Different groups, different motives: identity motives underlying changes in identification with novel groups

Social identification is known to have wide-reaching implications, but theorists disagree about the underlying motives. Integrating motivated identity construction theory with recent social identity research, the authors predicted which motives underlie identification with two types of groups: interpersonal networks and social categories. In a five-wave longitudinal study of social identity processes among 268 new university residents, multilevel analyses showed that motives involved in identity enactment processes--self-esteem, belonging, and efficacy--significantly predicted within-person changes in identification with flatmates (an interpersonal network group), whereas motives involved in identity definition processes--meaning, self-esteem, and distinctiveness--significantly predicted within-person changes in identification with halls of residence (an abstract social category). This article discusses implications for research into identity motives and social identity.

Contextualism as an Important Facet of Individualism-Collectivism

Beliefs about personhood are understood to be a defining feature of individualism-collectivism (I-C), but they have been insufficiently explored, given the emphasis of research on values and self-construals. We propose the construct of contextualism, referring to beliefs about the importance of context in understanding people, as a facet of cultural collectivism. A brief measure was developed and refined across 19 nations (Study 1: N = 5,241), showing good psychometric properties for cross-cultural use and correlating well at the nation level with other supposed facets and indicators of I-C. In Study 2 ( N = 8,652), nation-level contextualism predicted ingroup favoritism, corruption, and differential trust of ingroup and outgroup members, while controlling for other facets of I-C, across 35 nations. We conclude that contextualism is an important part of cultural collectivism. This highlights the importance of beliefs alongside values and self-representations and contributes to a wider understanding of cultural processes.

Detection of color vision defects in chloroquine retinopathy

OBJECTIVE

The effect of chloroquine toxicity on color vision is unclear. The authors identified the color defects seen in chloroquine retinopathy and determined the sensitivity and specificity of clinical color vision tests for detecting the presence of previously diagnosed chloroquine retinopathy.

DESIGN

Case-control study.

PARTICIPANTS

Chloroquine retinopathy was defined using previously published criteria. Data from 30 patients with retinopathy and 25 patients using chloroquine but with no evidence of retinal toxicity were collected.

METHODS

All patients were tested with the following six clinical color vision tests: Ishihara, Farnsworth D-15, and Adams Desaturated-15 (Dsat-15), City University 2nd Edition (CU), Standard Pseudoisochromatic Plates Part 2 (SPP-2), and American Optical Hardy Rand Rittler (AO HRR).

MAIN OUTCOME MEASURES

The number of failures was determined for each test. The types of color vision defects were classified as blue-yellow (BY), red-green (RG), or mixed RG and BY (mixed).

RESULTS

Of the 30 patients with retinopathy, 28 (93.3%) of 30 patients failed at least 1 color vision test, demonstrating predominantly mixed defects. Five (25%) of 25 of the control subjects failed at least 1 test, and these defects were predominantly BY. The sensitivity and specificity of the tests are as follows: SPP-2 (93.3%, 88%), AO HRR (76.7%, 88%), Ishihara (43.3%, 96%), Dsat-15 (33.3%, 84%), D-15 (16.7%, 96%), and CU (20%, 92%).

CONCLUSIONS

Color vision can be affected by chloroquine and should be tested routinely with a color vision test designed to detect both mild BY and protan RG defects to maximize sensitivity for toxicity. The SPP-2 and AO HRR are two tests that meet these criteria. The Ishihara has a low sensitivity, as do the D-15 tests and CU. All of the tests have similar specificity for chloroquine toxicity. If color vision defects are detected in patients at risk of developing chloroquine retinopathy, additional testing is indicated to rule out toxicity.

Detection and prevention of maculopathy associated with antimalarial agents

Rheumatologists use both cholorquine and hydroxychloroquine in the treatment of systemic arthritic and immune disease. Hydroxychloroquine is much more expensive but is better tolerated by patients. My experience in watching patients being switched from one drug to another suggests that chloroquine is more effective in some patients than is hydroxychloroquine. Reynes thought that a review of the literature suggests that chloroquine is more toxic at 250 mg/day as compared to 400 mg of hydroxychloroquine if dose is based on these dosages. This theory may be related, in part, to the observation by Raines and associates that chloroquine crosses the blood-retinal barrier whereas hydroxychloroquine does not. Patients should be assessed 6 months after starting antimalarials. Routine automated perimetry is not indicated. An appropriate examination would include visual acuity testing, color-vision testing, Amsler grid testing, and corneal assessment. Patients should be dosed on the basis of ideal body weight (not actual body weight) to reduce the incidence of macular toxicity. Patients with no risk factors should be examined no more than once a year.

Rural background and clinical rural rotations during medical training: effect on practice location

BACKGROUND

Providing health care services in rural communities in Canada remains a challenge. What affects a family medicine resident's decision concerning practice location? Does the resident's background or exposure to rural practice during clinical rotations affect that decision?

METHODS

Cross-sectional mail survey of 159 physicians who graduated from the Family Medicine Program at Queen's University, Kingston, Ont., between 1977 and 1991. The outcome variables of interest were the size of community in which the graduate chose to practise on completion of training (rural [population less than 10,000] v. nonrural [population 10,000 or more]) and the size of community of practice when the survey was conducted (1993). The predictor or independent variables were age, sex, number of years in practice, exposure to rural practice during undergraduate and residency training, and size of hometown.

RESULTS

Physicians who were raised in rural communities were 2.3 times more likely than those from nonrural communities to choose to practise in a rural community immediately after graduation (95% confidence interval 1.43-3.69, p = 0.001). They were also 2.5 times more likely to still be in rural practice at the time of the survey (95% confidence interval 1.53-4.01, p = 0.001). There was no association between exposure to rural practice during undergraduate or residency training and choosing to practise in a rural community.

INTERPRETATION

Physicians who have roots in rural Canada are more likely to practise in rural Canada than those without such a background.

To wear or not to wear: current contact lens use in the Royal Canadian Mounted Police

OBJECTIVE

The Canadian Ophthalmological Society was asked by the Royal Canadian Mounted Police (RCMP) and the Canadian Human Rights Commission to render an opinion on the acceptability of contact lenses as a reasonable accommodation to the uncorrected visual acuity standard.

DESIGN

Survey by mailed questionnaire.

SETTING

Canada.

SUBJECTS

All RCMP general duty constables with a visual acuity code of V3, V4, V5 or V6 (n = 348) and a random sample of approximately 25% of the constables with an acuity code of V2 (n = 809). Of the 1040 questionnaires returned, 1037 were usable (final response rate 89.6%). Of the 1037 respondents 316 were in the V3 to V6 group and 721 were in the V2 group.

OUTCOME MEASURES

Reported frequency of problems with spectacles or contact lenses, weighted according to sampling fraction.

RESULTS

A total of 934 respondents indicated that they used some form of visual acuity correction while on duty; of the 934, 360 reported that they wore contact lenses at least some of the time. Approximately 75% of the spectacle wearers reported having to remove their spectacles because of fogging or rain. Although contact lens dislogement or fogging (21.2%) was less frequent than spectacle dislogement (59.2%), 35.4% of the contact lens wearers reported that they were unable to wear their lenses because of irritation on at least one occasion in the previous 2 years; the median length of time was 3.14 days. When the additional amount of time due to other causes is factored in, it is clear that contact lens users wear spectacles for substantial periods while on duty.

CONCLUSIONS

Not only are RCMP general duty constables who usually wear contact lenses likely to have to wear spectacles at some time, but it is also possible that they will have to remove their spectacles and function in an uncorrected state in critical situations. Thus, altering the current standard to allow the use of contact lenses as a reasonable accommodation would not ensure effective and safe job performance.

Assessment and management of ocular foreign bodies

Ocular trauma in sports is unexpected and can result in dramatic vision loss. Some of the most insidious yet serious ocular injuries result from retained intraocular foreign bodies, and therefore sports physicians, trainers, and emergency physicians should have a high degree of suspicion when evaluating sports- and work-related eye injuries. This article presents a stepwise approach to history, physical exam, management, and referral when intraocular foreign bodies are a possibility. The authors also present pitfalls in diagnosis, give specific treatment options, and stress the importance of primary prevention and safety protection.

Eye injuries in athletics and recreation

Sports-related eye injuries represent a significant eye health hazard worldwide. In the USA, it is estimated that eye injuries from sports account for more than 100,000 physician visits per year at the cost of greater than $175 million. The sports responsible for the greatest number of injuries are baseball, ice hockey, and racquet sports. In the USA there are over 189 million participants in these sports with a disproportionate number (one-third) of injuries involving the pediatric population. The most common injuries are abrasions and contusions, followed by more serious injuries, including hyphema. Substantial reduction in the incidence of eye injuries through prevention has been demonstrated in the sport of hockey which can serve as a model for other sports. Specific criteria for protective eyewear must be developed. Polycarbonate plastic lenses and frames which are sturdy and impact resistant provide optimal protection. Lensless goggles, street wear and spectacle correction glasses do not provide adequate eye protection. The ophthalmologist's role in preventing sports-related eye injuries includes addressing particular sports participants needs, identifying one-eyed athletes, and informing patients of the need for protective eyewear.

Diagnosis of traumatic cyclodialysis by ultrasound biomicroscopy

BACKGROUND AND OBJECTIVE

To evaluate the ability of high-frequency ultrasound biomicroscopy to diagnose traumatic cyclodialyses not evident on clinical examination.

PATIENTS AND METHODS

Six eyes to six patients with posttraumatic hypotony and/or shallow anterior chamber and suspected cyclodialysis clefts were examined with slit-lamp biomicroscopy, gonioscopy, B-scan ultrasonography, and ultrasound biomicroscopy. Ultrasound biomicroscopy provided high resolution of cross-sectional images of the anterior chamber angle, posterior chamber, and anterior uveal tissue.

RESULTS

Ultrasound biomicroscopy confirmed the disinsertion of the ciliary body from the scleral spur and associated ciliary body detachment in all eyes. Gonioscopy failed to demonstrate a cyclodialysis cleft in five eyes because of hyphema (two eyes) and abnormal iris architecture (related to trauma) precluding visualization of the angle recess (three eyes). Using information from ultrasound biomicroscopy imagining, one patient underwent a ciliary body reattachment procedure and repair of the cyclodialysis cleft.

CONCLUSION

Ultrasound biomicroscopy is a noninvasive method that can accurately diagnose the presence of traumatic cyclodialyses and can aid in surgical management. It is particularly useful in the presence of hazy media, hypotony, and/or abnormal anterior segment anatomy.

Ruptured globes following radial and hexagonal keratotomy surgery

OBJECTIVE

To ascertain if cases of radial keratotomy wound rupture were occurring and whether the globes ruptured through the corneal incisions.

DESIGN

Cases of traumatic ruptured globe after incisional corneal refractive surgery were collected from ophthalmologists and from peer-reviewed and other ophthalmic literature.

RESULTS

Twenty-eight human eyes (eight previously unreported) are known to have ruptured through refractive corneal incisions in activities of daily living (n = 12), assault (n = 7), motor vehicle accidents (n = 5), and sports (n = 4). Two patients died of their injuries. Of the remaining 26 ruptured eyes, eight (31%) recovered 20/40 or better visual acuity. Six eyes (23%) were totally blinded, six (23%) were legally blinded, and six (23%) had best corrected visual acuity of 20/40 to 20/100 despite multiple surgical procedures.

CONCLUSIONS

As radial keratotomy becomes more popular the pool of patients who may experience traumatic ruptured globe will grow. Every patient who has had radial keratotomy should be aware that the surgery has weakened the eye(s).

Ultrasound biomicroscopy in the assessment of anterior scleral disease

High-frequency ultrasound biomicroscopy is a new method of examining subsurface anterior segment structures of the eye at microscopic resolution. The sclera has a high internal reflectivity and can be differentiated from the cornea, and overlying and underlying tissue. Using this modality, we examined 18 patients with various manifestations of scleral disease. Localized anterior staphyloma could be differentiated from other causes of a black spot on the scleral surface. Episcleral thickening could be differentiated from involvement of the sclera itself. Different patterns of scleral involvement could be imaged including diffuse low-reflective mottling, low-reflective nodules extending into the scleral substance, and scleral thinning. Scleral thinning could be assessed and quantified. Underlying changes in the vitreous could be detected. Ultrasound biomicroscopy was a useful adjunct to clinical examination in the assessment of anterior scleral disease.

The ocular safety of hydroxychloroquine

The insert currently supplied with hydroxychloroquine states that patients should have an initial ophthalmological assessment and then regular assessments every 3 months. The rheumatologist should expect a report from the ophthalmologist, which includes a corneal assessment of tissue dose, a reference to visual field defects if present on the Amsler grid, and a comment concerning the status of the patient's color vision. Daily dose is more important than duration of dose, regarding maculopathy. The visual prognosis of retinopathy is excellent if the diagnosis is made at an early stage of the disease. This report suggests that ophthalmological review need only occur initially and on a yearly basis if the daily dose of hydroxychloroquine is less than 6.5 mg/kg/d and the duration of therapy is less than 9 years.

An ultrasound biomicroscopic analysis of angle-closure glaucoma secondary to ciliochoroidal effusion in IgA nephropathy

Immunoglobulin A nephropathy is a common glomerulonephritis of unknown cause. Episcleritis, scleritis, anterior uveitis, and keratoconjunctivitis sicca have been associated with this disease. We diagnosed angle-closure glaucoma secondary to ciliochoroidal effusion in a patient with IgA nephropathy confirmed by biopsy. High-frequency ultrasound biomicroscopy was used to determine internal relationships of angle structures and to follow changes with treatment. Supraciliary effusion undetected by B-scan ultrasound and retinal examination was easily imaged by ultrasound biomicroscopy. Glaucoma mechanisms included forward rotation of the ciliary processes, which caused direct angle closure in a manner similar to plateau iris. Ultrasound biomicroscopy showed that cycloplegia improved this mechanism by retracting the ciliary processes, but angle closure secondary to forward iris bowing from pupil block remained. Iridectomy was performed and immediately opened the angle. Ultrasound biomicroscopy proved a useful method of defining mechanisms and a helpful guide to treatment in this type of glaucoma.

Long-term course of antimalarial maculopathy after cessation of treatment

Since 1980 I have examined some 1650 patients for the presence or absence of antimalarial maculopathy. Bilateral, irreversible visual field defects have been diagnosed is 62 patients, 37 of whom have been followed for at least 4 years. The 22 patients who presented with relative scotomas did not lose central visual acuity; over a median follow-up period of 6.0 years 33 (75%) of the eyes maintained their visual field, 5 (11%) showed some improvement in visual field, 4 (9%) lost some visual field, and 2 (4%) manifested small absolute scotomas. Nine (60%) of the 15 patients who presented with absolute scotomas were symptomatic. Over a median follow-up period of 8.8 years 19 (63%) of the eyes in this group lost one or more lines of visual acuity, including 4 (13%) that became legally blind; 19 (63%) lost field owing to an increase in the size of the absolute scotomas (13 eyes) or the development of new absolute scotomas (6 eyes). The results suggest that the visual prognosis is excellent if antimalarial therapy is stopped at an early stage of the disease.

Comparison of threshold and standard Amsler grid testing in patients with established antimalarial retinopathy

To evaluate the sensitivity of threshold Amsler grid testing in the detection of established antimalarial retinopathy, 30 eyes of 15 patients with bilateral, irreversible field defects were examined with the standard Amsler grid and the threshold Amsler grid. Four eyes (13%) showed significant enlargement of large relative scotomas on testing with the threshold Amsler grid. Although only a small proportion of the eyes demonstrated an increase in the size of the scotoma, the patients had established field defects of varying depth, in some cases absolute scotomas. A prospective study in patients with early disease (i.e., with small, shallow scotomas) may be worth while.

Is corneal deposition of antimalarial any indication of retinal toxicity?

Ninety-five percent of patients on chloroquine demonstrate corneal deposition of the drug with the pupil dilated; less than 10% of patients on hydroxychloroquine show any corneal changes when so examined. I describe one patient on chloroquine and two on hydroxychloroquine who demonstrated large amounts of corneal antimalarial drug, leading to the early diagnosis of definite retinopathy. Examination of the cornea with the pupil dilated may reveal the presence of retinal toxicity in some patients.

Ocular effects and safety of antimalarial agents

The clinical experiences with 1,500 patients receiving chloroquine or hydroxychloroquine over a 15-year period are reviewed. Forty-six patients with confirmed irreversible, bilateral, early chloroquine retinopathy have been followed prospectively since 1980. Patients presenting with normal color vision and relative paracentral scotomas appear not to progress over short-term follow-up of five years. Retinopathy in patients presenting with less than 20/20 vision, abnormal color vision, and positive fluorescein angiography may progress even if treatment with the medication is discontinued. The Amsler grid is an effective method of screening patients taking antimalarial agents for early relative paracentral scotomas. Color vision testing and fluorescein angiography are useful in elderly patients with age-related macular disease when visual field testing is unreliable.

Lupus retinopathy. Patterns, associations, and prognosis

In a prospective study of 550 patients with systemic lupus erythematosus (SLE), 41 were found to have retinopathy. Lupus retinopathy in the majority of cases consisted of a microangiopathy, with an excellent prognosis for vision. Five patients developed other complications that resulted in loss of visual acuity. Lupus retinopathy was associated with active SLE in 88% of patients and with lupus cerebritis in 73% of cases. Retinopathy in SLE was a marker of poor prognosis for survival.

Eye protection in racquet sports

This article summarizes the clinical and experimental data leading to the Canadian Standards Association (CSA) certification of six eyeguards for racquet sports in Canada in November 1986. A parallel approach involving the American Standard of Testing and Materials (ASTM) is discussed and eyeguards meeting specifications are illustrated.

Eye Protection in Racket Sports: An Update

In brief: A growing number of eye injuries in squash and racquetball in the late 1970s triggered research on eye protectors for these sports. The investigations showed that lensless eye guards were ineffective and that the frames of some lensed eye guards shattered when hit by a ball. Subsequently, Canadian and US organizations set standards for eye guards, requiring that the devices protect the eye from a ball traveling at 90 mph. Seven commercially available eye guards now meet the Canadian or US standard or both. Polycarbonate is the best lens material for eye guards. There is no substitute for approved eye guards; neither experience nor ordinary prescription glasses nor lensless eye guards provide good protection.

Dose relationships in patients with early chloroquine retinopathy

Thirty-five patients with bilateral irreversible chloroquine retinopathy have been identified prospectively since 1980. The dose relationships of chloroquine were examined specifically in these patients with particular reference to daily and total dose of chloroquine. Thirty of the 35 patients received 250 mg of chloroquine/day or less.

Keratitis associated with the use of proparacaine hydrochloride

Images

Lymphoma simulating uveitis (masquerade syndrome)

The authors present three recent cases of intraocular lymphoma. All three patients presented with apparent hypopyon and uveitis. Although the diagnosis was a difficult one to make, an aspiration of the anterior chamber with appropriate cytologic studies was conclusive in one case. The neoplasm may masquerade as any type of intraocular inflammation, anterior or posterior. We discuss the management and prognosis of these patients and review 68 cases from the world literature. Radiation therapy plays an important palliative role in this condition.

Floppy eyelid syndrome

Papillary conjunctivitis has many causes. In chronic cases unresponsive to topical medications a diagnosis of floppy eyelid syndrome may be missed if careful examination for lid laxity is not performed. Of the 27 previously reported cases of this syndrome 26 were in men. This report presents two cases in women and reviews the syndrome's management.

Eye injuries associated with war games

War games, an outdoor activity combining recreation, military maneuvers and fantasy, are becoming a popular recreational sport. Increasing numbers of players are suffering eye injuries. In the last year 26 cases of serious eye injuries were reported to Canadian ophthalmologists; in 15 eyes vision was reduced to 6/24 or less. Although eyeguards are provided, all the injuries had occurred when the participants were not wearing them. Methods of preventing eye injuries in war games are discussed.

The use of Amsler grids in early chloroquine retinopathy

A survey of Canadian ophthalmologists and rheumatologists suggests that there is a significant incidence of definite chloroquine retinopathy in their patients. As hydroxychloroquine and chloroquine appear to be better tolerated and less toxic than some other drugs used in the treatment of rheumatoid arthritis and systemic lupus erythematosus, there is a need for a simple, patient-administered test for early diagnosis of chloroquine retinopathy. The Amsler grid and smaller Yannuzzi modified Amsler grid are simple, inexpensive, and correlate well with scotomas found with static and kinetic perimetry.

Ophthalmologic injuries

The types of eye injuries that occur in various sports are discussed, with an emphasis on racquet sports and ice hockey. Both field management and treatment by a specialist are considered. Physicians should encourage players to wear polycarbonate or industrial safety-thickness lenses or protective face cages.

Critical flicker fusion frequency in early chloroquine retinopathy

Since increasing numbers of patients with connective tissue diseases are taking chloroquine and its derivatives, there is an urgent need for a simple, reasonably fast method of screening for toxic effects on the retina. Measurement of the critical flicker fusion frequency is one technique for assessing retinal function. Its screening value was assessed in a study of nine patients with bilateral visual field defects and visual acuity of 6/12 or better after various periods of chloroquine therapy and nine healthy subjects matched for age and sex who had never taken chloroquine. The control subjects' eyes consistently demonstrated the normal pattern previously described, whereas 16 of the 17 eyes tested in the patients showed one of two abnormal patterns of response.

Ophthalmologic injuries

Increasing numbers of young people are being attracted to organized sports. Racquet sports, as they are individual sports, will give a lifetime of continual pleasure. Increasing numbers of eye injuries are being seen, however. Now that adequate eye protection is available, it behooves all physicians who are interested in prevention of eye injury to encourage players to wear polycarbonate or industrial safety thickness lenses, or protective face cages in suitable sports frames, to prevent any of the catastrophic, serious, and blinding eye injuries seen in the past.

Eye Protection for Squash and Racquetball Players

In brief: The author discusses 19 ocular injuries in squash and racquetball players who wore eye guards with an opening between the upper and lower rim. The more recently developed eye guards that protect the eye with thick plastic should prevent direct injury from rackets or balls.

Eye Injuries in Racket Sports: A Continuing Problem

In brief: Hyphema was the most common serious injury in this review of 67 squash and 18 racquetball eye injuries. Several patients had corneal lacerations and retinal detachments, and many had lid contusions, small lacerations, and subconjunctival hemorrhages. Eight sustained severe loss of vision. Open eye guards did not protect all players who wore them, and all types of prescription lenses were breakable. Since these patients had several years of experience, competitive players may be at higher risk. Carefully chosen eye guards and defensive playing could solve much of the problem.

Eye injuries in racquet sports: a continuing problem

Images

Anomalies of the human hyaloid system

We describe two asymptomatic cases of persistent anomalies of the human hyaloid system. Fluorescein angiography of a cyst of the hyaloid system shows leakage from the hyaloid vessels.

Eye injuries in squash: a preventable disease

As more Canadians are taking up squash the incidence of eye injuries is increasing dramatically. Over 2-1/2 years, 23 cases from one urban practice were examined. Almost half of the group required inhospital treatment. Five patients sustained a permanent decrease in vision; these cases involved three corneal scars, one cataract and one macular cyst. Patients wearing glasses or hard contact lenses appear to be more susceptible to serious eye injury. Experience does not appear to reduce the likelihood of eye injuries; the patients in this study had played squash for 5.6 years on the average. Consequently the medical profession must take the lead by encouraging squash players to use protective equipment now available to reduce the incidence of these injuries that pose so much personal hazard.