Background
: Rubella is a viral infection of childhood. Its clinical manifestations are not serious, but rubella in early pregnancy can result in congenital rubella syndrome. In Korea, there have been several rubella outbreaks in 1996. We performed an epidemiological study about a rubella outbreak in middle and high school students in an isolated small town.

Methods : This study was carried out from March 22, 1996 to April 29, 1996. The target populations were middle and high school students(middle school-1,269, high school-966 students) in Namseonri. They were given a questionnaire containing sociodemographic characteristics, past vaccination history and rubella-like symptoms. We selected 70 clinically diagnosed patients and 233 students with rubella-like symptoms from the questionnaires. Through IgM and IgG ELISA, we analyzed the serum of selected students. All of the middle and high school students except those with clinical rubella were vaccinated on March 27.

Results : 1) The number of IgM positive students was 65 among 303 selected students. 58 students among the IgM positive group were diagnosed clinically, and 7 patients had subclinical infection. 2) Male patients were more predominant than female, especially in high school(M:F, 2:1 in middle school, 7:1 in high school). 3) Positive rates of IgG gradually increased by grade from 58.3% to 92.9%(1st grade of middle school to 3rd grade of high school). 4) IgG titer of the booster vaccinees(2nd and 3rd grade female, high school) was significantly higher than younger female students(p<.05). 5) After mass vaccination, 3 more patients caught rubella in high school during 1 month follow-up.

Conclusion : Among 2335 students, IgM positive patients were 65 with incidence rate of 2.8%. Mass vaccination of the students is an effective preventive method in a rubella outbreak.

Background
: Post-Herpetic Neuralgia(PHN) is the most common and serious complication of herpes zoster(H-Z). Especially in the elderly, intractable chronic pain is caused by PHN and it affects the quality of life severely. The study examined the predictive factors of PHN for its prevention and treatment.

Methods : 691 cases of patients with herpes zoster who visited department of dermatology were studied of Kwang Ju Christian Hospital during the five years from Jan. 1991 to Dec. 1995. Retrospective chart review was used to compare occurrence of PHN according to age, sex, residential area of patients, inpatients of outpatients status, nerve dermatome, interval of treatment, methods of treatment, associated conditions and duration of PHN. The authors compared the incidence of patients with PHN and patients with H-Z according to above variables. For statistical analysis, we used chi-square and t-test through SPSS/PC+(P<0.05).

Results : The incidence of PHN was 22.9%(158/691) and increased with age. The incidence of patients under 60 years of age was 16.5%, more than 60 was 30.7%(P<0.05). There was no statistical significance concerning sex, residential area of patients, methods of treatment, associated conditions in the incidence of PHN compared to patients with H-Z. The significant difference in the incidence of PHN was shown between inpatients and outpatients status(20.5%, 27.3% respectively)(P<0.05). Anatomical site of PHN of the highest incidence was the opthalmic branch of trigeminal nerve(27.1%), followed by cervical(26.0%), thoracic(24.4%) and sacral(22.2%) in order of sequence. Associated conditions or diseases of PHN were observed in 80 patients(24.7%) including hypertension(39.5%), tuberculosis(39.3%), malignancy(34.5%), COPD(33.3%), chronic hepatitis(22.7%), DM(15.4%). The interval between the onset of H-Z and the initiation of treatment showed that significant difference in the incidence of PHN was on the fourth day with less than and more than 4 days showing 18.5% : 25.1% respectively(P<0.05).

Conclusion : The important factors affecting the incidence of PHN were interval between the onset of H-Z and the initiation of treatment, age and inpatients or outpatients status. The methods of treatment(acyclovir or steroid), sex, residential area of patients, associated conditions and nerve distribution were not significant factors.

Background
: Medical dispute is increasing and its effect on society is serious, but reasonable settlement system is absent. Nevertheless patients and families choose medical dispute. But there is little research on patients and their families who choose to settle by medical dispute. Therefore this study examines the impact of medical malpractice to patients and their families and their reasons for choosing medical dispute after mishap.

Methods : Data were collected from 234 subjects who inquired of Medical Malpractice Family Association about malpractice suit. Questionnaire was composed of demographic characteristics, characteristics of hospital, characteristics of medical malpractice, degree of satisfaction with explanation and attitude of the treating doctor, effect of medical malpractice on patients' life and reasons that patients and their families choose to settle by medical dispute. Factor analysis with varimax rotation was carried out to reduce the reasons to a smaller number of clearly interpretable factors. Multiple regression analysis was carried out to identify the variables relevant to these main themes.

Results : Degree of satisfaction with doctor's explanation and attitude was less than 10%. Over 60% of respondents stated that medical malpractice seriously affected their lives. Four main themes emerged from the factor analysis of reasons for dispute which includes dissatisfaction with doctor's attitude, wanting to prevent similar incident in the future, call to account, and compensation. The relative importance in the order of frequency was wanting to prevent similar incident in the future, dissatisfaction with doctor's attitude, call to account, followed by compensation. Multiple regression analysis was used to identify the variables relevant to these four main themes. Clinical specialty group and degree of satisfaction on attitude were significantly associated with the dissatisfaction with doctor's attitude. Clinical specialty group, patient's condition, effect of medical malpractice on life and degree of satisfaction on attitude were significantly associated with the call to account. Academic career, clinical speciality group, patient's condition, effect of medical malpractice on life and degree of satisfaction on attitude were significantly associated with the compensation.

Conclusion : From the above results, the reasons patients and their families choose to settle by medical dispute were diverse and associated with demographic characteristics, doctor's attitude, effect of mishap on life, et. al.

Background
: Recent increase in use of the periodic health screening is due to a concern for health. But study of patient's compliance with recommended periodic health screening has not yet been conducted. This study was accomplished to clarify which aspect to be considered in order to increase patient's compliance after health screening.

Methods : This study was done from March 3 to May 15 in 1997 by Hanil health care center. Among 370 workers in a state-run corporation who received health screening two years ago, 170 men were advised to receive and additional laboratory test or treatment at the time. They were asked to fill out a questionnaire and were interviewed by doctors to evaluate their compliance. 162 of 170 patients(95.3%) were enrolled in the study, except 8 patients who did not answer the questionnaire.

Results : The mean age of patients was 54 years. Most of them were technicians and managers, graduated from high school or higher, and had an annual income of at least 35,000,000. The disease of requiring an additional test or treatment were in the order of liver disease, hypertension, gastrointestinal disease, urologic disease and abnormal urinalysis. 68 patients(42%) were compliant and 94 patients(58%) were noncompliant. For reasons of noncompliance, 27 patients(28.7%) answered "because I had no symptoms", 20 patients(21.2%) answered "because I didn't think I needed the test or the treatment" and 12 patients(12.7%) answered "because I was busy". The factors influencing compliance were analyzed through chi-square or Fisher's exact test. Their compliance was highly related to the patients' insight into the necessity of the test, the existing disease, and the reporting method of the health screening results. It was not associated with the patients' feeling about their health status, the health behaviors such as smoking and drinking, occupational factors, distance from thire homes to the hospital, or the presence of a hospital near home for those who didn't live in Seoul. The independent effect of the factors influencing the compliance was evaluated by means of stratified analysis. The only independent factor associated with the compliance was the patients' insight. The compliance according to diseases was higher than average in hypertension, liver disease, diabetes mellitus and urologic disease, and lower than average in pulmonary disease, gastrointestinal disease, thyroid disease, cardiac disease, opthalmologic disease and abnormal urinalysis.

Conclusion : The most influencing factor related to compliance was the patient's insight into the necessity of the further testing. We should consider a proper way to increase compliance on health screening. Direct counseling, if possible, is recommended following health screening and way to increase patient's compliance utilising mail report as another.

Background
: Family physicians in their on primary practice frequently encounters patients with fever, which is one of the common symptoms. Fever is an important symptom and can occur in mild disease, common cold, influenza, acute pharyngotonsillitis or can originate from a particular severe disease, such as bacterial endocarditis, malignant lymphoma and SLE, which need more aggressive management. Therefore, we studied patients who were admitted with short-term fever or long-term fever to find out their causes of febrile diseases and to compare the differences with previous other studies.

Methods : 601 patients with fever above 37.2 degree centigrade or those who were transferred from other hospitals due to long-term fever were enrolled from Jan. 1991 to Jun. 1997. Patients' medical records were reviewed and classified according to disease, sex, age. Srandardization of Petersdorf's rule for F.U.O. was used.

Results : 601 patients were randomly selected among which 301 were males and 300 females. Males were 147 and females 147 young adult patients as compared to 154 males and 153 females were elderly patients. According to disease category, the number of infections, connective tissue diseases, neoplastic diseases and other diseases were 442(73.5%), 14(2.3%), 87(14.5%) and 21(3.5%), respectively. The number of diseases of undetermined case was 37(6.2%). The most frequent disease was pneumonia with 103(31.1%). UTI and tuberculosis were the 2nd and 3rd most common diseases. The total number of F.U.O. patients was 82(13.6%). According to the disease categories there were 29(35.4%) in infections, 2(2.4%) in connective tissue diseases, 12(14.6%) in neoplasms, 2(2.4%) in others and 37(45.2%) in unknown origin. The most common disease in the classification of sex and age of F.U.O. was infections and tubrculosis.

Conclusion : In the clinical study of febrile patients admitted from Jan. 1991 to Jun. 1997 through medical record review, the disease category in the order of frequency was infection, neoplasm, connective tissue disease and the distribution of F.U.O was same result. In comparison with other study, the order of connective tissue disease and neoplasm was different in other hospital study but same result was taken in comparison with Petersdorf's study.

Background
: Smoking is a very dangerous behavior and people know that it will lead to fatal health problems. But many people continue to smoke. We studied psychiatric aspect of smoking.

Methods : We distributed self-questionnaire to people who visited Dong-San Medical Hospital for periodical examination and checkups between the months of April and June, 1996. It consisted of inquiries on their smoking status and symptom check list for minor psychiatric disorders(SCL-MPD). Among the total of 147 men 58 were current smokers, 63 non-smokers, 26 ex-smokers. We compared minor psychiatric differences between each groups by Student t-test.

Results : The mean age of current smokers, ex-smokers and non-smokers were 44.9±8.9, 44.8±8.4 and 46.6±9.6, respectively. Among 10 dimensions of SCL-MPD, the smokers (includes current smokers and ex-smokers) had significantly higher scores on anger-hostility, interpersonal sensitivity and obsessive-compulsive dimensions than those of non-smokers(P<0.05). When comparing with current smokers and non-smokers, current smokers had significantly higher scores on anger-hostility and obsessive-compulsive dimensions(P<0.05). Between ex-smokers and non-smokers, ex-smokers had significantly higher scores on anger-hostility and obsessive-compulsive dimensions(P<0.05). But, no significant differences were observed between current smokers and ex-smokers.

Conclusion : Smokers(current smokers and ex-smokers) were highly associated with anger-hostility, interpersonal sensitivity and obsessive-compulsive disorders compared to non-smokers. But, no minor psychiatric differences were observed between current smokers and ex-smokers.