Background
Osteoporosis and hearing impairment are known to be associated, but specific data regarding gender, bone mineral density (BMD) measurement sites, and hearing frequency ranges remain unclear. This study aimed to clarify the relationship between hearing loss and BMD in adults over the age of 50. Additionally, the study sought to determine the frequency ranges of pure tone audiometry (PTA) related to osteoporosis, identify BMD measurement sites, and investigate gender differences.
Methods
A total of 1,523 adults (651 men and 872 women) over the age of 50, who participated in a medical health check-up at a university hospital, were included. PTA was conducted to assess hearing, and BMD was measured using dual-energy X-ray absorptiometry at the lumbar vertebrae (LV) and femur.
Results
In women over the age of 50, a significant association was observed between hearing impairment and osteoporosis (P<0.01), but no such association was found in men. Lumbar BMD (L1–4) in women was significantly associated with hearing loss at 4,000 and 8,000 Hz (both P<0.05), whereas femoral neck and total femur BMD showed no significant relationship. In multiple logistic regression analysis, the odds ratio (OR) between osteoporosis and hearing threshold at 4,000 Hz (OR, 2.078; 95% confidence interval [CI], 1.092–3.954) and 8,000 Hz (OR, 2.648; 95% CI, 1.543–4.544) remained statistically significant in women after adjusting for age and other risk factors.
Conclusion
In women over the age of 50, low BMD at the LV is significantly associated with hearing impairment, particularly at the high frequencies of 4,000 and 8,000 Hz.

Citations

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• Associations of heavy metals and urinary sodium excretion with obesity in adults: A cross-sectional study from Korean Health Examination and Nutritional Survey
  Juyeon Lee, Sue K. Park, Iman Al-Saleh
  PLOS ONE.2025; 20(1): e0317190.     CrossRef
• The relationship between excess sodium intake and metabolic syndrome: Worth consideration?
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  Lu Yin, Sidong Li, Yongmei He, Lin Yang, Li Wang, Chao Li, Yaqin Wang, Jing Wang, Pingting Yang, Jiangang Wang, Zhiheng Chen, Ying Li
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  Jeong-Hyeon Bae, Min-Young Shin, Eun Ha Kang, Yun Jong Lee, You-Jung Ha
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Background
Metabolic syndrome (MetS), characterized by abdominal obesity, hypertriglyceridemia, low high-density lipoprotein (HDL) cholesterol, high blood pressure, and high fasting glucose level, is a common risk factor for cardiovascular disease and associated complication. We examined the relationshipbetween the metabolic syndrome and risk of chronic kidney disease (CKD) in Korean women. Methods: We used data from 10,170 women, aged 30-89 years, who had visited the health examination center at a tertiary care hospital in 2006. The data were studied cross-sectionally. MetS was identified using the modified criteria of the National Cholesterol Education Program Adult Treatment Panel Ⅲ (NCEP-ATPⅢ). CKD was defined as an estimated GFR< 60 ml/min per 1.73 m². The multivariable-adjusted(adjustment for age, a high school education, body mass index (BMI),alcohol drinking, current and former smoking, previous coronary heart disease, menopause and physical inactivity) odds ratio of CKD (95% CI) associated with each component of the metabolic syndrome, was calculated using logistic regression models. Result: 1,039 participants developed MetS. The multivariable-adjusted odds ratios (OR) of CKD in participants with MetS, hypertriglyceridemia and high blood pressure compared with participants without those factors were 2.68 (95% CI, 1.77-4.06), 1.96 (95% CI, 1.34-2.88), 2.00(95% CI, 1.38-2.89). Compared with participants with no MetS traits, those with one, two, equal to or more than three traits of MetShad OR of CKD of 1.24 (95% CI, 0.75-2.06), 1.56 (95% CI, 0.89-2.75), 2.18 (95% CI, 1.21-3.93), respectively. Conclusion: We found that Korean women with MetS had an increased risk for developing CKD. Finally, earlier identification and management of MetS might improve patient health and prevent the progression of CKD.

Background
Recently, an elevated serum homocysteine level has been reported to be associated with increased fracture risk and reduced bone mineral density (BMD). So far, little research has been done to evaluate such association in Korean population. Therefore, we investigated the association between serum homocysteine levels and BMD in Korean adults. Methods: The subjects consisted of 2,750 adults who visited a health promotion center at a university hospital from January 2005 to March 2006. Self-administered questionnaires provided information about lifestyle and medical history. Fasting plasma samples were collected and BMD of the lumbar spine and femoral neck were obtained by dual energy X-ray absorptiometry. To adjust for menopausal state, the female subjects were divided into three groups according to age (≤45 yrs, 46∼55 yrs, 55 yrs ＜). Multiple linear regression analysis was used to evaluate the association between serum homocysteine levels and BMD in each gender and age group. Results: The results adjusted for alcohol and smoking history showed significant association between serum homocysteine levels and BMD in women (Lumbar spine: Ղ=-0.006, P=0.015, Femoral neck: Ղ=-0.065, P=0.012) but not in men (Lumbar spine: Ղ=0.001, P=0.240, Femoral neck: Ղ=0.001, P=0.242). With analyses by three age groups, plasma homocysteine level was associated with both lumbar and femoral BMD in age 46∼55 women (Lumbar spine: Ղ=-0.014, P=0.024, Femoral neck: Ղ= -0.007, P=0.019). Conclusion: Our study suggests that increased serum homocysteine level is an independent risk factor for low BMD among women, especially perimenopausal women. Further studies about the sexual differences and the mechanisms linking serum homocysteine level to BMD are needed. (J Korean Acad Fam Med 2008;29:175-181)

Background
Recently, the diagnosis of non-alcoholic fatty liver disease (NAFLD) has been made more frequently, as the use of ultrasonography on health screening has been on the rise. The aim of this study was to elucidate the relationship between NAFLD and the metabolic syndrome defined by NCEP-ATP III criteria. Methods: A total of 1,675 subjects, who attended for routine physical check‐ups, were screened. Among those, 401 subjects were selected after excluding the subjects with either significant alcohol consumption, evidence of viral or toxic hepatitis, significant liver or renal dysfunction, or overt thyroid disease. NAFLD was diagnosed if the subjects had a "bright liver" on ultrasonographic examination. The diagnosis of metabolic syndrome was made according to the criteria of NCEP-ATP III established in 2001. Results: The prevalence of NAFLD was 27.2%. Blood pressure, body weight, body mass index, waist circumference, and serum levels of total cholesterol, triglyceride, fasting glucose and liver enzymes were higher among the subjects with NAFLD than the control. The prevalence of obesity, IFG/DM, dyslipidemia and hypertension was higher in the NAFLD group. The prevalence of the metabolic syndrome was 19.2%, which was higher in the NAFLD group than the control group. The odds ratio of NAFLD for the metabolic syndrome was 6.458 (95% C.I. 3.178∼13.124). Conclusion: NAFLD was closely associated with the metabolic syndrome regardless of the presence of obesity. (J Korean Acad Fam Med 2007;28:667-674)

Background
: Reduced pulmonary function is a common outcome in pulmonary patients with reduced bone mineral density. But, there are few studies on the relationship in adult females who do not have pulmonary diseases. Thus, this study was to assess the correlation between bone mineral density and pulmonary function in healthy women.

Methods : A total of 193 subjects was selected among adult females who visited a health promotion center. BMD was measured by Dual energy X-ray absorptiometry and T-score of lumbar spine (L1-L4) was used. Pulmonary function was measured by spirometer and questionnaire survey was used to obtain information from the subjects.

Results : Mean T-score of L-spine was -0.284, FEV₁ (pred %) was 98.82% and BMI was 23.50 kg/m². The results showed positive correlation (0.128) between BMD and FEV₁ by multiple regression analysis (P＜0.05).

Conclusion : As FEV₁ of subjects increased, BMD increased in adult women who did not have pulmonary diseases.

Background
: Previous studies reported an increased risk of pancreatic cancer among diabetes patients, and fasting blood glucose level is widely used to determine the presence of diabetes mellitus. The aim of this study was to analyze the influence of fasting blood glucose level on pancreatic cancer death by a large, prospective cohort study in Korean population.

Methods : A total of 1,306,476 participants in the Korean Cancer Prevention Study (KCPS) were enrolled. A health examination including fasting blood glucose level and life style questionnaire was done as a baseline examination from 1993 to 1995, and they were followed up to 2002. Pancreatic cancer death outcome for 10 years according to the fasting blood glucose level was explored.

Results : At the beginning 63,510 (4.9%) participants had diabetes mellitus. In multivariate Cox proportional hazards models, controlling for age and current smoking, the presence of diabetes increased the risk of mortality for pancreatic cancer excluding those who died of pancreatic cancer within 1 year (Men: HR 1.7; 95% CI, 1.4∼2.1, P＜0.0001, Women: HR 1.8; 95% CI, 1.3∼2.6, P=0.0003). As fasting blood glucose level, elevated the pancreatic cancer risk was increased. Men with fasting blood glucose level≥140 mg/dL had a higher risk of pancreatic cancer than those with FBG＜100 mg/dl. (Men: HR 2.0; 95% CI, 1.6∼2.5, P＜0.0001, Women: HR 2.1; 95% CI, 1.4∼3.1, P=0.0002).

Conclusion : Elevated fasting blood glucose level increased the risk of pancreatic cancer death among Koreans.

Background
: Breastfeeding is not common in Korea despite its known benefits. The role of family physicians is important in promoting breast-feeding since they can provide prenatal and postnatal care on lifelong basis. This paper analyzed a survey of family physicians on their knowledge, attitude, experience, and training concerning breastfeeding.

Methods : The survey was carried out by e-mail enquiry to the residents and board-certified physicians registered in the Korean Academy of Family Medicine. The enquiry was developed by Gary L. Freed composed of 18 questions about knowledge, attitudes, experience, and training. The answers to the questions were analyzed to give frequency and the associations between the variables.

Results : Among the total, 64% of the residents and 76% of the physicians answered yes to whether breastfeeding was the best means of feeding an infant under 6 months of age. Also, 83% of the residents and 85% of physicians answered it was right to quit breastfeeding completely when breast abscess developed. The breastfeeding promotion was done more frequently by those who had personal experience. They had higher rate of educating patients than those who did not (28% vs. 9%, P＜0.0001). Despite its importance, 86.5% of the residents and 77.6% of the physicians answered that they did not have enough opportunity to learn about breastfeeding during their training years.

Conclusion : Although family physicians are required to play a role in promoting breastfeeding, they are insufficiently trained under the current system. Therefore, it is necessary to develop a training program to educate the residents on breastfeeding.

Background
: Obesity has been proposed as a risk factor for cardiovascular diseases. CRP has been proposed as an independent risk factor for cardiovascular diseases, and has been associated with body weight and body fatness. It has been known that weight reduction reduces CRP. We examined the hypothesis that weight loss can reduce plasma CRP levels in Korean, obese premenopausal women.

Methods : In a sample of 36 Korean obese (BMI 25.00 ∼47.02 kg/m²), premenopausal (22∼48 years) women, we measured hsCRP, plasma lipid profiles, blood glucose, body weight, body mass indexes, body fatness and intraabdominal body fat area. A 12-week weight reduction program was conducted in 36 obese women. When the program was finished, fat distribution, hsCRP and lipid profile test was repeated. The effects of weight loss on CRP levels were tested by means of paired t-test and nonparametric Wilcoxon signed rank test.

Results : We found that plasma CRP level was positively associated with body weight, body mass index, body fatness, CT-measured abdominal visceral and subcutaneous fat area. After a 12-week weight loss protocol, the average weight loss was 7.97±3.46 kg (P＜0.0001) with loss of fat mass 5.29±0.59 kg, and 1.98±1.20 kg lean body mass. Plasma CRP levels were both positively associated with plasma CRP level reductions (P=0.0437).

Conclusion : Obesity and adiposity influenced significantly on plasma CRP in Korean premenopausal women on cross sectional basis. Moreover, 12-week caloric restriction induced weight loss decreased plasma CRP levels. Weight loss represents an intervention to reduce plasma CRP and can mediate to reduce cardiovascular disease risk in Korean obese premenopausal women.

Background
: The aim of this study was to elucidate the relationship between nonalcoholic fatty liver disease diagnosed by ultrasonography and the metabolic syndrome defined by NCEP-ATP III criteria.

Methods : Sixty-nine adult male subjects with negligible alcohol consumption underwent an anthropometric and laboratory investigation. The ultrasound scan of the liver was performed to determine the presence and the severity of nonalcoholic fatty liver disease.

Results : Nonalcoholic fatty liver disease was diagnosed in 36 cases by ultrasound scan. According to the severity of nonalcoholic fatty liver, triglyceride, HDL- cholesterol, alanine aminotransferase, aspartate aminotrasnferase, fasting insulin level, HOMA-IR, and obesity related variables (body mass index, percent body fat, waist circumference) showed a significant difference. The independent variables which account for the severity of nonalcoholic fatty liver disease was waist circumference, and alanine aminotransferase which is a predictor of nonalcoholic steatohepatitis. The prevalence of metabolic syndrome was 41% vs 6.1% in nonalcoholic fatty liver group vs control group, respectively, and the odds ratio was 11.1 (95% CI 2.29∼53.6). The prevalence of nonalcoholic fatty liver was increased with increasing the number of features of metabolic syndrome.

Conclusion : Nonalcoholic fatty liver disease was closely related to the metabolic syndrome and the severity classification of nonalcoholic fatty liver by ultrasound scan could be useful to predict of the severity of insulin resistance, and the risk of nonalcoholic steatohepatitis.

Background
: Korea is a highly prevalent area of isolated anti-HBc with a rate of 15%, but there is neither vaccination nor management guideline agreed. To know the management for Hepatitis B Vaccination for adults with isolated anti-HBc, we investigated immune response to hepatitis B vaccination in adults with isolated anti-HBc.

Methods : The 23 adults with persistent isolated anti-HBc, who visited a health promotion center from Dec. 1998 to Aug. 1999, were vaccinated with Hepavax^±-B by the standard schedule (0, 1, 6 month) and anti-HBs titers were measured 1 month after 1st and 3rd vaccinations (1, 7 month).

Results : After the 1st vaccination, 18 (78.26%) developed anti-HBs seroconversion. Among them, 4 (17.39%) had titers of 10∼49 mIU/ml, 8 (34.78%) 50∼99 mIU/ml, and 6 (26.09%) more than 100 mIU/ml. All non-responders after the 1st vaccination remained as such even with 3 doses of complete vaccination. The majority of seroconverted group did not show more anti-HBs response with further vaccination.

Conclusion : Since none of adults with isolated anti-HBc had a primary response, which indicated few false positive results. Therefore they should be excluded on vaccination programs in Korea. To differentiate between immunity and occult infections, a single dose of vaccine with a follow-up anti-HBs test is preferable for adults with isolated anti-HBc. If the test shows a seroconversion it would indicate protective immunity, if not, then occult infection may be suspected.

Background
: Urinary incontinence has a negative impact on the lifestyle of sufferers, affecting not only their physical condition but also their well-being. But only few patients visit doctors for treatment. The purpose of this study was to measure the quality of life in women with urinary incontinence.

Methods : Among the people who visited a tertiary hospital in Seoul for a health exam or primary care during April 2002, we selected 161 women over 20 years old. We measured their quality of life by the Medical Outcomes Study (MOS) 36-Item Short-Form Health Survey (SF-36) questionnaire. Excel 2000 statistical program was used for statistical analysis.

Results : The active incontinence group, who experienced urinary incontinence within 1 year, were 48 women and the normal group without urinary incontinence at all were 65 women. The average SF-36 score was 76.5 in total women, 69.0 in active incontinence group, and 81.5 in normal group. The percentage of those seeking treatment was 10.4% and 64.6% of women have never sought help.

Conclusion : These results suggest that the incontinent patient had a much lower quality of life than normal women, but there were only few patients who sought treatment.

Background
: As the population with chronic degenerative disease or functional impairment has increased in terms of the advanced aging society, the inevitability of home health services for the homebound have been augmented as a token of the trend toward the nuclear family along with the family capacity of care declined. For the past several years, home nursing service facilities have been enlarged and partially have been fulfilling these requirements. However, there are a great number of demands for home health service by physicians. Thereupon, we designed the following study to observe the cases of home visits by a medical office practice and to provide some information about the need of the home visit and its clinical features.

Methods : The study was conducted reviewing currently remained 84 data of home visit records at a home-visit- specialized medical office practice for 10 months in 1999. Its information collected was as below: patient's sex, age, frequency and duration of visit, distance to visit location, reason being homebound, and reason for visit.

Results : Of the reviewed records of 84 patients, comprised of 356 home visits, the median age of the patients was 67.5 years. They were visited 2 times as a median and with a median duration of 4 days. Physician drove a median distance of 6.1km one-way. Most common diagnoses were cancer and cerebrovascular diseases, equally with 10.8%. Reasons for being homebound were neurologic problem (28.6%), frail elderly (21.4%), terminal illness (20.2%) in order. Sixty two patients (73.8%) were permanently homebound and 12 patients (14.3%) were not. Reasons for visits were routine follow-up (42.1%) and evaluation of a new problem (19.9%) in the chronic homebound and terminal illness care (17.1%). While 102 visits (28.6%) should have begun by doctor-based visit, 233 visits (65.4%) including routine follow-up could be considered to be replaced for home nursing services. Even out of 233 visits, not all could be replaced and some should remain as physician's regular follow-up.

Conclusion : There were needs of home visit in both permanent and transient homebound patients, in cases of exacerbation, new problem and routine follow-up of chronic homebound patients, and also in acute illness of previously healthy persons. To meet the needs of homebound patients in seeing the physician, and to offer adequate health services, the physician's role should be acknowledged in home nursing service, and home visit by physician should be institutionalized and carried into effect.

Background
: Comprehensive geriatric assessment is identified as a dynamic process responsive to the changes on health status that occurs over time in the context of extremely increasing trend in the numbers of the elderly people, their office visit, and the medical cost universally. We completed the comprehensive geriatric assessment and applied it to the Korean elderly through the multi-center trials.

Methods : We performed studies variables using questionnaires, with interviewing, physical examination to number of total 312 elderly people who visited the department of family medicine or physical medicine and rehabilitation of the 11 university hospital or general hospital in Korea from July 1, 1999 through October 31, 1999. We, the geriatrician, met and discussed 3 times to complete the comprehensive geriatric assessment through the consensus panel.

Results : We found the sex ratio of 312 subjects was 1 to 2 (104 males and 208 females) and the average age was 73.2 years old. The orders of more frequency of self-reported health status of the respondents were hypertension, arthritis, cataract, gastrointestinal disturbance, diabetes mellitus, urinary/fecal incontinence, depression, cerebrovascular accident, anemia, and heart disease. Nearly 15% of those showed depression 41.6% of those were in the status of socially isolation. We found 43.1% of those showed hypertension, 3.7% isolated systolic hypertension, and 20.2% orthostatic hypotension. Of those, cognitive impairment were measured in 37.1%, gait disturbance 13.0%, and the risk of malnutrition 39.6%. Geriatrician spent 21.1 minutes per person during the process of comprehensive geriatric assessmnet.

Conclusion : We realized we could diagnose and intervene effectively certain hidden conditions/ diseases, particularly urinary incontinence, falls, visual impairment, hearing impairment, pain, depression, social isolation, cognitive impairment, and orthostatic hypotension, with using the comprehensive geriatric assessment. These results reflected the fact that the comprehensive geriatric assessment might be necessary for the care of the elderly.

Background
: The prevalence of dementia is estimated to be as high as 5-10% over 65 years of age in Korea. it is important to evaluate of dementia for the elderly, Because of the chronicity and progressiveness of the disease. However, cognitive impairment often goes unrecognized by physician because the many previous tools to evaluate cognitive function in the clinical setting are complex, time-consuming and sometimes questionable correlation with real world functioning. The purpose of this study is to assess the usefulness of T도 Time and Change test as screening test for dementia, on the basis for the correlation between this measure(T&C) and MMSE-K.

Methods : The subject for this study consisted of 64 elderly who visited to the outpatient depa-rtment of family medicine of the Ehwa Mok-dong hospital or Elderly Welfare Center in Seoul. They received the T&C test and MMSE-K examination. Sensitivity, specificity, negative predictive value, and Pearson' Correlation coefficient were calculated using standard formulas.

Results : The T&C had a sensitivity of 505, a specificity of 88%, a positive predictive value of 60%, a negative predictive value of 77%, respectably. when timed cutpoints were added, The T&C test had a sensitivity of 95%, specificity of 83%m a positive predictive value of 75%, a negative predictive value of 97%. respectivaly.

Conclusion : The Time and Change(T&C) tests can be an effective, simple and performance based tool to recognize dementia. Further validation with a representative elderly sample is needed to establish screening value in primary care of community populations.

Background
: Brief intervention with problem drinkers have been shown to be effective, but physicians often do not ask about alcohol use because of time constraints and lack of knowledge. If a single question can be used to screening for problem drinker effectively, primary care physicians could detect problem drinker earlier and reduce future complication and morbidity. The purpose of this study was to evaluate the usefulness of single-question.

Methods : One family medicine’s resident interviewed 163 patients who visited Dongdaemun Hospital’s Health care management center of Ewha Woman’s university from January 27th 1999 to February 26th 1999, and the patients answered the written forms of questionnaires. This written forms contained the followings: (1) age, sex, education, income level, occupation, smoking, drunken driving, (2) “On any single occasion during the past 3 months have you had more than a bottle of Soju or three bottles of beer or five glasses of whisky?” (3) CAGE, NAST test, Quantity of alcohol was determined by the calendar-based review in the past 4 weeks. At-risk drinker defined as drinking more than 56g on one occasion, or more than 196g of pure alcohol during a week for men; more than 42g on one occasion, or more than 96g of pure alcohol during a week for women. Also alcohol use disorder was defined by the DSM-IV criteria and problem drinker was defined as either at-risk drinker or a alcohol use disorder.

Results : The single question had a positive predictive value of 82.2%, and negative predictive value of 95.5% with a sensitivity of 93.8% and a specificity of 86.9% for problem drinkers.

Conclusion : A single question about alcohol-use would be a effective tool for detecting problem drinker.

Background
: Upper respiratory infection account for many of the visits in primary care. As most URIs are caused by viruses, antibiotic therapy is not desirable. However, for URI treatment antibiotic therapy is commonly used, which causes many public health proplems such as drug-resistant becteria and high medical cost. This paper examines patient knowledge of the normal presentation of a URI, beliefs in the effectiveness of antibiotics and health care utilzation.

Methods : A survey of 200 outpatients or their families was conducted in one university hospital from March to April, 1998. Two URI conditions were given for the survey:(1) a condition of 5 days' duration with cough, sore throat, and clear nasal discharge (question 1), (2) a condition of the same symptom as (1) except discolored nasal discharge (question 2). For various questions in each of these conditions they were to answer in 5 point Likert-type scale. Statistical softwares of SAS 8.0 and GAUSS 3.21 were used for analyzing the survey data.

Results : For question 1, 61% of the sample reported that they would seek care from a physician while for question 2, 75% of the sample reported that they would do so (p<0.1). the health service suppliers, in the order of visiting frequencies, were pharmacy (58%), hospital (38%), no visit (2.5%), public health center (0.5%), and Chinese medicine clinic (0.5%) for question 1 and pharmacy (54%), hospital (42%), no visit(2%), Chinese medicine clinic(0.5%) and public health center (0.0%) for question 2. For question 1, 54% of the sample and for question 2, 63% reported that they believe antibiotics were effective (p=.068). For question 1, 79.5% and for question 2, 89.5% of the subjects reported that they had complied to prescriptions of doctors or pharmacists (p<0.05). Out of those subjects, only 19.5% for question 1 and 21.2% for question 2 reported that they checked the presence of antibiotics in the prescriptions. A multivariate analysis shows that older people, normally used antibiotics and current smokers had higher tendency of seeking care and stronger beliefs in the effectiveness of antibiotics.

Conclusion : There is a lack in patient understanding of normal presentation of a URI and the effectiveness of antibiotics as a treatment. A confusion about the meaning of discolored nasal discharge is particularly evident. The patients visited pharmacies more often than hospitals, and majority of them (80%) did not know the details of their prescriptions.

Background
: Hypertension, diabetes, hyperlipidemia and coronary heart disease are closely related to obesity. Recently incidence of such diseases are remarkably increased. Many researches have been done to find out to implement prevention and treatment of such diseases. Abdominal obesity is one of the most important contributing factors of metabolic complication. This study was done to compare indicators of obesity with abdominal fat amount which was measured by anthropometric parameter and computed tomogram, and to find correlation between the risk factors of atherosclerosis and the indicators of obesity.

Methods : Fifty nine healthy premenopausal women without diabetes, coronary heart diseases or history of other chronic disease were enrolled. Blood pressure and simple anthropometric parameter were measured. Computed tomograms in umbilical and femoral regions were performed. From serial blood samples, plasma fasting glucose and insulin, cholesterol and triglyceride were measured and atherogenic index was calculated.

Results : The ratio of visceral fat area and skeletal muscle area at the mid-thigh level was found to be highly correlated(R=0.965, p<0.001) and atherogenic index showed similar patterns to the waist circumference, the waist/height ratio and the waist/hip ratio. Especially, the waist/height ratio was found to be the most reliable indicator of obesity to predict atherogenic index.

Conclusion : Although the ratio of visceral fat and skeletal muscle area at the mid-thigh level which is measured by computed tomogram was the best indicator of visceral fat, these results proved that waist circumference and the waist/height ratio were also good indicators of the risk factors of atherosclerosis. By simple anthropometric measurements, it can help to find the remedy and prevention of obesity in practices.

Background
: Familial aggregation of coronary risk factors is well known, which are hypertension, hyperlipidemia, diabetes mellitus, and obesity. However interspouse relation of the risk factors has remained controversial. As spouses are not blood-related, any risk factors to which the couple is exposed. Moreover, the effect of assortative marriage should be considered. This study is designed to identify interspouse relation of coronary risk factors and to document the effects of marriage duration to spouse concordance.

Methods : From May 1995 to March. 1999, we enrolled 1,859 couples who had visited the Health Promotion Center at Seoul National University Hospital. We analysed interspouse correlation of body mass index, blood pressure, glucose, serum lipid factors, uric acid, smoking, alcohol drinking, and stress known as coronary risk factors. The correlation coefficients were compared according to marriage duration.

Results : There was statistically significant spouse concordance for all risk factors with the exception of smoking. The correlation coefficients of blood pressure, total cholesterol, and triglyceride increased with marriage duration but troughed at 30-39 years of marriage. Those of body mass index and glucose peaked at early and late marriage duration. Those of HDL-cholesterol and uric acid was relatively fixed throughout marriage.

Conclusion : The presence of significant interspouse correlation for most of the coronary risk factors reflect the influence of assortative marriage and environmental factors on spouse concordance. If a spouse has many cardiovascular risk factors, partner should be evaluated for risk factors.

Background
: The waist/hip ratio is an useful index of abdominal obesity, but it includes two variables which may result in a false interpretation. The purpose of this study is to evaluate the usefulness of waist/height ratio as a predictor for the risk factors of coronary artery disease(CAD).

Methods : 1395 persons(818 men & 577 women) were selected as subjects who visited the Health Examination Center at Ewha Mokdong Hospital from October 1996 to March 1997. Waist circumference was measured at the level of umbilicus with standing position. Hip circumference was measured at the level of the largest circumference of the hip. We set the criteria of the risk factors as hypertension(systolic BP≥140mmHg and/or diastolic BP≥90mmHg), glucose intolerance(fasting blood glucose≥115mg/dl), hypertriglyceridemia(>160mg/dl), hypercholesterolemia(≥200mg/dl), and low HDL-cholesterol level(<35mg/dl). The morbidity index of CAD was calculated by the sum of the risk factor scores(one point per item if present).

Results : There was significant correlation between waist/height ratio, waist/hip ratio and body mass index(BMI)(p=0.0001). BMI had more strong correlation with waist/height ratio(r=0.81) than waist/hip ratio(r=0.48). According to the simple regression analysis, BMI, waist/hip ratio and waist/height ratio had significant correlation with all of the risk factors and the morbidity index. According to the multiple regression analysis, waist/height ratio had significant correlation with age, weight, height, systolic BP, triglyceride, cholesterol and HDL-cholesterol. The risk factor morbidity index of the groups with waist/height ratio over 0.45 was significantly more higher than the group of the lowest risk factor morbidity index(waist/height ratio under 0.4) in men(p=0.01). For women, 0.46 was the level which the risk factor morbidity index increased significantly(p<0.01).

Conclusion : Waist/height ratio can be a useful index of abdominal obesity. And it may be used as a more easier and better predictor of multiple CAD risk factors than waist/hip ratio. We can predict that waist/height ratio over 0.45 in men and over 0.46 in women may have more higher coronary artery disease risk.

Background
: Korea is an endemic area of viral hepatitis B with a rate of 5~10% carrier state. Therefore, hepatitis B vaccination is performed nationwide. But 5~15% of health individuals fail to respond adequately to the vaccine and an approved guideline for the nonresponders has not been developed yet. This study is designed to identify risk factors for those who lack anti-HBs after hepatitis B vaccination and to document the results of a double-dose revaccination in such nonresponders to the primary vaccination.

Methods : From Feb. 1996 to Aug. 1997, we assessed 51 healthy subjects(HBs Ag negative, anti-HBs negative, anti-HBs negative and a normal LFT). All subjects were vaccinated with Hepavax-B® 1.0ml, 24 by a rapid schedule(0, 1, and 2 months) and and 27 by a standard schedule(0, 1, and 6 months). Anti-HBs titers were evaluated 3 months after the third vaccine and assessed the nonresponders(anti-HBsTiter < 2mIU/ml) and the hyporesponders(2~10 mIU/ml). All 13 nonresponders were revaccinated with 2 ml of Hepavax-B 3 months after the primary vaccination. Anti-HBs titers were evaluated 1 month later.

Results : The difference in age(p<0.01) and smoking amount(p<0.05) between the responders andhe hypo and the nonresponders were statistically significant. There were more males and higher body mass index in the hypo and the nonresponders but not statistically significant. The seroconversion rate after the double-dose vaccination was 92.3%(12/13) with an average titer of 58.08 mIU/ml(1~132.4 mIU/ml).

Conclusion : Increase in age and smoking amount were the risk factors of the nonresponders after the primary vaccination. Most of the hypo and the nonresponders to the primary vaccination responded adequately to the double-dose revaccination.

Background
: Research is essential for the development of family medicine as a professional field in primary care, Since information is available through the articles in the Journals of Family Medicine which contain subjects such as disease mechanism, pathophysiology, drug or new treatment method, and it is necessary to evaluate the contribution of recent researches in this field. The paper is intended to evaluate the current status of the quality of papers published in the Journal of the Korea Academy of Family Medicine (below JKAFM) and provide statistical data & direction of studies in the future.

Methods : 1218 articles in 185 editions of JKAFM were analyzed among 188 editions published from Nov.1980 to Dec. 1996. The papers were classified into Case Report, Original Article, Review Article by the type of papers, and then categorized into descriptive studies, analytic studies, and clinical trials by its methodology. In each category, the papers were stratified by the topic. Also, the analysis was conducted according to the authors, research subjects, sampling methods and the statistical methods, and observed the changes each year through 1980s to 1990s.

Results : The portion of original articles has increased from 18.6% in 1980s to 73.9% in 1990s. In terms of research methodology, the portions of analytical studies and clinical trials occupy 28.8% and 2.1% in 1990's respectively, compared with those of 1.8% and 0.6% in 1980's. When the papers were stratified by study topics, topics on family medicine showed the highest of 34.9% of the total. According to the detailed stratification, the principle of family medicine recorded 24.2%. In terms of sampling method, 89% and above was from the clinical data when current data were used, and 69.1% was by questionnaires when the data were newly collected. The most of the study subjects were outpatients of family medicine departments. The portion of papers in which the statistical analysis was not included was 29.9% in 1980s which decreased to 15.7% in 1990s. In terms of the statistical analysis methodology, the Chi-square test was the most frequently used(26.2%), followed by Descriptive(19.6%), t-test(18.2%) and ANOVA(8.7%) were the next.

Conclusion : The academic performance of family medicine can be most effectively measured by the analysis of the journals on family medicine. According to the analysis, the papers based on clinical activity is increasing in recent years with substantial contribution, which means that the field of family medicine has found its own position in medical science and is developing actively. In terms of study methodology, the portion of analysis study is getting larger, and the various method are being tried. The application of statistical methods is being developed in its quality and quantity. It should be noted that research on family medicine should provide the basis for new knowledge and promote public health by the integrated and intensive efforts.

Background
: The functional dyspepsia gives rise to such a symptom similar to peptic ulcer without showing a noticeable lesion(e.g, gastric or duodenal ulcer) by endoscopy or upper GI serises, and it has been known that this is about twice as many as the peptic ulcer. However, there is no exact theory about its pathophysiology and it is suggested that multiple factors including genetic, physiologic, psychologic, environmental factors are engaged. Especially, in respect to the occurrence of functional dyspepsia and psychological factors, there have been many clinical studies over the world. But, we still need more studies in this country, therefore, this study has been initiated to give help patients of functional dyspepsia, investigating their characteristic traits through MMPI.

Methods : From March to September in 1996, the patients who visited the family medicine out-patients department of St. Mary's hospital of Catholic Medical College were sampled in this study. There were 46 patients having a similar symptoms to peptic ulcer without showing pathologic lesions by endoscopy. Through an interview and some basic tests, the 41 controls who had no dyspeptic symptoms and were not affected to a noticeable physical or physiological disorders were selected for the normal reference group. The standardized MMPI of our country was applied to the whole object groups to get a result. Then each average value were analyzed by the t-test and chi-square test. And the psychological pattern analysis was done.

Results : In demographic aspects, there were no significant differences between the two groups. The mean T score for each measure of the two groups falls within the normal ranges with their values being of between 30 to 70. And the average of L, F and K measure, known as the validity measure, did not give a significant differences between the two groups. The measure of Hs, D, and Hy have appeared significantly high in the patients group(p<0.01) and the Pd measure, too(p<0.05). While Mf, Pa, and Ma measure have not shown a significant differences, Pt, Sc, and Si measure have very significant differences(p<0.01).

Conclusion : In the patient group with the functional dyspepsia, the measures of Hs, D, and Hy where they indicate a neurotic pattern have shown a very significantly high point as well as those of Pd, Pt, Sc, and Si where they indicate a psychotic pattern. This reveals that in the group of the functional dyspepsia neurotic or psychotic trends to attribute. However, it is very hard to define the characteristics of a group with just on test, so further study with more variable test will be necessary.

Background
: Family physicians should actively carry out adult immunization. DM is a common risk factor of influenza and pneumococcal pneumonia related complications, so DM patients should receive influenza and pneumocaccal vaccinations. The authors investigated recognition and performance of influenza and pneumococal vaccination among DM patients.

Methods : We surveyed knowledge and performance of influenza and pneumococcal vaccination among the 203 diabetic patients living in Seoul and responding to telephone interview, who visited one DM center in general hospital form March 3, to March 7, 1997.

Results : Among 203 DM patients, the risk factors for influenza and pneumococcal pneumonia other than DM were old age of 65 or over(35.0%), cardiovascular diseases(5.9%) and chronic pulmonary disease(4.9%). The recognition rate and performance rate of influenza vaccination were 27.6% and 21.2% respectively, there was a statistically significant relationship between these rates(P<0.01). Those vaccinated 43 patients for influenza knew the need of vaccination through family members and relatives(58.1%) and through medical doctors(32.6%). Although 85.2% of 203 DM patients answered that they received education about need of vaccination through DM education program conducted at hospitals, but only 9 patients(4.4%) recognized well. The reasons for not performing influenza vaccination were 'lack of knowledge'(63.1%), 'no experience of influenza'(12.5%), 'forget for the moment'(5.0%) and 'regard injection as a nuisance'(2.5%) in desending order. The recognition rate and performance rate of of pneumococcal vaccination were all zero percents. The reasons for not performing pneumococcal vaccination were 'lack of knowledge'(91.1%)' 'no experience of pneumococcal pneumonia'(6.4%), 'regard injection as a nuisance'(1.5%) and 'forget for the moment'(1.0%) in descending order.

Conclusion : The recognition and performance rates of influenza vaccination were low and those of pneumococcal vaccination were all zero percents among DM patients because they did not recognize well the need of these vaccinations. Therefore, the doctors who see DM patients should actively recommend influenza and pneumococcal vaccination and DM educational programs must include education for these vaccinations.

Background
: The studies about that hypertension commonly associated with dyslipidemia and that dyslipidemic hypertension increased mortality compared with hypertension only and dyslipidemia only, suggests an important clinical entity. Therefore, this study aimed to identify prevalence and describe potential insulin resistance of dyslipidemic hypertension, and compare about them with two other groups(dyslipidemia only, hypertension only.)

Methods : The data in this study was analyzed from 1,296 persons who had visited Health examination center in Ewha Womans University Mok-dong Hospital from Jan. to April, 1996. Prevalence of dylipidemia, hypertension and dislipidemic hypertension were measured. Average age, and frequency of male, obesity and NIDDM in three groups were measured. Odds ratios of sex, obesity, smoking, and DM according to two age group consisting of persons before and after 50 years were calculated for three groups.

Results : Frequency of dyslipidemia only was 27% and of hypertension only was 8%. ; conjoint frequency(dyslipidemic hypertension) was 7%, which is 1.5 times greater than expected value(4.7%) if the two diseases were independent. In characteristics for age, sex, obesity and NIDDA, All three groups(dyslipidemic hypertension, dyslipidemia only, hypertension only) w-normal subjects. Dyslipidemic hypertension was more likely to be obese and had a greater frequency of NIDDA than two other group(dyslipidemia only, hypertension only). Odds ratio was contrasted with three groups for sex, smoking, obesity, NIDDA stratified by age to more indentify association with insulin resistance. Sex was associated with male in two groups(dyslipidemia only, dyslipidemic hypertension) of younger group and dyslipudemia only group of older group, but associated with female in hypertension only and dyslipidemic hypertension of older group. Smoking was associated with dyslipidemia only group of younger group. Obesity was associated with increased odds of dyslipidemia only(2.03) and hypertensive(2.24) in older group, but associated with decreased odds with dyslipidemia only(0.56). NIDDM was associated with increased odds of dyslipidemia only(2.39) and dyslipidemic hypertension(3.32) in youger group.

Conclusion : Dyslipidemic hypertension is common and more often than would be dictated by chance alone, which is consistent with a distinct syndrome. Dyslipidemia and hypertension were associated with potential insulin resistant states of obesity and DM in this study. So, treatment of dislipidemic hypertension should focus on weight control and exercise, which increase insulin sensitivity.

Background
: It is well known fact that smoking is hazardous and fatal to health. Recently, physician's counselling about smoking cessation is carried out sucessfully and its importance is emerging. If phsicians can easily identify the current smoking status of the patient, the frequency of counselling will increase dramatically. This study evaluated the effect of including smoking status as a vital sign on the frequency of physician discussions with patients about smoking and physicians advice to quit smoking. Its purpose is to utilize this to practical practice.

Methods : From September 1 to October 31 in 1995, we analyzed 99 first-visit male patients(over age 20) who finished questionnaires which is composed of 7 questions during visiting family practice clinic in Ewha Womans University Mokdong Hospital in Seoul. Simple institutional change in clinical practice involved training the nurse how to use progress notepaper with a vital sign stamp that included smoking status(current, former, of never) along with the traditional visit signs from October, 1 1995 to October, 31, 1995 and just the traditional vital sign(blood pressure, body temperature, pulse rate) from September, 1, 1995 to September, 30, 1995. The contents of the survey were questions about whether the patient smoked, whether the patient was asked about smoking status by a doctor and, for smokers, whether they were urged to quit smoking.

Results : From September 1, 1995 to September 30, 1995, 52 patients participated and from October 1, 1995 to October 31, 1995, 47 patients did and the current smokers were 30 and 34 patients respectively. After expansion of the vital signs, patients were much more likely to report inquiries about their smoking status on the day of a clinic visit(an increase from approximately 53.3% at baseline to 82.4% at intervention ; P<0.05). The vital sign intervention was associated with significant increase in the percentage of smokers who reported that their clinician advised them to quit smoking (from approximately 36.7% at baseline to 61.7% during the intervention ; P<0.05). Age, age at which smoking was started, the number of cigarettes currently being smoked daily and number of previous quit attempts were not statistically significant.

Conclusion : Expanding the vital signs to include smoking status was associated with a dramatic increase in the rate of identifying patients who smoke and of intervening to encourage and assist smoking cessation. This simple, low-cost intervention may effectively prompt family physicians to inquire about use of tobacco and offer recommendations to smokers.

Background
: For control of diseases, the relative importance of prevention and treatment of the disease has become greater day by day and, accordingly. the importance of health education is being emphasized. In conducting health education, we are aware that using mass media exerts a great effect upon the readers in general. However, We seldom find any study on what kind of health in formation the mass media is providing and furthermore. if the if the information provided is fit for reader in general. In this study, we strove to ascertain, through a content analysis, if the daily newspapers reported adequate articles of health information on cancer, on of the most important health problems in this country.

Methods : A prepared analysis table containing 11 different items(evaluation standards) was distributed to a family medicine specialist and internal medicine specialist, and a graduate student in the doctoral course of public health science. they were asked to analyze 143 articles, pertaining to cancer, reported in nine different daily newspaper during the period from January 1992 December 1993. Three different analysis tables, prepared by the three analyzers, were consolidated by each of the 11 items and the consolidated table was analyzed.

Results : As for the items entitled "The contents of article were too professional for the readers(in general) to understand." and "Article contained too difficult terminologies for the readers to understand", 39.2% and 34.3% of the readers gave affirmative answer to the respective question. This meant that more than on third of the readers thought the articles were too difficult to understand. The result of analysis reflects that the headlines accurately reflected the contents of the articles(88.8%) and there were very few academic errors(2.1%). Articles pertaining to high technology were 35.0% of the total and articles including an adequate explanation of the prevention and early diagnosis of cancer were only 34.5% of th total It also indicates that 14%, 2.1%, 20.3%, and 35.7% affirmative answers were given to each of the following four (4) items, respectively: "foreign case was reported as if it were a case in this country". "rare case was reported as if it were a common case", "case in a limited area was inadequately generalized and reported as a common case", and "article was written by using only on viewpoint on a topic which was being criticized." If we consider any on of the above four items as an exaggerated article, 42.7% of the total articles fall into this category. As for the last item, "in total view, the article contributed to the health promotion of the readers", only 53.1% of the articles had a affirmativex answer.

Conclusion : The articles concerning cancer. reported n the daily newspapers in this country, did not provide inaccurate on health. However, many of the articles were determined to be too difficult to understand, or provided exaggerated information, and only about on half of the articles are considered to have contributed to the health promotion of the readers.

Background
: The growing prevalence of alcohol related disorders in Korea has posed significant position in medical practice. In order to detect the alcohol problems before patients have become dependent on alcohol or sustained organ damage, a sensitive and accurate markers has been required. In this study, comparison of laboratory tests and questionnaire(MAST) was undertaken as scree ning instruments that may be used to identify drinking abult males in risk.

Methods : Data was obtained from 423 men in Health Care Center in Ewha Mokdong Hospital on epidemiologic status, alcohol consumption amount, mean corpuscular volume(MCV), MAST scores in the period from July 1994 to August 1994.

Results : MCV was increasing with age(P<0.01), γGT, MCV and age were correlated positively with alcohol consumption(P<0.01). Obesity ratio and γGT also were correlated with alcohol consumption(P<0.01). The relationship between alcohol consumption and these variables was not changed after controlling for age and obesity ratio. Between low alcohol group and high alcohol group, there was a significant difference in γGT, MCV, and alcohol conaumption(P<0.01). When criterion with γGT 50U/L or over and MCV 94 fl or over were taken, sensitivity of γGT was 42.7%, But when MCV and γGT was combined, sensitivity had increased to 63.4%.

Conclusion : γGT and MCV were correlated positively with alcohol consumption. Neverthless, their correlation was insufficient to make the test useful for screening. But When We use them together, their screening power will be increased.

Background
: Recently, the frequency of the diseases in the geriatrics is on the increase gradually as increasing of the aged population. The acute abdomen which incurs danger if an adequate management is not performend under the exact diagnosis in the geriatric patients is common. This study analyze the factors influencing on postoperative complications and mortality for decreasing the rate of them.

Methods : we analyzed age and sex distribution, disease distribution, coexisting diseases, preoperative phyical status, anesthesia time, it's complication and mortality, complication distribution and causes of death of 105 cases of the geriatric patients undergone emergency operation for acute abdomen on from Jan. 1991 to Aug. 1993 at Seoul Christian General Hospital.

Results : The sex ratio between male and female was 1:1.2, the range of age was from 65 to 87 years. 70-74 years was most common(31.4%) among the classifications of the age. In distrubutions of diseases, acute appendicitis was the commonest(35.2%), hepatobiliary disease was 28.6%, and upper GI tract disease was 18.1%. The coexisting diseases were found in 68.8%, of patients and cardiovascular disease was the commonest(28.2%). In preperative physical status, Class II was the commonest(40.0%) and Class V was 2.9%. In anesthesia time, the number of cases between one and two hours was 48 cases and was the commonest(45.7%) and that below 2 hours was 59 cases(56.2%). Postoperative complications were found in 31.4% of patients, pulmonary complication was the commonest, and the next was intestinal obstruction. The mortality rate was 11.4% and multiple organ failure was the most common in the cause of death, the others were sepsis and acute respiratory failure etc.
In the analysis of factors affecting complication and mortality, the age was not related to the complication and mortality. The complication was the highest in patients with colorectal disease and the mortality was the highest in patients with strangulated hernia. There was a large number of complications in the patients who have had coexisting diseases and also the mortality rate was higher among them, but there were no significant differences statistically. The higher the Class, the higher the complication and the mortality rate on the preoperative physical status. There were more frequent complications in the anesthesia time above 2 hours. The mortality rate was higher in the anesthesia time below 2 hours but there was no significant differences statistically.

Conclusion : Consequently, postoperative complication and mortality in the geriatric patients were not related to age, but associated with primary diseases, coexisting diseases, preoperatice physical status and anesthesia time. Therefore it is thought hat postoperative complication and mortality will be decreased, if primary physicians make every efforts to diagnose early primary disease, concern about the existence of coexisting disease, improve the preoperative physical status, and decrease the anesthesia time in management of geriatric patients.

Background
: Acute appendicitis is a common disease which needs surgical treatment among acute abdomen, but the specific sutdy is applied very seldom because of emergency operation neccessity. Therefore this study was carried out to find out a way of help for preoperative diagnosis and treatment of this diseases, to analyze intestinal diseases except appendicitis among operation cases of appendicitis preoperatively.

Methods : For 3 years from August 1990 to July 1993, we reviewed clinical reports which 25 cases of intestinal diseases among 881 cases of performed operation under preoperative diagnosis of acute appendicitis, and analyzed sex and age distribution, complete blood count, disease distribution, postoperative diagnosis, operative method, pathologic diagnosis and postoperative progress.

Results : The age distribution shows that 4th decade is the highest incidence, and male and female ratio is about 5 to 1. We cannot find any differences between these intestinal diseases and appendicitis in symptom, physical examination and leukocyte count. The mean duration of symptom was 6.1 day that is longer than acute appendicitis. Benign diseases were dominant, and cecal diverticulitis was the highest, and others such as cecal tuberculosis, cecal inflammatory mass, cecal cancer, Meckel's diverticulum, appendix carcinoid tumor, appendix mucocele and appendix cancer were found.

Conclusion : If the 4th decade male patient who were suggested acute appendicitis and duration of symptom is longer than that, detailed history taking with radiologic approach must be taken with a deep concern. It must be considered diverticulitis in 4th decade and malignant disease as well in over the 5th decade. When the opinion is different from clinical symptom before operation and findings in operation, more careful stances are essential for trying to find out other intestine with doubt.

Background
: Upper gastrointestinal bleeding is the most difficult problems at emergency status and early accurate diagnosis and prompt emergent care is needed because of variable etiology and high mortality. We studied comparatively about relationship between upper gastrointestinal bleedings and it's prognostic factors.

Methods : We analyzed 42 cases that upper gastrointestinal bleeding from on Feb. 1992 to on Jan 1993 at hospital setting.

Results : Among the 42 cases, the ratio of the male to the female is 2.8 to 1, more common in the male and the 3rd decade is the most common. For the etiologic cause, peptic ulcer is the most common as 19 cass. The character of the bleeding is mixed type of hematemesis and hematchezia to 45.2%. The predisposing factors are alcohol abuse and drug.

Conclusion : The significant risk factors are the evidence of associated disease, increased bleeding tendency, decreased hematocrit and increased BUN. We conclude that these patients must be treated with early, active management and therapy.

Background
: Nation-wide medical insurance has been offered since July 1, 1989 and 129 Emergency Patients Information Center, and emergency medical system has been in operation since July 1, 1991. Emergency patients and those acutely died, however, have been ever increasing. By analyzing emergency patients died, authors made this study to reevaluate the role of doctors of family medicine in emergency medical care who are in responsible for primary medical care.

Methods : Out of 23,802 patients who visited the emergency room of Seoul Christian General Hospital from January 1, 1990 to December 31, 1991, authors examined emergency care charts of 326 patients who died during emergency care at the emergency room and those died before getting to the emergency room.

Results : The total number of patients died was 326 with the ratio of 2 to 1 between male and females. By age, the largest number of patients(19.60%) was in their fifties. In particular, more than half(61.00%) of patients died were in the age of 20 to 59, the period of energetic social and economical activity. Classified by the cause of death, the number of existing diseases(38.04%). The largest number of patients(30.00%) visited the emergency room within 30 minutes after accidents or attacks of diseases. Most of the cases(60.80%) were occurred at Choongrang-ku and 38.70% of the total cases were carried by family members.

Conclusion : The medical care for emergency patients should be done on the spot with the occurrence of the emergency cases. The education to the emergency medical care specialists who actually do emergency care on the spot as well as generals who generally get to the spot first is very important. In this point of view, doctors of family medicine who in charge of primary treatment should alway keep in mind the fact the they the emergency care is one of special fields of primary treatment. They should provide the most efficient, economical and effective emergency medical care with professional knowledge and technique of emergency care.

Background
: Knowledge and experience of the family physician who sees patient for the first contact care have an effect on the referral content and outcome. So we carried out this study to determine the relationship between the knowledge and experience of the physician and the referral content and outcome by comparing the physician according to grade.

Methods : We select March, May, September and December according to the seasons in order to stand for one year, from June 1991 to May 1992. We review the medical record of the 449 patients who visited our OPD of family medicine then referred to other specialties.

Results : Total referral rate was 3.7%. Compared referral rate according to grade, 3rd-year residents had lower referral rate than 2nd-year residents and staff has lower referral rate than residents.(P<0.05, P<0.001 respectively) The most common reason for referral was for diagnosis and treatment(29.4%), and then for treatment(24.1%), request by the patient(23.6%). The most frequently referred specialty was Internal Medicine(33.5%), and then Orthopedis, neurology. There was a trend to increase the treatment rate and relationship between the referral and minor problem by rising the grade of the physician.(P<0.001, P<0.01 respectively)
Agreement rate of diagnosis before and after referral was 63.3%. There was no significant difference according to grades. In the outcome of referral, no follow-up patient was most common(43.9%), and then improved(31.2%), admitted(18.9%).

Conclusion : There were significant differences according to grade in the treatment rate, relationship between referral and main problem before referral. But there were no significant differences in the reasons for referral, referred specialties, agreement rate of diagnosis before and after referral. In the referral rate, there were significant differences between 2nd-year residents and 3rd-year residents, and between residents and staff. Many biases may be in the study of the referral, so the study to minimize these biases is needed.

Background
: Hypercholesterolemia is a well known risk factor of coronary heart disease. In Korea, coronary heart disease is increasing according to the change of dietary patterns and other causes such as economic growth. In order to make more appropriated our therapeutic guidelines and to analyse about characteristics of patients with hyperlipidemia, we carried out this study.

Methods : We examed therapeutic compliance and results according to therapeutic methods and change of serum lipid levels after termination of treatment to 58 hyperlipidemias who were diagnosed and treated due to hyperlipidemia. This 58 hyperlipidemic patients were visited family medicine out-patient department at Seoul Christian General Hospital during period from Sep.1.1991 to Aug. 31. 1992.

Results : Among patients with hyperlipidemia, only 29.3% terminated their treatment, and only 58.6% had follow-up checks. The incidence of termination of treatment was higher in the group using lipid-lowing medication than in groups not using lipid-lowing medication than in groups not rsing lipid-lowing drugs. The duration of treatment was shorter in the group using lipid-lowing medication than in groups not using lipid-lowing drugs. After treatment, mean serum levels of total cholesterol and triglyceride decreased regardless of therpeutic methods. Mean serum levels of total cholesterol and triglyceride after termination of treatment increased, and the increase in total cholesterol level was statistically significant.

Conclusion : The compliance and self recognition of hyperlipidemic patients about their disease were very low and life styles and dietary patterns were not maintained after termination of the treatment. Therefore, it is necessary to educate and propagate our people about the significances of complications caused by hyperlipidemia at National Health Provoking level, because it may cause significant public health problems.

Background
: There is probably overwhelming consensus that addictive disorder such as cigarette smoking is markedly resistant to long-term modification. But studies of nontherapeutic populations indicate that long-term self-cure of smoking is relatively common events. So it is of considerable importance to understand variables which are as associated with quitting among smokers.

Methods : Among 1627 about males who registered in life long health maintenance program of Seoul National University Hospital, 121 quitters (for more than 1 year) and 277 persistent smokers were selected. We analyzed the contents of health risk appraisals of them

Results : The variables positively associated with smoking cessation included age, education, marriage, and exercise. But multivariate analysis showed that age, education and exercise were associated with smoking cessation and marriage was not related with smoking cessation.

Conclusion : This analysis focused upon the relationship between baseline variables and cessation for smokers who were not offered any particular program. These findings could be used in the future design of more refined study on baseline factor associated with smoking behavior and more effective smoking cessation program.

Background
: Once attacked by paralytic poliomyelitis, most of patients have difficulties in their social activities and need a close assistance in their rehabilitation efforts. By examining the relation between the onset of paralytic poliomyelitis and the paralytic pattern, this study made to provide some helps in estimating the prognosis of the paralytic poliomyelitis and their rehabilitation activities.

Methods : Authors made suvey on 48 paralytic poliomyelitis victims who work at 00 electronic company in Seoul, Korea.

Results : The ratio between male and female was approximately 2 to 1. Out of 48 victims, 46(95.8%) were attacked by poliomyelitis before 5 years old. The victims were country-widely distributed and most of them were attacked in summer. The victims attacked under 5 years old have paralysis on their both legs (52.2%), those after 5 years old show paralysis on both legs.

Conclusion : Most of the victims were attacked by poliomyelitis under 5 year old, have paralysis on their both legs and need early stage rehabilitational education and treatment. Family members and social level concern and help should be continuously given to them so that they can manage their stable social activity. In relation, the role of family physician is important for them.

Background
: Recently, the traffic accidents are increasing and the frequency of the fracture of femoral shaft has been increased in children. The fracture of femoral shaft in childhood will cause disturbance of ambulation and daily life, because the abnormality of bone growth after fracture will influence the length of leg. So it is very important to manage and evaluate such patients continuously before they have reached adolescence. So, we had carried out this study in order to make appropriate therapeutic guidelines for the treatment and clinical investigation of complication in the femur shaft fracture in children.

Methods : We had examined 51 patients who had admitted to orthopedic surgery department in Seoul Christian Hospital because of the fracture of the femoral shaft, before 13 years old from Sep. 1986, to Mar. 1992.(conservative treatment group: 43 cases, operative treatment : 8 cases)

Results : The group distribution of femoral fracture was most common in 6~8 age. The main cause of fracture was traffic accident(72.5%). Most patient has occurred during spring to summer, while children's activity was relative increased. The combined injury was 60.8% ; 31 of 51 cases. The most common fracture type was transverse fracture 47.0%. The location of fracture were that middle third 60.8%, proximal third 31.4% and distal third 7.8%. The average callus formation time in X-ray was 16 days in conservative group and 20 days in operative group. The average overgrowth range was 10.3mm in conservative group and 9.7mm in operative group. Both of all were good result and difference between them was not statistically significant.

Conclusion : The most of the fracture of femoral shaft in children have been treated conservatively, whereas a small proportion treated operatively and both have revealed relatively good result. The operative management would be the one of the excellent management methods, if the patient was selected according to accurate indication. We must have the knowledge of continuous management and consultation about the overgrowth of leg in children with the fracture of femoral shaft.

Background
: Through the examination on the actual smoking condition of high school student with the family factors, the relationship between the problems of family APGAR and smoking, psychological influence by smoking and articles of newspaper and public opinion on smoking, this study tried to provide helpful materials which can be used to make education plans to let them stop smoking.

Methods : To make survey, authors selected 505 junior and senior students (male: 222, female: 283) from four high schools, of which two(a girls' and a boys') are located in Seoul and the rest in the country.

Results : Among the surveyed students, 38.7 of boys and 12.0% of girls smoke habitually. About the motives of smoking, 34.1% start smoking through the inducement of their friends, 30.0% curiosity and 27.0% stress. About the age when first smoked, 20.3% responded that they start smoking before 13 years old, 24.8% at the age of fourteen, 25.4% at fifteen, 13.7% at sixteen, 9.3% at seventeen and 6.2% at eighteen, which showed that the earlier their first smoking experience, the higher the rate of tendency sticking to habitual smoking. The 18.3% of smoking students and 1.8% of non-smoking ones experienced addicting drug. In addition, 93.0% of smoking group and 27.2% of non-smoking one experienced drinking. When it comes to the family factors in smoking, religion of family member did not make any noticeable statistical differences. The higher the average family income, the higher the rate of smoking. The students whose parents have a do-as-you-2like-it attitude of education showed higher rate of smoking that those of democratic one. In particular, students who had habitually smoking family members recorded comparatively high smoking rate. The average family APGAR score was 5.7. The 15.0% of students had severely dysfunctional family 37.8% moderate and 35.6% healthy functional family, of which severely dysfunctional group showed high smoking rate.

Conclusion : Severely dysfunctional family group showed high smoking rate and a variety of family factors influenced on the adolescent smoking. Since smoking has serious influence on their physical and psychological status, the early stage education to help them stop smoking and the recovery from family dysfunction are thought to be very important.

Background
: Bacause head trauma patients can have serious sequelae, head trauma patients should be evaluated quickly by sensitive and specific diagnostic tools. For this reason, the use of brain computed tomographic(CT) scan is increasing. But unnecessary brain CT scans can reasult in increased medical cost and loss of critical time for managment of other fatal injuries. Therefore certain criteria for requesting brain CT scan is needed. This prospective study was attempted to see if the positive brain CT scan can be predicted by the patient's clinical features and, if so, to develop indications for brain CT scan use in Korea.

Methods : The data were collected from 130 subjects who were treated in the emergency room for head trauma and received brain CT scan. The sensitivity, specificity, positive and negative predictive vlaues were calculated the association between each clinical feature and positive CT scan was tested by X²-test and forward stepwise logistic regression. The score system was developed using likelihood ratio, and the cut-off point was estimated in Receiver Operating Characteristic(ROC) curve between sensitivity and false-positive rate.

Results : The percent total of positive CT scan was 30% and the classification of head injuries were Subdural Hematoma(SDH), Epidural Hematoma(EDH), Intracranial Hemorrhage(ICH), Brain contusion, Subarachnoid Hemorrhage(SAH), and traumatic infarction in order of decreasing freaquency. There were significant statistical associations between positive CT scan and loss of consciousness more than 5 minutes, Glasgow coma scale, skull fracture by forward stepwise logistic regression. The cut-off point in this scoring system using likelihood ratio was 12.

Conclusion : The positive CT scan can be predicted by the patient's clinical features in most of cases and the scoring system may help the predictability.

The diabetic patients were evaluated by Diabetes Quality of Life(DQOL) measure in this study. The diabetes quality of life(DQOL) was initially designed for use in the Diabetes Control and Complication Trials.
The purpose of this study is to evaluate DQOL toward fasting blood sugar, sex, treatment modality, duration of the D.M., and site of life. This study has been made of 105 patients that have been visited to Severance, Kanghwa, Chungmu hospital during 6 months (1990.4-1990.9)
1. The difference between males and females was not found on the total DQOL, but males were significantly less distressed than females in diabetes related worry individual scale. (P<0.05)
2. The difference in fasting blood sugar levels was not found on the DQOL. There were no significant differences in fasting glucose levels.
3. The difference in treatment modality group such as diet & exercise group, oral hypoglycemic agent group, and insulin therapy group were found on the the total DQOL, with diet & exercise group being significantly less distressed than oral hypoglycemic agent group and insulin therapy group were found on the the total DQOL, with diet & exercise group, being significantly less distressed than oral hypoglycemic agent group and oral hypoglycemic agent group being significantly less distressed than insulin therapy group.(P<0.01), especially in satisfaction and impact individual scale.
4. The difference between urbans and rurals, was found a total DQOL, with urbans being significantly less distressed than rurals.(P<0.01), especially in worry individual scale.

Serum lipids level were studied in 281 non-insulin dependent diabetic patients who were admitted at Yonsei University Hospital from January 1989 to December 1989.
The results obtained were as follows :
1. There was significant difference according to sex in cholesterol, LDL : cholesterol and HDL : cholesterol in diabetic patients.
2. There was no significant difference according to age and treatment modality in serum lipid level.
3. There was significant difference according to the duration of diabetes in cholesterol and LDL-cholesterol.
4. There was significant difference accrding to fasting blool sugar in triglyceride.
5. There was significant difference according to duration of diabetes in cholesterol and LDL-cholesterol.
6. There was significant difference between hypertensive and normotensive patients in cholesterol and LDL-cholesterol.