnaire and personal interview. And the whole subjects were 157 persons excluding 8 persons who responded inadequately.

Results : The medical institute which is chosen when ill was drugstore (49%), private clinic (35%), general or university hospital (13.3%). The reason to choose was near distance 37.6%, simple process 35.7%, be professional 12.1%, be economic 3.8%, good facilities 3.2%, be kind 1.3%. Desirable doctor was credible doctor(40.1%). Only 25.5% of subjects responded they knew family medicine but 77.1% answered that family medicine is necessary. More than ninety five percent said they were willing to register to department of family medicine, and the reason was whole family could consult to a doctor promptly and conveniently. Classifying by APGAR scores, highly functional families were 63.5%, midrange functional families were 30.1%, and dysfunctional families were 6.4%.

Conclusion : In spite of low level of knowledge about family medicine in Pusan area, there were higher willingness to participate in family practice in a group of high family APGAR score.

Background
: The sinusitis is one of the common diseases in children. It tends to be chronic in nature. Also, It is difficult to treat because of its complications-serous otitis media, posterior nasal dripping, and chronic pharyngitis, etc. We carried out this study to assess the clinical characteristics of chronic sinusitis in children.

Methods : The authors assessed from chart review the clinical characteristics of 97 children with paranasal sinusitis who had visited out-patient clinic of Family Medicine Department, Keimyung University Dongsan Medical Center from January, 1990 to December, 1990.

Results : The children between 0~6 age were more than those between 7~15 ages, and there were more male than female with male to female ratio of 2.2:1. Winter was the most prevalent season in occurrence of paranasal sinusitis among four seasons. 7.2% of all cases had the past history of allergic diseases. bronchial asthma was most common, the next was allergic rhinitis followed by eczema and urticaria. The most common clinical manifestation was nasal obstruction (72.3%) followed by mouth open breathing (61.9%), snoring (58.8%) and rhinorrhea (52.6%). Throat injection(73.1%) was most common physical finding, the next was postnasal dripping(23.7%). Chronic hypertrophied tonsils and adenoid was the most common complication(69.4%), followed by serous otitis media(43.6%) and pneumonia(6.2%). On radiographic findings of maxillary sinus, bilateral lesion was more common than unilateral one. Opacity (49.5%) was common among local findings of paranasal sinusitis.

Conclusion : For treatment of chronic sinusitis and early detection of its complications effectively, We should take a careful history taking, physical examination, and radiologic examinations. We also suggest that the screening test for serous otitis media in patients with chronic sinusitis should be performed.