Background
: Irritable bowel syndrome(IBS) is a common disease, but its definition in adolescent in not definitely established yet. In this article the prevalence and clinical manifestations of the IBS in adolscents were explored. And the effects of stress on the IBS were studied. Also the relationships between family function and IBS were studied.

Methods : In December 1995 self-reported questionnaires were distributed to all members of one high school students in Kyunggi-do. The 896 questionnaires except incomplete questionnaires from 901 students were analyzed. A Questionnaire is composed by questions for the diagnosis of IBS,a global assessment of recent stress scale, family APGAR score, FACES III. To know the effects of stress and family function in IBS, IBS patients were compared with non-IBS students who were matched by class year and sex.

Results : The prevalnce of IBS was 16.5% in male and 22.9% in female. Abdominal pain or discom-fort which is relieved with defecation, associated with a change in frequency of stool, associated with a change in consistency of stool was manifested in about half of patients. Altered stool passage was common;but altered stool frequency, passage of mucus were less common. Only 12.9% of the patients visit the doctor. The stress scores assessed by a global assessment of recent stress scale were higher in the all fields of stress in te IBS patients. The family APGAR scores were also higher in the IBS patients. But there were no differences between non-IBS and IBS patients in adaptability and cohesion assessed by FACES III.

Conclusion : The prevalnce of IBS in high school students was 16.5% in male and 22.9% in female. It is as high as that of adults. And IBS in high school students was associated with stress and the family APGAR score.

Background
: The point of partient care is shifting from biological aspects to general functional aspects. Functional status s useful in individual partient care and ressearch. Many methods of measuring functional status have been developed and used in clinical practice but few are feasible at busy outpatient care settings. WONCA/COOP Charts is proved to be valid and reliable tools of measuring functional status in many countries. So we tested the validity and reliability of Korean version of COOP/WONCA Chart.

Methods : The COOP/WONCA Charts was translated by Korean bilingual family physicia and it's contents was reviewed by editing professional ad lay persons; and finally re-translated to English by Korean-English translator. Reliabilty is tested by test-retest methods in one hour and two weeks after the first test. Construct validity is confirmed by multitrait-multimethod method in comparison with English DUKE Health Profile. Statistical analysis was done with SAS/PC 6.04 by Spearman correlation.

Results : The correlation coefficient of the 1 hour retest is in the range of 0.6138(daily activity dimension) to 0.8972(physicial fitness dimension), but correlation coefficient of 2 week is in the range of 0.1136(change in health) to 0.5424(daily activities), which is lower than 1hour retest correla-tion coefficient in all dimension.In terms of construct validity, convergent validity is satisfactory in 'social activities', 'overall health', 'pain' dimensions, but not satifactory in 'physical fitness', 'feelings', 'daily activities', but disctiminant validity is satisfactiry in 'social activitis', 'overall health, 'daily activities', 'pain' dimensions, but partially satisfactory in 'feelings' dimension, and unsatisfactry in 'physicial fitness' dimension.

Conclusion : The first Korean version of COOP/WONCA Charts is some limitation of reliability and validity especially 'physical fitness' dimension. More meticulous translation and further validity and reliablity testing will be necessary.

Research Background : It is well-known that there are significant differences in clinic blood pres-sure (CBP) and ambulatory blood pressure (ABP) among many hypertensive patients. These differen-ces are called the "white-coat effect"(WCE). There have been studies to find a method of predicting the WCE and to investigate a correlation between the WCE and anxiety of paients. However, anxiety scales adopted in the former studies were fount to be inadequate to measure the anxiety which patients experience in clinics. In this study we developed a new scale, called the "white-coat anxiety scale"(WCAS), which can effectively measure the anxiety of hypertensive partients in clinics and help to find a method of predicting white-coat hypertension in the future.
Methouds: The WCAS was developed on the basis of te test anxiety scale and the manifest anxiety scale, whose validity and reliability have been proved. First, a test questionnaire was made with professional advices of a psychiatrist, a preventive medicine staff, and a professor of education. Patient anxiety symptoms were classified into three categories : autonomic hyperactivity, motor ten-sion, and cognitive symptom. Twelve questions were made in each category to make the test question-naire of 36 questions. Second, after a pre-test, a final questionnaire was made by rejecting two ques-tion, whose internal consistencies were found to be poor, in each category. The final questionnaire of 30 questions was checked with the test-retest correlation method. Third, a survey was actually done on hypertensive patients whose 24 hours ABP's were monitered either in department of family medicine, a university hospital of in a general hospital. Finally, based on the survey, the correlation between the WCE and WCAS was evaluated. The WCE was determined by subtracting the CBP value with the aerage value of 24 hours ABP.

Results : The study subjects were composed of 15 patients in departiment of family medicine, a university hospital and 25 patients in a general hospital. They consisted of 23 male and 17 female patients, and their average age was 50.6 years. The internal consistency of the WCAS was estimated to be 0.87, and the correlation of the test-retest results was found to be 0.90. The correlation coefficients between the WCAS and the WCE were 0.48 for the daytime systoli lood pressure(SBP), 0.33 for the night-time DBP, and 0.45 for the mean DBP. These values show that the difference of the CBP from daytime blood pressure has a strong correlation with the WCAS. The correlation between the WCE and the WCAS was found to be similar for the SBP and the DBP. Among the patient anxiety symptoms, the cognitive symptom is not correlated wit the WCAS.

Conclusion : The newly developed WCAS has a high reliability and shows a strong correlation with the WCE. In order to introduce the new scale to a clinical use, more studies are required to find a cutoff value of the WCAS and to check the possibilities of predicting white coat hypertension with the WCAS.

Background
: It has been estimated that up to 80% of all illness in a physician's office is due to psychosocial stress. The BEPSI was developed as instrument of stress measurement in a busy practice and was well correlated with other stress scales. In Korea, Bae JM et al developed Korean-translated BEPSI, which was used broadiy in health examination. In this study, authors, attempted to measure reliabilty, validity and cut-off point of Modified-Korean BEPSI which was modified in two items
Methd: Data were collected from 201 subject over 20 years old who first visited outpatient clinic of Department of Family Medicine, Seoul National University Hospital.The validity was measu-red with correlation with Lee's 98 items which have proven valdity.
Resuls: The study subjects was 56% female and 44% male, 93% married, 53% with high school education or less, 62% employed. Test-retest reliability and Cronbachs alpha of the Modified BEPSI was 0.68, 0.80 respectively. The correlation coefficient of the Modified BEPSI was 0.23(P<0.01). The Modified BEPSI showed normal distribution and cut-off point according to quartile and 1 standard deviation was 2.2, 2.4 respectively.
Conclustions: The Modified BEPSI correlates with Lee's 98 items and has no difference with previous study(Bae JM et al, 1992) and can be substituted for previous BEPSI version.

Background
: Lactobacilli play an important role in maintaining vaginal pH and preventing partho-gens. The population of lactobacilli and vaginal pH in patients complaining vaginal discharge differ from that in normal. This study is to eveluate the usefulness of vaginal pH measurement as a simple screening method for differentiation of the causes of vaginal discharge in primary care.
Method: 100 patients with vaginal discharge underwent several examinations, 86 cases were finally diagnosed by diagnostic criteria and classified by causes. Clinical features, vaginal pH and lactobacilli population of all 86 cases were reviewed to evaluate the usefulness for differential diagnosis.
Result: Bacterial vaginosis was found in 46%, fungal vaginits in 34% mixed infecton 13% and trichomonas vaginitis in 7% of 56 cases with known causes. Peak incidence was found in age group 21~50 without differences according to the causes. Vaginal douche did not affect on differential diagnosis. Appearance of discharge was not discriminative except for amine odor in bacterial vaginosis and combined itching in fungal vaginitis. Lactobacilli population and vaginal pH were highly discrimina- otive according to the causes. Decreased lactobacilli(100%) and high vaginal pH(92%) were found in bacterial vaginosis, and predominant lactobacilli(68%) and low vaginal pH(74%) in fungal vaginitis. Sensitivity of vaginal pH measurement were 92% in bacterial vaginosis and 74% in fungal vaginitis respectively.

Conclusion : Primary care practitioners should be able to diagnose actively and treat common vaginosis or vaginitis. This results indicate that sensitive vaginal pH measurement can be helpful in differentiating diagnoses for vaginal discharge in primary care setting when used with symptoms and physical signs. It seems to be desirable that pH measurement would be used in primany care setting because of low cost, simpleness, and time saving.

Background
: Acute appendicitis is a disease that required emergency operation and Should be diagnosed differentially of all patient having abdominal pain by family physician. The purpose of this study was to decrease the incidence of misdiagnosis by estimating the factors that have an influence to final diagnosis.

Methods : This study is a clinical analysis of 205 cases which was operated under the impression of acute appendicitis at the Yong Dong General Hospital during 1 year period from June 1993 to May 1994.

Results : The age distribution was between 5 years and 79 years of age, and its peak incidence was in the second and third decades, Sexual composition was 48.6% in male versus 51.4% in female. It occurred most frequently in the spring and summer seasons and its peak incidence was in June. The duration of symptoms in most cases before admission was two days(62.5%). On admission, chief complaints was right lower quadrant pain(91.2%), physical fingdings showed right lower tender-ness(93.2%) and rebound tenderness(61.5%). Leukocytosis(10.000/mm³ or over) on admission was foand in 77.6% of the patients. Radiologic findings (Simple abdomen) showed paralytic ilues(47.8%) and scoliosis (15.6%). Histopathologically nonperforated cases were 73.7% and perforated cases were 11.2%.

Conclusion : Most of the patients showing the pain, tenderness, and rebound tenderness in right lower quadrant and leukocytosis were proved to have acute appendicitis. At least, family physiciants shonld know how manage panperitonitis and gynecologic problems.

Background
: The mortality rate of cervical cencer is still the number one among the female cancer. The cervical cancer can be detected in early stage by cytology and biopsy which may be curable disease in early stage. In our study clinical and pathological studies were made on 48 cases of malignances of uterine cervix which were confirmed by the pap smear test and punch biopsy.
Method: This study was performed on 4,827 patients visiting obstetrics and gynecology out-patient department at YoSu Chunnam hospital to take pap smear test from Jan. 1, 1992 to Dec. 31, 1993. Punch biopsy had been done those who were seen abnomal finding.
Result: 1.The incidence of cervical carcinoma was 0.99%, the age distribution was from 26 to 78 years and most prevalent age group was 30~39 years. The average age was 45.9.
2.The distribution of pap smear result were Class 1 70.87%, Class 2 22%, Class 3 5.94%, Class 4 1.12%, Class 5 0.06%
3. About 40.6% of the cases were postmenopausal women and the average number of pregnancy was 5.1 and the number of delivery was 3.5 and the number of abortion was 2.5.
4. The result of cytology and biopsy were ompatible in 75%, the cytology result were higher grade than biopsy result in 7.7%, and cytology result was lower grade than biopsy result in 17.3%.
5. The most prevalent age group of noninvasive uterine cervical carcinoma was 30~39 years old, average of 42.9 years old.
6. Among the invasive cervical carcinoma, squamous cell carcinoma was 77%, adenocarcinom was 23% and most prevalent age group was 50~59 years which occupy 54% of all cases.

Conclusion : The incidence of cervical cancer in Yosu area was very close to nation wide data. In this study, we have found that the incidence of cervical carcinoma dose not seem to be related to the number of pregnancy, state of menopause. The rate of lower grade result of cytology than actual biopsy result was slightly high and the incidence of cervical carcinoma has increased by twice in 1993 compare to the year of 1992.

Background
: Diabetes mellitus is a common disease that needs continuours contraol, therefore the patient is stressed by continuous diet therapy and other problems. Although the study of diabetes mellitus related to depression was reported in Korea, depression tendency of diabetes mellitus patients were ignored on clinics. So, this study was done for evaluation of depression and anxiety tendency of diabetes mellitus patients and its related factors by BDI and SAS questionnairs.
Method: Based on selection group by 80 diabetes mellitus patients of Yeosu Chonnam Hospital from May, 1, 1994 to October, 30, 1994. And, the control group was 80 normal subjects who are same sex and similar age(±3 years old) of sampling group.

Results : Depression and anxiety tendency of diabetes mellitus group is higher than non-diabetes mellitus group(P<0.01). The average BDI score for diabetic group was 21.1±11.5 and for contraol group was 16.8±7.5. The average SAS score for diabetic group was 41.1±10.7, and for control group was 36.5±8.2. General state of diabetic control is related to BDI score(P<0.01), but not SAS score.

Conclusion : Depression and anxiety tendency of diabetes mellitus group is higher than that of non-diabetes group, therefore family phisician who provide continuing, comprehensive care in primany care must have concerns sbout depression and anxiety tendency of diabetes mellitus patients.

Background
: Stroke is the second common cause of death in Korea. It may cause severe and irreversible damages to human health. Risk factors and prevention of stroke have been interested by many physicians and patients. There are many studies about rick factors of stroke in the world. but there are no reliable epidemiologic studies abut risk factors of stroke in Korea. So this study was designed to investigate the risk factors of cerebral infarction. Especially, we focused on the lipid profile in cerebral infarction.

Methods : 102 cases were selected among patients who confirmend by Brain CT of MRI as cerebral infarction at one University Hospital and one City Hospital. Age-sex matched 102 patients, who were not diagnosed as stroke by CT or MRI, were selected as a contral group. Information was taken by charts review. Adjusted odds ratios for individual risk factors were calculated by multiple logistics regression anaysis.

Results : Average total cholesterol level was 216.1mg/dl in the case group and 190.7mg/dl in the control group. A patient who had cerebral infarction had almost 2.5 times more likely to have hypercho-lesterolemia(cholesterol>200mg/dl) than a patient who did not have a stroke(adjusted odds ratio is 2.48, 95% confidence interval, CI : 1.27~4.8, p<0.01). HDL-cholesterol average was 39.4mg/dl in the case group and 46.6mg/dl in the control group. A patient who had cerebral infarction had almost 0.5 times more likely to have not hypoHDL-cholesterolemia(HDL-cholesterol<35mg/dl in male, HDL-cholesterol<45mg/dl in female) than a patient who did not have a stroke(adjusted odds ratio is 0.46, 95% CI:0.23~0.92, p<0.05). LDL-cholesterol average was 147.8mg/dl in the case group and 114.5mg/dl in the control group. A patient who had cerebral infarction had almost 3.1 times more likely to hane hyperLDL-cholesterolemia(cholesterol>130mg/dl) than a patient who did not have a stroke(adjusted odds ratio is 3.07, 95% CI:1.59~5.96, p<0.01). Triglyceride average was 144.4mg/dl in the case group and 149.0mg/dl in the control group. There was not statistically significant diference between two groups. In concerning with other risk factors, obesity was not statistically significant risk factor. Hypertension and Diabetes Mellitus were statistically significant(two p-value are all less than 0.01). Its adjusted odds ratio were 5.24(95% CI:2.8~10.22) and 5.32(95% CI:2.14~13.21)

Conclusion : Hypercholesterolemia, HypoHDL-cholesterolemia, hyperLDL-cholesterolemia, Hyper-tension, and Diabets Mellitus were significant risk factors for cerebral infaction. But Triglyceride and Obesity were not statistically signficant risk factors.