Background
: Cancer is the second leading cause of death in Korea. Colorectal cancers rank fourth in term of total cancer mortality. Colorectal cancers have been the focus of screening for early detection. Few current data are available regarding factors associated with participation in cancer screening examinations in the general population. This study investigated associations of age, income, education, marital status, smoking, drinking, sleeping, presence of a hemorrhoid, and attitudes toward cancer prevention with participation in three cancer screening tests for colorectal cancer.

Methods : To identify the factors associated with participation in cancer screening examinations, 2372 men in a certain company were surveyed in 1992. Cancer related questions were included to determine the attitudes toward cancer prevention and the history of tests performed that are used for screening for colorectal cancer.

Results : Statistically significant (P<0.05) strong predictors of ever having had a specific cancer screening test were as follow:(1) digital rectal examination: above 40 years old(OR=3.4, 95% CI 2.1-5.4), having a hemorrhoid(OR=2.9, 95% CI 1.7-5.0), and regular exercise(OR=2.1, 95% CI 1.2-3.5); (2) fecal occult blood: above 40 years old(OR=4.2, 95% CI 2.5-7.2) and (3) colonoscopy or sigmoidoscopy: above 40 years old(OR=3.5, 95% CI 2.4-5.2), married(OR=3.5, 95% CI 1.6-7.7), and heavy drinker(OR=1.8, 95% CI 1.2-2.7).

Conclusion : The largest differences among the population for participation in cancer screening examinations involved age. Education and encouragement may persuade men participate more in screening.

Background
: Since the Independence in 1945, the Republic of Korea(ROK) has maintained fundamentally the liberal health care system by the influence of U.S.A. Therefore, as in the case of U.S.A., the primary health care system of ROK has fallen in the chaos. Recently, the new government of ROK seems to retry the introduction of 'Family Doctor Registration System(FDRS)' in spite of the 1996's failure. In order to conduct FDRS efficiently, there should be a thorough investigation on the opinions of doctors and people in the community. This study was conducted with a view to collecting necessary information regarding the implementation of FDRS.

Methods : By mailing, the self-administered questionnaires were collected twice during March 18 to May 12 in 1998. The questionnaire had been prepared trough several discussions, pretest, and final correction by five family physicians and two health care policy professors. The subjects consisted of 2,093 family physicians.

Results : Though the overall response rate was only 28.2%(591) subjects, age distribution for the study subjects was similar to that of average family physicians. The subjects consisted of 451 males and 138 females. The number of those whose age was less than 40 was 49.9%(195). 'The group that agrees with the introduction of FDRS' was 58.5% of all respondents; 'the group that objects' 14.4%; and 'the group undetermined' 24.7%. The 73.6% of all respondents had negative opinion on increased administrative work. Only 21.3% expected their net income to increase. On multiple logistic regression analysis, relatively large city rather than metropolitan Seoul, the smaller number of visiting patients a month, regular resident training experience, and male sex resulted in having a significant positive relationship with the introduction of FDRS. Further analyses are called for to identify differences of opinions between family physicians and single specialty medical practitioners

Conclusion : The results of this survey should be reflected into the health care policy when retrying to implement FDRS in Korea.

Background
: Although urinary incontinence is a common problem, its prevalence and severity in community is not well established. The main objects of this study were to define the prevalence in adult men and women who came to a primary care office for health care.

Methods : Men and women aged 20 years and over who came to family physician's offices seeking health care for any reason during an 2-week period were the subjects of a survey by anonymous questionnaire. Ten family practice offices in Cheonan Practice-Based Research Network parti-cipated. We defined "current significant urinary incontinence' as over any degree of annoying incontinence in the past 12 months.

Results : Of the 1,130 responders, 46.3% experienced urinary incontinence. Incontinence was experienced by 26.7% of the men and 50.2% of the women. 'Current significant urinary incontinence' was experienced by 3.7% of the men and 10.12% of the women.

Conclusion : Urinary incontinence as a common problem among those seen in primary care settings, and patients hesitate to seek consultation of their problems with physicians. Therefore, family physicians should deal with the symptoms of incontinence more attentively during history taking.(J Korean Acad Fam Med 1999;20:55~61)

Background
: Obesity and its complications are increasing as social economic standard of living is improving and life style has been changing in Korea. There is growing evidence that the visceral/subcutaneus adipose tissue area ratio (VSR) on computed tomography (CT) is closely related to the obesity complication. Therefore, it is important to determine whether the VSR reduction is produced during weight loss. The purpose of this study was to observe and compare the amount of reduction of intraabdominal fat between low calorie diet(LCD) alone and LCD with exercise.

Methods : Sixty obese females were randomly prescribed a LCD alone or a LCD with exercise. Thirty obese females were treated with a LCD of 1,000kcal/d for 8 weeks (group A). Another thirty obese females were treated with a LCD of 1,000kcal/d combined with supervised aerobic exercise for 8 weeks(group B). Weight, height, BMI, and body fat distribution were measured in all subjects immediately before and after 8 weeks of this study. The body fat distribution was assessed by CT, by which the total abdominal adipose tissue area (AT), subcutaneous abdominal adipose tissue (SAT), intraabdominal adipose tissue(VAT), and visceral/subcutaneous adipose tissue ara ratio (VSR) were measured at the level of the umbilicus. A venous blood sample was taken after an overnight fast to determine lipid, glucose, and insulin concentrations in all subjects before and after 8 weeks of this study.

Results : Body weight, BMI, CT measurement of total(AT), visceral (VAT), and subcutaneous(SAT) fat were found to be decreased significantly in the two groups B decreased significantly (P<0.05) during weight loss. Fasting plasma glucose and total cholesterol levels significantly decreased in the both groups(P<0.001). Fasting plasma insulin and triglyceride levels significantly decreased in the group B, but not in group A.

Conclusion : This study shows that the VSR decreased significantly in group B, but not in group A. Fasting plasma inulin and triglyceride levels decreased significantly in group B, but not in group A. These results suggest that the LCD with exercise is more effective in reducing expected complications of obesity than LCD alone.

Background
: Alternative medicine is defined as a non-orthodox therapeutic practices including chiropractic, acupuncture, herbal medicine, faith spiritual therapy or as all sorts of medical care that do not follow the medical community standards. Patients do not think of modern medicine as the absolute solution to their health problems and they will sometimes ask for complementary therapy and in want of referral to alternative practitioner. We have investigated the primary physician's attitude and behavior towards alternative medicine.

Methods : Randomly selected 770 practitioners, in primary care practice in Seoul, were questioned from July to September in 1996 about the attitude to wards alternative medicine, the reasons and symptoms when referring, and experience in alternative medicine practice.

Results : 150 questionnaires were returned and among them 139 completed one(18.1%) were analyzed. Among 770 doctors, 35(25.2%) have refereed patients to alternative practitioner before and more referrals were made when they worked together closely or had some prior training. The belief of special effect of alternative medicine on certain disease was the first reason to refer. Other reasons were for herbal medicine, acupunture, and chiropractics in the order of sequence. The standard way to learn alternative medicine was to attend seminars available through certain institutions. On referral either chronic pain or musculoskeletal disease were the most chief complaints or main diseases of patients. 15 doctors(10.8%) had some experience in practicing an alternative approach and the patient subjects were more likely to be women, and there was increased tendency to be working with another doctor, and to have been trained for such practice. The items used by alternative practitioners were acupuncture, herbs in the order of sequence.
Conclusions：Alternative medicine is accepted somewhat by primary physicians in Seoul although the rate of referral and practice is lower than 54% compared to 16% in Canada.

Background
: The purpose of this study is to investigate the correlations between distal radius BMD and other skeletal site(L2-L4, Femoral neck, Ward's triangle, Trochanter) BMD's, and to find out the usefulness of DTX-200. Methods : The authors surveyed the subjects of 76 perimenopausal women who had visited Kyu-nghee Medical Center and measured their bone mineral densities(BMDs) from February, 1997 to July, 1997. Measurements were done for distal radius, ultradistal-8mm radius BMD using DTX-200(OSTEOMETER, Denmark), and other skeletal sites(L2-L4, Femoral neck, Ward's triangle, Trochanter) BMDs using EXPERT(Lunar, USA). Using SPSS for windows, the correlation coefficients of the BMDs of both instruments were calculated. Results : The total number of subjects were 76 (average age:54.8 years, range 32~78years). Among them, 67 were postmenopausal women. The BMD measurements of various skeletal sites were as follows : distal radius, 0.41±0.07(g/cm²), ultradistal-8mm radius 0.34±0.07(g/cm²), femoral neck 0.82±0.18(g/cm²), trochanter 0.72±0.17(g/cm²), Ward's triangle 0.59±0.22(g/cm²), L2-L4 0.98±0.16(g/cm²). The correlations of BMDs between distal radius and femoral neck, trochanter, Ward's triangle, and L2-L4 were 0.44, 0.35, 0.47, and 0.63, respectively. The correlations of BMDs between ultradistal-8mm radius and femoral neck, trochanter, Ward's triangle, and L2-L4 were 0.64, 0.34, 0.41, and 0.69 respectively. Conclusion : The correlations of BMDs between distal radius and those of femoral neck, trochanter, Ward's triangle, L2-L4 were moderately high.

Background
: With the increase of interest in health promotion, doctor's role in health promotion has been progressively emphasized. Although there were many findings which showed that interventions by doctors can result in important changes in the health behaviors of patients, little was known about patient's perception of doctor's intervention. Therefore, we attempted to find out about the factors related to patient's interests in health behaviors(smoking, alcohol drinking, body weight, and exercise) and patient's perception of the need for doctor's intervention in changing these health behaviors.

Methods : The study subjects were patients who visited either two private clinics(265 patient) or the department of family medicine in a tertiary hospital(410 patients) located in Seoul. Questionnaires the concerning demographic characteristics, patient's interests, health behaviors, and their perception of the need for doctor's intervention in changing health behaviors were administered to the study subjects between March 1997 and June 1997.
We examined the factors which had significant relationship with patient's interest and the perception-ns of the need for doctor's intervention in health behaviors with multiple linear logistic regression analysis. The relationship between patient's interests in health behavior and the perception of the need for doctor's intervention was evaluated with Spearman's correlation coefficients.

Results : Patient's interest and the perception of the need for doctor's intervention in smoking were significantly higher in males, smokers, and private clinic patients. Patient's interest in alcohol drinking was significantly higher in males, ex-smokers, and drinkers. Patient's perception of the need for doctor's intervention in drinking was significantly higher in males, smokers, drinkers, and those who had chronic disease. Patient's interest in body weight control was significantly higher in females, ex-smokes, tertiary hospital patients, and those who viewed themselves as obese. Patient's perception of the need for doctor's intervention in body weight control was significantly higher in private clinic patients and those who viewed themselves as obese, and was significantly lower in those who recognized their body frame as normal. Patient's interest in exercise was significantly higher in those who were older and who was exercising more than once a week. Patient's perception of the need for doctor's intervention in exercise was significantly higher among tertiary hospital patients. Significant relationship between patient's interest and the perception of the need for doctor's intervention in health behaviors, especially in smoking and drinking habit, was observed in private clinic patients as well as those in tertiary hospital.

Conclusion : The degree of patient's interest in health behaviors and their perception of the need for doctor's intervention in health promotion was significantly different according to the type of health behavior, the individual health habits, the demographic characteristics, and the type of medical center used by the patient. Therefore, doctors should pay more attention to proving interventions that affect the health behaviors of patients in consideration of these factors.