Background
: A large number of children with psychosocial dysfunction are not recognized within schools or primary care settings. In several research, an incresaing amount of attention has been paid to the importance of low family support as apredictor of psychosocial dysfunction in children. Our study examined the agreement and relationship between the lack of family support as measured by the Family APGAR and child psychosocial dysfunction as screened by the Pediatric Symptom Checklist(PSC). Therefore, We studied the usefulness of Family APGAR as a screening tool of child psychosocial Dysfunction.

Methods : We set 643 children that are engaged in elementary school. We gave a questionnaire to their parents and made them record the questionnaire which contained the sociodemographic date, past history of child and parents, the Family APGAR and the translated Pediatric Symptom Checklist(PSC). Finally, we analysed only 506 complete data. We use the SAS/PC 6.12 that is a statistical analysis program.

Results : Children with a lack of family support (APGAR+) were 5.1 times as likely to receive scores indicating dysfunction on the PSC(PSC+). Families with a lack of support were significantly more likely to report low parental educational achievement and low income. Sixty percent of children from families with a lack of support were identified as having a psychosocial dysfunction by the PSC rating; however, only 24% percent of the children identified with psychosocial dysfunction by the PSC had scores indicating poor family functioning on the Family APGAR. Families with a lack of support had significantly higher total scores on PSC(mean=20.2) than families with adequate support(mean=11.9) the strength of the agreement between the Family APGAR and the PSC was k=.29.

Conclusion : A lack of family support is associated with child psychosocial dysfunction as assessed by the PSC. However, the Family APGAR was not a sensitive measure of child psychosocial dysfunction, and thus it supplements, but does not replace the PSC.

Background
: Ischemic heart disease is the most important cause of the chest pain, and its frequency is increasing enormously. The purpose of this study is to find out the way of early detection and/or ruling out the cardiogenic chest pain by history taking.

Methods : From July 1996 to December 1999, 248 patients visited the chest-pain clinic and took the questionnaire about characteristics of the chest pain. And we found out the diagnosis that caused the chest pain. 46 patients of them were excluded because of the unreliable responses or uncertain diagnosis. So, we compared the characteristics of the chest pain with causes for 202 patients.

Results : The sex ratio of patients was 1.43:1(male:female). The average age was 41.8±14.0 for male and 47.3±14.8 for female. The causes of the chest pain were cardiogenic(23.2%), musculoskeletal(19.3%), psychogenic(14.8%), gastrointestinal(12.4%), and pulmonary disease(6.9%), patients with the past history of diabetes, hypertension, alcohol intake, or angina were more likely to have cardiac disease. Choking (O.R=2.19, C.I=1.08-4.44), splitting(O.R=3.38, C.I=1.24-9.21), or exploding pain (O.R=2.65, C.I=1.02-6.88) was more likely to be originated from cardiac disease. And patients with cardiogenic chest pain aggravated their symptoms by climbing the stairs (O.R=3.47, C.I=1.52-7.90). But, pricking pain(O.R=0.18, C.I=0.04-0.82) or chest pain associated with dyspepsia(O.R=0.16, C.I=0.04-069) was less likely to be originated from cardiac disease.

Conclusion : For detection and/or ruling out the cardiogenic chest pain, we have to check out characteristics of the pain, but also factors that associated with the pain or aggravating the pain.

Background
: Recently, childhood obesity has increased and became a major health concern in Korea. The aim of this study is to measure the prevalence of childhood obesity in rural city and to explore the risk factors of obesity including obesity of parents.

Methods : We made 13 convenience samples of elementary school and attached kindergarten located in Asan-city, ChungNam, in 2001. We surveyed children's height, weight, and risk factors of childhood with a self-recorded questionnaire answered by parents. Children's obesity was evaluated by ideal body weight which is defined as the 50th percentile of weight for Korean children of the same height and sex in 1998. The criteria of parents' obesity was over 25of BMI.

Results : The subjects were 1,558 children among 1870 respondents. The prevalence of childhood obesity was 9.4% and that of male children was 11.0% and that of female children was 7.9%. The older in both male and female, the higher the obesity prevalence was. Mother's age were significantly higher in obese children. Birth weight and family income were also significantly higher in obese children. Birth weight and family income were also significantly higher in obese children. There was a higher family history of obesity in obese children. Risk factors associated with childhood obesity were gender, age of child, mother's age, birth weight, number of siblings, family income, and family history of obesity.

Conclusion : The prevalence of childhood obesity in Asan-city was 9.4%. Children whose father, mother, or parents were obese tended to be obese.

Background
: Medical decisions concerning the prolongation of life. the right to die and euthanasia are among the most extensively discussed issues within medicine and law today. The purpose of this study was to evaluate the attitudes of medical of students and housestaff toward euthanasia.

Methods : From July 15 to september 15 of the 1998, the responses of 180 medical students and 132 housestaff to a self-adbministered questionnaire were analyzed to identify attitudes toward euthanasia. Over 312 respondents about attitudes toward euthanasia, the analysis of differences between proportions was made by the Chi-square test.

Results : About 69.9% of the respondents thought euthanasia should be legalized. The findings suggest that Buddhists (77.5%) and non-religious groups (88.1%) tend to support euthanasia more than Christians. Futhermore, medical students (74.4%) support euthanasia more than housestaffs(63.6%), male(75.1%) more often than female(57.9%). about 73.1% of the respondents said that active euthanasia is not justifiable, and 79.2% said that they do not like performing active euthanasia. In respect to passive euthanasia, 69.0% said that it is not ethically justifiable, but 63.0% would perform this as if it were legal. Housestaffs of internal medicine (76.9%) were more willing to do euthanasia than pediatrics (70.0%), surgery (63.6%), family practice (53.8%) and Ob/Gyn(33.3%).

Conclusion : Respondents have positive attitudes toward legalization of euthanasia.. Most considered that passive euthanasia is not morally justifiable. But if it were legalized, they would still be disturbed by active euthanasia. The opinions of physician and medical students directly affect patient care and their attitudes must be considered if clear plicies are to be developed concerning euthanasia.

Background
: Tobacco health warning labelling as one of the smoking education act has been improved in many countries. But there was no change of tobacco health warning labelling after 1989 in korea. So, for the purpose to help developing new tobacco health warning labelling, we searched the recognition rate of tobacco health warning labelling in family physician and their evaluation of labels which were required form 1976 to 1988, and after 1989 in korea.
Method: Family physicians who were participated in autumn conference 2000 of the Korean Academy of Family medicine were questioned about their recognition and evaluation of tobacco health warning labelling required form 1976to 1988 and after 1989.

Results : Response rate to questionnaire was 25%(250/1000), but completely filled response rate included in study was 14.5%(145/1000). The recognition rate of tobacco health warning labelling required in 1976-1988(86.7%) was higher then after 1989(61.4%). When compared by sex, age, and smoking status, each results are similar. Respondents evaluated the tobacco health warning labelling required in 1976-1988 that the information was absolutely small and the vagueness of sentences lead smokers misconceived adverse effect of smoking, and also pointed out that the changed labelling after 1989 is not enough to transmit sufficient information. Respondents recognized that because government provided military personnel with tobacco of free charge, it decreased confidence and warning effect of tobacco health warning labelling(72.4%). Respondents answered active campaign of government against smoking would increase the effect of tobacco health warning labelling(92.4%), but the monopoly of tobacco production by government would support (local) government finance(75.9%).

Conclusion : New tobacco health warning labelling is needed to increase readability, warning, information against smoking, because present labelling is not recognized well and limited to give information against smoking.

Background
: Recent advances have been made in the treatment of acute stroke, but the effectiveness of the new therapies is highly time dependent. Patients with acute stroke often arrive at the hospital too late to receive the maximum benefit from these new stroke therapies. Efforts to reduce delay time of therapy for acute stroke may be more effective if the factors that delay hospital arrival are identified and targeted for specific intervention. So we studied about reason of delay of hospital presentation in patients with acute stroke.

Methods : The 85 acute stroke patients group who admitted to the Young-dong severance hospital from April to August 1999 were enrolled in this study. We collected clinical data from the medical record, including demographic characteristics, date and time of symptom onset, date and time of presentation to the hospital, medical history, and symptoms at stroke onset. And informants about stroke, method of transportation, the patient's interpretation of the symptoms were interviewed. We defined early arrival as within 3 hours of awareness of symptoms.

Results : The 85 patients were interviewed, early arrival were more likely to arrive by ambulance (P<0.001), admit via emergency department(p=0.001), interpret their symptoms as a stroke(P=0.005) and use readings as a informants about stroke(P=0.027) than late arrivals. Also they were younger than late arrivals(P=0.027). Main reason of delay of hospital presentation was because they expect spontaneous improvement(43%), mistake as other disease(23.3%), arrive via other medical institute(20%).

Conclusion : Late arrivals expected spontaneous improvement, misinterpreted their symptoms as those of other disease and didn't choose proper medical institute for acute management. Considerable education is needed to increase the knowledge about stroke and proper acute management.

Background
: Although it has become obvious that male osteoporosis represent a public health issue, few studies has been done in Korea concerning the association between grip strength and bone mineral density(BMD) in men. This study was undertaken to enforce the necessity of muscle strengthening exercise program to improve BMD in middle-aged men by evaluate the association between grip strength and BMD.

Methods : The study was performed from January to December 1998 in the health screening center of CHA hospital with 174 men who measured both BMD and grip strength. BMD was measured at the proximal and distal radius of the dominant hand using Osteoplan p-DXA and grip strength was measured from the dominant hand using dynamometer. Daily calcium intake was measured through the interview with the diet therapist. Other datas were obtained from the questionnaire.

Results : We found a significant positive correlation between grip strength and BMD of distal and proximal radius(r=0.208; P<0.01, r=0.2555; P<0.01) and a significant negative correlation between age and BMD of distal and proximal radius(r=-0.313; P<0.01,r=-0.190; P<0.05). There was no correlation between calcium intake and BMD. BMI was correlated significantly only with BMD of distal Radius(r=0.194; P<0.05). There was no significant difference in BMD either by smoking or exercise. The multiple regression analysis showed that grip strength was independently correlated with BMD of the proximal radius significantly(β=1.731, P<0.05), but not with BMD of the distal radius after adjusting the confounding variables.

Conclusion : In conclusion, there is a significant correlation between grip strength and BMD in middle aged men. Therefore it can be safely concluded that it is helpful to carry out muscle strengthening program to improve muscle strength and increase BMD for preventing male osteoporosis.