John M. Dorman

Contagious Diseases in Competitive Sport: What Are the Risks?

Abstract Great concern is often expressed over the possibility of contagion among athletes in competitive sports, particularly sports with much person-to-person contact. Human immunodeficiency virus (HIV) is only the most notorious of infectious agents; potentially, other viruses, bacteria, and even fungi may be involved. Because of the concern, however, special attention is paid to HIV and hepatitis B infections. For most of the infections considered, the athlete is more at risk during activities off the playing field than while competing. Inclusion of immunizations against measles and hepatitis B among prematriculation immunization requirements (PIRs) for colleges and universities would eliminate these two diseases from the list of dangers to college athletes and all students. Education, rather than regulations, should remain the cornerstone in considering the risks to athletes from contagious diseases.

The Storey of college health hygiene. Thomas A. Storey, MD (1875-1943) and the promotion of hygiene.

The word hygiene originally defined a comprehensive plan for preserving individual and community health in all its dimensions. In the latter half of the 19th century, Dr Edward Hitchcock Jr established a system of hygiene at Amherst College that became the model for campus hygiene programs. Dr Thomas A. Storey of Stanford University, an advocate of teaching hygiene to college students, wrote articles and textbooks and was active on national committees that promoted college hygiene programs. Storey was one of the founders of the American Student Health Association, later renamed the American College Health Association, which in its early years chose promotion of hygiene as a major objective. As the 20th century progressed, the profession of health education emerged. With its emergence came the realization that health education, once viewed as primarily a matter of delivering health information to students, required an appreciation of human behavior as well. By 1950, the word hygiene had given way to health in most contexts in recognition of this new paradigm.

Emergency Postcoital Treatment: Practical and Ethical Barriers to Use

Emergency postcoital treatment-the morning-after pill-has been used on college campuses for about 20 years, but it is little used in other populations. Some of the possible reasons for its sparse use, including lack of awareness, the fact that the oral contraceptives have not been approved for this use, the fear of liability, and ethical considerations, are discussed. The authors major focus is on the ethical considerations.

The Hippocratic Oath

pollo the physician, the sun god, drove the chariot of sun. He was the son of Zeus and Leto and the ,brother of Artemis, goddess of the moon. Apollo’s son was Asclepius, who was taught healing by the centaur Chauron; so skilled in medicine was he that he could restore the dead to life. This talent angered Pluto, god of the underworld, who persuaded Zeus to destroy Asclepius with a thunderbolt.’ The staff of Asclepius, always pictured with one serpent, is the symbol of the American Medical Association. The caduceus, the staff of Hermes, has two snakes and is surmounted by two wings; it also is sometimes used as a medical insignia. The daughters of Asclepius were Hygiea and Panaceia, whose names have been immortalized in the English language. By the 5th century BC, when Hippocrates was born on the Isle of Cos off the southwest coast of Asia Minor, the followers of Asclepius had for generations been the sole possessors of the knowledge of healing, using both diet and drugs.? I t seems likely that Hippocrates belonged to the school founded a century earlier by Pythagoras in Crotona, on the Italian peninsula. This philosophical school held that the human soul was immortal, that reincarnation existed, and that the works one did in this life determined his destination in the life to come. To Pythagoreans, medical skill was the greatest wisdom attainable, and medical standards could not be set too high. In addition to the wisdom of his oath, Pythagoras also left medicine many other familiar passages: “Life is short and

Herpetic Lymphangitis in a Student Population

Lymphangitis has traditionally been considered a hallmark of bacterial infection. Two cases of lymphangitis due to herpes simplex are presented. The dermatology literature is briefly reviewed. Herpetic lymphangitis abates spontaneously without the use of antibiotics. Management of dermatologic herpes is also considered.

University Infirmary Admissions for Drug Abuse, 1968–1970 and 1973–1975

University overnight infirmary admissions for drug abuse were reviewed over the 2-year periods 1968--1970 and 1973--1975. Hallucinogen abuse diminished over the years studied while alcohol abuse increased. Marijuana abuse was essentially unchanged. Diazepam overdosage generally replaced barbiturate overdosage, while aspirin remained the most common drug in overdose situations.

Missions and Medicine at Amherst: Family Ties to Edward Hitchcock Jr., the Missionary Movement, and the American University of Beirut.

Abstract The Haystack Movement began at Williams College in 1805, occasioning the spread of American missions throughout the world. A half century later, two graduates of nearby Amherst College, Edward Hitchcock Jr and Daniel Bliss, laid the foundations for college health services in this country and for mission work and education in the Middle East. The influences of these two 19th century Amherst alumni are still felt today in our college health services and at the American University of Beirut.

Comments on "Uncomplicated E coli Urinary Tract Infection in College Women" Keeping Up With Changing Sensitivities

ne of the reviewers for the article by Robert Ansbach, Karen Dybus, and Rachel Bergeson1 made the following comment: “This is a very nice little study which is valuable not because its results are earth-shattering, but because it illustrates a model that can and should be replicated widely among college health services.” I would agree, with a few qualifications. It is interesting that the authors write from the northeastern United States, where, as they note in their article, there is somewhat less resistance to trimethoprim/sulfamethoxazole (TMP/SMX) than is true in the South and West. Here at Stanford, we found a sensitivity to that same drug of 82% (2002), lower than their 86%, so we also fit that pattern. Many of our providers here turned to nitrofurantoin as their first-line drug, especially since it became available in a twice-daily dosing formulation; in my experience, expecting students (or doctors) to take medications more than twice daily is optimistic. However, nitrofurantoin must be taken for 7 days, not just 3.2,3 Also, it is dramatically less effective on our campus for organisms other than E coli: only 45% of our Klebsiella infections were susceptible to nitrofurantoin. We had no Proteus in our sample, but it is equally ineffective there. Thirdly, nitrofurantoin is not an effective drug for pyelonephritis and should not be used if there is any suspicion of that diagnosis.4 The authors of the present study found that 100% of their infections were susceptible to nitrofurantoin, which was used 28% of the time as the initial antibiotic; they do not indicate the length of time for which it was prescribed, and they also do not mention any causative organisms other than E coli. For the moment at Stanford, we are continuing to get cultures contrary to current recommendations.5 We do dipstick screening of the urine at the health service and then send it to the hospital for culture if there is a suggestion of infection on the results or if the patient’s symptoms are convincing (an exception to this practice is after-hours calls— urinary tract infections (UTIs) are 1 of the only diagnoses for which we prescribe antibiotics over the phone without seeing the patient). I am continuing to use TMP/SMX as my drug of choice. It is inexpensive, available generically, and effective as a 3-day medication. Within 48 hours, I know whether it is the right choice (as does the patient!) and can change it accordingly. It is interesting that the authors found that amoxicillin/ clavulanate was effective in 93% of their infections. In a recent article in the Journal of the American Medical Association, researchers compared this drug with ciprofloxacin as an initial choice for uncomplicated UTIs in women and concluded that it was not as effective as ciprofloxacin, even if the cultures showed sensitivity to amoxicillin/clavulanate (81% susceptible or intermediate).6 Only 58% of their patients were cured with a 3-day course of the latter drug. Incidentally, at Stanford’s student health service, we have tried not to use ciprofloxacin as a first-line drug for uncomplicated UTIs. All the above said, I would still agree with the initial reviewer of Ansbach and colleagues’ article1: health clinic personnel need to be aware of the sensitivity patterns for UTIs in their local populations on an ongoing basis.

Immunization Update, 1985

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