Background
: Chronic fatigue is a common symptom in primary care setting in Korea and classified into medically explained and unexplained according to the precipitating factors. The medically explained chronic fatigue may be associated with many well-known physical and psychological conditions and the medically unexplained chronic fatigue is classified into chronic fatigue syndrome and idiopathic chronic fatigue. The chronic fatigue syndrome is an illness that has unknown etiology and severe disabling fatigue and has been known to most physicians and public since mid-1980's. Many researches are ongoing in developed countries, although the pathophysiology and treatment of this syndrome are controversial. But in Korea, the researches for chronic fatigue and the chronic fatigue syndrome are very rare. Our goal was to assess the clinical characteristics of chronic fatigue and the chronic fatigue syndrome in Korea.

Methods : The study subjects were chronic fatigue patients visiting the chronic fatigue clinic in Kangbuk Samsung Hospital from Feb. 1, 1998 to Aug. 31, 1998. After medical history, physical examination, laboratory tests and questionnaire(including fatigue, anxiety and depression scales), the study subjects were classified into the medically explained(psychological disorder and physical disorder group) and unexplained chronic fatigue patient groups(the chronic fatigue syndrome group and idiopathic chronic fatigue group).

Results : The final study subjects were 97 patients(psychological disorder(20), physical disorder(20), idiopathic chronic fatigue(27), chronic fatigue syndrome(30)). Compared to the explained chronic fatigue group, unexplained chronic fatigue group had higher female ratio, lower body mass index, lower blood pressure, higher fatigue scale scores, and the higher prevalence of anxiety and insomnia.

Conclusion : From our results, unexplained chronic fatigue patients had higher fatigue severity and higher prevalence of anxiety and insomnia than the explained chronic fatigue patients. Although there are limitations to generalizing the results of this study(selection bias), it is significant in that it is the first study of the chronic fatigue syndrome in Korea.

Background
: Aging brings organic change and functional decline in men. An example of those functional declines is the functional change of autonomic nervous system, which is usually experienced as having postural hypotension as a typical symptom, and many other related symptoms as well. Thus, in order to study the autonomic dysfunction caused by aging, we surveyed the occurring frequency of postural hypotension and its related symptoms, and investigated the relationship between such symptoms and the influence of external factors, in order care and treat the aged patients.

Methods : 396 people over the age of 65 years who visited the geriatric clinic located in Kwangju Park, during the period from April 1996 to August 1996, were investigated their characteristics, the related symptoms and external factors through interview, and examination to determine the presence of postural hypotension, checking the blood pressure and pulse rate in a recombent position after resting, one minute later when seated and then one minute later when standing. After in put of the data with SPSS/PC+, the statistical analysis was carried out using the Chi-square and t-test.

Results : The 396 subjects consisted of 267 males and 129 females. The 93(23.5%) subjects showed postural hypotension, which appeared to have significant relationship with growing age but no significant relationship with the external factors such as sex, drinking, smoking, disease, medication, etc. However, under the pathological factors like disease and medication, the occurrence of postural hypotension were found to be somewhat high. The most frequent symptoms in order of sequence were postural symptoms(60.6%), impotence(58.8%), incontinence(21.0%), constipation(17.7%), diplopia(17.2%), decreased sweating(12.9%) and swallowing difficulty(7.3%), and all of these symptoms showed the significant relation with growing age. Postural symptoms were significantly related to postural hypotension, but other symptoms were not. And, postural symptoms had significant relationship with cerebrovascular disease. Also, postural symptoms showed the significant relationship with impotence, incontinence, constipation, diplopia and swallowing difficulty, but other symptoms were found to have no such relationship with each other and with external factors.

Conclusion : The aged people generally report symptoms caused by autonomic dysfunction. Especially postural symptoms are the most commonly experienced symptoms and, for the most part, accompanied by other symptoms, thus, the evaluation of autonomic dysfunction, especially on postural hypotension is important. And, since risk factors such as disease and medication influences the occurrence of postural hypotension, it should be appropriately considered when diagnosing and treating aged people. We think that continuous research on other risk factors and study to establish the proper guidelines to assess the autonomic dysfunction should be conducted in the future.

Background
: A good deal of medical information is in circulation with the great advances in communication technology. This study sought to collect and classify a wide variety of data in circulation, to determine the effects of this medical information via PC on people, to see whether people feel that it is useful, and how it can be applied clinically.

Methods : Contents of medical information in circulation were classified and analyzed from domestic PC network including Chollian, Hitel, and Unitel. The survey was conducted with 700 subjects who were given medical counsel through above communication networks between August 1 and September 30, 1997. They were given questionnaires for usefulness of medical information via e-mail and among these, cross-sectional study was made with 336 respondents who were feasible for statistical analysis.

Results : Users of medical information currently in circulation can be roughly classified into general and professional ones. Information for general user can by grouped by its content into one for medical common sense, medical consultation, First Aid, self-diagnosis, medical insurance, drug therapy, medical test interpretation, guide information for hospital and clinic visitors. The survey showed the following responses : PC communication was useful(70.8%), its education efficacy was higher than other measures(62.3%), it helped for the prevention of diseases(59.8%), it was useful in the reduction of medical fee(71.4%), I'll get the web information even if charged(63.1%), it helped for the correction of mistaken medical common sense(58.8%), it helped for the understanding of medical service in a hospital(63.5%).

Conclusion : Practically, PC communication can provide general users medical information in a convenient and useful way. In addition, this information can be helpful in the reduction of medical fee and prevention of diseases, and more effective in patient education than other measures.

Background
: Despite widespread recognition of the hazardous health effects of smoking, adolescent smoking continues increase, emerging as a public health problem. However few studies have focused on smoking cessation programs for adolescent smokers. The purpose of this study was to measure the short-term effects of adolescent smoking cessation program performed by the Seoul School Health Center.

Methods : Four hundred and twenty adolescent smokers referred from their schools form March to December of 1996 were assessed before and immediately after the program with a self-questionnaire. The data acquired from these 420 students was analyzed.

Results : Males were found to have a higher rate of daily smoking as compared with females. Middle school students had an earlier starting age than those of high school students. About 70% of the students had tried to stop smoking and about 1/3 had a high level of self-efficacy in stop smoking. More than 80% of the students were current alcohol drinkers and 10% ever had experience with other drugs. Many showed poor academic performance and low degree of satisfaction with their schools. More than 50% had experienced punishment at school. Middle and high economic status were more common than low status, 73.3% had smokers in their families and 43.3% showed severe dysfunction in family APGAR. Smoking cessation rate immediately after the program was 37.4%, highest in female high school students and lowest in male high school students. Factors shown to be significantly associated with smoking cessation in males were school age, FTQ scores, presence of peer smokers, smoking and alcohol status, self-efficacy in stop smoking and degree of satisfaction with their schools. School age, presence of peer smokers, smoking and other drug use status, self-efficacy in stop smoking, academic performance, degree of satisfaction with their school, experience of runaway from home, economic status and presence of smokers in their families were significant factors in females. Stepwise logistic regression showed that current alcohol users were less likely to succeed in smoking cessation and those with a higher level of self-efficacy in stop smoking were more likely to succeed in males. In females, high school students with higher economic status were more likely to succeed while those with smokers in their families or experience of runaway from home were less likely to succeed.

Conclusion : To promote smoking cessation, specified and risk-based approaches are considered to encourage the motivation of adolescent smokers. For more effectiveness, programs will need to comprehensively include the school, the family, peers, alcohol and other drug issues as well as smoking problem itself.

Background
: Falling in elderly persons can lead to disability, hospitalizations, and premature death. It may also result in a psychological trauma termed fear of falling. Although it has been reported in developed countries that such fear may lead to staying home or other self-restriction of activities with debilitating physical consequences, it has not been studied yet in Korea. So we conducted this study to examine relative frequency of fear of falling and its association with measures of falling, activities of daily-living, depression, frailty in elderly persons living in a home for the aged.

Methods : We conducted a cross-sectional study of a sample of 152 subjects among 163 elders living in a home for the aged in Seoul. Data on demographic and medical characteristics, and cognitive(MMSE-K), functional(ADL, Instrumental ADL), and psychological(GDS-K) functioning, and measures of fall and frailty were obtained during assessments. We asked the subjects whether they had fear of falling in a dichotomous manner.

Results : The incidence of falls in the prior year was 29.6%, and the relative frequency of fear of falling was 57.2%. The variables associated with fear of falling with a statistical significance were as follow; old age(≥80 years), no education, no alcohol drinking, no smoking, use of assistive device, experience with falls and fall with injury in the prior 12 months, any disability in ADL, 3 or more disability in IADL. In a stepwise logistic regression analysis, experience with falls(OR 2.80, 95% CI 1.12-6.97), 3 or more disability in IADL(OR 2.99, 95% CI 1.33-8.78), and no alcohol drinking(OR 3.23, 95% CI 1.36-7.95) were still associated independently with fear of falling.

Conclusion : Fear of falling is common in the institutionalized elderly persons in Korea, and is associated with decreased instrumental activities, recent experience with falls, and no alcohol drinking. Therefore it represents the need for effective intervention to prevent and limit the consequences of falls and fear of falling in elderly persons.

Background
: This study was designed to evaluate medical instruments purchases by Korean family practitioners in private practice. We then proposed guidelines for purchasing equipments for new physicians who are just beginning their private practice.

Methods : A questionnaire was sent to 646 family practitioners managing their private clinics. The questionnaire assessed current medical equipments purchases. They were then asked which instruments they would recommend or discourage others form purchasing. We analysed 123 returned questionnaires(19%).

Results : The number of instruments they have was between 4 to 26, and the average was 13. The most frequently owned items included in descending order: otoscope (89.9%), electrocardiograph(82.5%), ophthalmoscope(78.9%), ultrasound(78%), ultraviolet sterilizer(73.2%) and microscope(69.9%). The instruments they recommended avoiding were sigmoidoscope(27.3%), cryotherapy kit(25%), laser therapy kit(21.1%), thermo-hemorrhoidectomy instrument(20%), and defibrillator (20%). Instruments they recommended purchasing were otoscope(87.0%), elctrocardiograph(83.0%), ultrasound(74.8%), gastrofiberscope(65.9%), ultraviolet sterilizer(63.4%), microscope(57.7%), and plain radiographic unit(<100mA, 56.1%). The most frequent advice given in purchasing medical instruments was "Avoid over(purchasing) at the beginning". Some instruments were different in possession rate according to sex, age, and practice patterns.

Conclusion : This study evaluated medical instruments purchases of Korean family practitioners in private practice. This compiled list may be of benefit to new physicians who are just opening their own clinic.