Biomedical subjects
J Justice
Publications and source records attributed to J Justice.
Use of traditional and modern health services by Laotian refugees.
Although refugee health care emerged as a special interest in the United States following the influx of almost a million Southeast Asians since 1975, few studies have been done of the influence of refugee traditions on the use of Western medical services. The illness patterns, medical beliefs, and health care behavior of a Southeast Asian refugee group, the Mien from Laos are described in this study. A cohort of 119 Mien refugees living in Richmond, California, was observed for a 6-month period. In-home interviews were undertaken about all episodes of ill health, including treatment and health care decisions. This study shows that the Mien integrate traditional healing beliefs and practices with the use of American health services. Such findings are important because the increasing cultural diversity in the United States, particularly in Western states, necessitates that health care professionals understand the importance of cultural factors for access to and the use of health care by all patients including refugees and other immigrant groups.
Tapping employee insights with the Nominal Group Technique.
In our scenario, we brought together the manager, pharmacist, full-time and part-time sales people, the delivery person, and the stock person, to give a perspective from every possible area of operation. We have found that input from all employees often generates ideas that they would not have thought of on their own. We suggest that NGT, used on a quarterly basis, for instance, would be an excellent means of developing team spirit, employee participation, and meaningful and effective solutions to problems. NGT is much better than trying to "go it alone," especially in today's competitive environment. NGT helps us realize that the potential contribution of employees is great, but generally untapped. The process requires planning but little time; yet it can produce astounding results, both in encouraging team spirit and in protecting profitability. The process fosters effective use of a participative style of management. It forces us, in effect, to use our most valuable resource: the people we manage.
The bureaucratic context of international health: a social scientist's view.
Using primary care as an example, this paper examines how the bureaucratic structures and culture of the international health agencies have affected the planning and delivery of health programs. Many primary health care programs were ineffective, as research undertaken in Nepal has shown, because they reflected the perspective and needs of the health bureaucracies involved rather than those of the local villages receiving services. Similarly, work in other South and Southeast Asian countries reveals that primary health care was interpreted differently in different bureaucratic settings and adapted to bureaucratic needs, but not necessarily adapted to village cultures and conditions. Social scientists, who are trained to analyze and articulate different cultural contexts, can play a key role in helping international health bureaucracies become more sensitive to the rural village cultures they serve.
Clinical comparison of 10 percent and 25 percent intravenous sodium fluorescein solutions.
Sodium fluorescein solutions, 3 ml of 25% solution and 5 ml of 10% solution, were compared with a double-blind crossover method in a group of 41 normal volunteers and in a group of 42 patients who had diverse ophthalmic disorders. Following injection of the solutions into the antecubital vein, visualization, serial fluorescein angiograms, and five-minute phase angiograms were studied and compared. The untoward reactions reported in both studies were of types usually associated with sodium fluorescein, the most common of which was a mild, transient nausea. On the basis of our results, there is no significant difference in the incidence and severity of adverse reactions between the 10% and 25% solutions. In the volunteer study, the 25% solution was significantly superior in visualization and paired comparison (P less than .001) in the patient study, the 25% solution was significantly superior in angiogram quality (P less than .01), five-minute phase angiogram (P less than .05), and paired comparison (P less than .005). The overall superiority of the 25% concentration in a 3-ml volume was demonstrated both subjectively and objectively in the volunteer study and in the patient study.
Voluntary nystagmus.
Voluntary nystagmus is a pendular, rapid, conjugate, primarily horizontal, benign nystagmus initiated and maintained by voluntary effort. The amplitude is variable, but always low. The rate is constant and rapid. Convergence is variable--apparently essential in some, nonessential in others, but related in all of our cases. This condition appears to have a familial component and is more common than originally thought. Voluntary nystagmus should be considered when dealing with any patient exhibiting nystagmus in order to minimize the possibility of misdiagnosis as occurred in one of our cases.
Cilioretinal arteries. A study based on review of stereo fundus photographs and fluorescein angiographic findings.
The incidence of cilioretinal arteries in 2,000 eyes of 1,000 consecutive patients was determined by review of stereo color fundus photographs and fluorescein angiographs. One or more cilioretinal arteries were present in 49.5% of all patients or in 32.1% of the eyes. The arteries occurred bilaterally in 14.6% and contributed to some portion of the macular circulation in 18.7% of the patients. A great deal of variability of size, number, and distribution of cilioretinal vessels was observed. Prior studies that were based on direct visualization of the fundus have reported cilioretinal arteries in 7% to 29.6% of patients examined. Careful review of stereo fundus photographs and early phase fluorescein angiographs aided in the observation of these vessels that might otherwise have been unrecognized. We believe the method of review accounts for the high incidence of cilioretinal arteries in our series.
Autosomal recessive retinitis pigmentosa and Coats disease: a presumed familial incidence.
Three of four siblings of normal parents had a combination of Coats disease and retinitis pigmentosa bilaterally. Our report of their respective cases is, to our knowledge, the first report of a familial incidence of the combination of the two diseases in an individual and supports the implication that Coats disease may be a genetic abnormality. The pathological process was essentially the same in all three patients, although it occurred differently in one of the three siblings and gave rise to an altered functional and clinical picture. The similarities may indicate that the convenient categories of "tapeto-retinal degenerations" are clinical variations of the same genetic abnormality.
Anterior segment fluorescein angiography.
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Ocular fundus photography.
This chapter is a review of fundus photography techniques, with particular emphasis on the important parameters of producing high quality fundus photographs. The role of fundus photography has extended beyond that of a documentary service to one with specific diagnostic value. Thus, ocular fundus photography relates directly to patient care and is an essential part of the sophisticated armamentarium of any clinical ophthalmological unit.
Fluorescein angiography.
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Basic interpretations of fluorescein angiography.
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Adverse reactions to intravenous fluorescein.
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Dominant cone-rod dystrophy.
Six generations of a family were studied extensively allowing the description of an autosomal dominant dystrophy of both rods and cones. The dystrophy is characterized by onset between ages 6 and 8 with gradual decrease in vision and progression to the point of no light perception. Abnormalities of color vision, visual field, refraction, fixation behavior, fundus appearance, fluorescein angiography, electroretinography, electrooculography and dark adaptation are presented. The importance of this family in the classification of inherited retinal dystrophies is stressed and the need for an expanded classification is discussed. The role of genetic counseling is stressed in such severe diseases.
An improved method of viewing topical fluorescein.
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Aid for visualizing epithelial edema.
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