Background
: It is well known that the vinyl house cultivation affects the health status of rural farmers. But few studies about the vinyl house disease are available. Therefore, this study was conducted to investigate the vinyl hose syndrome and its related factors in Chonnam rural residents.

Methods : 453 vinyl house farmers and 652 non-vinyl house farmers aged 20 years or more were interviewed individually with a structured questionnaire from May to June, 1992.

Results : The mean age of the vinyl house workers and non-vinyl house workers was 41.0 and 43.4 years old respectively. The mean daily working hours were 7.0 hours in the vinyl house group and 4.6 hours in the non-vinyl house group. The mean frequency of applying agricultural chemicals in one year was 10.9 in the vinyl house group and 6.2 in the non-vinyl house group. The rate of intoxication by agricultural chemicals of the vinyl house workers was 1.8 times higher than that of the non-vinyl house group. The prevalence of farmers' syndrome was 13.8% in females of the non-vinyl house group. The mean score of subjective fatigue symptoms reported by the vinyl house and non-vilyl house groups was 15.0 and 15.5 respectively. The complaint rates of the vinyl house group were higher than those of the non-vinyl house group in 'headache', 'yawning', 'hate to talk', 'irritability', 'general ache', 'dry throat' and 'cold sweating'(P<0.05). Factors strongly associated with the vinyl house disease were working duration, daily working hours, the score of Farmer's syndrome in males and the score of Farmer's syndrome in females.

Conclusion : Compared the vinyl house group with the non-vinyl house group, the prevalence of farmer's syndrome in the former was lower, but the complaint rated of subjective fatigue symptoms causing intoxication with agricultural chemicals and heat stroke, etc. by specific working environment into the vinyl house were higher than the latter.

Background
: As interest of people about health focused on early detection of disease and health promotion, periodic examination is increased. Plasma glucose test and semiquanititative urine stick test have been used currently as a screening test of DM. We evaluated the significance of urine glucose test as a screening test for DM in mass screening through the detection rate and validity of the urine glucose test using semiquantitative urine stick stest. We also examined the proporton and age distribution of people with abnormal plsma glucose level.

Methods : We inquired the level of fasting plasma glucose and urine glucose of 19,920 men who enrolled on the periodic health examination of one coporation. The level of urine glucose was measured by the urine stick using the oxidative enzymatic method.

Results : The sex of 19,920 objects was only man with age ranging from 20's to 50's. Age distribution was not corresponding to the standard demographic distribution pattern. The number of people with positive urine stick test was 125, 1.45% of total objectives and increased with age, 0.78% in the group under 30 years old and 5.1% in the group more than 50 years old. Sensitivity of urine glucose test was 29.8% and increased with glucose level, 20% in the group of plasma glucose 140-170mg/dl, 43.6% in 180-199mg/dl and 58.0% in more than 200 mg/dl. Sensitivity also increased with age, 0.0% in the group under the 30-year-old, 14.9% in the group of 30's, 45.7% in 40's and 51.6% in 50's. Also false negative rate of urine glucose test was high, 70.2%.

Conclusion : Urine glucose test with urine stick seems to be defective method in cost-benefit as a mass screening examination considering low sensitivity of 29.8%, low positive predictive rate of 68.8% and low prevalence of DM, although specificity is high. It may be selectively used in high risk group or in people with symptoms of DM. It seems to be proper to diognose DM with plasme glucose test when suspicious of DM, too.

Background
: Hepatitis C Virus(HCV) infection is known as one of the most important causes of liver diseases such as post-transfusion hepatitis, sporadic hepatitis, liver cirrhosis and hepatocellular carcinoma. The prevalence of antibody to Hepatitis C Virus(anti-HCV) among blood donors was about 0.3-1.5% by first generation enzyme immunoassay(EIA). Second gengration anti-HCV among Korean adults and identify the route of HCV transmission.

Methods : Serum samples from 5,718 adults who visited Korea University Hospital Health Care Center were tested for second generation anti-HCV EIA, serum ALT(alanine aminotranferase), HBsAg, anti-HBs and anti-HBc. Questionnaires including presumptive risk factors of HCV were obtained from 47 anti-HCV positive cases, and those results were compared to the results from 137 anti-HCV negative cases.

Results : The overall prevalence of anti-HCV was 1.6%(89/5,718). The prevalence of anti-HCV increased with aging significantly(P<0.01). The prevalence of anti-HCV in elevated(ALT>40IU/L) serum ALT cases was significantly higher than in normal(ALT≤40IU/L) cases(5.4% vs 1.1% P<0.01). Anti-HCV status was associated with history of transfusion significantly(P<0.05), but the following factors such as operation history, family history of liver diseases, history of sexually transmitted disease, alcohol intake and history of acupuncture or tatooing were not associated with status of anti-HCV.

Conclusion : Prevalence of anti-HCV among Korea adults was 1.8%. Age matched prevalence of anti-HCV in Korean adults was higher than the other countries in North Europe or North America, but similar to that of Spain or Japan. Prevalence of anti-HCV was increased with aging. To elucidate the meaning of anti-HCV positivity in this, futher sutdy is needed

Background
: In order to evaluate the immunogenicity and safety of recombinant DNA yeast derived hepatitis B vaccine(Euvax-B) among healthy adults a clinical trial was conducted.

Methods : 70 healthy adults(male 58, female 12) were included from August 1993 to June 1994. 40 cases were given 1.0ml of yeast derived vaccine(Euvax-B) intramuscularly in the deltoid muscle at 0, 1, 6 months and 30 controls were given 1.0ml of plasma derived vaccine(Hepavax-B) by same method. Anti-HBs antibody was tested at 1, 2, 6, 7 months after first vaccination by radioimmunoassay(Abbott).

Results : After three injections the seroconversion rate of case group(97.1%) was similar to that of control group(100.0%). Geometric mean titers were 302 RIA units(95% CI 179-526) in case group and 631 RIA units(95% CI 322-1,277) in control group. Adverse events were fatigue(2.5%), myalgia(2.5%), fever(1.3%), pain in injection site(1.3%) in case group and myalgia(8.6%), dizziness(1.7%) in control group.

Conclusion : Immunogenicity of recombinant DNA yeast derived hepatitis B vannice(Euvax-B) among adults is comparable to that to plasma derived by 0, 1, 6 month schedule.

Background
: Acute appendicitis is a common disease which needs surgical treatment among acute abdomen, but the specific sutdy is applied very seldom because of emergency operation neccessity. Therefore this study was carried out to find out a way of help for preoperative diagnosis and treatment of this diseases, to analyze intestinal diseases except appendicitis among operation cases of appendicitis preoperatively.

Methods : For 3 years from August 1990 to July 1993, we reviewed clinical reports which 25 cases of intestinal diseases among 881 cases of performed operation under preoperative diagnosis of acute appendicitis, and analyzed sex and age distribution, complete blood count, disease distribution, postoperative diagnosis, operative method, pathologic diagnosis and postoperative progress.

Results : The age distribution shows that 4th decade is the highest incidence, and male and female ratio is about 5 to 1. We cannot find any differences between these intestinal diseases and appendicitis in symptom, physical examination and leukocyte count. The mean duration of symptom was 6.1 day that is longer than acute appendicitis. Benign diseases were dominant, and cecal diverticulitis was the highest, and others such as cecal tuberculosis, cecal inflammatory mass, cecal cancer, Meckel's diverticulum, appendix carcinoid tumor, appendix mucocele and appendix cancer were found.

Conclusion : If the 4th decade male patient who were suggested acute appendicitis and duration of symptom is longer than that, detailed history taking with radiologic approach must be taken with a deep concern. It must be considered diverticulitis in 4th decade and malignant disease as well in over the 5th decade. When the opinion is different from clinical symptom before operation and findings in operation, more careful stances are essential for trying to find out other intestine with doubt.

Background
: The study was performed in order to investigate the interfering factors on regular test of pap smear and the attitude for cervical cancer screening.

Methods : The 442 women who visited in Kyeongju County health centre for cervical cancer examination were performed by questionnaries.

Results : The total number of collected data was 442. The rate of respondents who have the idea of necessity for periodic pap smear was 70.7%, the women who regularly performed Pap smear among subjects was 35.3%. The most common cause of no regular examination is forgetting of examination. The most frequent reason for not having a Pap smear is shyness.

Conclusion : To increase the attendance of cervical cancer screening test, the education might be important for recognition by means of health campaign, more dynamic recommendations of doctor, and nationwide public information through mass media.

Background
: Glaucoma is one of the main causes of blindness throughout the world and the prevalence of glaucoma increases with the increasing numbers of elderly in our population. Typically, glaucoma occurs without any subjective symptoms until the late stage of the disease. Early detection of glaucoma by screening and therapeutic intervention are therfore of the highest importance for the prevention of blindness by glaucoma. The purpose of this study was to demonstrate the importance of glaucoma screening in family practice.

Methods : We conducted glaucoma screenings by tonometry and direct opthalmoscopy in the health examination center of university hospital in Chungjoo. A total of 283 subjects were screened and patients with suspected abnormalities were referred to opthalmologist.

Results : The mean intraocular pressure obtained with Shiotz tonometry was 14.73mmHg and there was no sexual or age-related differences. Of 17 patients referred to opthalmologist 9 patients (3.18%) were confirmed as having glaucoma. The most common type of glaucoma was low tension glaucoma.

Conclusion : Glaucoma is the preventable cause of blindness and one of the objectvies of family medicine is early diagnosis and disease prevention. Therefore, we support the view that it is prerequisite to adopt glaucoma screening in health examination.

Background
: In recent years, the disease related with atherosclerosis, such as coronary heart disease and cerebrovascular disease, are increasing with the change of diet and socioeconomic status among Koreans. Thus, we investigated the risk factors of atherosclerosis in persons who took medical examinations.

Methods : We studied on the prevalence of atherosclerotic risk factors, such as smoking, lack of exercise, obesity, hypertension, hyperglycemia, hypercholesterolemia, high LDL-cholesterolemia, low HDL-cholesterolemia. The subjects were 4,396 persons(men 2458, women 1957) who took medical examinations in the period from June 1990 to June 1991 at Asan Medical Center. We used questionnaires designed for getting information on their exercise and smoking. We checked their height, weight and blood pressure. Blood sugar and serum lipids were measured after the subjects fasted for more than 12 hours. The indices of risk factors were defined as followings : obesity ; ≥120% of ideal body weight, hyperglycemia : fasting blood sugar ≥ 140mg/dl, hypertension : diastolic BP ≥ 90mmHg or systolic BP ≥ 140mmHg, hypercholesterolemia : serum cholesterol ≥ 240mg/dl, high LDL-C ≥ 160mg/dl, low HDL-C : <35mg/dl in men, <45mg/dl in women.

Results : Followings are the summary of the results. The prevalence of smoking is 41.2% (men 55.7%, women 20.8%) among subjects, lack of exercise 23.9%(men 25.5%, women 23.9%), obesity 17.5%(men 17.2%, women 22.7%), hyperention 5.9%(men 7.4%, women 5.7%), hyperglycemia 3.7%(men 5.4%, women 2.5%), hypercholesterolemia 10.4%(men 10.9%, women 9.8%), high LDL-cholesterolemia(men 8.6%, women 9.1%), low HDL-cholesterolemia 21.4%(men 13.4%, women 31.7%). The prevalence of lack of exercise, obesity, low HDL-cholesterolemia higher in women than men. Hypertension, hyperglycemia, hypercholesterolemia and high LDL-cholesterolemia increased with age.

Conclusion : Most of the risk factors of atherosclerosis except male gender, age, and genetic factors were potentially reversible. The prevalence of smoking, lack of exercise, obesity was very high in this study. Thus for prevention and management of atherosclerosis, we should educate people to modify life style. We hope that this study will provide the basic information for the future studies on the risk factors factors of atherosclerosis.

Background
: Though there are some women who deliver at hospital that they have not visited for prenatal care, there are only a little knowledge about the reason and effect of such behavior.

Methods : Data were gathered from 121 women who gave birth at Pochun medical center during September 1993 and who met the inclusion criteria by paper-interview and chart reviews. They were composed of 59 controls who received prenatal care at Pochun medical center and 62 cases who did not receive prenatal care at that center.

Results : The most frequent reason for self-changing hospital was patient's desire to deliver at the place near her mother's home(37.2%). Other reasons were mere preference for general hospital(19.4%), self-change due to medical problem(12.9%) and so on. There were no difference in average birth weight, types of delivery, average delivery cost.

Conclusion : Most reasons were not related to medical problems. There were no significant difference between cases and controls in delivery outcome.

Background
: Feeling obese for one's figure can be a sufficient reason for self-alienation, especially in women. It may be a main cause of inferiority complex about their appearance. Therefore, we studied the relation between obesity and depressive trends based on the self-evaluation for their body figure among teen-age girls sensitive to the changes of their weight and body figure.

Methods : In July 1993, we surveyed for 1,096 school girls whose ages were from 12 to 19. As an objective evaluation of body figure status, we calculated Body Mass Index(BMI=weight(kg)/height2(m2)) based on the physical examination done by each school in May 1993, and we classified the subject as underweight(BMI<18), acceptable weight(18≤BMI<25), and obese(BMI≥25). By using Korean BDI, we divided groups as no depression(BMI score 0-14), mild depression(15-19), and marked depression(≥20). We also asked about self-perception for their body-image and classified the result as dissatisfaction for lean figure, satisfaction, dissatisfaction for fatness, and hatred for fatness.

Results : In the body figure distribution of respondents ; underweight was 16.2% ; acceptable weight was 78.8% ; obese was 4.9%. The patterns and distributions of self-recognition for their body were like these ; dissatisfaction for lean figure(2.6%) ; satisfaction(57.4%) ; dissatisfaction of fatness(35.2%) ; hatred for fatness(4.8%). As the results above, 40.0% of respondents regarded themselves as obese. Obese-perceptual rate of obese group was 90.8% and obese-hatred frequency was 20.4%. For the acceptable weight group, 43.7% amd 4.5% for each. Even for the underweight group, the rate was 6.2% and the frequency was 1.0%(P<0.001). 50.9% of marked depression showed the dissatisfaction or hatred for fatness. And the rate of marked depression in hatred for fatness was 67.4%(P<0.001). In a distribution of depressive trends accoding to the body fiqure, the rate of mild depression was highest in obese group, whereas acceptable weight and underweight showed 67.0%, 65.0% of each. And the rank of marked depression rate as follows ; acceptable(40.3%) ; overweight(40.3%) ; underweight(28.7%).

Conclusion : For teen-age girls the prevalence of obesity was considerably low compared with that of adults, but the degree of obese-perception and frequency of hatred for fatness were notably high. We concluded that obesity and inferiority complex for their appearance had much influences on the teen-age girls' depression. Accordingly, on the consultation for the obesity, family physicians should consider supportive therpy in view of psychosocial aspects.

Background
: The family type of our country is mixed with extended family and nuclear family, it is different from western but has not been compared and studied objectively. Then we performed this study to compare and analyze the family function of two family types for helping the family medicine treatment.

Methods : We have selected 65 extended family and 65 nuclear family in the Seoul and Gyounggi-Do and evaluated their family function by Olson's FACES III.

Results : In FACES III cohesion of extended family, there were 5 cases(7.7%) in disengaged, 23 cases(35.4%) in separated, 29 cases(44.6%) in connected and 8 cases(12.35%) in enmeshed. In that of nuclear family 20 cases(30.8%) in disengaged, 26 cases(40.0%) in separated, 16 cases(24.6%) in connected and 3 cases(4.6%) in enmeshed. In FACES III adaptability of extended family, there were 17 cases(26.2%) in rigid, 21 cases(32.3%) in structured, 18cases(27.7%) in flexible and 9 cases(13.8%) in chaotic. In that of nuclear family 8 cases(12.3%) in rigid, 11 cases(16.9%) in structured, 26 cases(40.0%) in flexible and 20 cases(30.8%) in chaotic. In FACES III family type of extended family there were 31 cases(47.7%) in balanced, 29 cases(44.6%) in midrange and 5 cases(7.7%) in extreme. In that of nuclear family 21 cases(32.2%) in balanced, and 37 cases(56.9%) in midrange and 7 cases(10.8%) in extreme.

Conclusion : Cohesion scale of extended family was higher than that of nuclear family and adaptability scale of nuclear family was higher than that of extended family.

Background
: The number of the aged in rural community is recently increasing according to the development of social, economical and medical field has contributed to prolong life expectancy and the younger nowadays are moving into urban areas. This team study aims to focus on the influence of family resources upon family function through their family APGAR score by examining their family backgrounds : whether their spouses are alive or not, of what type their family is, whether they live together with their children or not, now many they are living with, if any, and much living expenses is, etc.

Methods : This research is based on the questionnaires for 129 inpatients over 65 year old in Jung-Up and Bo-Sung Hospital of Asan Foundation during the period from Nov.1, 1993 to Feb. 28, 1994 and 100 healthy old people living near the above hospitals in the same villages. We have examined their influence on the family function by comparing the mean scores of each item of the family APGAR questionnaires with that of those concerning the type and affinity of family resources. The investigation has been made simultaneously by the attending physicians for the inpatients and by our team for the ordinary healthy group.

Results : Mean family APGAR scores for each group show a meaningful difference as follows : the inpatients' 4.25±2.85 family APGAR was, the healthy's family APGAR was 5.66±1.78(P<0.001). The amount of living costs does not affect the family APGAR score between inpatient and healthy groups. In comparison between the old with their spouse and the spouseless, the result shows a significantly high old one whose spouse is alive(Inpatient;P<0.001, Healthy ; P<0.05), and we got the lower score in a single one whose duration of being single is longer(Inpatient ; P<0.01, Healthy ; P<0.001). In view of the existence of any family member, the old who live alone(single family show a low score than who live with their spouse, child or both(P<0.001). But the old who live with their spouse, with children or with both does not show any meaningful difference in the Family APGAR score among them(Inpatient; P>0.05, Healthy ; P>0.05).

Conclusion : Through this study, the amount of living expenses reflects little influence upon the family APGAR score, but whether live with(regardless spouse, their child or both) or without, whether their spouse are allive or not, and in case if widower or widow(spouseless), the duration of being single reflect much more influence upon the family function. The spouse group shows better family function(P<0.05) than the spouseless group and family function lessens when the death of one's spouse marks a longer period and the living alone(single family) comparatively convey lower family function.

Background
: The colon cancer is the fourth most common cancer in Korea. But its incidence tends to increase in recent days. The fecal occult blood test which can be used in screening test of colon cancer is simple, specific and low in cost. But the effectiveness of the test for early detection of colon lesion has not been evaluated in Korea. The purpose of this study is to evaluate the detection rate of the fecal occult blood test for colorectal lesions-colon cancer, etc in health examination.

Methods : We reviewed 8,865 medical records of patients who received health examination in Yongdong Sevrance Hospital since November 9th, 1992 until June 20th, 1994 and collected data with positive results in guaiac test to evaluate further diagnostic methods and treatment modalities for the detected lesions.

Results : Four hundred forty nine cases(5.1%) were found to have positive of 8,865 cases. Forty five cases(10.0%) with positive results received further evaluation to see if they have any disease. As a further evaluation method, Ba enema and endoscopy were performed on 84.4% and 26.7% of 45 cases, respectively, 64.4% of these had normal results. The most common diagnosis of the abnormal results were hemorrhoids, followed by polyps, diverticuli and a cancer.

Conclusion : 35.6% of cases had positive guaiac thest had abnormal colorectal lesions, Therefore it is considered the neccessity of the positive cases to get further evaluation in Korea, too.

Background
: In actual primary care practice, patients and family physician may have different perceptions about the family phyician's role and attitude that can cause the conflict between them. The purpose of this study was to explore conflicting area about family physiian's role attitude, and practice which might show discrepancy between physicians and patients.

Methods : Ninety family physicians and residents from 10 teaching hospitals with family practice training program and 537 patients from 10 primary and secondary level of family practice center were surveyed by the same questionnaire from Sept. 5 to 9. The data was analyzed statistically by SAS program.

Results : Family physician's and patient's expectation showed a marked discrepancy in referring to specialty. Seventy-six percent of the patients felt physician should refer a serious problem to a specialist and one of the most important family physician's role was referring his patient to the most appropriate specialty properly. But only 38.9% of family physicians agreed to this concept. Most family physicians and patients clearly recognized general gatekeeping role of family physicians, but about the half ot the patients felt it was better to get the proper specialties according to his condition than primary care services, but the most family physician disagreed to this concept. Gatekeeping role of the family physicians accepted more frequently in highly educated patients(P<0.0001) and female(P<0.05). Most patients and doctors agreed that family physician was competent to manage most medical problems in family circumstances and family physicians should get periodic assessment of his medical competence. Sixty-seven pecent of family physicians agreed that family physician should concern about the nonmedical problem but only 40% of patients agreed that. Seventy one percent of patients felt it was important to know family circumstances for proper management but forty eight percent of physicians agreed to this. Patients prefered to be told what to do in everything but forty eight percent of family physicians agreed to this. Patients considered best attitude of family physician was profession, caring, responsibility, considerate, familiarity, sympathetic in the order of frequency. There was marked disagreement in medical problems which chould be handled without referral by family physicians. Those were pneumonia, pulmonary tuberculosis, examinations for breast cancer, acute and chronic hepatitis, circumcision, hypertension in the order of frequency.

Conclusion : Perceptions of family physicians and patients strongly conflicted in the area of referral. There was also disagreement in the gatekeeping role and some areas of practice without consultation.