Barbara M Junghans

Doctors talking with patients/patients talking with doctors : improving communication in medical visits

The verbal and nonverbal exchanges that take place between doctor and patient affect both participants, and can result in a range of positive or negative psychological reactions-including comfort, alarm, irritation, or resolve. This updated edition of a widely popular book sets out specific principles and recommendations for improving doctor-patient communications. It describes the process of communication, analyzes social and psychological factors that color doctor-patient exchanges, and details changes that can benefit both parties. Medical visits are often less effective and satisfying than they would be if doctors and patients better understood the communication most needed for attainment of mutual health goals. The verbal and nonverbal exchanges that take place between doctor and patient affect both participants, and can result in a range of positive or negative psychological reactions-including comfort, alarm, irritation, or resolve. Talk, on both verbal and non-verbal levels, is shown by extensive research to have far-reaching impact. This updated edition of a widely popular book helps us understand this vital issue, and facilitate communications that will mean more effective medical care and happier, healthier consumers. Roter and Hall set out specific principles and recommendations for improving doctor-patient relationships. They describe the process of communication, analyze social and psychological factors that color doctor-patient exchanges, and detail changes that can benefit both parties. Here are needed encouragement and principles of action vital to doctors and patients alike. far-reaching impact.

Referral rates for a functional vision screening among a large cosmopolitan sample of Australian children

The aim of this study was to investigate the incidence of functional vision problems in a large unselected cosmopolitan population of primary school‐age children and to investigate whether constant clinical criteria for functional vision problems would be implemented by the practitioners involved in the screening. Refractive errors, near point of convergence, stereopsis, strabismus, heterophoria and accommodative facility were assessed for 2697 children (3–12 years) of varying racial backgrounds living in Australia. The spherical component of the refractive error ranged from −7.75 to +9.50 D (mean +0.54 D, ±0.79) with a distribution skewed towards hypermetropia; astigmatism ranged from 0 to 4.25 D (mean −0.16 D, ±0.35). There was a trend towards less hypermetropia and slightly more astigmatism with age. Mean near point of convergence was 5.4 ± 2.9 cm, heterophoria at far and near was 0.12 ± 1.58Δ exophoria and 1.05 ± 2.53Δ exophoria, respectively, 0.55% of children exhibited vertical phoria at near >0.5Δ, accommodative facility ranged from 0 to 24 cycles per minute (cpm) (mean 11.2 cpm, ±3.7), stereopsis varied from 20 to 800 s (′′) of arc with 50% of children having 40′′ or better. The prevalence of strabismus was particularly low (0.3%).

A role for aquaporin-4 in fluid regulation in the inner retina

Many diverse retinal disorders are characterized by retinal edema; yet, little experimental attention has been given to understanding the fundamental mechanisms underlying and contributing to these fluid-based disorders. Water transport in and out of cells is achieved by specialized membrane channels, with most rapid water transport regulated by transmembrane water channels known as aquaporins (AQPs). The predominant AQP in the mammalian retina is AQP4, which is expressed on the Müller glial cells. Müller cells have previously been shown to modulate neuronal activity by modifying the concentrations of ions, neurotransmitters, and other neuroactive substances within the extracellular space between the inner and the outer limiting membrane. In doing so, Müller cells maintain extracellular homeostasis, especially with regard to the spatial buffering of extracellular potassium (K+) via inward rectifying K+ channels (Kir channels). Recent studies of water transport and the spatial buffering of K+ through glial cells have highlighted the involvement of both AQP4 and Kir channels in regulating the extracellular environment in the brain and retina. As both glial functions are associated with neuronal activation, controversy exists in the literature as to whether the relationship is functionally dependent. It is argued in this review that as AQP4 channels are likely to be the conduit for facilitating fluid homeostasis in the inner retina during light activation, AQP4 channels are also likely to play a consequent role in the regulation of ocular volume and growth. Recent research has already shown that the level of AQP4 expression is associated with environmentally driven manipulations of light activity on the retina and the development of myopia.

A role for choroidal lymphatics during recovery from form deprivation myopia

BACKGROUND The choroid of the chick swells markedly during recovery from experimentally induced myopia. It has been demonstrated previously that the lymphatic sinusoids of the choroid contribute most to the expansion. This raises important questions about the particular ultrastructural changes occurring in choroidal lymphatics as a means of understanding the role these vessels might play in emmetropization. METHODS Thirteen hatchling chicks were monocularly occluded for 2 weeks to induce myopia and then allowed normal visual experiences during recovery for periods of 0 to 72 h before sacrifice. RESULTS Electron microscopic analysis detailed the temporal progression of vascular changes and provides qualitative evidence for edema in the extravascular space. Quantitative analysis showed that the frequency of open junctions between lymphatic endothelial cells (an indicator of passive fluid transfer) increased over the 3 days of recovery. Lymphatic fenestrations (an indicator of active fluid transfer) were rare in both nondeprived eyes and in form-deprived eyes at the time of occluder removal, but increased in density significantly over the first 24 h of recovery before returning to control levels by 72 h. The number of lymphatic endothelial caveolae did not change significantly during recovery, nor did the number of fenestrations along the walls of choriocapillaris vessels. CONCLUSIONS The walls of the lymphatics of the chick choroid open to allow greater fluid transfer during re-emmetropization than normal; the lymphatics may play an important role in the maintenance of chorioretinal fluid balance and homeostasis.

Little evidence for an epidemic of myopia in Australian primary school children over the last 30 years

BackgroundRecently reported prevalences of myopia in primary school children vary greatly in different regions of the world. This study aimed to estimate the prevalence of refractive errors in an unselected urban population of young primary school children in eastern Sydney, Australia, between 1998 and 2004, for comparison with our previously published data gathered using the same protocols and other Australian studies over the last 30 years.MethodsRight eye refractive data from non-cycloplegic retinoscopy was analysed for 1,936 children aged 4 to 12 years who underwent a full eye examination whilst on a vision science excursion to the Vision Education Centre Clinic at the University of New South Wales. Myopia was defined as spherical equivalents equal to or less than -0.50 D, and hyperopia as spherical equivalents greater than +0.50 D.ResultsThe mean spherical equivalent decreased significantly (p < 0.0001) with age from +0.73 ± 0.1D (SE) at age 4 to +0.21 ± 0.11D at age 12 years. The proportion of children across all ages with myopia of -0.50D or more was 8.4%, ranging from 2.3% of 4 year olds to 14.7% of 12 year olds. Hyperopia greater than +0.50D was present in 38.4%. A 3-way ANOVA for cohort, age and gender of both the current and our previous data showed a significant main effect for age (p < 0.0001) but not for cohort (p = 0.134) or gender (p = 0.61).ConclusionsComparison of our new data with our early 1990s data and that from studies of over 8,000 Australian non-clinical rural and urban children in the 1970s and 1980s provided no evidence for the rapidly increasing prevalence of myopia described elsewhere in the world. In fact, the prevalence of myopia in Australian children continues to be significantly lower than that reported in Asia and North America despite changing demographics. This raises the issue of whether these results are a reflection of Australias stable educational system and lifestyle over the last 30 years.

Prevalence of myopia among primary school children in eastern Sydney

Background: Worldwide there is concern that the prevalence of myopia is increasing but the prevalence of myopia in Australian school children has not been analysed in detail. This study examines the prevalence of refractive errors in a large unselected population of primary school children in the eastern suburbs of Sydney.

Ionic control of ocular growth and refractive change.

The physiological mechanisms underlying the abnormal vitreal and ocular growth and myopic refractive errors induced under conditions of visual form deprivation in many animal species, including humans, are unknown. This study demonstrates, using energy dispersive x-ray microanalysis, a systematic pattern of changes in the elemental distribution of K, Na, and Cl across the entire retina in experimental form deprivation myopia and in the 5 days required for refractive normalization after occluder removal. In our report we link the ionic environment associated with physiological activity of the retina under a translucent occluder to refractive change and describe large but reversible environmentally driven increases in potassium, sodium, and chloride abundances in the neural retina. Our results are consistent with the notion of ionically driven fluid movements as the vector underlying the myopic increase in ocular size. New treatments for myopia, which currently affects nearly half of the human population, may result.

Limbal lymphangiogenesis after corneal injury: an autoradiographic study

Blood and lymphatic vessel proliferation into the cornea occurs after severe trauma. Whilst the events early in blood vessel growth are reasonably understood, little is known of the early events in lymphangiogenesis. In this study, a model for proliferating lymphatic vessels using tritiated-thymidine autoradiography and light microscopy is described. A two-hour labeling index of 0.59% occurred in the lymphatic endothelium of the normal unstimulated limbus. After thermal cautery of the peripheral cornea, labeling of the limbal lymphatic vessels increased significantly at 36 hours, rose to a maximum of 6.8% four days after injury and thereafter returned to normal levels. Blood capillaries with a background level of 0.83% showed an increase in labeling at 17 hours, with high levels occurring at 36 hours (13.6%) and again from 61 to 84 hours (12.6%). Venular cells increased labeling at 25 hours from a control level of 0.58%, with a sharp peak of activity around 36 hours (13.2%). Synthesis of DNA similarly returned to normal levels in the blood vessels after four days. The staggered onset and differing durations of significantly increased labeling suggest either that various stimuli or arrays of stimuli are involved, or each cell type responds differently to the same stimulus for proliferation.

The limbal vascular response to corneal injury. An autoradiographic study.

Thermal cautery of the peripheral cornea in rats caused proliferation of the limbal vasculature and invasion of the cornea. Tritiated-thymidine was used to identify premitotic activity in a total of 53,192 limbal vascular cells in five categories, viz., arteriolar endothelial cells, venular endothelial cells, arteriolar perivascular cells, venular perivascular cells, and capillary cells. From normal values in the range of 0.29 to 1.37%, the 2 h labeling indices reached a maximum of 13 to 14% in both endothelial and perivascular cells of venules and capillaries. Of particular interest was the finding of 18% labeling in arteriolar perivascular cells, and 7% in arteriolar endothelial cells. The categories showed a staggered onset of DNA synthesis, ranging from 17 h postcautery for capillary cells to 36 h for arteriolar endothelium and both arteriolar and venular perivascular cells. The duration of increased DNA synthesis also varied. Endothelial cells of both arterioles and venules showed narrow labeling peaks (12 to 24 h), while the adjacent perivascular cells and cells of the small vessels labeled for some 60 to 70 h. These results suggest that more than one stimulus to angiogenesis may be involved, or that the various cell types respond differently to the same stimulus.

Refractive errors in students from Middle Eastern backgrounds living and undertaking schooling in Australia

Background:  Environmental factors associated with schooling systems in various countries have been implicated in the rising prevalence of myopia, making the comparison of prevalence of refractive errors in migrant populations of interest. This study aims to determine the prevalence of refractive errors in children of Middle Eastern descent, raised and living in urban Australia but actively maintaining strong ties to their ethnic culture, and to compare them with those in the Middle East where myopia prevalence is generally low.