Purpose: A number of disorders cause dysphagia, which is the perception of an obstruction during swallowing. The purpose of this study was to determine the prevalence of dysphagia in primary care patients.Methods: Adults 18 years old and older were the subjects of an anonymous survey that was collected in the clinic waiting room before patients were seen by a physician. Twelve family medicine offices in HamesNet, a research network in Georgia, participated.Results: Of the 947 study participants, 214 (22.6%) reported dysphagia occurring several times per month or more frequently. Those reporting dysphagia were more likely to be women (80.8% women vs 19.2% men, P ‫؍‬ .002) and older (mean age of 48.1 in patients with dysphagia vs mean age of 45.7 in patients without dysphagia, P ‫؍‬ .001). Sixty-four percent of patients with dysphagia indicated that they were concerned about their symptoms, but 46.3% had not spoken with their doctor about their symptoms. Logistic regression analyses showed that increased frequency [odds ratio (OR) ‫؍‬ 2.15, 95% CI 1.41-3.30], duration (OR ‫؍‬ 1.91, CI 1.24 -2.94), and concern (OR ‫؍‬ 2.64, CI 1.36 -5.12) of swallowing problems as well as increased problems eating out (OR ‫؍‬ 1.72, CI 1.19 -2.49) were associated with increased odds of having talked to a physician. Conclusions: This is the first report of the prevalence of dysphagia in an unselected adult primary care population. Dysphagia occurs commonly in primary care patients but often is not discussed with a physician. (J Am Board Fam Med 2007;20:144 -150.)Swallowing is a complex motor reflex requiring coordination among the neurologic system, the oropharynx, and the esophagus. A number of disorders, both benign and malignant, interfere with the swallowing process and cause dysphagia.1 Patients with dysphagia suffer significant social and psychological burdens associated with their symptoms of difficulty with swallowing, including anxiety with meals or avoidance of eating with others. 2The diagnosis of dysphagia is important because of the associated morbidity and mortality. Untreated dysphagia can lead to dehydration, malnutrition, respiratory infections, and death.2 The elderly with symptoms of dysphagia are at increased risk of the complications of dysphagia, including aspiration pneumonia. 3 Several studies have identified the elderly as being at risk for the development of dysphagia. 4,5 The prevalence of solid-food dysphagia was found to be 7% in elderly patients (62 years old and older) in a family medicine clinic in a medical university.

Introduction: This study examined barriers to colorectal cancer (CRC) screening in people living in rural areas.Methods: We identified 2 rural counties with high rates of CRC and randomly contacted county residents by telephone using a published listing.Results: Six hundred thirty-five of the 1839 eligible respondents (34.5%) between the ages of 50 and 79 years living in McDuffie and Screven counties, Georgia, agreed to complete the survey. The mean age was 62.2 years (SD, ؎7.5 years); 72.4% were women, 79.4% were white, and 19.5% were African American. African-American respondents had lower CRC screening rates (50.4%) than whites (63.4%; P ‫؍‬ .009). Significantly more African Americans compared with whites reported barriers to CRC screening. Based on logistic regression analyses, having a physician recommend CRC screening had the strongest association with having a current CRC screening, regardless of race.Conclusions: Important racial differences existed between African Americans and whites regarding the barriers to CRC screening and factors impacting current screening. However, endorsement of a small set of questionnaire items-not race-had the strongest association with being current with screening. Physician recommendation for CRC screening had the strongest association with being current with CRC screening. (J Am Board Fam Med 2012;25:308 -317.)

Extraverted behaviors will continue to be an important part of medical training and practice, but the merits of introverted behaviors warrant further consideration as both medical training and practice evolve. Educators who make manageable adjustments to current teaching practices can improve the learning for both introverted and extraverted styles of academic engagement.

PurposePsychological flexibility involves mindful awareness of our thoughts and feelings without allowing them to prohibit acting consistently with our values and may have important implications for patient-centered clinical care. Although psychological flexibility appears quite relevant to the training and development of health care providers, prior research has not evaluated measures of psychological flexibility in medical learners. Therefore, we investigated the validity of our learners’ responses to three measures related to psychological flexibility.MethodsFourth-year medical students and residents (n=275) completed three measures of overlapping aspects of psychological flexibility: (1) Acceptance and Action Questionnaire-II (AAQ-II); (2) Cognitive Fusion Questionnaire (CFQ); and (3) Mindful Attention and Awareness Questionnaire (MAAS). We evaluated five aspects of construct validity: content, response process, internal structure, relationship with other variables, and consequences.ResultsWe found good internal consistency for responses on the AAQ (α=0.93), MAAS (α=0.92), and CFQ (α=0.95). Factor analyses demonstrated a reasonable fit to previously published factor structures. As expected, scores on all three measures were moderately correlated with one another and with a measure of life satisfaction (p<0.01).ConclusionOur findings provide preliminary evidence supporting validity of the psychological flexibility construct in a medical education sample. As psychological flexibility is a central concept underlying self-awareness, this work may have important implications for clinical training and practice.