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
: primary physicians should understand not only the biomedical status but also the functional capacity of their patients. There are Many instruments designed to measure functional status, but none of them are confirmed to be valid and reliable in Korean version. This study was designed to develop Korean version of COOP/WONCA charts which are approved to be reliable and valid through many international studies, and to evaluate their validity and reliability.

Methods : The charts were translated to Korean language and evaluated face validity. The patients who visited family medicine outpatient clinic of one hospital from June to July in 1994 were included in this study. They administered COOP/WONCA Charts and MOS-20 measurement which was also translated. In order to test the validity, the correlation codfficients between the same items of COOP/WONCA Charts and MOS-20 measurement were calculated. Then the convergent and discriminant validity were evaluated via Multitrait-Multimethod approach. To test the reliability. 30 persons who completed the COOP/WONCA Charts readministered the same charts after 1 hour, and 22 persons of them administered again after 1 or 2 weeks when they revisited the clinic. The test-retest correlations and Cronbach's alpha coefficient were calculated.

Results : The average convergent validity correlation between COOP/WONCA Charts and MOS-20 measurement was 0.5232, and ranged from 0.3502 to 0.8714. Most of them met the 5 criteria proposed by Campbell and Fiske. 1-hour-test-retest intraclass correlations ranged from 0/7160-0.9529, and 1 or 2-week-test-retest correlations ranged from 0.3516-0.7250. Cronbach's α coefficient was 0.7937.

Conclusion : Developed Korean version of COOP/WONCA charts are reliable, valid, and useful for quickly measuring patient function in primary care setting. But those items which showed lower convergent validity coeffcients such as physical fitness and social activities should be reevaluated.

Background
: The coronary vascular disease begins in early life, and hyperlipidemia, one of the risk factors, begins in early life, too. So, the screening and management of hyperlipidemia for children are important. We started this study to find out the distribution of serum lipid levels of Korean children and to identify the related factors with lipid profile, such as family history of vascular disease, obesity, etc.

Methods : We took the anthropometric data and measured the serum total cholesterol, triglyceride and HDL-cholesterol for all students of one elementary school in Seoul(1480 children). And we checked the family history of angina, hypertension, diabetes mellitus and cerebrovascular disease by questionnaire.

Results : We examined 806 males and 674 females. In female, total cholesterol, triglyceride and LDL-cholesterol levels are 180.7±27.7mg/dl, 98.4±40.8mg/dl and 101.6±25.4mg/dl, respectively. These values are significantly higher than males' (175.6±26.9mg/dl, 85.9±35.8mg/dl, and 97.3±25.7±mg/dl) And HDL-cholesterol level is significantly lower in females(59.4±10.3mg/dl) than males(61.1±10.2mg/dl). There were significant positive correlations between total cholesterol and triglyceride, HDL-cholesterol and LDL-cholesterol. Family history of vascular disease is not related with hyperlipidemia. There were high hyperlipidemia rate in females and obese children(obesity index ≥ 20%), but 18.9% of normal weight children had hypercholesterolemia. Total cholesterol level is influenced by age, sex, height and obesity index and they could explain the 3% of total cholesterol level. Triglyceride level is influenced by sex, height and obesity index and they could explain 14% of triglyceride level.

Conclusion : Serum lipid levels of Korean children are not lower than other countries. For the screening of hyperlipidemia, survey of family history by questionnaire or check the obesity index are not enough to choose high risk group.

Background
: As a primary care physician, Family physician should have concern in early detection of cancer. Early detectionof malignancy is very important because usually, the disease more untreatable when cancer is discovered among the tumor markers. There is opinion that urinary hydroxyphenyl derivative is useful for detection of various kinds of cancer, recently. We study whether GIFTEC test is clinically available in respect to early detection or not.

Methods : Data gathered for in 1954 patients for general health examination during the period from May 1992 to october 1993 in Kang Dong Sacred Hospital.

Results : among 1954 ptients, 1795 patients were GIFTEC negative patients, 159 patients were GIFTEC negative patients and 4 cancer patients in GIFTEC positive patients. Therefore cancer prevalence of this study was 8/1,954(0.4%). sensitivity was 4/8(50%), specipicity was 1,791/1,946(92%) false positive rate was 155/1,946(8%), false negative rate was 4/8(50%), positive predictive value rate was 4/159(2.5%), negative predictive value rate was 1,791/1,795(99.8%).

Conclusion : In this study, although GIFTEC test is clinically available for cancer screening test for excluding cancer, but because of low sensitivity and very low rate of positive predictive value, We knew that the clinical availability of GIFTEC test for early detection of cancers was not available.

Background
: This study is carried out to see if there is any difference in the family function of children-patients between those hospitalized through the emergency room where immediate treatments are available anytime and those hospitalized through the outpatient department where they have to wait for available doctors and the treatment is given only during the office hours

Methods : The family function and family environment of children-patients who had been hospitalized at the Kwangju Christian Hospital from May through July were evaluated by Family APGAR and FACES Ⅲ. Diseases of children in each group were also comparatively evaluated and one-to-one correspondences were mode between the two groups. Then 82 children were respectively selected from each group and the two groups were compared by T-test and chi-square test in terms of SPSS.

Results : There were no differences in general characteristics of children of both groups, and in both groups the number of boys was bigger than that of girls. As to the clinical characteristics, chief complaints of the study group were dominated by fever, respiratory difficulties, and convulsive attacks, while they were dominated by coughing in the control group. When it comes to the manifestation period of major symptoms before hospitalization, the study group took 4.5±0.52 days and the control group 7.9±0.81 days with the former showing showing short enough, in terms of statistical significance, period(p<0.01). But on sifgificant differences were found in the duration of hospitalization between the two groups. In the comparison of family functions, the study group showed 6.8±0.28 points on family Apgar score, 24.8±0.19 points on adaptability, and 33.9±0.8 points on cohesion, whereas the control group showed 6.9±0.26 points on family APGAR score, 24.9±0.67 points on adaptability, and 34.0±0.79 points on cohesion, showing no significant differences between the two groups. As to the family type, the Mid-ranged type was dominant in both groups-51 children(62.2%) in the study group and 44 children(33.7%) in the control group.

Conclusion : There is no significant difference in the family function of children patients hospitalized through emergency room and those hospitalized through the outpatient department.

Background
: It is generally accepted in Korea that most of the third year high school(H3) students who are under the academic competitive pressure for college enterance examination seem to be forced to restrict their daily amount of sleep in order to have more time for studying. It is well known that sleep and anxiety interact in a complex manner. The aim of this study is to determine if the trait anxiety could affect sleep patterns in H3 students This article is part of a broad survey study concerning sleep patterns in Korean middle and high school students.

Methods : In the survey study, the Korean version of Spielberger's trait anxiet scale(1970) and sleep questionnare were administered to 240 H3 students(160 male, 80 female) who go to the same school and live in a large city, Kwangju. Two groups of students with high and low trait anxiety levels(58 in each group) were selected based on the trait anxiety scale ratings and then the differences between the two groups were examined in terms of night sleep and daytime sleepiness on weekdays, as well as experiences of abnormal sleep episodes.

Results : Regarding the night sleep, the high anxiety group estimated their sleep was significantly less refreshing than the low anxiety group despite the fact that there were no significant differences between the groups in terms of bed time, rise time, time in bed, sleep latency, frequency of awakening and awakened methods. On components of night sleep regularity, bed time and sleep length were significantly more irregular in the hight anxiety group than in the low anxiety group whereas rise time did not differ between the two groups. Daytime naps were more frequently taken in the high anxiety group than in the low anxiety group, while the experience of daytime dozing and the situations of dozing were not significantly different between the two groups. Abnormal sleep episodes at night such as difficulty in falling saleep, sleep talking, nightmare, and waking up due to headache, seizure, or leg discomfort were significantly more frequent in the high anxiety group than in the low aniety group.

Conclusion : Although all vriables of sleep are not clearly different between the high and low anxiety groups, the findings demonstrated that trait anxiety may contribute to sleep characteristics in H3 students, and suggested the need for further studies on a variety of behavioral aspects along with daytime learning efficacy associated with sleep restriction in H3 students with high trait anxiety.

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
: spite of a variety of papers on clinical contents in primary helth center of family medicine according to ICPC coding system, they are mainly limited to the metropolitan or urban areas. This paper is, therefore, expected to provide data for fesidency training as well as for a reference to family physicians who are to serve for primary health care of rural community by analyzing clinical contents of new patients in a rural area according to ICPC coding system. Also this paper, We hope, will give a brief idea of present status of the public health centers in rural areas.

Methods : The authors visited a Public health center operated by a doctor who had finished the course of intern training. Among 1,271 new patients in a year from Jan. 1993 to Dec. 1993, we sampled randomly 1,000 patients with an even distribution by month and by area and analyzed their medical charts.

Results : In sex ratio of the subjects of investigation, female was superior to male by 419(41.9%) to 581(58.1%) in the total of 1,000 patients. By age, fifties(50-59 yeare old) was the most common age group. The total number of Reason For Encounter(RFE) was 1,454, the average RFE per patient was 1.45, and the kind of RFEs was 122. A cough was the most common RFE by 269 cases(18.5%). Accoding to division of REF by chapter, Respiratory disease was the most common RFE by 481 cases(33.1%). The 111 kinds of diagnoses were used and Upper Respiratory Infection among them accounts for the major portion by 345 cases (27.2%). The total number of Referrals to the other hospitals was 37 cases which amounts 3.7%. Almost half of it, 18 cases(48.7%), was to the Internal Medicine Department.

Conclusion : The authors analyzed the clinical contents of a Public health center in a rural area according to ICPC coding system. It was our intention that the data in the paper could be used for residency training as well as for a reference to the family physicians who will serve for primary health care of rural community.

Background
: Helicobater pylori are gram-negative spiral bacteria that are associated with gastritis, peptic ulcer, and gastric cancer.

Methods : For detection of Helicobacter pylori infection, we studied 109 patients with upper gastrointestinal disorders from January 1994 to August 1994. The results are as follows.

Results : 1. The reviewed patients was 78 men(71.6%) & 31 Women(28.4%) and average age of them was 51±10.6.
2. H. pylori was isolated from 55(50.5%) cased among 109 patients.
3. According to the endoscopic diagnosis, the detection rates of H.pylori was 56% in gastritis, 53.8% in gastric ulcer, 31.3% in gastric cancer & 25.0% in gastric polyp.
4. According to the anatomical position of stomach, 57.1% in antrum, 44.5% in body, 50.0% in angle, and 33.3% in pylorus.

Conclusion : In conclusion, there was a strong association between the detection of H.pylori and stomach disease, especially gastritis & gastric ulcer.