Background
The educational assessment of residents is very important in order to check their knowledge and to improve their ability. In case of family practice, the residents spend most of their training time in outside rotations with other specialities. Therefore, they are requested to be evaluated by each specialist after each rotation. To give more accurate assessment, we surveyed directly our family practice residents and family practice faculties. Methods: A questionnaire was sent to family practice residents and family practice faculties in 116 hospitals from May to June 2006. The response rate was 29% and 78%, respectively. Results: Among the total, 70.2% of family practice residents thought an assessment is necessary, but only 51.7% were evaluated. Overall, 90.4% of family practice faculties knew about the assessment of residents made by other specialists, and only 56.7% of faculties requested other specialists to assess their family practice residents. Conclusion: Most of the family practice residents and their faculties knew the need for assessment, but they complained there were no objectivity and the assessment tool was lacking. In order to solve this problem, it is urgent to develop a unified form and guidelines of assesment. (J Korean Acad Fam Med 2007;28:616-625)

Background
This study was conducted to survey the current status of family medicine residency programs and to evaluate the difficulties in training of the curriculums. Methods: Questionnaires on residency programs were sent to all the centers of residency programs by mail in April 2006. The questionnaire included detailed characteristics of residency programs, curriculum schedule, reasons for failed specific curriculum, and review and measures by the program center and the Korean Academy of Family Medicine to resolve problematic curriculums. Results: A total of 113 residency programs responded. Among the 93 residency programs except for the 20 subsidiary hospitals, inadeguate subjects were mainly dermatology (12 programs, 12.3%), psychiatry (6 programs, 7.5%), ophthalmology (5 programs, 7.1%), and otolaryngology (5 programs, 7.1%). Training rejection rate was higher in dermatology (13 programs, 14.4%), radiology (11 programs, 13.1%), gastrofibroscopy (8 programs, 9.5%), and psychiatry (5 programs, 6.2%). Emergency me-dicine in 4 programs and general surgery in 3 programs had a longer duration of training than initially planned. Difficulties in training some subjects were due to failed establishment of specific curriculums in non-university hospital. Commonly established clinics were health promotion center, obesity clinic, smoking cessation clinic, geriatric clinic, stress clinic, and clinical nutrition clinic. Family medicine center programs included gastrofibroscopy, obesity, smoking cessation, geriatrics, hospice care, and evidence-based medicine. Conclusion: There is repeated demand for taking measures to promote better curriculum in the nation-wide view of family medicine. Dermatology, radiology, psychiatry, and otolaryngology were the subjects difficult to receive training. Measures to strengthen the weak subjects are urgently needed. (J Korean Acad Fam Med 2007;28: 367-374)

Background
: Family environment has an important effect on the development of children. During childhood and adolescence, depression and anxiety are common forms of psychopathology. Therefore, the relationship between family function and depression·anxiety in children was investigated in this study. This research was intended to aid management of children in the field of primary care.

Methods : This study was based on the survey administered to 193, 4th grade students of two elementary schools in the area of Sung-buk in Seoul, Korea, in May, 2003. We investigated family function, depression and anxiety by self-rating using the Smilkstein's Family APGAR, the Kovacs's CDI and the Reynolds's RCMAS. At the same time, home environment characteristics (Family Structure, Parental Religion, Parental Education and Monthly Household Income) were investigated.

Results : There were no significant differences in home environment characteristics between Family APGAR groups (P＞0.05). CDI scores were significantly higher for children whose parents had education levels of middle school or lower (P＜0.05). However, there was no significant difference in RCMAS scores between home environment characteristics (P＞0.05). CDI score was significantly different between Family APGAR groups (P ＜0.05). And, RCMAS scores was significantly higher in poor family function groups than good family function groups according to Family APGAR groups (P＜0.01). Both CDI and RCMAS scores was negatively correlated with Family APGAR scores (r=-0.376, P＜0.01) (r=-0.266, P＜0.01) and CDI score was positively correlated with RCMAS scores (r=0.711, P＜0.01).

Conclusion : In groups where the Family APGAR score was lower, both CDI and RCMAS scores were significantly lower. Accordingly, when caring for children, family physicians should need to their family function and know that it has an effect on children's emotions.

Breaking bad news to patients with an advanced cancer is a difficult task for physicians. Some strategies can be used when breaking bad news to patients with advanced cancer. However, many doctors were not trained sufficiently. 43-year old male complaining of general weakness and melena was diagnosed as an advanced gastric cancer with hepatic metastasis. We could deliver this bad news to the patient and his family step by step. Honest discussion allowed patient to be reassured about many points of concern and helped them to be calmer and to plan and readjust hopes and aims. Bad news cannot be broken gently, but it can be given in a sensitive manner and at the individual's pace. Sometimes doctor's own anxiety can be barrier to tell the truth. When we give the information, we always keep in mind about the respect for truth, the patient's rights, the duty to inform, maintaining hope, and the sanctity of the individual contract between patient and doctor.

Background
: As evidence-based medicine is getting popular recently, the importance
of randomized controlled trial as a research methodology is also getting highlighted. This study
was conducted in order to identify the status quo of randomized controlled trial research in
major domestic journals and to provide baseline data for constructing Korean clinical trial
database such CCTR (Cochrane Clinical Trial Registry).

Methods : Five journals issued by
domestic publication industry were selected, out of which 127,560 original articles, equal to
253 volumes, were investigated. The author extracted the articles, which performed pro
spective clinical trial, targeting human beings. The selected papers were analyzed with experts
to single out randomized controlled trial among them. Furthermore, the quality of the
re-selected ones were assessed according to Jadad Quaility Assessment Scale.

Results : After
analysis, it turned out that the number of papers adopting prospective clinical trial were 406
volumes (3.2%) of 12,760 and that they increased from 157 in 1980s to 224 in 1990s.
However, the percentage of prospective clinical trial monographs, introduced during 1980s and
1990s, remained 2.0 to 4.0. The number of randomized controlled trial-based papers were 115,
accounting for 0.9% of total articles. The number of RCT increased to approximately two fold
from 1980s to 1990s. Quality analysis showed that among a total of 115 RCT papers, those of
scoring 1 and 3 were 16 (13.9%), 82 articles obtained score 2 (72.2%). There was no papers,
which won the marks of 4 and 5.

Conclusion : It was found that domestic randomized
controlled trial research was weak both in number and quality. Therefore, it is necessary to
activate clinical medicine study with good quality to upgrade the amount and quality of
monographs.

Background
: Arterial stiffness is a strong indicator of cardiovascular risk. Increased visceral fat confers greater risks of metabolic syndrome and cardiovascular events. The aim of this study was to elucidate the relationships between arterial stiffness and regional distribution of abdominal adiposity (i.e. subcutaneous and visceral adipose tissue).

Methods : Thirty obese participants (M：F=17：13, mean age=53.6±12.0 years) underwent anthropometric measurements, laboratory procedures such as serum lipid levels and abdominal computed tomography scan. The aortofemoral pulse wave velocity was measured by foot to foot method using two continuous Doppler waves.

Results : Pulse wave velocity was positively associated with age, hip circumference (P＜0.01), visceral to subcutaneous abdominal fat ratio and body weight (P＜0.05), but independent of the total abdominal, visceral, and subcutanous fat. Although not positively associated, the mean pulse wave velocity tended to be higher in patients with history of hypertension or diabetes.

Conclusion : The site of abdominal fat distribution contribute to the prediction of arterial stiffness and visceral adiposity is associated with increased risk of cardiovascular events.

Background
: Abdominal obesity is recognized as an important risk factor of metabolic diseases and atherosclerosis. The purpose of this study was to investigate the effects of vibration baths on abdominal fat and blood lipid profiles in obese women.

Methods : From Apr. to Jun 2000, the 32 obese women received vibration baths for 4 weeks (30 minutes/day, repeated 5 times per week). The people were divided randomly into two groups, the case (n=17) and the control (n=15) group. The case group received vibration baths (55 Hz) and the control group took baths only. Body weight, height, body mass index (BMI), body fat distribution, lipid profiles, and blood pressures were measured in all subjects immediately before and after 4 weeks of the study. The body fat distribution was assessed by CT scan by which both total abdominal and visceral fat areas were measured at the level of the umbilicus.

Results : After 4 weeks, 13 subjects remained in both groups, respectively, and the total abdominal and visceral fat area decreased significantly in the case group compared from those of the control group. There were no significant differences in body weight, body fat mass, serum lipid profiles, and blood pressures before and after the baths in the two groups.

Conclusion : These results suggest that vibration baths is effective in decreasing abdominal fat. But there were no significant weight change, the effect is insufficient in obesity treatment goal.

This is the first case report of myasthenia gravis with cosxisting hyperthyroidism and thymic hyperplasia in Korea. Thirty two year-old man visited in the clinic with exthophalmos, ptosis, dysarthria and dysphagia. Serum anti-acetylcholine receptor and anti-microsomal antibodies was increased significantly. The chest CT showed a large soft tissue mass at the anterior mediastinum. The anti-thyroid drug, glucocorticoid, cholinesterase inhibitor and intravenous immunoglobulin was given as a treatment. After thyroid function is normalized, thymectomy will be done.

Background
: Obesity can be considered as hyperaccumulation of body fat. Therefore, the aim to treat obesity is to decrease body fat. Abdominal total fat calculated in computed tomography is thought to be the most accurate index measuring body fat. The body mass index (BMI) and body fat mass are the representative indices also. Leptin is a protein hormone expressed by obesity gene in adipose tissue. It inhibits food intake and increases energy consumption, thereby controls obesity. With a study of relationship between plasma leptin level and body mass index and abdominal total fat area, we tried to find the usefulness of leptin as an index of adiposity.

Methods : The adiposity level was approximated by BMI, computed tomography and bioelectical impedence. To further explore the relationship with body composition, body fat distribution was determined by computed tomograph. To quantify the relationship between serum leptin level and adiposity, correlation analyses have been conducted.

Results : The subjects were 32 females with a BMI of over 25 kg/m². The mean plasma leptin level was 14.2±5.9 ug/L. We investigated the correlation of plasma leptin level with subcutaneous and visceral fat. The plasma leptin level showed a significant correlation with BMI and body fat mass, and was significantly correlated with subctaneous fat (P＜0.01), but not with abdominal visceral fat.

Conclusion : A significant correlation between plasma leptin level and body fat mass was observed. The distribution of subcutaneous fat showed differences in plasma leptin level. Therefore, the plasma leptin level may be used as an index of change of body fat mass, especially subcutaneous fat.

Background
: Symptoms of musculoskeletal system is a common problem, followed by those of respiratory system. Most patients with problems of musculoskeletal system are examined and treated by a primary doctor. This research was performed to inquire into a method which can increase the effectiveness and the precision of history taking in patients with problems of musculoskeletal system in primary care and also to assess a self-marking method were patients can mark their pain site on a normalized picture.

Methods : In the department of family medicine and rehabilitation of an university hospital in Seoul, 44 patients with musculoskeletal pain on their first visit in an outpatient clinic were asked to put marks on a normalized picture and also mark the degree of pain with a visual analog scale from 0 to 10, before history taking. After history taking, the doctor also marked the spot of the patient's pain on the normalized picture and then compared the spots together. After comparing the two pictures of the doctor's and the patients', they then drew another picture with only one spot to avoid overlapping spots. We compared the differences among the patients in every decade from ages 20 to 60 and divided the value of visual analog scale into 3 groups concerning the spots drawn by patients, and compared the relations between them.

Results : The pain spots drawn by doctor only were on the lumbar spine and the shoulder whereas most of pain spots drawn by patients only were on the upper back, the cervical spine, and the lumbar spin. The older the patient and the lower the degree of pain was, the more humerous it had spots.

Conclusion : It is considered that with a general history taking method and a self-marking method, clinical effectiveness will be great to the patients having pain on the abdomen, the cervical spine, and the lumbar spine and to those who are elderly and with lower pain spots.

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
: 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
: Despite the development of medical knowledge and technology, it has long been pointed out that the treatment guidelines are not sufficiently based on evidence. It has not been yet studied how evidence based medicine if implemented when physicians make their therapeutic decision. The purpose of this study was to determine the degree of evidence based interventions in a university based family medicine outpatient clinic.

Methods : The degree of evidence based practice was evaluated using Ellis and Gills' method developed by the Evidence-Based Medicine Center in Oxford. The patients' records of an outpatient clinic of a university hospital were reviewed on the primary diagnosis - intervention. The evidence based guidelines were defined as traditional textbooks and the results of randomized controlled trials found on databases such as Medicine, Clinical evidence, Best evidence, and Cochrane. In case where there were no guidelines, consultation with the specialists was done. The degree of the evidence based therapeutic interventions was assessed by three levels.

Results : There were 179 primary diagnosis - intervention pairs, among them, 125 pairs (69.8%) of interventions were based on randomized controlled trial evidence and 19 pairs (10.6%) based on convincing non-experimental evidence. No evidence was found for 35 pairs (19.6%). As a result, 80.4% of the total 144 pairs were regarded as evidence-based medicine.

Conclusion : The result showed that considerable portion of the total cases were evaluated as based on clinical evidence, which is similar to the conclusions of the previous studies in other countries. We hope that future similar studies will be conducted in other institutions as well as in other specialities.

Background
: Patients diagnosed as an advanced cancer and families need accurate information about the length of survival in order to plan for and to make the best use of the time that remains. The health care of that patient can then be redirected toward palliation and mobilizing resources to ensure a comfortable life. The purposes of this study were to evaluate the prognostic value of performance status plus some physical symptoms and some biological indices and therefore to assist in planning appropriate palliative care.

Methods : This study was performed on 151 patients, who had been diagnosed as advanced cancer in Korean University Guro Hospital from July 1999 to July 2000.: We requested Karnofsky performance status scale, mental status, jaundice, severity of pain, anorexia, voiding difficulty, dyspnea and dry mouth. We assessed the biological indices by leukocyte count, plasma albumin, proteinuria.

Results : We could confirm 82 patients' death(54.3%) of 151 patients. Univariate analysis showed that Karnofsky status scales mental status, jaundice, severity of pain, anorexia, voiding difficulty, dyspnea, dry mouth, leukocyte count, albumin and proteinuria demonstrated a statistically significant predictive prognosis. Multivariate analysis using Cox's proportional hazard model showed that age, performance status, albumin, proteinuria were independent predictors of survival and severity of pain had the borderline value.

Conclusion : Age, performance status, albumin and proteinuria were the independent prognostic factors for patients with advanced cancer.

Background
: A predominant accumulation of adipose tissue in abdominal region confers increased risk of cardiovascular disease. The best technology available for measurement of regional fat distribution is computed tomography. However, computed tomography is limited its use for clinical purposes by cost. The aim of this study is to identify the best simple anthropometric index of abdominal visceral fat accumulation.

Methods : To quantify the relationship between anthropometric indices of abdominal obesity (waist circumference, waist-to-hip ratio, waist-to-height ratio, body mass index, abdominal sagittal diameter) and abdominal(total, visceral, subcutaneous) fat areas measured by computed tomography, correlation and multiple regression analyses have been conducted.

Results : No significant difference for waist circumference, body mass index and sagittal diameter between men and women have been found. Mean value of waist-to-hip ratio is larger in women, but waist-to-height ratio is larger in men. The mean abdominal total fat area and mean subcutaneous fat area are higher in women. Interestingly, men, despite lower total fat area, have higher mean abdominal visceral area. Thus, the mean visceral fat-to-subcutaneous fat ratio is much higher in men. Abdominal sagittal diameter shows the highest correlation(men: 0.69), women: 0.76) with abdominal visceral fat area in both genders. stepwise analyses have been performed to determine the best simple anthropometric index of abdominal visceral fat accumulation. In men, the significant indices are abdominal sagittal diameter, body mass index, and waist-to-height ratio. In women, abdominal diameter is the only significant index.

Conclusion : Abdominal sagittal diameter, in comparison with the waist circumference, waist-to-hip ratio, waist-to-height ratio and body mass index, is the best predictor of the amount of abdominal visceral fat.

Background
: 　Antibiotics are often indiscriminately prescribed for respiratory tract infections. This study was conducted to describe the prescription pattern of family physicians for respiratory tract infections.

Methods : In each clinic of 50 representative family practitioners, about 20 consecutive patients with diagnosis of respiratory tract infection were enrolled into the study. The data were collected by questionnaire to physicians just after patient interview.

Results : The number of study subjects was 1020, of which 55.7% was less than 15 year old. Antibiotics were prescribed to 73.9% of total subjects. According to diagnosis, the antibiotic prescription rate was 51.5% in common cold, 86.0% in pharyngitis, 88.6% in bronchitis, 98.9% in sinusitis, and 100% in otitis media. In common cold, the factors which significantly increased the antibiotic prescription were 1)patient age less than 15 year old (OR=1.70, CI= 1.06-2.73), 2)more than two visits during the same episode(OR=1.95, CI=1.27-2.99), 3)yellow and thick rhinorrhea(OR=2.22, CI=1.16-4.25), 4)yellow and thick sputum(OR=3.31, CI=1.34-8.19), and 5)throat injection(OR=2.50, CI=1.42-4.39). Among patients to whom antibiotics were prescribed, 48.7% of patients were given the antibiotics by intramuscular injection. The most frequently prescribed antibiotics were penicillin and macroride among per-oral medicine and ribostamycin and lincomycin among intramuscular medicine. The reason for antibiotic prescription were 1)possibility of bacterial infection(43.4%), 2)prevention of bacterial complication(23.7%), and 3)definite evidence of bacterial infection(22.5%).

Conclusion : Family practitioners prescribe antibiotics indiscriminately for the respiratory tract infection. The prescription was influenced by patient's age, number of clinic-visit, and clinical symptoms and signs.

Background
: Decision about life sustaining treatments ought to be based on the patient’s in formed preferences. This study was to see if there were any differences in acceptance by patients, their primary care givers and doctors for end-of-life care according to situations, and if any, to analyse the factors related with different attitudes.

Methods : A structured questionnaire survey of end-of-life care preferences was performed on 162 cancer patients and their primary care givers in four university hospitals and one general hospital from March 1, 1999 to February 29, 2000. A similar survey was done for doctors practicing at the above, hospitals during the same period to investigate their attitudes toward providing end-of-life care to an assumed nearly bed ridden patients. ANOVA, t-test and Wilcoxon rank sum test were used to compare acceptance of intervention among the groups or according to the various situations. Factors presumed to be related to the acceptance were sought and analysed by stepwise multiple regression.

Results : The difference in acceptance of intervention between the primary care giver group and the doctor group was not significant in almost every situation, showing significantly higher than the patient group(P=0.001). All three groups showed higher acceptance when a therapeutic intervention rather than a diagnostic test was proposed(P=0.001). When expected survival was 30 days rather than 7 (P=0.01), and when the therapeutic intervention was thought as non-invasive rather than invasive (P=0.001). The less anxious the patient was , the higher the acceptance. From the patient. Patients with a religion had higher acceptance rate than non-religious patients. Primary care givers who expected sure of the disease accepted more of the postulated care than those who did not (P<0.05). Wives of mother-in-laws of patients showed lower acceptance than those in other relationship(P<0.05). The longer the patient had been diagnosed with cancer, the higher the acceptance of the primary care giver (P<0.1). Direct relatives showed higher acceptance than that of collaterals(P<0.01). Family doctors specializing in family medicine had lower acceptance than doctors of other specialties and interns(P<0.05)

Conclusion : The acceptance of intervention by patients was lower than that of primary care givers and doctors and depended on the expected survival and the type, of intervention.

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

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

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

Background
: Many of the major life events that appear to affect biologic system and health occur within the context of the family and can have a profound psychosocial and biologic impact on family memebers. So, the present study attempted to exmins the relati-ons of family function with stressful life events, depression, and physial and psychological symptoms reported by partients.

Methods : Design : Cross sectional, observational study. Participants : 41 healthy adult males from a family medicine ambulatory care unit in a tertiary hospital located in Guro completed a series of psychometric instruments that include the Family APGAR(Adaptation, Parnership, Grorwth, Affection, and Resolve< FACESIII(Family Adaptability and Cohesion Evaluation Scale), Modified 46-item Stressful Life Events Scale, Lee's 98-items Stressful Life Event Scale, Korean version of BEPSI(Brief Encounter Psychosocial Instrument) and BDI(Beck's Depression Inventory Scale).

Results : Family APGAR was negatively correlated with stress related life event(both in total negative events -0.30, -0.37, respectively ; p<0.05) and BEPSI(0.56, p<0.0001). No significant correlation could be found between family function and positive life events. Family APGAR also revealed significant negative correlation with BDI(-0.61;p<0.0001). Among the three family types, severe dysfunctional family demonstrated highest level of stressful life events, score, perceived stress, and depression(p<0.05).

Conclusion : The higher the assessment of the family functions(Family APGAR), the lower the level of stressful life events, perceived stress and depression. There, knowledge of the family function, stress, and coping could useful to family physicians in the whole person approach of their patients.

Background
: The adequate and appropriate pain control for the terminal cancer patients which should have heen given is not simple matters to be accomplished. Because there was not enough accumulated experiences for the most of medical doctors through their residency training and they are not comfortable to give analgesics to terminally illed patients, particularly narcotics.
Therefore the author attempt to make actual method to use in paractive with analyzing the requirement of analgesics, the method how th give analgesics, the side reaction from narcotic analgesics and the cahracteristics of terminally illed cancer patients in order to make a suggest how th approach to the terminally illed patients, particularly narcotics.
Therefore the author attempt to make actual method to use in paractive with analyzing the requirement of analgesics, the method how th give analgesics, the side reaction from narcotic analgesics and the cahracteristics of terminally illed cancer patients in order to make a suggest how th approach to the terminally illed patient successfully.

Methods : A retrospective chart audit of analgesic type and amount was performed on the medical records of 100 terminal cancer patients who had been expired in the Holy Welfare Hospital from July 1991 through August 1993. Different typers and amounts of analgesics were converted to a common standard, and oral morphine equivalent(OME) relative to 1mg of oral morphine. Descriptive statistics were used to characterize patient analgesic use during the last 30 days and the last 5 days of life. Associations between analgesic use and select patient characteristics(age, sex, cancer site, metastasis, family life cycle, family type and pain intersity at the last 5 days of life) were explored.

Results : 1. The number of patients was 110, male, 60 cases(54.5%) and the female was 50 cases(45.5%) respectively.
2. 90% of 110 subjects had required analgesics to given at some time during terminal care. The 11 patients did not need any analgesics at all, 2 other patients did not need any analgesics during the last 5 days of life. However, 84.5% out of the all patients received narcotic analgesics at some time during the terminal course.
3. Most of the patients in this study used the long-acting form of oral morphine in regular basis and talwin was most frequently given alalgesics on an as-needed-basis. 61.7% of 99 subjects had been received analgesics by mouth during the last 30 days to the end of life and during the last 4 days, the requirement of pain killer by mouth had been decreased markedly to 54.6%. Parenteral and rectal route were prefered route of drug admistration as reach to the end of life.
4. The range of mean daily analgesics used was between 17.3 and 397.5 OMEs. The proportion of patients using analgesics increased while reach to death. The mean of daily requirement of analgesics longer than a month in duration was 73.6%mg(OME1) and the median was 58.0mg OMEs. During the last 5 days of life, the mean daily analgesic requirement was 79.5mg(OME2) and the midian was 61.5 OMEs. There was significant difference between OME1 and OME2(P<0.05).
5. OME2 was positively related with pain intensity at the last 5 days(P<0.05)/
6. OME2 was inversely related to age(r=-0.2978, P<0.01).
7. There were no statistically significant difference in OME2 by sex, staging, bone metastasis, family life cycle and family type.

Conclusion : The most of all terminally illed cancer patients acquired analgesics to take care of their terminal stage of life although there was some individual differences in the requirement of pain medication. Large and enormous doses of analgesics may sometimes be required to control cancer pain. To control apin properly was the one of important method th take care of terminally illed patient as breaking vicious cycle to pain-fear to death-depression, and preventing anxiety, hopelessness and give up dignity as a human being.
The side reactions from the analgesics ware not prominent as to avoid to give medication and those could be ignored.

Background
: To prepare the basic educational data for primary care physicain who work to maintain and enhance the health of people in community. The authors carried on disease frequency analysis in medical Insurance in Korea.

Methods : To clarify the frequency of reasons which made people to use health delivery system in Korea, the authors has made descriptive study with 113,244,548 cases of actual visits to the health delivery system of Korean medical insurance from January 1st to December 31st of the year 1991. The objectives of this study are 100,000 random sampling cases of medical visits among 113,244,548 actual cases of those.

Results : 1. Females(54.5%) have made more frequent medical visits to the health care system than males(45.5%) 2. The frequent diagnoses are acute upper respiratory infection of multiple or unspecified site, acute bronchitis&bronchiolitis, acute nasopharyngitis, acute tonsilitis and acute pharyngitis in order. 3. There is a significant dissimilarity of disease pattern between the in-parient and out-patient group. Among the upper twenty frequent disease, only five disease are concord between the two groups. 4. There are higher prevalence of respiratory infections in the first and second decade, genitourinary infections in the third and forth decade, gastrointestinal diseases in the fifth and sixth decade and then hypertension above the seventh decade.

Conclusion : 53.3% of all visits to health care system were upper twenty frequent diseases. The people who have acute, transient problems made more frequent visits to the primary health care system than to the secondary or tertiary of those. It is needed to encourge primary health care system.

Background
: Low birth weight is the most important determinant of the chances of the newborn to survive and to experience healthy growth and development. Pregnancy can be seen as a time when the family's boundaries are shifting(or are failing to shift) to accommodate a new member. According to the circumplex model, one would hypothesize that families at either extreme of cohesion or adaptability would not do well at navigating the transition of pregnancy and the birth of a child, Therefore we carried out this study to determine the effects of family functioning on infant birth weight(IBW).

Methods : The mother's perception of family function was assessed with FACES Ⅲ and collects sociodemographic data. Randomly selected mothers in Korea University obstetric clinics, while they are in 28 to 36 weeks of their gestational period were invited to participate this prospective study from June through August 1991. Listwise deletion on any one variable reduced the sample to 120 mother-infant pairs. IEW and other variables affecting IBW were compared by family function type.

Results : IBW is positively related with gestational age(r=0.361) and weight gain during pregnancy(r=0.267) and negatively associated with highest systolic blood pressure(r=-0.240) and age of pregnant women(r=-0.180). 15% of family was considered to be dysfunctional. There were no statistically significant difference in this analysis between sociodemographic determinants(educational level, occupation, religion, income, et al) and biomedical characteristics(gestational age, prepregnancy weight and weight gain during pregnancy, highest systolic blood pressure) of functional and dysfunctional families, IBW from women with dysfunctional family significantly smaller than from whose mother with healthy functional families(p<0.05).

Conclusion : Maternal anxiety and stress or social support have been to be related to the outcome of pregnancy, as understanding of the contribution of the family system to pregnancy outcome increases, it should be possible to intervene early in pregnancy to modify risk factors associated with family systems, the major goal of this research is to generate information that can improve the outcome of pregnancy.

It is a recent trend that the birth and mortality rates have been decreased and average life span prolonged in proportion to the socioeconomic and scientific advances.
More and more people live to a ripe old age, consequently elderly patients are steadily increasing.
This tendency is more remarkable in the rural areas where there is much drift of population comprizing the young and the matured.
This study purported to make a comparative investigation of the diseases among geriatric population in rural and urban areas.
Based uppon ICD-9 (International Classification of Diseases), the author made a comparative study of all senior citizens beyond the age of 65 who were hospitalized to the Korea University hospitals at Kuro, an industrial city, and at Yoju, a rural town, from July 1986 to June 1989. The trends of population at the two places for the four years were investigated at the same time.
As a result, the following differences were noticed between two areas.
First, the increase rate of old population 65 years of age and over in the percentage of total population in the rural area far surpassed that in the urban industrial area, and so did the number of aged inpatients in the rural area accordingly.
Second, although there was little difference in the average number of geriatric diseases per inpatient, that of the industrial city being 2.4 and that of the rural town 2.1, the characteristic of each elderly patient were in general multiple nature.
Third, the industrial area abounded mostly with cardiovascular system disease, malignancy, GI tract diseases, endocrine system diseases. In particular, hypertension, D.M., lung cancer and etc. were more predominant in the industrial city. On the other hand, while the rural area also tended to give rise to cardiovascular diseases, GI tract idseases, respiratory system diseases, and infection, the rural town outnumbered the industrial city in the cases of COPD, spondylosis and arthropathy, tuberculosis, heart failure, drug intoxication, etc. (P<0.05).
Fourth, granting that there are these differences between the two areas, what was commonly shared by them was the marked tendency of more and more people reaching a great age, with the inevitable result of increasing geriatric inpatients. Besides, despite some differences in the order of predominant diseases, geriatric diseases of both areas were similar on the whole in that they were mostly characterized by slow and chronic processes.