• Title/Summary/Keyword: public medicine

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A Study on the Usefulness of Perfusion MRI in Grading of Gliomas (뇌교종의 악성도 평가에서의 관류자기공명영상의 유용성에 관한 연구)

  • Khang, Hyun-Soo;Kim, Jong-Man;Ko, Shin-Kwan;Moon, Chan-Hong;Yu, In-Kyu;Han, Dong-Kyoon
    • Journal of radiological science and technology
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    • v.32 no.4
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    • pp.461-469
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    • 2009
  • To predict the tumor grading, various imaging modalities have been applied clinically. This study determines clinical usefulness of perfusion MRI, using relative cerebral blood volume in grading of the gliomas. We did a retrospective review of 17 patients (mean age, 57.5 years; 11 male, 6 female) who underwent perfusion MR and conventional MRI, and then correlated pathologically after operation. Statistical analysis of regional cerebral blood volume and relative cerebral blood volume(rCBV) was performed by using softwares such as PAT by SIEMENS and Xmap ver 2.0 developed by ourselves. Six patients out of 13 were low-grade gliomas while eleven patients were the high-grade gliomas. Mean relative CBV (m_rCBV/white matter) in the low-grade gliomas was 1.62, and mean relative CBV(m_rCBV/cortex) was 0.12. In the high-grade gliomas, mean relative CBV(m_rCBV/white matter) and mean relative CBV(m_rCBV/cortex) were 33.53 and 0.96. Mean relative CBV of gliomas were elevated with a statistical difference(P<.05), compared with contralateral white matter(P=.019) or cortex(P=.025). Furthermore mean relative CBV(m_rCBV/white matter) was much higher than mean relative CBV(m_rCBV/cortex). Perfusion MRI using regional cerebral blood volume and rCBV is very useful imaging modality for grading the glioma.

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The Cosmetic Operation without Healing Purpose - A comparative insight into the ruling of BSG and BGH - (미용성형의료 - 우리 판결례와 독일 판결례의 비교·분석적 소고 -)

  • Ahn, Bup-Young
    • The Korean Society of Law and Medicine
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    • v.16 no.1
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    • pp.3-82
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    • 2015
  • This paper is concerned in the theme of the liability for the breach of duty to inform(Haftungszurechnung der $Aufkl{\ddot{a}}rungspflichtverletzung$) and the malpractice of cosmetic surgery. Here, the terms, treatments for healing purposes and purely medical-technical cosmetic operations are well integrated in the category of "medical conduct(medizinische Handlung)" within the meaning of the public and administrative 'Medical Law'. In the judgment of 6. 13. 2013 Az. 2012DA94865 provides the KHGH(Korean Highest Court of Justice) to inform the patient about the prospects and risks of cosmetic surgery(Infrabrow Excision Blepharoplasty) stringent requirements, similar to the judicature of BGH(cf. BGH, Urt. v. 6. 11. 1990, Az.: VI ZR 8/90). Even in the judgment of 5. 12. 2014 Az. 2013GASO865646 the SZLG(Seoul Central Regional Court) recognizes the physician contract for 'cosmetic septoplasty' as a sort of contract for work. The medical treatment(${\ddot{a}}rztliche$ Heilbehandlung) is still regarded as a prototype of the medical activity, therefore in the meaning of the 'Civil Law(KBGB)', its term needs to be used immediately for healing purposes. The cosmetic operation, desired by a patient, differs from the healing treatment by the element of "indication" and the fact that the "healing purpose(Heilzweck)" itself is missing. In comparative context - methodically fully aware that the unreflective term transfer between different laws might contradict their legal purposes - a series of judgments BSG(BSGE 63, 83, BSGE 72, 96, BSGE, 82, 158, BSGE 93, 252 etc.) and some judgments of LSG are reviewed. In addition, also the dogmatic topic for the "legal natur of a medical treatment contract" is to reconsider by comparative introducing BGHZ 63, 306. Now in view of the current state of greater popularity of artificial cosmetic surgery still indeed is the sentences: The doctor is minister naturae, a helper of nature. A doctor promises regularly only the proper treatment of the patient, but the contractual liability for work should not be excluded in medical conditions for cosmetic surgeries altogether. "With cosmetic operations, seeking to eliminate the external deformities, the doctor may miss the medical profession entirely." - A. Laufs, Medical Law, 5th ed. P. 18.

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The effects of dental prostheses to the quality of life among the elderly (일부 노인의 치과보철물 상태가 구강건강관련 삶의 질에 미치는 영향)

  • Hur, Ik-Gang;Lee, Tae-Yong;Dong, Jin-Keun;Hong, Song-Hee
    • The Journal of Korean Academy of Prosthodontics
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    • v.48 no.2
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    • pp.101-110
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    • 2010
  • Purpose: This study has been conducted in order to examine the oral health status and dental prostheses status, and the effects of dental prostheses to the oral health related quality of life among the elderly using social welfare centers. Material and methods: For this purpose, the researcher conducted a questionnaire survey and oral examination of 275 samples of old persons using 7 social welfare centers located in Daejeon metropolitan city. The oral health related quality of life was measured by GOHAI (Geriatric Oral Health Assessment Index). Results: 1. The less age and the more education and the more subjective economic status and living with spouse of family status, the higher GOHAI showed. 2. Mean age of first using of removable denture is 62.11 years old and average life cycle of removable denture is 10.76years. 57.5% of study subjects use removable denture and complete denture user of study subjects are 13.8%. 3. In the case that they use fixed prostheses rather than removable ones and in the complete denture they use both sides (upper and lower) rather than single side, showed higher GOHAI. 4. In the case that they showed higher degrees of satisfaction with dental prostheses and can use them always and showed no necessity for new dental prostheses and denture adaptation is good, GOHAI showed higher. Conclusion: In order to improve oral health related quality of life among the elderly who have many missing teeth, it is required to restore their masticatory ability to the normal level by restoring the missing teeth which has lost its function through providing proper dental prostheses.

Health Economic Approach to End-of-Life Care in the US: Based on Medicare (말기의료의 경제적 요소에 관한 논의: 미국 메디케어 상황을 중심으로)

  • Suk, Ryan
    • The Korean Society of Law and Medicine
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    • v.15 no.1
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    • pp.335-373
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    • 2014
  • According to one Medicare report, in the US, total federal spending on health care expends almost 18 percent of the nation's GDP, about double what most industrialized nations spend on health care. And in 2011, Medicare spending reached close to $554 billion, which amounted to 21 percent of the total spent on U.S. health care in that year. Of that $554 billion, Medicare spent 28 percent, or about $170 billion, on patients' last six months of life. So what are the reasons of this high cost in EOL care and its possible solutions? Much spendings of Medicare on End-of-Life care for the terminally ill/chronically ill in the US has led health economics experts to assess the characteristics of the care. Decades of study shows that EOL care is usually supply-sensitive and poor in cost-effectiveness. The volume of care is sensitively depending on the supply of resources, rather than the severity of illness or preferences of patients. This means at the End-of-Life care, the medical resources are being overused. On the other hand, opposed to the common assumption, "The more care the better utility", the study shows that the outcome is very poor. Actually the patient preference and concerns are quite the opposite from what intense EOL care would bring about. This study analyzes the reasons for the supply-sensitiveness of EOL care. It can be resulted from the common misconception about the intense care and the outcome, physicians' mission for patients, lack of End-of-Life Care Decision which helps the patients choose their own preferred treatment intensity. It also could be resulted from physicians' fear of legal liabilities, and the management strategy since the hospitals are also seeking for financial benefits. This study suggests the possible solutions for over-treatment at the End-of-Life resulting from supply-sensitiveness. Solutions can be sought in two aspects, legal implementation and management strategy. In order to implement advance directive properly, active ethics education for physicians to change their attitude toward EOL care and more conversations about end-of-life care between physicians and patients is crucial, and incentive system for the physicians who actively have the conversations with patients will also help. Also, the general education towards the public is also important in the long run, and easy and official advance directive registry system-such as online registry-has to be built and utilized more widely. Alternative strategies in management are also needed. For example, the new strategic cost management and management education, such as cutting unnecessary costs and resetting values as medical providers have to be considered. In order to effectively resolve the problem in EOL care for the terminally ill/chronically ill and provide better experience to the patients, first of all, the misconception and the wrong conventional wisdom among doctors, patients, and the government have to be overcome. And then there should be improvements in systems and cultures of the EOL care.

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A Study on Growth Acceleration in Korean as Indirected by the Maximum Growth Age in Body Height (한국인(韓國人) 신장(身長)의 최대발육연령(最大發育年齡)으로 본 발육촉진현상(發育促進現象)의 추이(推移)에 관(關)한 연구(硏究))

  • Shin, Hyung-Gyun;Park, Soon-Young;Park, Yang-Won
    • Journal of Preventive Medicine and Public Health
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    • v.17 no.1
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    • pp.173-192
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    • 1984
  • On the basis of the study intended to research by crosssectional study keeps pace with semilongitudinal study the growthaccelerating phenomena that Maximum Growth age in teenager's body-height. By the random sampling method, the subject of study are 12659 persons(male; 6355, female; 6304) that they are from 7 ages to 17 ages in the whole country including the rural community. The measurement period passed three month days, the statistical data became electronic data processing system with computer. The other side, body-height and MGA of Koreans who had been for during the period from 1925 to 1966 proved transition of the growth-accelerating phenomena by research data reported between 1913 and 1983. The results are as follows; 1. The Growth and Development-Value of Body-height An age bracket the growth and development-value of body-height were, respectively, male is $123.88{\pm}5.05cm$ and female is $123.29{\pm}5.54cm$ for 7 ages group. these indices increased with age. the top-value reach, respectively. $169.08{\pm}5.62cm$ and $157.57{\pm}6.13cm$. The intersecting ages of male and female were the age $8.5{\sim}12.5$, during these periods, female excelled male but after these periods, male excelled female again. In case of body-height, MGA's are 7.0cm for male between 12 and 13 ages, and 7.01cm for female between 8 and 9 ages. As a rule, body-height of male excelled female but intersection phenomena of male and female appeared between 8.5 and 12.5 ages. By reginal groups, it is most prevailing is Seoul, and medium size cities and rural community rome in order. By regional groups, intersection phenomena of male and female are. a region of Seoul; $$8.5{\sim}11.5$$ ages a region of Daejeon; $$7.5{\sim}9.5$$ ages rural community; $$11.5{\sim}14.5$$ ages the whole country's average; $$8.5{\sim}12.5$$ ages By regional groups, the rate of maximum increase in a year are a region of Seoul; male is 7.23cm as 13 ages female is 7.65cm as 9 ages. a region of Daejeon; male is 7.85cm as 11 ages. female is 8.39cm as 9 ages. rural community; male is 7.65cm as 14 ages. female is 6.25cm as 12 ages. the whole country's average; male is 7.0cm as 13 ages. female is 7.01 as 9 ages. 2. Maximum Growth Age (M.G.A.) By reginal groups, maximum Growth Age's are as below in a region of Seoul, MGA's are 12.63 for male and 9.01 for female, which shows that MGA for female appears about 3.5 years earlier than that for male. In a region of Daejeon, MGA's are 9.20 for male and 8.93 for female, which. show that they are all much the same in M.G.A. In rural community, MGA's are 14.00 for male and 11.89 for female, which shows that MGA for female apperars about 2 years earlier than that for male. In the whole average, MGA's are 13.01 for male and 8.97 for femal, which shows that for female appears about 4 years earlier than that for male. For boy, M.G.A. shows fastest-growing in Daejeon, and Seoul and rural commonly come in order. For girl, It shows equal growth in Seoul and Daejeon, rural community comes later. 3. The M.G.A's in body height of male are respectively the age 15.02 in 1913, 14.23 in 1956, 13.86 in 1967, 13.62 in 1975, and 12.82 in 1981, while those of female are the age 12.0 in 1940, 11.52 in 1965, 9.53 in 1975, and 11.16 in 1980; these data show that the MGA of the Koreans has been getting younger. 4. The equation of linear regression of all the MGA's in body height are as follow; Male: Y(M.G.A)=$-0.020{\times}$ (the year)+15.19: female:Y(MGA)=$-0.028{\times}$(the year)+13.2549. 5. The corelation of all the MGA's in body height are as below; male; r=-0.329 female;r=-0.252 6. From the transition of the growth-accelating phenomena in 1980 we can capture the fact that the MGA's has been getting younger by 0.2 year per 10 years. 7. The MGA's in bodyheight are shown in table 4... 8. The future growth-accelating phenomena in body height are expected to show the similar tendency like that of the past, in 1910's but it should by more precisely reviewed after investigating the phenomena of the years directly ahead.

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A Study of Electrolyte Excretion and Salt Intake in a Rural Community (일부 농촌지역 주민의 요중 전해질 측정을 통한 식염 섭취량 추정과 고혈압과의 관계 연구)

  • Moon, Joung-Joo;Ham, Sun-Hee;Choi, Kyoung-Ae;Yook, Mi-Ee;Chai, Young-Hee;Kim, Ki-Soon
    • Journal of Preventive Medicine and Public Health
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    • v.24 no.1 s.33
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    • pp.8-15
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    • 1991
  • This study was carried out in order to examine the urinary excretion of electrolytes (Na, K) and their relationship with blood pressure, and to estimate the amount of daily salt intake in a rural community. From January to March in 1987, a mobile screeing team visited 40 villages, and carried out health screening of 537 adult volunteers whose age were over 30 years and collected 12-hours overnight urine. To determine the completeness of collection, the urinary creatinine was measured. If the creatinine excretion was beyond the range given to the age group, the sample was excluded from the analysis as an incomplete collection : 345 samples were remained for analysis. This study revealed the following results. 1. The mean excretion amounts of urinary electrolytes for 12 hours were Na 193.5 mEq, K 20.8 mEq, creatinine 1.0 g. The mean ratio of electrolytes were Na/K 9.84, Na/creatinine 0.44, K/creatinine 0.046. 2. Both the mean excretion amount of K and the mean ratio of K/creatinine were less in hypertensives than in normotensives. K excretion also showed a tendency towards a decrease in inverse proportion to systolic blood pressure when it exceeded 120 mmHg. There was no significant difference between the hypertensives and normotensives in Na excretion. The sodium to potassium ratio increased in poportion to systolic blood pressure. 3. The mean daily salt excretion amount was 22.4 g. Assuming that 90% of the intake was excreted, the estimated amount of daily salt intake was 24.9 g.

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The Effect of working Noise Exposure and Military Background on the Hearing Threshold (특수병과의 과거 군 소음 노출이 소음 노출 작업자의 청력에 미치는 영향)

  • Chung, Ho-Keun;Kim, Kyoo-Sang
    • Journal of Preventive Medicine and Public Health
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    • v.36 no.2
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    • pp.137-146
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    • 2003
  • Objectives : Impaired hearing is a prevalent occupational hazard, not only in industry, but also in the armed forces. In military life, noise has unusual characteristics, and constitutes a serious hazard to hearing. The aim of this study was to analyze the hearing threshold data in order to compare the hearing loss among shipyard workers, representing different workers, and a military service background. Methods : A cross-sectional audiological survey, combined with a questionnaire study, was conducted on a stratified random sample of 440 shipyard workers, with long-term exposure to noise. The employees were divided into four groups, according to their working and military service backgrounds, in relation to their exposure to noise. Results : As expected, the working and military noise exposure group (Group I) had significantly poorer hearing than the other groups. The high frequencies (2-8 kHz) showed the greatest difference in terms of poorer fearing in both ears. The prevalence of noise-induced hearing loss (NIHL) was highest in Group I. A logistic regression analysis was applied to determine the dependence of the NIHL in relation to age, smoking, drinking, working duration, ear protection, past history of ear diseases, and working and military sonics backgrounds, on the noise exposure The important factors found to be related to the NIHL, in relation to noise exposure were: age, work duration, and working and military service backgrounds. The adjusted odds ratio estimates for NIML in the right ear were 4.5 times greater (95% CI 1.7-11.6) for the military noise exposed group, and 7.9 times greater (95% CI 2.0-31.3) for the working noise exposed group than in the controls. The hearing thresholds at the pure-tone average and 4 kHz were significantly increased with age and work duration with both the working and military service backgrounds. Conclusions : From these results, specific preventive programs were planned, which should be assessed by epidemiological surveillance of the military noise exposed population.

Egg Antibody Farming and IgY Technology for Food and Biomedical Applications (식품과 생의학을 위한 계란 항체생산과 IgY 기술의 활용)

  • Sim, Jeong S.;Sunwoo, Hoon H.
    • Proceedings of the Korea Society of Poultry Science Conference
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    • 2003.07b
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    • pp.37-54
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    • 2003
  • It has been recognized that the hen. like its mammalian counterparts. provides young chicks with antibodies as protection against hostile invaders. This system facilitates the transfer of specific antibodies from serum to egg yolk. and provides a supply of antibodies called immunoglobulin Y(IgY) to the developing embryo and the hatched chick. The protection against pathogens that the relatively immuno-incompetent newly hatched chick has. is through transmission of antibodies from the mother via the egg. Egg yolk. therefore. can be loaded with a large amount of IgY against pathogens which can immobilize the existing or invading pathogens during the embryo development or in day-old chicks. Thus. the immunization of laying hens to various pathogens results in production of different antigen-specific IgY in eggs. Egg yolk contains 8~20 mg of immunoglobulins (IgY) per $m\ell$ or 136~340 mg per yolk suggesting that more than 30 g of IgY can be obtained from one immunized hen in a year. By immunizing laying hens with antigens and collecting IgY from egg yolk. low cost antibodies at less than $10 per g compared to more than $20.000 per g of mammalian IgG can be obtained. This IgY technology opens new potential market applications in medicine. public health veterinary medicine and food safety. A broader use of IgY technology could be applied as biological or diagnostic tool. nut-raceutical or functional food development. oral-supplementation for prophylaxis. and as pathogen-specific antimicrobial agents for infectious disease control. This paper has emphasized that when IgY-loaded chicken eggs are produced and consumed. the specific antibody binds. immobilizes and consequently reduces or inhibits the growth or colony forming abilities of microbial pathogens. This concept could serve as an alternative agent to replace the use of antibiotics. since today. more and more antibiotics are less effective in the treatment of infections. due to the emergence of drug-resistant bacteria.

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A Study on Network Hospital and the Ban on Opening and Operating the Muliple Medical Institution (네트워크병원과 의료기관 복수 개설·운영 금지 제도에 관한 고찰)

  • KIM, JOON RAE
    • The Korean Society of Law and Medicine
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    • v.17 no.2
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    • pp.281-313
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    • 2016
  • Our Constitution obliges the state to protect the health of the people, and the Medical Law, which embodied Constitution, sets out in detail the matters related to open the medical institution and one of them is to prohibit the operation of multiple medical institutions In the past, there was a provision stipulating the same purpose. But because the Supreme Court interpreted that several medical institutions could be opened if the medical treatment was not made at the additional medical instition which was opened in the another doctor,s license, multiple medical institutions could be opened and operated. However, some health care providers opened the several medical institutions to another doctor's license just by the excuse of the business management and then did illegal medical cares like the unfair luring of patients, overtreatment, and commition treatment for more profits. So, the health rights of the people came to be infringed on. Accordingly, lawmakers amended the Medical Law for medical personnel not to open and to operate more than one medical institution. As the amended medical law prohibited a medical personnel to open multiple medical institution, some medical personnels insisted that the amended medical law is unconstitutional under which they could not be able to open and operate medical institutions on based on free investment and bring out the benefits of network hospitals. But the regulation to prohibit multiple institutions does not apply only to a medical personnel. Many other experts like lawyer and pharmacist can open only one office under such a restriction. If the regulation goes out of force, the procedure that multiple medical institutions should be opened and operated in the capacity as a medical corporation or a non-profit corporation does not have to be followed. And we should keep in mind that the permission for medical personels to open multiple medical institutions could lead virtually to commercial hospital. If in the nation with a very low rate of public medical service, If only a few medical personnels with capital own many medical institutions and operate commercially them, this could cause a falling-off in quality of medical service, ultimately infringe on the health rights and the life right of the people.

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Snoring Clinic Visitors' Knowledge of Obstructive Sleep Apnea Syndrome (코골이 클리닉을 방문한 환자들의 폐쇄성 수면무호흡증 인식도)

  • Lee, So-Jin;Lee, Jin-Seong;Shin, Hong-Beum;Cho, Sang-Yong;Rhee, Chae-Seo;Jeong, Do-Un
    • Sleep Medicine and Psychophysiology
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    • v.18 no.2
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    • pp.87-94
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    • 2011
  • Objective: OSAS (obstructive sleep apnea syndrome) is a common disorder and its consequences are often serious. It is important to detect the disorder early in the course for proper treatment. This study is to grasp the snoring clinic visitors' knowledge level of OSAS. Method: One hundred and seventy-nine visitors at the of snoring clinic of Seoul National University Hospital were surveyed by questionnaire about reasons of visit and knowledge of treatment methods of snoring and OSAS, diagnostic method, OSAS-related symptoms, and complications. Results: Most of the respondents (89.4%) "have already heard about OSAS" and the major sources of information was the mass media (58.1%) such as television and radio. More than half (60.3%) were aware that snoring is closely related to OSAS. More than half (59.8%) recognized that a nocturnal polysomnograpy was necessary for proper diagnosis. Two thirds (67%) of the respondents noted surgery as a treatment for snoring. More than half (55.9%) answered that they would follow the doctor's advice on the treatment choice. Only 12.3% of respondents "have heard about nCPAP". No one chose nCPAP (nasal continuous positive airway pressure) as a treatment for either snoring or OSAS. About one third (34.6%) of the respondents were aware that OSAS is related to hypertension. Only 12.8% noted that OSAS is related to diabetes mellitus. Conclusion: Visitors at the snoring clinic were found to have substantially limited knowledge of health risks and proper treatments of OSAS. We suggest that it is crucially important to educate patients and offer easy-to-understand information on snoring and OSAS. We predict that provision of educaiton and information to patients and general public will faciliate the diagnosis and treatment of snoring and OSAS and reduce the related disorders such as hypertension, stroke, and diabetes mellitus.