Background
: In order to have confidence in the results of a study, it is necessary to establish that questionnarire is both valid and reliable in questionnaire related study. If a foreign questionnaire is used in another country, the translation validity must be verified. In Journale of Korean Academy of Family Medicine the portion of questionnaire related articles is increasing, but problem of reliability and validity in questionnaire has not been verified yet.

Methods : All of the questionnaire related articles published in the Journal of Korean Academy of Family Medicine from November 1980 to December 1995 were analyzed. The frequency of the questionnaire related articles, the type of researches, type of questionnaires, type of administrations and validity problem of the questionnaires were reviewed.

Results : Among total original articles, relative frequency of questionnaire related articles was 44%. Among questionnaires related articles, the proportion of articles about questionnaire ifself was 5.2%. Among 40 kinds of standard questionnaires, the numbers of kinds that reliability, validity, and both reliability and validity was validated were 14, 18, and 12 respectively. Only 8 kinds of questionnaire were validated in translation validity.

Conclusion : In most cases, the questionnaires used in articles in Journal of Korean Academy of Family Medicine were not validated and it should be the impetuous for rethinking of reliability and validity of questionnaire.

Background
: The national health care system where primay care health service functions properly, provide better medical outcomes in individual health service as well as national health policy. This is quasi experimentally designed, prospective study for the purpose of developing a model of primary health service in Korea. We provided Family Registration Program reinforcing primary health care for 1 year in order to assess medical outcomes and verify the benefit of the program.

Methods : Three board certified family physician assigned to 263 families, 1057 people provide 6 items of medical service reinforcing accesibility, comprehensiveness, continuity, accountability for 1 year. After the program the use of the medical services was reviewed by the medical records, to assess the quality of care during the program two self reporting questionnaire surveys was perfor-med by Continuity, Comprehensiveness, Personal relationship Questionnaire(CCPQ) before and after the program. Another self reporting questionnaire survey was also performed to assess the factors relating the use of the program.

Results : Over the seventy percents of families utilized at least one service item, most frequently using service item was medical service in outpatient department, total number of visit was 695 by 161 people in 102 families. The number of beeper call was 226, 75.3 per a family physician. The reason of beeper call were medical problem(59.7%), services to inform laboratory result(25.9%), and appointment for medical service(13.7%). The scores of CCPQ before and after program were 6.48±1.48 and 8.66±1.76, which meant that better quality of medical service was provided during the program. The reason for under-utilization of the program were 'No health program'(52.9%), 'Not Familiar with how to use the program' (34.3%), 'Felt sorry to call'(20.6%), which meant many families misunderstood the program. Over the seventy percents families had visited other physicians' offices during the program by the reasons of 'Near home' (56.7%), 'Already have a regular doctor'(26.9%). Sixty eight percents families satisied the program and 88.1% of families willed to participate in the re-registraion program.

Conclusion : By the fact that most of families registered were satisfied with familiy registration program, we conclude that this program provided quality care and could be settled in our medical system, but still remains a lot of efforts to make to have such a program known to public and utilized by many people.

Background
: Depression appears by major disease entity itself but also by physical symptoms frequently and often accompanies with many other diseases. Therefore patients who tend to ignore emotional factors visit to primary care only with additional symptoms. Primary physicians recommend to investigate for somatic diseases but the results are not significant because depression os missed. Identification of depression which appears as physical symptoms is a major role for primary physicians, because they can provide adequate medical care and can relieve the additional symptoms. The purposes of this study are measurement of frequency of depression in primary care and investigation of symp-toms this study are measurement of frequency of depression in primary care and investigation of symp-toms and diseases that are correlated with depression.

Methods : Study subjects were all of first-visit patients to Department of Family Medicine, Seoul National University Hospital from May 8th to June 10th, 1995. We investigated depression by Beck Depression Inventory and also demographic characteristics(sex, age, education, marital status, occupa-tion) was collected. Medical charts of responders was audited to collect all registered symptoms and diseases, and we investigated correlations with BDI scores. Adjusted correlations of symptoms and diseases with BMI scores were calculated by ANCOVA, Cut-off value of BMI scores was adopted with 16 points which was reported that false negative rate was minimal in clinical setting.

Results : The response rate was 77.8%(207/266) and patients who had BDI score 16 or over were 14.4% of men and 38.5% of women. The prevalence of all depressive tendency was 28.0%. Symptoms which had significant demographic characteristics-adjusted correlations with BDI scores were total number of symptoms, anxiety, fatigue, chest discomfort, weight loss, peripheral tingling sense, general weakness, indigestion, skin lesion, multiple pain. Diseases correlated with BDI scores were anxiety disorder, adjustment disorder, tension headache, panic disorder, anxiety/depression, depression, FGID, hypertension and total number of diagnoses.

Conclusion : The results of the study were that the rate of diagnosis of depression was relatively low(6.8%) than the higher frequency of depressive tendency and total number of symptoms was significantly correlated with depression(p=0.0001). Theses symptoms and diseases and used as predictors for depression in primary care.

Background
: Obesity itself is independent risk factor of cardiovascular diseases but recent studies have demonstrated that regional fat distribution rather than obesity itself is a risk factor for cardiovas-cular diseases. The aim of this study was to analyze the relationship of obesity and increased waist-hip ratio to other risk factors for cardiovascular diseases(blood pressure, fasting blood sugar, serum lipids and lipoproteins).

Methods : The study was conducted in 382 subjects(make 197, female 185) who visited a periodic health examination center in a tertiary hospital from Aug 1th to 31th of the year of 1995. Subjects were checked sex, age, height, weight, waist, circumference, hip circumference, blood pressure, fasting blood sugar, serum total cholesterol, triglycerides, HDL-cholesterol and LDL-cholesterol. Overall obe-sity was measured by BMI(body mass index) and abdominal obesity evaluated by waist-to-hip ratio (WHR) and Conicity index. Subjects were divided into 4 groups according to their BMI(<25.0≥25.0) and WHR(male<0.91, ≥0.91/female<0.85, ≥0.85)

Results : Higher mean value of total cholesterol was found in abdominal obesity and normal weight with increased WHR than groups with normal WHR in male. In female, the mean value triglycerides in normal or underweight with increased WHR was significantly higher than in normal higher and than of HDL-cholesterol was lower than gluteofemoral type obesity. Conicity index was significantly positively correlated with BMI, WHR in both sexes. A significant positive correlation emerged between Conicity index and age, systolic blood pressure, fasting blood sugar, total cholesterol and a significant negative correlation emerge between Conicity index and HDL-cholesterol in male. In female, a signifi-cant positive correlation was founded between Conicity index and age, blood pressure, fasting blood sugar, total cholesterol, triglycerides and a significant negative correlation with HDL-cholesterol.

Conclusion : Obesity and increased WHR is associated with rick fators of cardiovascular diseases and WHR and Conicity index is useful in measuring abdominal obesity. So, the author suggest incorpo-rtate measurement of BMI and WHR, Conicity index into the routine. examinations of obese patients to enhance the evaluation of health risk.

Background
: The purpose of this study was to examine the smoking behavior and knowledge, attitude on smoking behavior of elementary school children was begin to expose cigarette smoking.

Methods : In October 1995, a total of 4,251 school children randomly sampled from 27 elementary schools in Seoul and 23 elementary schools in Incheon were assessed with self-completing question-naire pertaining to smoking behavior and knowledge, attitude on smoking.

Results : The smoking experience rate of 5th. grade school children in this study was 13.4% in boys and 2.9% in girls. The current smoking rate was 1.04% in boys and 0.15% in girls. The mean knowledge score was found to be higher in boys than in girls. However, the mean attitude score was found to be higher in girls than in boys. Important risk factors of 'smoking experience' were male sex, smoking mother, smoking siblings, higher knowledge scores and lower attitude scores on smoking.
There were significant positive correlations between knowledge and attitude scores. The knowledge scores were influenced by sex, smoking experience and religion. The attitude scores were influenced by sex, smoking experience, smoking status of father and smoking status of siblings.

Conclusion : Children who had experienced smoking had higher knowledge scores and lower desi-rable attitude scores. The smoking prevention program should give attention to this exposure group and based on the education model which influence to the attitude and behavior of children rather than providing information about the health hazards of smoking.

Background
: It is well known fact that smoking is hazardous and fatal to health. Recently, physician's counselling about smoking cessation is carried out sucessfully and its importance is emerging. If phsicians can easily identify the current smoking status of the patient, the frequency of counselling will increase dramatically. This study evaluated the effect of including smoking status as a vital sign on the frequency of physician discussions with patients about smoking and physicians advice to quit smoking. Its purpose is to utilize this to practical practice.

Methods : From September 1 to October 31 in 1995, we analyzed 99 first-visit male patients(over age 20) who finished questionnaires which is composed of 7 questions during visiting family practice clinic in Ewha Womans University Mokdong Hospital in Seoul. Simple institutional change in clinical practice involved training the nurse how to use progress notepaper with a vital sign stamp that included smoking status(current, former, of never) along with the traditional visit signs from October, 1 1995 to October, 31, 1995 and just the traditional vital sign(blood pressure, body temperature, pulse rate) from September, 1, 1995 to September, 30, 1995. The contents of the survey were questions about whether the patient smoked, whether the patient was asked about smoking status by a doctor and, for smokers, whether they were urged to quit smoking.

Results : From September 1, 1995 to September 30, 1995, 52 patients participated and from October 1, 1995 to October 31, 1995, 47 patients did and the current smokers were 30 and 34 patients respectively. After expansion of the vital signs, patients were much more likely to report inquiries about their smoking status on the day of a clinic visit(an increase from approximately 53.3% at baseline to 82.4% at intervention ; P<0.05). The vital sign intervention was associated with significant increase in the percentage of smokers who reported that their clinician advised them to quit smoking (from approximately 36.7% at baseline to 61.7% during the intervention ; P<0.05). Age, age at which smoking was started, the number of cigarettes currently being smoked daily and number of previous quit attempts were not statistically significant.

Conclusion : Expanding the vital signs to include smoking status was associated with a dramatic increase in the rate of identifying patients who smoke and of intervening to encourage and assist smoking cessation. This simple, low-cost intervention may effectively prompt family physicians to inquire about use of tobacco and offer recommendations to smokers.

Background
: It is well known that heavy alcohol consumption may result in various lesions on multiple organs and tissue, especially liver. This was conducted to evaluate the relations between the status of alcohol consumption and serum activity of hepatic enzymes such as AST, ALT, and √GTP that were usually used as a screening test.

Methods : All subjects were 906 persons, who visited and questioned at the outpatient clinic of Department of Family Medicine in Hanil Hospital from June, 1995 to August, 1995 for the purpose of regular health screening. We analyzed 825 persons, excluding 56 persons with HBsAg(+), 7 persons with hepatic problems wthin 6 months and 18 persons with medication drugs that could change serum activity of hepatic enzyme of joints, muscles, cardiac problems. Amount of alcohol consumption during 2 weeks and alcohol consumption once, duration, frequency per month were obtained by questionnaire. Alcohol dependent score was conducted using NAST questionnaire that was developed to evaluated alcohol dependency in Korean. The levels of serum activity of hepatic enzyme such as AST, ALT, √GTP were examined by enzyme method. Thest data were analyzed using SAS/PC statistic program.

Results : Total number of subjects was 825, of whom 559(67.8%) were male and 266(32.2%) were female, of whom 408(49.45%-male:36.52%, female:63.48%) were teetotalers and 417(50.55%-male:98.32%, Female:63.48%) were drinkers. Amount of alcohol consumtion during 2 weeks and alcohol consumtion once trended to increase with decresing age in male(P<0.01). The distribution of frequency f alcohol consumtion per month in drinkers was following 1 to 4 per month(37.9%), 5 to 9 per month(26.1%), 10 to 14 per month(14.8%), the above 20 per month(11.5%), 15 to 19 per month(9.5%). The distribution of duration of alcohol consumtion in drinker group was following the above 16 yrs(83.0%), 11 to 15 yrs(8.4%), 6 to 10 yrs(6.7%), the below 5 yrs(1.9%). The mean of alcohol dependent score was 0.88.
Statistical analysis of variance showed that the difference found between the various alcohol consum-tion group(during 2 wks and once) and frequency were significant for the mean AST, ALT, √GTP and the various alcohol dependent score was significant for the mean AST, √GTP, The varios duration was significant for mean √GTP(P<0.01). Statistical χ² trends test showed that the difference found between the varient drinking groups was only significant for the percentage of abnormal √GTP(P<0.01). Multivariate Linear Logistics regression analysis demonstrated that the effect of amount of alcohol consumtion once and alcohol dependent score on AST, duration on ALT, amount of alcohol cosumtion during 2wks on √GTP were statistically significant in male.
Counclusion: The serum activity of √GTP might have most effective value as a screening test for alcohol consumtion, then AST might have higher value than ALT.

Background
: Pain is the most common complaint in hospitalized terminal cancer patients, therefore, controlling the pain is important problem. The studies showed that 33%~60% of patients with advanced cancer were alert during the last 24 hours of life, and the majority of patients were able to continue oral medication until death. The study look at the analysis of analgesic use, both oral and parenteral, in hospitalized terminal cancer patients.

Methods : A retrospective chart review of analgesic type and amount was performed on the medical records of 194 hospitalized terminal cancer patients who had died in Yong Dong Serverance Hospital during the period of January 1, 1993 to December 31, 1994. Different types and amounts of analgesic were converted to a common standard : an oral morphine equivalant(OME) relative to 1mg of oral morphine. Associations between analgesic used and selected patient characteristics(age, sex, cancer site, pain, diet, mental status, and types, amount, and adminstration route of analgesic) were explored.

Results : The mean age f patients was 60.44±14.26 years. The total number of patients was 194, male, 132 cases(68%) and the female, 62 cases(32%). The frequent cancer site was liver(29.4%), lung(19.1%), stomach(17.0%), in order. There was no descriptive statistical significance between dosages of analgesic and age, sex, and cancer site. 93 patients(47.9%) were well oriented 24 hours prior to death, 54 patients(27.8%) 6 hours prior to death, and 17 cases(8.8%) 1 hour prior to death. 152 out of 194 patients(59.3%) complained pain, and 115 out of 152 patients were treated with analgesic to relieve pain. 86 out of 115 patients were able to continue on oral medication. 59 cases(51.3%) were given regularlly, 32 cases(27.8%) p.r.n.(pro re nata), and 24 cases(20.9%) regularlly and p.r.n.. 20 cases(17.4%) were took oral medication only, 71 cases(61.7%) were given parenteral injection. 72 out of 93 patients(77.4%) with an alert mental status had required analgesics during the last 24 hours prior to death, and 31 cases(43.1%) were given oral medication, and 56 cases(77.8%) were given parenteral injection, also 24 hours prior to death.

Conclusion : In this study, 152 out of total 194 patients(78.4%) complained pain before die of cancer. 115 patients(75.7%) were given anagesics to control pain and order, 83 patients(72.2%) were received regular analgesic prescritpion. Parenteral injection analgesics were much more frequen-tly used than oral medication to control pain in hospitalized terminal cancer patients, even through the cases of patients were able to take oral medication and had an alert mental status during the 24 hours before death.