Background
: According to different characteristics of health dimensions and its consisting item contents, valid and useful health status assessment tool for the elderly is rare. Because of the continuous increase in elderly population with functional disability in Korea, the need for a valid Korean health status assessment tool for the elderly is growing. Therefore, we have attempted to develop a Korean Health Status Measure for the Elderly in this study.

Methods : We gathered important health related items from 671 individuals aged 60 years and over to form item pool with interview. Then we classified all items into representative items according to its meaning with the experts in geriatrics. With these representative items we constructed a preliminary questionnaire. After wards we performed a pilot study for evaluating understandability, accessibility, item analysis, reliability and for detecting other modifiable limitations. After completing the pilot study we finally developed the Korean Health Status Measure for the Elderly (KoHSME V1.0)

Results : The number of collected health related items were 2,500 in the item pool. After classification of items in the pool, 40 representative items were selected for constructing preliminary version of the KoHSME. And we added 3 items of ‘general health perception’ dimension to 40 common representative items to construct a preliminary version of the KoHSME. It took an average of 18.8 minutes to complete the preliminary questionnaire by the elderly in the pilot study. Most responders (90.9%) thought the questionnaire was not difficult to understand. After the pilot study we added 2 items (wearing clothes, pain frequency) and omitted 1 item (eating). Finally, the KoHSME V1.0 questionnaire consisted of 44 items and 6 domains such as physical function, emotional function, social function, pain, sexual function, and general health perception. All items were Likert scale except pain intensity item, which was visual analogue scale.

Conclusion : The KoHSME V1.0 to assess health status and quality of life for the Korean elderly was developed. We think the KoHSME V1.0 is a reliable instrument for assessing health related to quality of life in the elderly. After documenting the validity, the KoHSME V1.0 can be a useful tool for comprehensive assessment of health status in the eelderly and for the medical outcome study.

Background
: No-show is a major obstacle for proper management in outpatient clinic. This study was performed to evaluate the effectiveness of a reminding telephone call on the compliance after no-show patients in family practice.

Methods : A nurse in family practice called to 590 non-compliant patients who did not visit on the appointment day within 80 days. A single telephone call attempt was directed primarily to the patient or family members for them to make another appointment. The outcome measure was an increased attendance rate within 3 months after telephone calling.

Results : The completed telephone contacted group (N=242) and failed group (N=348) were well balanced for all study variables except age. The attendance rate of 60.7% in the completed group, regardless of who was contacted by telephone, was 40.7% greater than 23.0% attendance rate in the failed group. In the univariate analysis, attendance for patients who lived near the clinic (within 1 hour) was better (45.3%) than that for any other group (P=.02). In the logistic regression analysis, only the telephone call reminder was an independent predictor of attendance (Adjusted OR=5.03, P<.001).

Conclusion : Telephone reminder is a very effective method of increasing attendance in a hospital-based family clinic. The reminder is a consistenly effective intervention whether the message is delivered to the patient or the family member.

Background
: Few studies have been done regarding the level of DHEA which is influenced by age, and their effect on cardiovascular disease and prevention of cancer. It is a well known fact that the level of DHEA is decreased with age and the aging is not a correctable risk factor for cardiovascular disease. The aim of this study was to identify plasma DHEA-S change by age and to find out if there was any correlation with serum DHEA-S and cardiovascular risk factors.

Methods : The author collected blood from 85 males and 80females who had no particular disease history and no specific findings on physical examination. If there were any changes of DHEA according to age, we analyzed the correlation of DHEA with cardiovascular risk factors such as blood pressure, total cholesterol, triglyceride, low density lipoprotein, high density lipoprotein and obesity index (body mass index, waist/hip ratio).

Results : In both males and females, plasma DHEA-S level peaked at third decade and the concentration of DHEA was significantly decreased according to age (p<0.01). In males, DHEA-S showed no correlations with cardiovascular risk factors. In females, DHEA-S showed negative correlations with systolic blood pressure, diastolic blood pressure, total cholesterol, and low density lipoprotein. Also, high density lipoprotein positively correlated with DHEA-S. These correlations in female subjects, however, disappeared after multiple regression analysis.

Conclusion : In both males and females, plasma DHEA-S was significantly decreased with advancing age. There was no significant correlation between DHEA-S and cardiovascular risk factors in both men and women.

Background
: Alendronate is on of the anti-resorptive drugs for the treatment of osteoporosis and results in a decrease of bone turnover. HRT is also known to decrease the bone turnover. Combination therapy with HRT and alendronate has made significant increase of BMD in postmenopausal women. But there were no available long-term results about combination therapy of HRT and alendronate on Korean osteoporotic women.

Methods : Eighty postmenopausal women with osteoporosis who visited the Climacteric Clinic in Samsung Cheil Hospital & Women's Health Care Center from April to July 1999 were subjects. Randomized open labeled case control study was made. We evaluated 37 postmenopausal osteoporotic Korean women who were treated for 2 years after enrollment. Subjects in Group I were treated with HRT only and group II had HRT with alendronate 10 mg daily. Subjects also were measured BMD at lumbar spine and makers of bone turnover before, one and two year after treatment.

Results : Common reasons for dropouts were side effects of HRT such as breast tenderness, irregular vaginal bleeding, economic problems, long distance from clinic etc. BMD in lumbar spine was increased 10.1% in the first year, and 12.0% in the second year in subjects treated with HRT and alendronate. But in HRT only group BMD increased to 6.4% in the first year and 7.8% at second year. Markers of bone turnover were decreased significantly in both groups compared with baseline value, but the percent changes of markers after 1 year and 2 years between the two groups were not significant.

Conclusion : This study demonstrated that, in postmenopausal Korean women with osteoporosis, 2 years of combination therapy with HRT and alendronate resulted in a significant and sustained increase in spinal BMD than HRT and alendronate resulted in a significant and sustained increase in spinal BMD than HRT only group.

Background
: Despite the fact that adolescent smokers are increasing in Korea, an effective smoking cessation program is not widely available. The purpose of the present study was to develop and evaluate a short term smoking cessation program.

Methods : The subjects involved in the smoking cessation program were 89 students from 9 different middle and high schools located in Seoul. They were referred to our program by their school teacher as a penalty for smoking in school. The duration of the program was a total of 270 minutes and the program was carried out in 3 sessions during a period of one week. The program included cigarette related experiments and life skills enhancement training, such as self-assertiveness, cigarette refusal skills and self esteem enhancement. The students considered to be smoke free at the end of less than 8 ppm. The stage of smoking cessation was also assessed at the beginning to later evaluate if any progress in stage had occurred. Certification was given to those who succeeded in meeting the smoke free criteria. The students who were not able to meet the smoke free criteria were given the certification only under the condition that they achieve a level of expiratory CO measurement close to that of a nonsmoker's.

Results : Eighty seven students out of the 89 received the certification and 90.7% had attempted smoking cessation during the program. 39.1% Among, met the smoke free criteria used in this study. There was a significant difference between those who declared to be smoke free (54.1%) on the questionnaire and those who actually met the smoke free criteria. There was an average of a 0.75 stage advancement in terms of the stage of smoking cessation (P<0.005).

Conclusion : The program yielded high smoking cessation attempt and cessation rate in spite of the short duration of the program.

Background
: Headache is one of the most common symptoms having experienced by many people. High school girls are expected to experience headache very often. Their proper treatment and adequate medical service is doubtful, and stressful environment of the Korean high school will augment the chronicity of headache. Knowing the forms of headache and categorizing the headache according to headache according to headache classification system is important for proper treatment of headache. Types of headache in high school girls have been categorized using the International Headache Society (IHS) system. The relationship of headache with beck Depression Inventory (BDI) and Family APGAR score of the headache group and the control group were investigated. Thus, the purpose of this study was to attribute to the treatment of headache in female youths.

Methods : The questionnaire on headache, under direct interviews, was given to each high school girls in Seoul, from March 1 to 31, 1999. The headache group was subclassified into migraine group, tension headache group and other headache group, using IHS system, Furthermore, the migraine group was subclassified into migraine with aura (classic migraine), migraine without aura (common migraine) and other migronous disorder. The students who had not experienced any headaches during the recent on year have been selected as the normal group. The normal group was compared with the headache group, I,e., tension headache and megraine. Depressed tendency was assessed using the BDI; and family function was evaluated by Family APGAR. The date were analyzed using SPSS 8.0.

Results : Among the subjects, 304 (60.4%) high school girls had experienced a headache during toe previous on year. The girls with migraine, tension headache, and other types of headache were 110 (38%), 81 (27%) and 113 (35%), respectively. The migraine group showed higher BDI scores (p<0.01). Also, the migraine group showed more depressiveness than the normal group (p<0.01), according to the scores on the BDI which were greater than the cutting score of 21. In the Family APGAR, there was no significant difference between the headache groups and the normal group(p>0.05).

Conclusion : When headache in high school girls was classified by using IHS system, headache in the migraine group was more prevalent than in the tension headache group and the normal group. And the migraine group had more depressive tendency. When physicians deal with headache in high school girls, they need to be aware of migraine headache and associated depressive tendency.

Background
: Korea is an epidemic area of hepatitis B. There are needs for longitudinal study to measure quantity of hepatitis B infection status in Korea. This study was designed to observe natural course of hepatitis B markers in the same person for three years. The objective of this study was to investigate incidence of new infection and persistence of previous infection.

Methods : The study subjects were clients who visited a health examination center in Seoul twice with an interval of three years, from 1995 to 2000. They replied as nonvaccinee on both occasions for hepatitis B by self-administered questionnaire. Hepatitis B markers were measured by radioimmunoassay on all visits. There were 103 subjects with 61 men and 42 women.

Results : The positive rate of hepatitis B surface antigen was 20.4% initially, which changed to 18.5% after three years. The positive rate of hepatitis B surface antibody was 61.2% initially, which increased to 66.0% after three years. The positive rates of hepatitis B surface antibody in men were 63.9% initially and 68.9% after three years, which showed statistically significant trend (p=0.08). The positive rate of hepatitis B core antibody was 89.3%, which remained the same after three years. There was no positive conversion case of hepatitis B surface antigen. The negative conversion rate of hepatitis B surface antigen was 2/63(3.2%). The positive conversion rate of hepatitis B surface antibody was 7/40(17.5%), and negative conversion rate of that was 2/63 (3.2%). The positive conversion rate of hepatitis B core antibody was 3/11(27.3%), and negative conversion rate of that was 3/92(3.3%).

Conclusion : Hepatitis B markers changed in the direction of infection incidence, rather than natural disappearance of markers in nonvacciness. The mechanism was postulated as occurrence of new infection mainly, but the possibility of double infection by variants of hepatitis B virus could not be ruled out. We confirmed that positive rate of hepatitis B marker in males was not only higher cross-sectionally, but also increased higher longitudinally. We suggest a follow-up study of hepatitis B markers to be performed because hepatitis B markers showed dynamic changes. We think the high risk groups of hepatitis B infection have a priority in follow-up studies.

Background
: In terminal cancer patients, alleviation of suffering is as important as the cure of disease. But their symptoms are often intractable. In such a case, sedation is usually considered to relieve these refractory symptoms. However, the decision to sedate has been an ethical concern to health care worker because of an effect on survival time of cancer patients. The aim of this study was to investigate the use of sedation in terminal cancer patients and its relationship with intractable symptoms.

Methods : One hundred and fifty six patients admitted to National Heath Insurance Corporation Ilsan Hospital, Department of Family Medicine for hospice care from September 2000 to the end of October 2001 were enrolled in the study. Demographic data, clinical symptoms, the use of sedation, the choice of medication, reasons for administration, and frequency were recorded.

Results : There were 81(51.9%) men and 75(48.1%) women. The mean age was 64.6±13.3 years. The primary sites of cancer were stomach 36(23.1%), lung 27(17.3%), and colo-rectal 19(12.2%). Common symptoms were pain, nausea/vomiting, and dyspnea. Among the subjects, 55(35.3%) receive sedation. The drugs used for sedation were lorazepam in 37(67.3%), haloperidol in 21(38.2%), and diazepam in 18(32.7%). Sedation was administered to relieve insomnia in 20(36.4%), agitated delirium in 20(36.4%), severe pain in 9(16.4%), dyspnea in 5(8.0%), and nausea/ vomiting in 1(1.8%)

Conclusion : Among the subjects, 55(35.3%) of 156 terminal cancer patients received sedation. Though most common symptoms were pain and dyspnea, the use of sedation was mostly limited to insomnia and delirium. Therefore, the use of sedation is not yet prevalent in Korea.