Background
: CRC is an ideal target for population screening because it is a prevalent disease with an identifiable precursor lesion. This study was performed for the purpose of comparing cost-effectiveness of CRC screening strategies.

Methods : The natural history of a simulated cohort of 50- year-old Koreans in the general population was modeled with and without CRC screening until age 80 years. We evaluated 16 different screening strategies with Markov model. Cases of positive screening test results were worked up with a colonoscopy. After polypectomy, colonoscopy was repeated every 3 years. Our main outcome measurements were discounted lifetime costs, life expectancy and incremental cost-effectiveness (CE) ratio, comparing 16 different CRC screening strategies.

Results : In base-case analysis, compliance was assumed to be 60% with the initial screen and 80% with follow-up or surveillance colonoscopy. The non-dominated strategies were colonoscopy every 10 years (COL10), colonoscopy every 5 years (COL5) and colonoscopy every 3 years (COL3). Strategies that only included sigmoidoscopy were generally not regarded as non-dominated strategies, but sigmoidoscopy every 5 years (SIG5) showed similar cost and effects as COL10 while sigmoidoscopy every 3 years (SIG3) had similar results as COL5. Other strategies recommended by the expert panel, such as sigmoidocopy plus colon study every 5 years were less cost-effective than the alternatives.

Conclusion : Colonoscopy is the most cost-effective strategy in Korea for colorectal cancer screening. Unfortunately, the number of physicians skilled enough to perform colonoscopy is not enough to meet the demands of screening for colorectal cancer in average-risk adults. Therefore, we consider alternative strategies such as SIG5 or SIG3.

Background
: Waist circumference and BMI have been known as an independent predictor for cardiovascular diseases. But some people with a normal BMI or normal waist circumference may have cardiovascular risk factors. Therefore, the purpose of this study was to investigate the simplicity and the usefulness of waist/height ratio as an index of obesity and to investigate the waist/height ratio as a predictor for metabolic risks in individuals with normal weight and/or normal waist circumference.

Methods : The subjects were 1,157 individuals (635 men, 522 women). The morbidity index for metabolic risk factors was calculated by the sum of the risk factors scores (one point per item, if present). We set the criteria of obesity as BMI≥25 kg/m², waist circumference of ≥90 cm in males and ≥80 cm in females, waist/hip ratio of ≥0.9 in males and ≥0.8 in females, and waist/height ratio of ≥50 cm/cm*100.

Results : There was a significant correlation among waist/ height ratio, waist/hip ratio, BMI, and waist circumference (P=0.000). The odds ratios for morbidity index (≥3) in normal BMI, waist circumference, and waist/hip ratio subjects with waist/height over 50 were significantly higher with 4.60, 3.83, and 2.79, respectively, and also higher in normal BMI with normal waist circumference subjects with 3.90 (P=0.000).

Conclusion : Waist/height ratio may be used a simple and practical index of obesity. Especially, it may be useful in subjects with normal BMI or normal waist circumference when predicting their metabolic risks.

Background
: There are several reports that vitamin C is one of antioxidants and can be used to protect cardiovascular diseases. Inflammation plays a major role in atherosclerosis, and the measurement of inflammatory markers such as high-sensitivity C-reactive protein (hs- CRP) may provide methods for risk prediction and reveal independent risk factors of cardiovascular diseases. The purpose of our study was to assess the correlation between vitamin C intake and plasma hs-CRP concentration.

Methods : The study subjects consisted of 2,012 individuals who underwent periodic health examination in a university hospital in Busan from June 2002 to January 2003. The subjects were questioned concerning their past medical history, alcohol intake, smoking status, physical activity. Body mass index, abdominal circumference, blood pressure, fasting glucose, lipid profile, general blood test, and hs-CRP were measured. The exclusive responsible dietitian evaluated the average calorie intake and vitamin C intake by food frequency questionnaire. To quantify the correlation between vitamin C intake and plasma hs-CRP concentration, Pearson correlation coefficient and Spearman correlation coefficient were presented.

Results : The vitamin C index (r=-0.051, P＜0.05) and the vitamin C intake per calorie intake (r=-0.075, P＜0.01) showed a significant correlation with the plasma hs-CRP level. The vitamin C intake and the vitamin C intake per calorie intake were significantly correlated with the plasma hs-CRP level after adjusting for sex, age, body mass index and smoking status.

Conclusion : These findings suggest that there was a significant correlation between the vitamin C intake and the hs-CRP concentration. Therefore, inflammatory status is higher in a person who takes small amount of vitamin C than a person who takes it plentifully. The former is presumed to have a higher risk of cardiovascular diseases thereafter.

Background
: The primary concern of a family physician is the healthcare of patients and their families, with the patient's disease itself being secondary. Family physicians should make efforts to discuss personal issues with their patients. This study examined how many patients were counseled about their private problems, especially family or sexual issues in the private clinics of Cheonan.

Methods : The subjects were the patients who visited a practice-based network from April to June in 2003. The data were collected through simple questionnaire about sociodemographic features of patients and their family and sexual problems.

Results : Eighty eight patients were studied for a total of 107 cases that consisted of 67 cases of family problems (62%) and 40 cases of sexual matters (38%). The common issues about family problems were `the partners' (23 cases, 21%) and `the patients` children' (29 cases, 27 %). The most frequent sexual problems were 'sexually transmitted diseases' (13 cases, 32.5%), `impotence' (7 cases, 17.5%), 'loss of libido, and unsatisfaction' (6 cases, 15.0%). Most physicians were involved in family and sexual issues with medications, and simple counseling with reassurance. Simple counseling was given for 14 cases (21.0%) for family issues and 18 cases (44.0%) for sexual issues. The patients were treated with medications in 47 cases (70.0%) for sexual and 15 cases (38.0%) for family problems.

Conclusion : The most common issue for family problems was their partners and for sexual problems was 'sexually transmitted diseases'. Most family physicians were involved with both simple counseling and medications.