The Journal of family practice
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There is controversy about the efficacy and feasibility of flexible fiberoptic sigmoidoscopy (FFS) as a screening test for colorectal cancer in asymptomatic adults aged 50 years and over. Some authorities recommend periodic FFS screening for all such adults, whereas other authorities do not recommend screening FFS at all. ⋯ Knowledge that sex and race are risk factors for colorectal cancer detectable by screening FFS may be important to those physicians who choose the selective screening approach. Further research is necessary to determine whether selective screening for colorectal cancer is efficacious, or whether the race and sex differences noted in this study are important in the etiology of colorectal cancer.
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The delivery of primary health care involves a complex interactive process between the provider and patient. One important feature of this interaction is provider concern for psychosocial issues. A study was undertaken to examine provider's actions with the patient and to describe the factors influencing the provider's concern with psychosocial issues. ⋯ Data from exit and follow-up interviews with patients plus a provider questionnaire were analyzed to identify factors associated with a provider's psychosocial concern. The results show that an interactional analysis focusing on clinician activities can be useful in describing important process-outcome relationships such as psychosocial concern. Factors such as type of visit, visit history, type of provider, and sex of patient and provider were associated with the amount of psychosocial concern displayed by providers and perceived by patients.
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Availability of tobacco products is a key factor in the initiation of smoking or use of smokeless tobacco by minors. Existing laws limiting such use are usually not enforced. The ability of minors to purchase tobacco products in Wichita, Kansas, was compared with results in previous reports. ⋯ Vending machines, however, were universally accessible. Sufficient retail outlets allowed purchase to ensure that minors who are determined to buy could supply themselves with tobacco. Strategies to limit the access of tobacco to minors are discussed.
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Once a major part of medical practice, physician house calls have declined in frequency over the years. Recently, it has been suggested that house calls are increasing. This study examined the current self-reported house call practices among recent graduates of family practice residency programs in the United States. ⋯ Fewer than 15% made house calls on a weekly basis. There was a downward trend by residency year in the percentage of physicians making house calls when comparing graduates from 1981 to 1986. House calls do not appear to be a significant part of the practice of young family physicians.
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A study was designed to identify criteria that could help select applicants to medical school with a lasting commitment to family medicine and to test the application of such criteria to predict career choice. The sample included 43 residents and physicians who chose family medicine when they entered medical school and five residents who decided on family medicine later. From the initial group, 19 remained stable in their choice of family medicine, and 24 switched to another specialty. ⋯ The characteristics of stable family physicians and those who became specialists were identified, and the predictive power of these criteria was tested with 30 graduates selected at random. Based only on their entrance records, 25 of the 30 graduates were correctly identified as future family physicians or specialists. The use of these criteria in the admission process is discussed in terms of increasing the number of students who will become stable family physicians.