Background
: Life expectancy is ever increasing due to medical advancements, but cancer death rate is also increased. Quality of life is an important issue in cancer patients. Despite developments of early diagnosis and treatments for cancer, the medical costs is increasing due to extended survival against cancer and the absolute numbers of terminal cancer patients. We assessed the medical costs and quality of life in terminal cancer patients by the types of medical facilities, which would contribute to effective management.
Method: A total 159 patients (males 70, females 89) with terminal cancer patients who were treated and died in various types of medical facilities(home hospice, charity hospital hospice unit, university hospital hospice unit, university hospital non-hospice unit) between November 1, 1997 and January 31, 1999 were included in the study. After the confirmation that the demographic factors correlated with factors of quality of life, the differences in the medical costs and quality of life(pain, depression, ADLs, family APGAR score) during the last 1 week of life in the various types of medical facilities analyzed by multi-way ANOVA with interaction of the significant demographic factors.

Results : The mean cost of types of medical facilities during the last week of patients as 65,332.5 won in charity hospital hospice unit, 105,165.5 won in home hospice, 702,083.4 won in university hospital hospice unit, and 1,037,358.6 won in university hospital non-hospice unit. The difference between free hospital hospice unit and home hospice in medical costs as not statistically significant, but the difference among charity hospital hospice unit and home hospice, university hospital hospice unit, and university hospital non-hospice unit as significant (p<0.001). The demographical factors of quality of life in terms of pain, depression, ADLs, and family APGAR score were compared among various facilities. The ADL score of home hospice was 8.2±3.3, which was lower than free hospital hospice unit and university hospital hospice unit(p<0.05). The mean pain score of home hospice as 1.7±1.7 and that of university hospital hospice as 1.2±1.2, and pain scores of home hospice were lower than free hospital hospice unit, and pain scores of university hospital hospice were lower than free hospital hospice unit and university hospital non-hospice unit(p<0.05). In depressions categorical scale of home hospice the score was 4.8±1.3, which was higher than those of free hospital hospice unit and university hospital non-hispice unit(p<0.05), signifying less depression. The family APGAR score was statistically insignificant among various types of medical facilities.

Conclusion : The cost of hospice care is less than the non-hospice care. We found that the patients of home hospice experienced less pain and depression even with low ADLs, and increased the quality of life in both psychological and physical aspects.

Background
: Women smoker faces increased risk for heart disease, stroke, cancers, and respiratory diseases as well as a number of gender specific risks. Maternal smoking has been linked to harmful effects on their offspring such as increased incidence of premature, stillbirth and sudden infant death syndrome, etc. Recently, the rate of female adolescent smoking in Korea is increasing, and the rate of adult woman has expected to increase. This study is aimed at obtaining basic information about smoking patterns and factors associated with smoking in Korean adult women.

Methods : From May 1995 to April 1999, a self-administered questionnaire was distributed to the female visitors of Health Promotion Center in Seoul National university hospital. The number of smokes was 492. The control group(984 nonsmokers) was selected by 1:2 age group matched random sampling. Smokers and control group were divided into three age group-young age(20-39 years), middle age(40-59 years), old age(60 years and over) - and analyzed the results using SPSS and EpiInfo software.

Results : The most frequent amount of cigarette smoking was below 10 cigarettes in all age groups. The duration of smoking was below 10 years in most young and middle age groups. In the old age group the duration of smoking was longer than others. Variables positively associated with smoking included alcohol drinking, being engaged in trade service, being unmarried or divorced or separated or parted for ever, high stress status, dissatisfation of life in young age group. The variable of no exercise was added to them in middle age group. In old age group alcohol drinking, no exercise, no school education were the positive meaningful factors associated with smoking in multivariant logistic regression analysis.

Conclusion : The modifiable variables associated with smoking in Korean adult women include alcohol drinking, high stress status, dissatisfaction of life and no exercise.

Background
: Since recent economic crises (IMF) in Korea, the number of new homeless is increasing(that is, ‘IMF style homeless’). There are only few studies on the health problem of this uniquely formed population. We have attempted to estimate the problem of health behavior and health status of this population.

Methods : Some homeless who agreed to enter the asylum during the winter were taken for medical check-up in Sunbuk Community Health Center from November to December, 1998. The participants filled up a self-reported questionnaire and physical examination, laboratory test, and chest x-ray were performed.

Results : Among ‘IMF style homeless’, the prevalence of hypertension(30.9% in primary screening, 7.3% in secondary screening), diabetes mellitus(9.4% in primary screening, 3.5% in secondary screening), syphilis(7.3%), and hepatitis B antigen carrier(5.3%) was higher than among the general population. But we could not find statistical difference according to the duration of homelessness. We found higher smoking rate and higher alcohol drinking amount per week in homeless than in the general population. The amount of alcohol drinking per week larger among those who had been homeless for more than 3 months (p<0.01).

Conclusion : The prevalence of chronic diseases in homeless was higher than in the general population, but statistical difference according to the duration of homelessness could not be found. The longer the duration of homelessness, the larger the amount of alcohol drinkin was seeing.

Background
: The purpose of this survey was to assess knowledge of the public on family medicine through the analysis of medical counseling by PC communication and compare them with that of internal medicine.

Methods : This survey analyzed the content of medical counseling by PC communication according to ICPC from Oct. 1996 to Jun. 1998. The survey was done by means of E-mail in Nownuri eyes and the selected medical departments were those of family medicine and internal medicine in Pusan National University Hospital.

Results : The total number of questions was 342, including 181 in the department of family medicine and 161 in internal medicine. In the analysis of medical counseling according to ICPC, there was a significant difference between family medicine and internal medicine in the reasons for questions by components(P<0.001). In family medicine, the reasons were symptoms, complaints(66.9%), diagnoses, diseases(18.8%), treatment, procedure, medication(17.2%), and diagnostic, screening, prevention(5.5%). In internal medicine, the reasons for questions were symptoms, complaints(64.6%), diagnoses, diseases(21.1%), treatment, procedure, medication(9.3%), and test results(4.3%).
There was a significant difference between family medicine and internal medicine in the questions by chapters(P<0.05). In family medicine, the questions about digestive system were 28 cases(15.5%), neurological system were 26 cases(14.4%), musculoskeletal system were 25 cases(13.8%), and unspecified were 25 cases(13.8%). In internal medicine, the questions about digestive system were 76 cases(47.2%), circulatory system were 21 cases(13.0%), and respiratory system were 15 cases(9.3%). The most common symptom was headache in family medicine and generalized abdominal pain in internal medicine.

Conclusion : There were significant differences in the age distribution, the reasons for questions, and the contents of questions between family medicine and internal medicine.

Background
: Overt hyperthyroidism is a well-known cause of secondary hyperlipidemia and atherosclerosis. However, there have been some dissenting report of abnormalities and in serum lipid concentration in patients with subclinical hypothyroidism. We have attempted to analyze serum lipid concentrations to investigate whether they are increased in patients with subclinical hypothyroidism and to see if there is a correlation between serum LDL-C and TSH concentrations.

Methods : Serum lipid profiles(total cholesterol, triglycerides, LDL-C, HDL-C) of patients with subclinical hypothyroidism (M/F=7/119) compared with age, sex and body mass index matched control subject(M/F=14/239) from Jan. 1. 1996. to Dec. 30. 1997.

Results : There were no significant differences of serum total cholesterol, LDL cholesterol, TG, and HDL concentrations in 126 patients with subclinical hypothyroidism and 253 control subjects(178.47±35.76mg/Dl vs. 173.05±35.963mg/Dl ; 113.33±52.89mg/Dl vs.117.64±68.70mg/Dl ; 112.89±33.25mg/dL vs 109.65±29.02mg/Dl ; 48.60±11.34mg/Dl vs 46.51±11.73mg/Dl). There was no correlation between LDL cholesterol and TSH concentrations in subclinical hypothyroidism(r=0.29, p<0.05).

Conclusion : Serum lipid concentration(total cholesterol, LDL cholesterol, and TG, HDL) was not increased in patients with subclinical hypothyroidism. There was no correlation between serum LDL and TSH levels in patients with subclinical hypothyroidism.

Background
: Korean health related Quality of Life Scale(KQOLS) was developed to measure the quality of life reflecting Korean’s own language expression and culture. In order to confide in the results of KQOLS, it is necessary to establish verification of the psychometric properties(reliability, validity, responsiveness).

Methods : KQOLS’s final 46 items and item option responses were established by expert panels. Reliability was tested by 2 weeks test-retest method and internal consistency methods. Validity was tested by factor analysis and clinical validity. Sensitivity and specificity for detecting treatment-related changes were also tested.

Results : A high degree of internal consistency was observed for each of domains(Cronbach’s alpha value of 0.77 or higher). Two weeks test-retest reliability correlation coefficients scores were highly significant except health perception domain. A principal components analysis identified 9 factors with eight values greater than 1.0 which were approximately the same as intended domains. Normal control group had statistically significant higher scores than patients group except in spiritual health and social function domains. Improved group of patients had statistically significant higher scores than non-improve group of patients after treatment except in spiritual health and health status perception domains.

Conclusion : Korean health related Quality of Life Scale(KQOLS) is both a valid and a reliable instrument, but fine refinements such as items revision and item response options modification will be needed.

Background
: Epidemiologic studies indicate that the central fat distribution rather than obesity itself may be an independent predictor for cardiovascular disease and metabolic disorders. The purpose of this study was to investigate the significance of waist circumference as index of central obesity and to investigate waist circumference as a measure for increased risk of cardiovascular disease in Korean adults using the ROC curve.

Methods : Four hundred seventy six subjects (339 men and 137 women) were included for this study. Subjects were selected among patients who visited the Health Promotion Center of Yeungnam University Hospital for general health evaluation from January to June 1999. Self-reported questionnaire of socioeconomic, health and lifestyle were recorded followed by measurement of higher, weight, waist and hip circumference, percent body fat, blood pressure, blood chemistry. We analysed best cut-off point of waist circumference for those with highest sensitivity and specificity of cardiovascular risk factors using the ROC curve.

Results : Waist circumference was related with blood pressure, total cholesterol, HDL and LDL cholesterol, triglyceride, but not with glucose in men. In women, waist circumference was related with blood pressure, glucose, total cholesterol, triglyceride, but not with HDL and LDL cholesterol.
Waist circumference at risk of cardiovascular disease seems different in Koreans compared to those of Caucasians. ROC curves showed that 84cm in men(sensitivity and specificity were 66.4% and 58.7%) and 78cm (Sensitivity and specificity were 78.3% and 53.4%) in women were useful in identifying those with at least one risk factors. There were some differences according to disease, age, smoking state, and alcohol intake. Cut-off point of waist circumference with at least one risk factor was about 3cm higher in age over 45years men, age over 55 years or postmenopausal women, smoker, and alcoholics

Conclusion : Measurement of waist circumference 84cm in men and 78cm in women could be adopted as a simple index for health promotion, to alert those at risk of cardiovascular disease, and as a guide to risk avoidance by self-weight management in Korea.

Background
: With proper management, hypertensive patients can maintain their health and prevent complications. But poor compliance is a main problem for management of hypertension. This study was designed to investigate the reasons among hypertensive patients who did not initiate antihypertensive medication despite recommendations.

Methods : Questionnaires were used for hypertensive patients who visited a health care center and an outpatient clinic of family department in a university hospital, from March to July, 1998. The non-medicated (noncompliant) group were those who had not taken antihypertensive drug at all with high blood pressure (higher than 160mmHg at systolic, or 100mmHg at diastolic phase initially and hypertensive range on the follow up), despite doctor’s recommendations. The medicated(compliant) group were those hypertensive patients who had taken antihypertensive drug well and visited the clinic regularly at least for 9 months during the recent 12 months.

Results : The total number of the noncompliant was 65, and the compliant 57. The mean age of the noncompliant was 50.8 and the compliant 58.0 years old. The mean blood pressure in the noncompliant was 162.6/106.6mmHg, higher than in the compliant 138.1/85.7mmHg. The main reasons refusing antihypertensive drug were fearful feeling for ‘lifelong medication’ (47.7%), followed by complications form drugs(30.8%). The reason for delaying treatment with antihypertensive drug is that the noncompliant showed more tendency to think ‘It would be the same’, or ‘better than starting medication early’ than the compliant. For the complications from drugs, 59.5% of the noncompliant answered. ‘I’m not sure, but it’ll be not good’, and those who answered ‘it’ll be not bad to have medication’ seemed to be less than in the noncompliant.

Conclusion : The patients who had been recommended but did not start on medication had less knowledge about the benefits of medication. We can assume that they are refusing antihypertensive because of their excessive anxiety about complications of and lifelong medication.