Clifford B. Reifler

Epidemiologic Aspects of College Mental Health.

pidemiology is the study of the distribution and determinants of health states in man. Two aspects of this definition should be noted. The first is the descriptive study of the distribution of health states (including disease); the second is the search for the determinants of that distribution, that is, for variables that have etiological significance. Most of the currently available epidemiological information is essentially descriptive in nature and the primary purpose of this paper is to give an overview of the state of knowledge in this area. Quantification of the extent of the problem is a first step and this paper will summarize information available on the prevalence of emotional disorder; that is, the number of cases of a condition in a population group during a specified interval of time.1 If one has the goal, however, of developing rational programs of intervention, either for the purpose of preventing illness or for the purpose of enhancing positive mental health, it is necessary to go beyond gross estimates of prevalence and to begin looking at variables that define both high-risk groups and what I have called “high-risk situations,” that is, those conditions in the college experience that are associated with the development of a disproportionate share of problems. In order to do this, incidence data rather than prevalence data are necessary and this paper will first deal with some of the problems involved in identifying this kind of information.2 Finally, I would like to focus on some of the variables that have been identified as relating to psychiatric morbidity (or at least to use of a psychiatric clinic) and which point the way toward fulfilling the second part of the epidemiologic promise inherent in the definition, that of identifying etiologically relevant information. As I have said, in order to identify etiologically relevant information, incidence data are necessary. Incidence is defined as “the number of cases of a disease that come into being during a specified period among a specified unit of population.”3 Incidence rates are thus a measure of the frequency of events as opposed to prevalence rates which relate to the existence of disease. For most illnesses it is usually impossible to measure directly the timing of the onset of a disease and this is particularly so for psychiatric conditions. Indirect measurements, such as onset of symptoms, time of diagnosis and date of hospitalization are therefore utilized to give an index of how many cases arise during a period of time. Most epidemiologic studies of college mental health relate, therefore, to the incidence of clinic usage, that is, data derived from those students who present themselves to the attention of mental health facilities. As we have noted before, it would be a mistake to confuse these usage rates with illness rates.4 Only a small proportion of those students with identifiable illnesses are seen professionally and, in addition, not all those seen professionally are classifiable as having an illness.5 A number of investigators have attempted to study the variables involved in such self-selection by comparing users and nonusers.6 Other studies have focused upon particular disease entities such as suicide or psychoses in which there was a high probability of almost all such events coming to professional attention.7 A number of other epidemiological studies have attempted to get some closer estimate of “true prevalence” of psychiatric disorder among college students by doing direct surveys of student populations, but only one study that I know of was methodologically designed to answer questions about incidence. Smith, Hansell and English studied a sample of college students at the beginning of their freshman year and again E JOURNAL OF AMERICAN COLLEGE HEALTH, VOL. 54, NO. 6

Vending Machines and the Self-Care Concept

For the past 3 years (1980-83), students at the University of Rochester in Rochester, New York, have had 24-hour access to a vending machine which dispenses over the counter medicines and contraceptives. The machine is located in a small health facility near the undergraduate residence halls. The health facility is staffed by a registered nurse who provides treatment for minor illnesses, health education information, and referrals to the universitys medical center. The facility stresses self-care, and a bulletin board located near the vending machine provides numerous health education brochures. The vending machine program represents a continuation of the emphasis on self-care. Instead of fostering dependency on the nursing staff the vending machine helps the students become self-reliant in reference to assessing their own health needs. Items dispensed by the machine include condoms, condoms and foam, aspirin, Sudafed, Robitussin, Acetaminiphen, Chlortrimeton, Cepacol, bandages, and thermometers. The items are sold to the students at cost. Condoms are the most popular item, and in 1982-83, 404 condom packages, priced at US

Use of Over-the-Counter and Home Remedies by College Students.

.50, were sold. Students who know what kind of medicine or health aid they want no longer are required to obtain these items by visiting the nursing staff. The image of the nurses at the facility is no longer that of a dispenser of over the counter drugs but that of someone who provides counseling, health education, and referrals. A survey conducted in 1983 revealed that the majority of the student body knew about the vending machine. This awareness reached 100% among senior class males. The purpose of the vending machine project is to make nonprescription medicines readily available to students, to make contraceptives available on a 24-hour basis, and to emphasize that the primary role of the facilitys nursing staff is to provide education, counseling, and referral services.

Infection control and employee health: epidemiology and priorities for program development

Abstract This study was designed to understand the prevalence, factors in selection, and appropriateness and safety of the use of nonprescription drugs and home remedies by a population served by a prepaid health program. The aim was to develop baseline data on self-medication and indicators of need for health education programs. Two surveys were conducted, the first among a random sample of students at a primarily residential university (N = 302), and the second among all the professional staff responsible for their care. The student questionnaire asked what brands of nonprescription drugs were used for 27 symptoms and what factors influenced the selection of a recently adopted over-the-counter (OTC) drug. All medications used by consumers for 17 symptoms were evaluated by University Health Service (UHS) staff. The pattern of student use of OTC drugs reflects patterns observed in other populations. Analgesics and cough and cold remedies were the most widely used internally administered drugs, while tooth...

Process and Results of an Immunization Requirement at the University of Rochester.

Infection control programs have traditionally focused their attention on various aspects of infection control in hospitalized patients. The relationship of infections occurring in hospital personnel to those occurring in patients may be underemphasized with the possible exception of the role personnel play in outbreaks or clusters of infection. Although most health care facilities and regulatory agencies now recognize the importance of infection control in health care personnel, 1-3 infection control programs have varying degrees of input and influence into occupational health matters? The purpose of the present study is twofold: (1) to further emphasize the importance of infection control-related problems to employee health in health care facilities by using an existing program as a starting point and (2) to identify the specific infection control-related problems seen in an employee health service. We have reviewed visits made by employees of the Strong Memorial Hospital to our personnel health service during a 1-year period. On the basis of our data, we have delineated four categories of service related to infection control that we feel are essential to employee health programs in health care facilities.

Factors in and methods for maintaining fiscal solvency in the health service of a small research university.

Abstract “A Double-Blind Study of Oral Acyclovir for Suppression of Recurrences of Genital Herpes Simplex Virus Infection,” JOHN M. DOUGLAS, et al. Patients with frequently recurring genital herpes were enrolled in a double-blind placebo-controlled trial comparing 200-mg acyclovir capsules, given five or two times daily, with placebo. Of 47 placebo recipients, 44 (94 per cent) had recurrences during the 120-day treatment period, compared with 13 (29 per cent) of 45 patients treated with acyclovir five times daily and 18 of 51 (35 per cent) treated with acyclovir twice daily (P < 0.001 for each regimen compared with placebo). The median time to the first clincial recurrence was 18 days in placebo recipients, compared with over 120 days in both acyclovir-treated groups (P < 0.001 for both groups compared with placebo). The mean monthly recurrence rate during the medication period was 0.86 in placebo recipients, compared with 0.13 in patients treated with acyclovir five times daily and 0.14 in patients treat...

Spontaneous recurrence of marihuana effect.

Abstract Maintaining fiscal solvency at the University of Rochester Health and Safety Division necessitates increased attention to income sources. Prepaid student fees and university funds are not increasing as rapidly as expenses. In order to maintain services, additional income must be sought from other areas such as expansion of the number of subscribers, increased fee-for-service patients, and increased third party collections. Continued review of expenses in terms of necessity, effectiveness, efficiency, and priority is required. Through the use of a computerized data information system, resource utilization can be explored and reviewed with timeliness and accuracy. Full utilization of the universitys accounting capabilities helps to segregate expenses easily and reallocate them to cost centers for purposes of accountability and review. Systems analysis of patient and paper flow can eliminate unnecessary tasks and reduce time required for other functions. The role of the Student Advisory Committee i...