Background
: In the Republic of Korea, there had been no reports about indigenous malaria cases since 1984 until a vivax malaria cases was detected in 1993. Thereafter from 1993 to 1996, 486 malaria cases were reported. Most of the patients were soldiers in the northern militarized zone. However, since 1997, several patients with malaria were detected in Kang Hwa where there had previously been no report of malaria cases. It is our intent to report the 16 cases diagnosed in Kang Community Hospital from January 1, 1997 to August 10, 1998.

Methods : Medical records of the malaria cases from January 1, 1997, to August 10, 1998 in Kang Hwa community Hospital were reviewed. All of the patients had no histories of traveling abroad, drug abuse or blood transfusion. They were all civilians. Laboratory studies including blood cell count, routine chemistry and platelet-associated IgG(PAIgG) and abdominal sonography were taken.

Results : All of the patients were diagnosed with malaria by blood smears. Common symptoms were fever(100%), headache(94%), rigors(81%), myalgia(56%), nausea or vomiting(44%), alternate day fever(25%), left flank pain(19%), diarrhea(13%), and abdominal pain(13%). Splenomegaly was detected in 92% of cases by sonography. Laboratory findings included leukopenia(37.5%), anemia(37.5%) and thrombocytopenia(81.3%). Platelet-associated IgG was elevated in 1 of 5 thrombocytopenic patients who had the laboratory study performed. All recovered without complications.

Conclusion : Cases of indigenous malaria have been progressively increasing in the Republic of Korea. Fortunately, patients responded well to treatment, but continued interest will be required in the future.

Background
: Recently, childhood obesity has been increasing steeply. many obese children have complications and high risks to become obese as adults. Therefore, we performed this study to assess childhood obesity in Kwangju area.

Methods : We examined 11,039 children (boys: 5,547, girls: 5,492) of ages 6-12 years. We defined obesity as more than 97th percentile of weight at each height. We also examined the degree of obesity by comparing with standard weight, which is defined as more than 20% above the standard weight for height. We identified four groups according to the degree of obesity. The ranges for each group was as follows : obesity at from 20% above the standard weight for height, mild obesity at 30% below and 20% above the standard weight for height, and moderate obesity at 50% below and 30% above the standard weight for height, and severe obesity at 50% above the standard weight for height.

Results : The prevalence of obesity that exceeded the weight centiles at each height by more than 97th percentile was 12.17%. The prevalence of obesity that exceeded the standard weight for height by more than 20% was 13.31%. Among them, 8.02% were mild obesity, 4.44% were moderate obesity and 0.84% were severe obesity.

Conclusion : Recently, the frequency of childhood obesity goes high in our society. We now know that obesity is a risk factor for some diseases, and therefore, more effective approaches should be developed treat and prevent childhood obesity.

Background
: The expansion and strengthening of primary care is approved as the only method to revise the ineffective health care system in Korea. In such a system, we intended to analyze the functional and regional distribution of specialists by investigating and classifying the hospitals where residents who completed their training in a university hospital located in Seoul for seven years are working and by acquiring the distribution of the subjects who are practicing as primary care physicians by year, specialties and location.

Methods : We selected 384 specialists, all of whom were trained as residents at a university hospital located in Seoul from 1987 to 1993. The hospitals they worked at were classified as primary, secondary and tertiary care hospitals according to the classification in the health care administration. The location of primary care hospitals among them was plotted on two maps; one of Seoul, the other of Korea.

Results : The number of females in the subjects was 68(17.%) and that of males 316(82.3%). The number of practitioners was 156(40.6%) and that of specialists working at the secondary care hospitals was 55(14.3%), and 147 specialists were working at the tertiary care hospitals(38.3%). With regard to the percentage of practitioners, dermatologic specialists presented with 60%, and relatively high group included obstetrics & gynecology(59.2%), family medicine(54.5%), plastic surgery(52.6%), otolaryngology(52.0%), pediatrics(51.7%), and orthopedics(48.6%). In tertiary care hospitals, chest surgery showed 72.7% as highest. Radiologic oncology presented with 66.7% and anatomical pathology with 66.7%. As to the location of primary care hospitals, 41.0% were in Seoul and 38.5% in Kyungkido. And the rest of the 20.5% were located in other areas of Koreas.

Conclusion : Considering the results of the study that show a great number of specialists are actually practicing as primary care physicians after their specialists' training, the present training system of spe-cialists needs to be revised and controlled in structure.

Background
: Obesity is not only one of the risk factors that affects the prevalence and aggravation of chronic diseases, but is also the cause of social unfitness because slimness has become a standard of beauty. We surveyed on the satisfaction about self body image, the factors which are related to it and weight control behavior of the adolescents in a local area of Korea. Methods : The survey was performed in a high school of Pocheon on August, 1996. Five classes out of 14 classes in 1st and 2nd grade were selected. The body mass index(BMI) was calculated from the measured height and weight. The satisfaction about body image which was estimated by the difference between present body image and wanted body image in 9 graded figures of body image was obtained from the questionnaire. The information about sex, religion, history of being teased about body image, body image of their parents, mean duration of watching TV in a day, body esteem, and binge-eating was obtained from the questionnaire and we evaluated the relationship between all of the above with BMI and body image satisfaction. We also investigated on the interest in education about weight control and efforts made by adolescents from the questionnaire on weight control behavior. Results : Total of224 students participated in this study and only 14.7% of them were satisfied with their body image. 58.9% wanted weight reduction and 26.4% wanted weight gain. They were more dis-satisfied with their body image when they were girls(p<0.01), had the experience of being teased about their body image(p<0.01), had low body esteem(p<0.01), and had high BMI(p<0.01). We could not find statistically significant relationship between body image satisfaction and other factors such as religion, the duration of watching TV in a day, the body image of their parents and binge eating. 64.3% of the subjects tried to control their weight and most(87.5%) tried to lose wight. The selected methods were diet control(65.3%) and exercise(52.1%) and the most preferred method of diet control was skipping meals(45.7%). Conclusion : Most of adolescents were not satisfied with their body image and this dissatisfaction was related to gender, history of being teased about their body image, BMI, and body esteem. Many of them had tried to lose weight and among the methods of weight reduction, there behaviors that were injurious to their health and growth.

Background
: Current research indicates that smoking among young adults tends to persist into later life. Furthermore, numerous studies have proven the harmful effects of female smoking on their offspring. These trends have produced a wide variety of(social, medical and economic) problems. This study is aimed at obtaining basic information to help prevent potential smokers from trying their first cigarette as well as to instruct to stop smoking. This study involves the following:1) investigating general factors affecting the smoking status of college students in addition to the deterents to smoking b) seeking to understand the familial influence on smoking status c) researching how smokers, exsmokers and nonsmokers perceive their familial influence on their smoking status.

Methods : In June 1998, a self-administered questionnaire was distributed to 800 students of two junior colleges by random sampling in Po'hang. 720 were returned and 642 displayed adequate responses. The questionnaires were analyzed using SPSS and EXCEL software.

Results : Among the total of 642 subjects studied, 220 were males(34.3%) and 422 females(65.7%). Of the male subjects 149(67%) were smokers, 64(21%) were ex-smokers and 25(11.3%) were non-smokers. Of the female subjects 22(5.2%) were smokers, 399(92.9%) were ex-smokers and 11(2.6%) were non-smokers. The number of cigarettes smoked per day was as follows:79 subjects(46.2%) smoked 10-20 cigarettes, 55(33.2%) smoked less than 10 and 37(21.6%) smoked more than a pack of cigarette. When considering the related factors which affect student smoking, it is evident that there is a growing tendency toward smoking among male students when they have close friends who are smokers and who consume alcohol on a weekly basis. About the motives of smoking, there was a significant difference between the following two cases. Those(36.2%) who successfully quit smoking had started to smoke through solicitation by friends, but only 2.7% were successful if they had started to smoke to relieve stress. When it comes to the influence of familial factors on successful versus unsuccessful attempts to quit smoking, the status of family smokers, whether or not smokers made their habit obvious to family members an whether or not the family allowed smoking did not have any noticeable statistical difference between continuation of smoking and smoking cessation. However there was an obvious difference among ex-smokers, non-smokers and smokers when they responded as to whether or not their family had an effect on smoking status and smoking cessation: ex-smokers(38.4%), non-smokers(30.6%) and smokers(17.0%).

Conclusion : In the light of the related factors attributed to the continuation of smoking in this study, it was revealed that there was a higher possibility of current smoking when the subjects were a male and have close friends who smoked and had a higher of average alcohol consumption. This study also indicated that the continued smoking rate was higher among individuals who started smoking because of stress than those who began smoking as a result of peer pressure. There was no significant relationship between smoking status and familial influence on smoking cessation between smokers an ex-smokers, but ex-smokers and non-smokers had more awarness of familial influence than smokers.

Background
: Physicians who provide primary care should be trained specifically to manage the problems encountered in a primary care practice. This study was carried out to know the residents' concerns and problems during outpatient care by analysing case discussions as an outpatient teaching.

Methods : We used 533 records discussed by 3 residents' teams for 1 year. Of discussion contents, symptoms or diseases were classified into codes and chapters using the ICPC (International Classification of Primary Care) coding system and the main topics of discussion into 12 types. We compared data among 3 residents' teams and also between the discussed contents and the diseases of patients who vis-ited a family practice for 1 year. We used relative discussion ratio to compare data.

Results : Of 533 discussed records, 106 kinds of symptoms or diseases were used and the 20 most common kinds accounted for 61.7%. Contents about menopausal symptom/complaint were 47 records(8.8%) and was the most frequent. Digestive part was the most frequent chapter(22.0%). Distribution of discussed main topics were diagnosis(35.5%), medication(26.8%), other treatment(11.6%), followup(5.8%), etc. There was some difference among 3 residents' teams by chapters and topics.
Visiting patients were 3,436 persons with 79 kinds of symptoms and diseases and prior 20 kinds accounted for 86.6%. Visited patients were some what different with the discussed contents by chapters.

Conclusion : Contents of case discussion in ambulatory setting were some what different among each teams and more diverse than the visiting patients. The residents could exchange many informations and find problems during ambulatory care. We think case discussion can be a good method for outpatient teaching.

Background
: It is widely accepted that muscle strength and bone mineral density have a significant positive correlation and most previous literature focus on the association between specific muscle groups and adjacent bones. This study examined the association of grip strength with bone density at distant sited, such as spine and femur area in peri- and postmenopausal women.

Methods : The study subjects were 30 perimenopausal and 108 postmenopausal women aged 40 years and older. Bone mineral density was measured at the lumbar spine and femoral area using dual energy x-ray absorptiometry. Grip strength was measured in both the dominant and nondominant hands using a dynamometer. Other data were gathered from the questionnaire.

Results : Significant negative correlations were noted between spinal and femoral bone mineral density and age and postmenopausal duration, and significant positive correlations were found between spinal and femoral bone mineral density and body weight, height, body mass index and both grip strength. Those who exercised had significantly higher spinal bone mineral density than those who did not and smokers had significantly lower spinal bone density than nonsmokers. There was no significant difference in bone mineral density by estrogen and calcium use. The multiple regression analysis examined the association of grip strength in the dominant hand to bone mineral density after adjustment for the confounding covariates.

Conclusion : Weak grip strength in the dominant hand is a marker for lower bone mineral density in peri- and postmenopausal women. Grip strength can be a useful index of osteoporosis.

Background
: Recently in Korea, the rate of addictive drug abuse is rapidly increasing in men on salary, housewives, and even in adolescents, who have been considered to be free from drugs, which presents a serious problem to the society. Especially, the habituation to gateway drug, such as cigarettes and alcohol, before 15 years old, would lead to the increased possibility of other drug abuse, including illicit drugs. Thereupon in this study, we intended to review the effect of adolescents' smoking on the drug abuse and deviated behaviors.

Methods : On September, 1997, randomly selected were 12 classes, on the basis of 2 classes per grade, from the two schools which was located each in Seoul and Bucheon. And survey was done on 610 students with non-nominal, self-reported questionnaire.

Results : The rate of adolescent smoking was 28.1% in male students and had increasing tendency of "the higher the grades, the higher the smoking rate"(17.0% in the 1st grade, 31.5% in the 2nd grade, 35.9% in the 3rd grade). The smoking rate of female students was 12.3%. From the 2nd grade of middle school to the 2nd grade of high school was the critical period when the smoking habit was initiated in almost 90% of the students. The experiencing rates of drug abuse in studied subjects were as follows : drinking(79.0%), stimulants(4.8%), sedatives(4.1%), hypnotics(3.1%), glue sniffing(1.5%), butane gas(0.7%), marijuana/hemp(0.2%). They were higher in the smoking group than in the nonsmoking group, showing statistical significances in most items except hypnotics and marijuana/hemp. Also similar results were shown in deviated behaviors between the groups.

Conclusion : With the concerted efforts of family, school, society and nation, we as family physicians should make efforts to delay and prevent adolescents' smoking, which is a gateway to drug abuse and deviated behaviors, and to increase people's recognition of health risks caused by smoking, and to provide proper program for adolescents to stop smoking.

Background
: Smoking is the single most considerable factor, which may likely affect one's health most adversely. Therefore, an effective control upon smoking has been the most important issue for all of the practitioners. Furthermore, the latter's concern on the alternative medicine has been steadily mounting these days. Accordingly, a series of clinical group study has been mapped out in order to clarify the effect and the outcome of acupuncture treatment and its rate of success.

Methods : The survey has been conducted from April 7th, 1998 for six months with the voluntary help of 130 students as our study objects, who were the 1st, 2nd and 3rd graders at two metropolitan high-schools in Seoul. A basic questionnaire has been prepared and collected at the first interview. The acupuncture treatment has been alternately administered at each side of ears once a week for the respective object students and the information had been questioned in the survey. When 5 months lapsed with no treatment after the initial four weeks of intensive application, a further follow-up survey was repeated all over again(once every week for 4weeks and another after 6 months). for the analysis of our finding, the SAS V6.12 has been used together with the one was ANOVA test, t-test, and Cochran-Armitage trend test.

Results : Those who managed to stop smoking after the acupuncture treatment of one week, four weeks and six months respectively were found as follows; 2 students(61%), 12 students(37.5%), and 8 students(25%), proving that the success rate for smoking cessation after six months was 25%. Those who decreased their number of smoking more than half were; 13 students(39.4%), 15 students(46.9%), 25 students(75%). The number of withdrawal symptom and the smoking cessation as well as the smoking reduction rate were not found correlated each other. The frequency of their smoking, the frequency of the smoking attempt, the period of their abstinence from smoking, the facts whether their family members of relatives smoked or not, the FTQ(Fagerstrom Tolerance Questionnaire), the frequency of their drinking and the motivation types of smoking(Why test) were found not influential upon the change of smoking tastes and their intensity of smoking wish by the treatment of the auricular acupuncture.

Conclusion : The change of smoking taste and the change on the intensity of smoking wish as the outcome of acupuncture treatment for the stop-smoking has been statistically significant.