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
: Urinary incontinence has a negative impact on the lifestyle of sufferers, affecting not only their physical condition but also their well-being. But only few patients visit doctors for treatment. The purpose of this study was to measure the quality of life in women with urinary incontinence.

Methods : Among the people who visited a tertiary hospital in Seoul for a health exam or primary care during April 2002, we selected 161 women over 20 years old. We measured their quality of life by the Medical Outcomes Study (MOS) 36-Item Short-Form Health Survey (SF-36) questionnaire. Excel 2000 statistical program was used for statistical analysis.

Results : The active incontinence group, who experienced urinary incontinence within 1 year, were 48 women and the normal group without urinary incontinence at all were 65 women. The average SF-36 score was 76.5 in total women, 69.0 in active incontinence group, and 81.5 in normal group. The percentage of those seeking treatment was 10.4% and 64.6% of women have never sought help.

Conclusion : These results suggest that the incontinent patient had a much lower quality of life than normal women, but there were only few patients who sought treatment.

Background
: For people who have high risk diseases or who are aged 65 years or more, routine influenza vaccination is required. However, in Korea, influenza vaccination rate of such people is low. We performed a study to assess the effectiveness of physician reminder in improving the rate of recommending influenza vaccination.

Methods : Among the patients who registered to tertiary care hospital family clinic center, 305 patients with diabetes mellitus or aged 65 years or more were randomly assigned into physician reminder group and control group. After excluding the patients who were vaccinated before the medical consultation or who did not attend the clinic, remaining 253 patients were included as final study subjects. For the physician reminder group, a sticker showing that influenza vaccination was needed was placed on each medical record. Demographic and clinical characteristics, recommendation of vaccination by physician, and the receipt of vaccination were checked through self-administered questionnaires, review of medical chart and order communication system, and telephone interview.

Results : The rates of recommending vaccination in the physician reminder group and the control group were 36% and 29.7%, respectively. The difference between the two groups was not significant. Vaccination rate in patients for whom influenza vaccination was recommended by their physician was 87.0%, whereas those for whom vaccination was not recommended was only 41.2%.

Conclusion : Physician reminder for influenza vaccination was not effective in this study. However, the physician's recommendation was effective in improving the influenza vaccination rate. Effective strategies will be needed to encourage physicians to recommend influenza vaccination.

Background
: Female sexual function is influenced by much more factors than that of male and has a close relationship with psychosocial factors. A satisfying sex life has a high correlation to a happy married life. A questionnaire provides easy access to private matters and in a multidimensional manner. The objective of this study was to identify the factors related to female sexual function to help sexual adjustment in marriage.

Methods : A hundred married women living with their spouses, who visited an outpatient clinic of family medicine department of a university hospital in Seoul were studied. After filling out the self-administered questionnaire, a face-to-face interview was done on all study subjects. For multivariate analysis of the related factors, the outcome variables were a binary response of the normal female sexual cycle ?drive, lubrication, orgasm, and satisfaction.

Results : The multivariate analysis showed that the household income was a significant factor related to Drive (Odds Ratio: OR=0.6, 95% Confidence Interval: CI 0.4∼0.9). Age was a significant factor related to Insufficient Lubrication (OR=1.1, 95% CI 1.0∼1.3). Insufficient foreplay was a risk factor for Insufficient Lubrication (OR= 2.4, P=0.052). In multivariate analysis of the Orgasm related factors, the perceived health status showed an OR of 7.1 (95% CI 1.5∼32.6) and both marital satisfaction and open communication showed an OR of 6.0 (95% CI 1.3∼26.8) and an OR of 5.8 (95% CI 1.2∼28.2), respectively. The significant related factors to Satisfaction were in order of importance of sex life, education, and open communication, with an OR of 3.6 (95% CI 1.7∼7.6), 2.5 (95% CI 1.1∼5.9), and 2.0 (95% CI 1.0∼3.8), respectively.

Conclusion : The positively related factors to female sexual function were good perceived health status, high marital satisfaction, placing importance in sex life, and open communication regarding sexual matters. Increasing age and household income were found to be factors adverse to female sexual function.

Background
: Obesity has been generally diagnosed by 'Body Mass Index (BMI)' in primary care. Recently the use of Bioelectrical Impedance Analyzer' has become popular in Korea to evaluate body fat rate (BFR), as cost is inexpensive and the method to use is simple. As a result, the opposed finding of normal BMI and elevated BFR vice versa in same individuals are being encountered frequently. We designed this study to find out the characteristics and cardiovascular risk of people in these groups.

Methods : The medical records of health promotion center were obtained and 22,704 applicants visitor who undeerwent health risk questionnaire, screening tests and physical examination for cardiovascular disease were reviewed.

Results : After adjusting for age, sex, exercise and education level, cardiovascular risk such as hypertension, DM, and hypercholesterolemia, LDL tended to increase linearly and HDL tended to decrease linearly with increase of BFR or BMI. In comparison with normal BMI and BFR group, the odds ratios of normal BMI and elevated BFR group or vice versa were increased.

Conclusion : If either one of BMI or BFR of a person was elevated, even though the other was within normal range, the cardiovascular risk of that person was shown to be high.

Background
: The purpose of this study was to find the factors associated with becoming obese children during the past 2 years in 6th grade children of elementary school and then to evaluate the high risk groups for childhood obesity.

Methods : The 738 children from May to June, 2001 in 6th grade of 5 elementary schools in Busan were the subjects of this study. The children's height and weight in 4th grade and 6th grade were obtained from school health records. We calculated the body mass index in 4th and 6th grades and classified into 3 weight groups (normal, at risk for obesity, and obese) according to the age and sex-specific BMI established by the Korean Academy of Pediatrics. If children's weight group in 4th grade was changed to heavier weight group in 6th grade, we defined it as increased group. Otherwise, we defined it as non-increased group. The association between the increase in weight group and parental and children's characteristics were analyzed by χ²-test, χ²-test for the trend, t-test, ANOVA and multiple logistic regression.

Results : Among the total, 3.3% of children with normal weight and 16.9% of children at the risk for obesity in 4th grade were transformed to increased group in 6th grade, respectively (P＜0.001). Children who had excessive appetite (P＜0.001), watched TV greater than or equal to 2 hours per day (P=0.004) or had an obese father (P=0.044) were more likely to become increased group. After adjusting for father's obesity, appetite and TV watching time in children, the odds ratio of transforming to increased group after 2 years in children at risk for obesity or in obese child in 4th grade was 2.5 (95% CI: 1.09∼5.55) compared to children with normal weight. Children having excessive appetite were 3.2 times (95% CI: 1.42∼7.01) more likely to become the increased group after adjusting for father's obesity, TV watching time and weight in 4th grade. Children watching TV greater than or equal to 2 hours/day was 2.8 times (95% CI: 1.27∼6.18) more likely to become increased group after adjusting for father's obesity, appetite and weight in 4th grade.

Conclusion : The risk of becoming obese was higher in children at risk for obesity or obese children in those with excessive appetite or those who have watched TV ≥2 hours/day for the past two years. These findings suggest promotion of educational plan to prevent childhood obesity.

The most common endogenous cause of Cushing's syndrome is Cushing's disease. The evaluation of patients with suspected Cushing's disease and syndrome requires an understanding of the proper use and limitations of the tests commonly included in the diagnostic work-up. The best screening test for Cushing's syndrome is a 24-hour urine collection with analysis for urinary free cortisol excretion. Low-dose and high-dose dexamethasone suppression tests, corticotropin assays, a corticotropin-release hormone stimulation test and inferior petrosal sinus cathaterization may be required for a definitive diagnosis. MRI is useful in localizing the lesion but some limitations. Surgical removal of the lesion by a trans-sphenoidal appraoch is usually successful, but long-term follow-up is required. We report a case of Cushing disease which shows such typical clinical characteristics of Cushing syndrome as weight gain, skin lesions, truncal obesity, striae, hypertension.