Background
: Stomach cancer is the most common cancer in Korea. Lifelong health management program recommends that males over 40 years and women over 50 years should undergo stomach cancer screening by endoscopy or upper gastrointestinal series every two years. The importance of re-screening of stomach cancer in a high risk group is emphasized.

Methods : A telephone questionnaire was done one year after to 123 patients over 40 years old considered as a high risk group with either chronic atropic gastritis, intestinal metaplasia, gastric ulcer, gastric adenoma among 804 subjects who had undergone an endoscopic examination from February 2002 to June 2003 at a university hospital health promotion center.

Results : The number of patients who responded were 109. The average recognition rate of high risk group was 53.2%. The rate of recognition of high risk group was lower in good subjective health estimation group and in less educated group, in old age group, and in chronic atrophic gastritis and intestinal metaplasia group. The rate of not receiving re-screening after 1 year was 48 (44.0%). Re-screening rate in patients with intestinal metaplasia (35.3%) and chronic atropic gastritis (39.1%) compared to gastric ulcer (77.8%) and gastric polyp (90.0%), in those not recognizing themselves as high risk group, in low education group, in old age, was lower.

Conclusion : In patients with chronic atropic gastritis and intestinal metaplasia, in those not recognizing themselves as high risk group, in old age and in good subjective health state. We need to educate the importance for regular screening of stomach cancer more intensively.

Background
: Osteoporosis is an important health concern among the postmenopausal women. Therefore, it is necessary to find out acceptable screening tools for osteoporotic patients. The purpose of this study was to evaluate the Risk Index by OSTA as a screening test for osteoporosis.

Methods : The study population was 322 naturally caused menopausal women in Korea. Their was of femoral neck and lumbar spine BMD measured by DEXA. Risk Index by OSTA, based on weight and age, was calculated and the sensitivity and specificity for osteoporosis and osteopenia were evaluated. To find out the proper cut-off point for osteoporosis and osteopenia among the postmenopausal women in Korea, we also compared the sensitivity and specificity of each Risk Index value.

Results : The mean age and ages at menopause were 59.1(±6.2) and 50.7 (±2.7) years, respectively. The prevalence of osteoporosis was 9.6% with femoral neck BMD. For oeteoporosis, using a cut-off point of -1 yielded a sensitivity of 74.3% and a specificity of 52.2% with femoral neck BMD. Using a cut-off of -2 yielded a sensitivity of 87.3% and a specificity of 70.9%. The ROC curve showed an AUROC 0.88 for Risk Index in identifying osteoporosis.

Conclusion : The Risk Index is an acceptable, simple and useful method in the diagnosis of osteoporosis with a Risk Index of -2 in Korean postmenopausal women.

Background
: As prostate cancer in men is increasing in Korea, the need for early detection by mass screening has become an important issue. Screening tests for early detection of prostate cancer are digital rectal examination, transrectal ultrasonography (TRUS) and prostate specific antigen (PSA) test. PSA test has been mainly used for prostate cancer screening in health promotion centers. However, PSA has a high sensitivity but low specificity. Therefore, PSA concentration can be increased not only in prostate cancer, but also in several benign prostate diseases such as benign prostate hyperplasia (BPH), prostatitis, and prostate ischemia. Also, PSA concentration can increase in the elderly. Therefore, we investigated the results of follow-up PSA tests, in the cases of increased PSA concentration on screening.

Methods : In 538 cases, the PSA concentration were increased over 2.5 ng/ml among total 17,302 males checked up on screening test at Ajou University Hospital from January 1999 to December 2001. Two hundred and four cases followed up with TRUS or prostate biopsy were chosen. We investigated 89 cases who performed follow- up PSA test. On the basis of the results of biopsy or TRUS, the subjects were classified into non-disease group, benign prostate disease group and prostate cancer group (possible or confirmed prostate cancer group).

Results : The mean age of non-disease group was 35.5 5.9 years, which was significantly lower than that of benign prostate disease group and prostate cancer group (P＜0.05). Compared to the mean age of prostate cancer group (60.6 10.4 years) and non-prostate cancer group (53.1 12.3 years), prostate cancer group was significantly older than non prostate cancer group (P=0.005). When the lower limit of age was set to 40 years (mean-2SD), confirmed prostate cancer group was significantly older than other groups (p＜0.001). The PSA concentration of confirmed prostate cancer group (11.33 7.58 ng/ml) was significantly higher than that of non-prostate disease group (4.35 2.22 ng/ml) and possible prostate cancer group (4.44 2.29 ng/ml) (P＜0.05). The follow-up PSA level of confirmed prostate cancer group (10.13 6.13 ng/ml) was significantly higher than that of non-prostate disease group (2.55 0.97 ng/ml), BPH group (4.33 3.80 ng/ml), prostatitis group (3.61 2.17 ng/ml), prostate cyst group (3.00 1.86 ng/ml) and possible prostate cancer group (3.81 2.82 ng/ml) (P＜0.05).

Conclusion : It is recommended that screening test for prostate cancer be performed after the age of 40. While follow-up PSA test is needed when the PSA is increased up to less than 10 ng/ml, prostate biopsy may be desired in the PSA value of 10.0 ng/ml or greater.

Background
: Hearing impairment is one of the most common physical handicaps of the aged. This diseases has recently attracted such amount of social attention and understanding as never attracted several years age, and high degree of achievement was made with regard to screening test method, diagnosis, treatment and rehabilitation. However, unfortunately, even now, not enough attention is being paid upon early discovery hearing handicap for patients frequently encountered in clinics.
Therefore, as a screening test method of senile hypacusis, we were to apply "Hearing Handicap Inventory for the Elderly - Screening Version" (HHIE-S) inquiries in Korea and studied the usabulity, sensitivity, specificity, positive predictive value and negative predictive value and cutoff point of this method.

Methods : This study was performed for 120 persons over the age of 60, who visited general health screening centers of one university hospital located in Seou, during the period of October 1996 through to March 1999. HHIE-S questionnaires were used and pure tone audiometry was performed to generate gold standard.

Results : Only 119 out of 120 initial subjects were included in the study because of incomplete questionnaire answers by excluded 10 subject. We defined gold standard of hearing handicap to be ⑴ lower than 30 dB of hearing capability of both ears to frequency between 1000 Hz and 2000 Hz or ⑵ lower than 40 dB of hearing capability of an ear to frequency between 1000 Hz and 2000 Hz, as determined by pure tone audiometry. Assuming cutoff point of HHIE-S as 4 points, the sensitivity and specificity resulted to bo 80%, and 67% each. Assuming cutoff point of HHIE-S as 6 points, the sensitivity and specificity were 76% and 78% each. At 8 points, the percentages were 64%, and 80%, At 10 points, the percentages were 64% and 85%. As a result of this study, the appropriate cutoff point is 6 points. In order to specify the correlation between questionnaire result and pure tone audiometry, we performed 500 Hz, 100 Hz and 200 Hz audi-ometry which are within conversational range, calculated arithmetic mean from the results, and inspected correlation between the resultant mean of the better performing ear and questionnaire resultant points. The correlation coefficient was 0.612 and Chronbach's alpha, as a measurement of internal consistency of the questionnaire was 0.9044.

Conclusion : HHIE-S proved to be useful in screening hearing handicap in the Korean 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
: Serum alpha-fetoprotein(aFP) is a useful diagnostic test on hepatocellular carcinoma(HCC) However, it is still questionable appropriate screening test or not

Methods : A total of 24,050 patients who visited the General Health Screening Center of Asan Medical Center from June, 1993 to June, 1994, were reviewed by chart and telephone survey. Among them 70 cases where serum aFP were elevated > 20ng/ml and 16 cases where HCC was suspected by abdominal ultrasonogram were selected and investigated for the existence of HCC. Four groups were divided into HBsAg(+), Anti-HCV(+), increased AST/ALT(abnormal LFT) and normal group. Each group was evaluated for sensitivity, specificity, positive, predictive value and negative predictive value of serum aFP for HCC.

Results : The prevalence of elevated aFP was 0.29%(70/24,050). There was a statistically significant difference between sexes. And the total number of HCC as 10 cases (42/100,000). With aging, the prevalence of HCC was increased. The prevalence rate pf elevated serum aFP and HCC had significant difference in anti-HCV(+), HBsAg(+) and abnormal LFT group compared to normal group(sGOT < 40U/1, HBsAg(-) and Anti-HCV(-)) (P<0.01).
In our study, sensitivity and positive predictive value of serum aFP for HCC were 100% and 14% in anti-HCV(+) group, 83.3% and 8.6% in abnormal LFT group, 80% in HBsAg(+) group, and 0% in normal group, respectively.

Conclusion : Serum aFP as a screening test for HCC in asymptomatic healthy people does not seem to be not valid. But it seems to be appropriate when it is applied for cases of abnormal LFT(sGOT >40U/1 or sGPT > 40U/1), HBsAg(+) and Anti-HCV(+) people.

Background
: Breast cancer is increasing cause of cancer-related mortality among Korean women. Early detection and treatment are the most important strategy for reducing breast cancer mortality. Despite of its importance as an early detection method, a low percentage of women practice breast self-examination(BSE) regularly. The aim of this study was to describe the effectiveness of patient education on performing BSE regularly and to identify predisposing factors associated with these activities.

Methods : Sixty-six women who did not have experience in BSE in the past were randomly assigned to the experimental group and the control group. We taught BSE knowledge and skill about BSE using breast models and audiovisual equipment for experimental group in patient education class. Women in control group, however, were simply educated by their physician about BSE knowledge and skill with only educational booklet during their outpatient visits. We observed the difference in regular BSE performance proportion between two groups 6, 12 months later and analyzed the predisposing factors affecting on the education effect. Direct and telephone interview methods were used to gather the information. Data were analyzed with t-test, x²-analysis and logistic regression using SAS 6.10, EGRET program.

Results : There were no differences in sociodemographic characteristics between study groups. They were followed for 12 months. At follow-up after 6 months 44.1% of women performed BSE regularly among experimental group and 18.8% of women did it among control group(OR= 3.4, 95% CI 1.1-10.4, p<0.05). At follow-up after 12 months proportion of women performed BSE regularly in experimental group(28.6%) was slightly higher than that of control group(22.2%), but that difference was not statistically significant. The prevalence of performing BSE regularly was higher among women who had experience in periodic health examination(OR=6.0, 95% CI 1.9-18.8, p<0.01), who had experience in mammography(OR=4.0, 95% CI 1.0-15.6, p<0.05). And the prevalence of performing BSE regularly also was higher among women who were older than 40 years old, married, had experience in cervical Pap smear, had knowledge about BSE before education, have done exercise regularly, had less number of health risk factors, but without statistical significance.

Conclusion : These results showed that effectiveness of patient education on BSE, if we determine the effectiveness of BSE education with regular performance of BSE, is relatively low among Korean women. We could see, however, that if we use breast models for demonstration in addition to usual educational material, the effectiveness of BSE education can be more effective. We also recognized that effectiveness of BSE education will not be continued for long time without any maintenance strategy. There were lots of predisposing factors which could affect the effectiveness of BSE education positively or negatively. So, family physicians who plan BSE patient education at their clinics must consider these factors.