Background
: The prevalence of dementia is estimated to be as high as 11.3% among cou-mmunity-dwelling persons over 65 years of age in Korea. The fear of dementia for both patie-nts and families is growing because of the chronicity and progressiveness of the disease. Though the recognition, evaluation, and management of patients with dementia are important for the care of older pateint, unfortunately, MMSE takes 5 to 10 minutes to administer and is cumber-some to carry for all elderly patients in busy office. The Clock Drawing Test has been known as valid, easily administered and low cost screening procedure for the congnitive impaiment associ-ated with dementia in general geriatric clinic population. In this study, we assessed the useful-ness of this measure as a screening test for dementia, on the basis of the correlation between clock drawing and MMSE-K

Methods : The subjects for this study consisted of 47 elderly who visited to two elderly clubs in Seoul from April 1996 through June 1996 or the outpatient department of Family medicine of the Ehwa Mok-dong hospital. They received the Mini-Mental Status Exam and the Clock Drawing test. Three observers evaluated them by ratings from 10(best) to 1(worst).
Inter-rater reliability of scores from the Clock Drawing Test was assessed and Pearson correla-tion coefficients were used to examine the relationships between scores from the Clock Drawing Test and MMSE-K.

Results : Their mean age was 75.4 tears with range of 65 to 91 years. There were 34 women and 13 men. Correlations between individual raters was highly significant(r=0.8939, 0.8552, and 0.8698, respectively ; P<.01). Compared to scores in MMSE-K, rating from clock drawings by each of 3 raters revealed statistically significant correlations(r=0.7164, 0.7398, and 0.6884, re-spectively ; P<.01).

Conclusion : The clock drawings can be rated reliably by even untrained observers and per-formance on this task relates significantly to performance on MMSE-K of severity. We con-general screening tool for dementia in a geriatric clinic population.

Background
: This study was performed to determine and compare the practice patterns of management of hypertension of the internists and family physicians in general hospitals and to compare them according to the JNC V guidelines.

Methods : Questionnaires were mailed to total 964 of internists and family physicians in general hospitals during May, 1996. 217 of them were returned with the response rate of 23.5%. Chi-square test and Fisher's exact test were performed to examine the statiscal difference between two groups.

Results : The mean age of the respondents wa 39.1 and 77.9% of them were male. 65.4% of hospitals for respondents were located in metropolitan cities. Concerning the number of measurements of blood pressure, 0.5% of the respondents measured just once before confirmation of the diagnosis. Items for physical examinations for initial evaluation were as follows; cardiac auscultation(94.0%), measurements of body weight and height(58.9%), ab-dominal examination(52.8%), auscultation for carotid bruit(41.7%), fundoscopic examination(25.6%). Regarding the laboratory tests, the frequency of evaluation of all item were higher than that of the physical examinations. For initial drug therapy, calcium channel blockers and ACE inhibitors were the most frequently chosen mediations. NO difference was found between two specialties or tertiary and secondart hospitals in this trend. With edu-cations for the life-style modification, 60-80% of the respondents educated the patients. NO difference was found between two specialties except one item.

Conclusion : As a whole the JNC V gudelines were not followed faithfully for the management of hypertension.

Background
: The patients visiting the primary care complain of the various symptoms. This symptoms may induce the stress or the recerse. In fact the stres can influence the symptoms and signs. So this study was done for the correlation of the symptoms and signs with stress.

Methods : This study was done about the patients visiting the family medicine department of the one university hospital. We collected the all items that can find in the charts for examining the symptoms and signs, and did the requests parter the patients wrote by themselves. The stress test was Psychosocial well being index to be constructed from the General Health Questionnaire. We tested the study by t-test, anova, chi-square, linear logistic regression.

Results : The total study numbers were 351. The stress cut-off point was 63 score. The stress group was consisted of 15 males and 43 females. The meaningful symptoms were headache, diz-ziness, fatigue, weakness, insomnia, anxiety or depression. The meaningful diagnoses were anx-iety or depression, tension headache(p<0.05). The meaningful sociodemographic factors were female, housewife or unemployed, menopause, monthly income below 200 ten thousands won.

Conclusion : It was found that the some symptoms and signs were statistically correlated with stress.

Background
: The prevalence of cognitive impairment in the elderly has been increasing in recent years with the growing or the aged population. Clinical assessment of cognitive function and mood is very important because cognitive impairment and depression commonly coexist in the elderly. The elderly interacts with the other family members, so cognitive im-pairment of the elderly influence family function. The objectives of this study were to delin-eate the factors correlated with cognitive function and to explore the relationship of depres-sion and family function with cognitive function.

Methods : This study was done during 20 day period from July to August, 1996. The subjects were home residents aged 60 years or more living in a subcounty of Kyungpook Province, Korea. The final analysis included 195 subjects(male 95 female 100). The questio-nnaire included sociodemographic data, MMSE-K(Korean version of Mini-Mental State Ex-amination) for evaluation of cognitive function, BDI for evaluation of depression and family APGAR score for evaluation of family function. The results were analyzed ny descriptive, comparative and correlative analysis.

Results : Mean MMSE-K score was 25.3±4.3 with female subjects(23.9±4.8) having sig-nificantly higher cognitive impairment when compaired to male subjects(26.6±3.2)(P<0.001). MMSE-K score was associated with gender, age, year of education(P<0.001). BDI and APGAR score(P<0.05). Religion, smoking and alcohol use were not associated with MMSE-K score. The prevalence of dementia by MMSE-K was 9.7% in definite dementia(MMSE-K≤19) and 23.1% with questionable dementia(20≤MMSE-K≤23). In male, the prevalence was 1.1% and 20.0% respectively. In female, the prevalence was 18.0% and 26% respectively, indicating difference between male and female subjects(P<0.001).

Conclusion : In the elderly, female gender, older age and lower educational level were associated with cognitive function impairment. There was a positive correlation between cognitive function and family function. The group with impaired cognitive function had more depression than the normal group.

Background
: Rapid progress in medical science and technology has lengthened the average span of life in general population and accelerated the increase in the elderly. This gave rise to the expansion of chronic degenerative disease in the elderly, and then led to an increase in the utilization rate of health care facility and medical fee in sequence.

Methods : In order to grope for an effective control program of chronic degenerative disease and to find out the characteristics of disease structure and uilization patterns of health care fa-cility in the elderly, the author analysed the 6,072,196 cases of insured medical record of Federa-tion of Korean Medical Insurance Societies from January 1st to December 31st of the year 1991.

Results : Essential hypertension(5.94%) is the most common disease in the elderly. And what follows are gastritis and duodenitis(4.29%), acute bronchitis and bronchiolitis(3.68%), acute upper respiratory infection of multiple or unspecified site(3.47%) and diabetes mellitus(3.21%). Twenty most frequent diseases constitute the top 50.27% and one hundred constitute over 85% of all frequency of health care facility utilization. There are different patterns of diseases be-tween two sexes. Pulmonary tuberculosis, chronic liver disease and cirrhosis, malignant neo-plasm of stomach, chronic obstructive pulmonary disease, occlusion of cerebral arteries, sprains and strains of knee and leg, malignant neoplasm of trachea, bronchus and lung, other open wound of head, erythematosquamous dermatosis are more than 1.5 times higher in male by the standardized frequency ratio. There is a significant dissimilarity of disease structure between primary and other types of health care facility, which presents the point of reinforcement in pri-mary care. The author has also noted elderly patients prefer secondary or tertiary health care facility in case of essential hypertension, diabetes mellitus, pulmonary tuberculosis, health failure, duodenal ulcer, chronic liver disease and cirrhosis, funtional gastrointestinal disorder, hyperte-nsive heart disease and chronic obstructive pulmonary disease which seems to be not so critical in most cases.

Conclusion : Patients of chronic degenerative disease tend to pursue the high quality of medical care and irregularly utilize health care delivery system.

Background
: Menopause leads to rapid bone loss, mainly as a result estrogen deficie-ncy and peri and postmenopausal symptoms are related with estrogen deficiency. We inve-stigated the relationship between peri and postmenopausal symptoms and vertebral bone mineral density(BMD).

Methods : Study subjects were women aged above 40 years underwent a vertebral bone density measurement with dual energy x-ray absorptiometry(DEXA). We examined the re-lationship between the menopausal symptoms by Kupperman index including vasomotor symptom and vertebral BMD in 74 perimenopausal and 205 postmenopausal women.

Results : On the basis of vertebral fracture threshold, 169 subjects were osteoporotic group and the others were nonosteoporotic group. Menopausal index was significantly high in osteoporotic group. And the osteoporotic one also complained of vasomotor symptom more severely. Theses findings were more definite during perimenopausal and early post-menopausal periods than late period.

Conclusion : The results suggest that menopausal symptoms of peri and early menopau-sal period are significantly related with vertebral bone loss and helpful in predicting the vertebral osteoporosis.

Background
: Musculoskeletal symptoms, such as pain, numbness, and ganglions on involved joints were common problems in repetitive job workers, who exposed to prolonged, repetitive use of the wrist in factory. This study was performed to compare the degree of musculoskeletal symptoms and prevalence of soft tissue mass (esp. ganglion on wrist) in repetitive job group with those of non-repetitive job group and to evaluate the association of development of ganli-on and the duration of wrist use.

Methods : Study subjects were 253 workers who work on a brick manufacturing factory and they were composed of 153 non-repetitive job workers and 100 repetitive job workers. Authors conducted a questionnaire survey among workers in the factory and examined their lesions.

Results : There were no significant difference statistically in age, level of education and work duration in both groups. It was statistically significant that the degree of wrist use was more frequent in repetitive job group than in non-repetitive job group(P<0.01). Musculoskeletal symptoms, such as pain and numbness on affected joints were more common in repetitive job group than in non-repetitive job group. Affected side was bilateral in three joints and right only in two joints(P<0.01, P<0.05). The prevalence of ganglions in repetitive job group(6 subjects, 6.0%) was much higher statistically than that in the non-repetitive job group(2 subjects, 1.3%). In a comparison of two groups according to the existence of ganglions, no stasistically signifi-cant differences were found in age, level of education and work duration. However, duration of wrist use was statistically significant relation with development of wrist ganglions(P<0.05). The 8 subjects with ganglion on wrist all worked manufacturing part in the factory. The duration of work ranged from two to fourteen years. The affected sides of ganglions on wrist were right In 3 cases and left in 5 cases. Size of ganglions ranged from 0.5 to 3 cm in diameter. Painful symptom in the ganglion was complained by two cases(25%) among 8 cases.

Conclusion : We suggest that prolonged, repetitive activities such as carrying a brick, have tendency to develop musculoskeletal symptoms and ganglions in the workers. Because high prevalence of ganglions in this factory seems to be an importnt occupational problem among repetitive job workers, further studies on the factors contributing to development of ganglions in this factory are needed.