Background
: Osteoporosis is a major public problem. Although clinicians have advocated hormone replacement therapy and other clinical measures, few studies have assessed whether these measures are being adopted by primary care physicians in practice. The purpose of this study is to investigate the practice patterns of primary care physicians and to assess the impact of doctors' specialty on osteoporosis management.

Methods : Questionnaire was sent to all primary care physicians in Inchon city. The questionnaire contained questions regarding general characteristics of physicians, practice pattern and whether he(she) participates in the management of osteoporosis.

Results : Among 451 practitioners, 172 replies were received. 53.3% primary care providers participated in the management of osteoporosis. 70.4% family physicians, 73.5% gynecologists and 70.4% orthopedic surgeons, 25.9% general internists, 30.3% general physician participated. Female physicians participated more than males. Concerning the reason why they did not participate, their reasons were deficiency of laboratory or radiologic facility in 70.1%, insufficient knowledge in 22%. 88.9% of physicians evaluated risk factors for osteoporosis. Groups concerning postmenopausal women, older age, history of bilateral oophorectomy were evaluated at high rate(above 75% physicians). Concerning prescription, they recommended exercise and dietary calcium in 51.5% and recommended HRT in 37.7%, calcium in 36.5%, calcitonin in 22.8%, vitamin D in 18.6%. 55.6% family physicians, 73.5% gynecologists, 20% general physicians, 11.1% general internists were prescribing HRT. History taking was done in 92.1%, along with breast examination in 58.7%, pelvic examination in 31.7% before HRT. Patient education was given in 45.5%.

Conclusion : Insignificant proportion of primary care physicians participated in the management of osteoporosis and in HRT. Their attitudes and practice patterns appear to be influenced by their profession and sex but not by age. We conclude that more participation of primary care physicians and their continuing education are required in the management of osteoporosis.

Background
: In order to improve the quality of life of dying patients so that they may die with dignity, they need to receive not only the physical, psychological, social, and spiritual care, but also systematic and continuous care. However, there is no adequate medical service at present. We studied terminal cancer patients' behavior patterns of health care utilization, the problems of caring for the patient, and medical services that bereaved families suggested for terminal cancer patients and their families.

Methods : From 271 patients' families who participated in our hospice program from March 1991 to February 1996, 108 bereaved families whom we could have contacted were interviewed by three student nurses with a structured questionnaire.

Results : The terminal cancer patients received their medical care through admission to hospital(45.4%), outpatient clinic(22.2%), emergency room(16.7%), and oriental medicine(12.0%). But during their terminal phase of the illness, 32.4% of patients never received medical care including oriental medicine, and 28.7% received alternative medicine care such as intake of mushroom and elm tree. 26 bereaved families(24.1%) pointed out the indifference of the medical team as a problem receiving proper hospital care, and 22 bereaved families(20.4%) emphasized emotional strain of their helplessness with the patient's suffering as a problem of caring for the patient at home. Over 90% of bereaved families from their experience suggested needs of continuous care, hospice care, home care, and 24hr telephone service.

Conclusion : There were inappropriate behavior patterns of health care utilization which resulted in large proportion of terminal cancer patients received alternative medicine never receiving proper medical care. Therefore, there is a need to develop the continuous and comprehensive care for terminal cancer patients and their family, such as hospice.

Background
: Hypothyroidism may be involved in a significant portion of the causes of hypercholesterolemia in Korea. In this study, we determined the frequency of suspected hypothyroidism in hypercholesterolemic patients and compared the frequency of elevated thyrotropin levels among the groups with various total cholesterol levels.

Methods : The study subjects were healthy, asymptomatic people who visited Health Promotion Center of Seoul National University Hospital. We excluded subjects with history of hypertension, DM and hypothyroidism. The study subjects underwent physical examination and filled out a questionnaire on health risk factors. Also blood chemistry and thyroid function test were done.

Results : Among 6479 subjects, 194(2.99%) had elevated(>4.1μIU/ml) thyrotropin levels. Among the hypercholesterolemic(≥240mg/dl) patients(n=868), 40(4.60%) had elevated thyrotropin levels. And there was statistically significant difference between normal cholesterolemic and hypercholesterolemic subjects(P<0.05). Among the patients with total cholesterol above 280mg/dl (n=180), 15(8.33%) had elevated thyrotropin levels. As amount of the total cholesterol increased, the frequency of elevated thyrotropin levels increased(P=0.001). And this result was consistent following adjustment for age, sex, BMI, smoking and drinking status(P<0.01).

Conclusion : Practicing physicians should be aware of the possibility of secondary hypercholesterolemia due to hypothyroidism and keep in mind the importance of evaluating TSH level.

Background
: Acute abdominal pain in children is one of the most common problems encountered in our daily practice. The children often are not able to tell us their exact complain symptoms and differential diagnosis of acute abdominal pain is difficult in its first encounter. When family physicians encounter patients with acute abdominal pain in the ambulatory care setting, they must make an appropriate decision for proper management such as admission, referral, discharge and followup without firm diagnosis. If it is possible to predict the course or prognosis of acute abdominal pain by clinical data concerning patient, it will be helpful to make a decision for the management of acute abdominal pain. So we tested for hypothesis that patients with acute intermittent abdominal pain and normal simple abdomen X-ray finding is not serious and shows favorable outcome.

Methods : 82 patients with acute abdominal pain were assessed from Oct. 1996 to Sep. 1997 at the emergency department of Kyungju Hospital, Dongkuk University. 69 patients among 82 showed normal simple abdomen X-ray findings. 67 patients were discharged and 2 patients were admitted. 64 patients were contacted by phone call after 1 week and reported their outcome of the previous abdominal pain.

Results : Among 64 subjects 36 patients were male and 28 patients female. 57 patients complained of intermittent abdominal pain and 7 patients complained continous abdominal pain. Positive predictive value of intermittent abdominal pain and normal simple abdominal x-ray was 98%. Outcome of patients with intermittent abdominal pain was more favorable than that of continous pain.

Conclusion : Acute intermittent abdominal pain and normal simple abdomen x-ray findings in children shows favorable outcome and can be managed in ambulatory care settings.

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.