Marjeanne Collins

Sexual Activity, Contraceptive Use, and Other Risk Factors for Symptomatic and Asymptomatic Bacteriuria: A Case-Control Study

In a study to determine the risk factors for urinary tract infection in college-aged women, women who presented with acute urinary tract infection to the student health service were compared to women without bacteriuria who presented with complaints of other acute illnesses. Among women who were sexually active, the following multivariate adjusted odds ratios (95% confidence intervals) were found; intercourse in the previous 48 hours, 58.1 (11.9 to 284.1); intercourse only in the previous 3 to 7 days, 9.1 (1.9 to 44.1); diaphragm use in the previous 48 hours, 8.4 (3.4 to 21.1); urination after intercourse, 0.5 (0.3 to 0.9); and past history of urinary tract infection, 2.7 (1.5 to 5.0). Several other factors previously postulated to be related to urinary tract infection were found not to be associated, including oral contraceptive use, tampon use, and direction of wiping after a bowel movement. When the women with symptomatic bacteriuria were compared to women with asymptomatic bacteriuria, the results were similar, except diaphragm use and urination after intercourse were no longer associated with urinary tract infection. When the women with asymptomatic bacteriuria were compared to women without symptoms and without bacteriuria, diaphragm use remained the only statistically significant risk factor. These findings should be taken into account in attempts to prevent urinary tract infection, as well as in subsequent studies of this disease.

Screening for problem drinking in college freshmen.

Abstract Several brief questionnaires have been developed for use in screening for alcoholism. College students manifest a different spectrum of drinking behaviors from adult alcoholics, and these questionnaires have not been validated for use in this group. This study examines the ability of the CAGE, Brief MAST, and Trauma Score to identify problem drinkers among college students. Problem drinkers were identified as individuals who both drank more heavily than 75% of their peers and had experienced a negative social or physical consequence as a result of their drinking. They were compared with a group of drinkers with neither characteristic. The CAGE was best able to separate these groups, with a sensitivity of 57% and a specificity of 85%. The Trauma Score and Brief MAST had optimal sensitivities of 45% and 34% and specificities of 79% and 46%, respectively. When used as a screening test for problem drinking in a population similar to ours, the CAGE will fail to identify 43% of problem drinkers due to ...

Potentially life-threatening hypophosphatemia in anorexia nervosa

An anorexia nervosa patient with hypophosphatemia secondary to starvation and laxative abuse is reported. During the course of refeeding by tube with a high caloric balanced formula, the patients serum phosphorous dropped from low normal on admission (2.7 mg/dl) to 0.4 mg/dl aggravated by an overdose of laxative she had stolen from the medicine cart. This required ICU monitoring during intravenous phosphorous administration. This case points out the potential hazard of oral realimentation in a severely cachectic anorectic.

Role of Steroids in the Treatment of Infectious Mononucleosis in the Ambulatory College Student

Abstract A double-blind, placebo-controlled study was performed to compare the effect of steroid treatment with placebo on the resolution of clinical symptoms and physical findings in infectious mononucleosis (IM). Forty-seven college students, aged 18–28 years, were entered into the study, of whom 26 were assigned to the steroid group and 21 to the placebo group. A positive mono-spot test and a clinical mononucleosis syndrome were required for entry into the study. Patients were evaluated at days 0, 7, and 28 for symptoms, physical findings, and performance on the Beck Depression inventory. The symptoms which were analyzed included fatigue, anorexia, difficulty swallowing, excessive pharyngeal secretions, inability to concentrate, decreased social activity, and loss of time from class due to illness. Physical findings which were analyzed included tonsillar erythema, edema and exudate, cervical and submandibular adenopathy, and enlarged liver or spleen. No significant difference was found between the ster...

Incidence of Beta Hemolytic Streptococcal Pharyngitis in Adolescent with Infectious Mononucleosis

Reports on the incidence of beta-hemolytic group A streptococci (BHGAS) in the pharynx of patients with infectious mononucleosis (IM) have varied from 3% to 33%. To ascertain the rate of infection, we prospectively performed serial throat cultures and determined anti-streptococcal antibody titers on 45 students with confirmed IM by Epstein-Barr virus-specific serology. One hundred healthy control students had throat cultures for comparison. The rate of recovery of BHGAS was similar in patients with IM (4%) and controls (3%). No students with IM had a fourfold rise of anti-streptococcal antibodies. We conclude that routine culture for BHGAS and/or treatment with antibiotic agents is not indicated in all patients with IM.

Interdisciplinary model for the inpatient treatment of adolescents with anorexia nervosa.

This paper describes the inpatient phase of an anorexia nervosa treatment program in an adolescent unit of a childrens hospital. This program focuses on four goals: improving eating behavior, improving socialization, achieving initial weight gain, and engaging the patient and her family with an outpatient psychotherapist. The patients were divided into three groups according to severity. All five Group I patients (less than 25% body weight loss) had a composite 100% achievement of the four goals. Twenty out of 21 Group II patients (greater than 25% body weight loss) had 100% achievement of the four goals. Three out of six Group III patients (greater than 25% body weight loss and requiring hyperalimentation) had 100% achievement of the four goals. The success of this inpatient program is felt to be due to the pediatric-psychiatric collaboration, the involvement of the family during the inpatient phase, the therapeutic use of an interdisciplinary team and of the social system of the inpatient unit including other patients and recreation therapist.

Humoral immune response in infectious mononucleosis: Late emergence of anti-EA(R) and the effects of corticosteroid therapy

The antibody response to Epstein-Barr virus (EBV) antigens in patients with infectious mononucleosis (IM) was studied to assess antibody appearance to the restricted (R) component of the early antigen (EA) complex and to determine the effect of corticosteroids on all aspects of the humoral immune response. Sixty college students with heterophil-positive clinical IM, confirmed by EBV-specific serology, were followed for a period of 4-26 weeks, Half received prednisone for six days, and the remainder received no corticosteroid therapy. Regardless of therapy, 48% of the patients developed anti-EA(R) antibodies. The response to other antigens was similar in both groups with the exception that antibodies to the EB-associated nuclear antigen (EBNA) developed later during convalescence and at lower titers in the corticosteroid-treated group. We conclude that 1) anti-EA(R) antibodies develop with considerable frequency following IM and are not a marker, as previously proposed, of unusually severe disease, and 2) corticosteroid therapy may retard the formation of anti-EBNA antibodies but it does not otherwise influence the humoral immune response to EBV.

Preenrollment Immunization Policies of American Colleges: An Assessment of the Need for Policy Implementation

Abstract The purpose of this study was to determine: (1) the preadmission immunization policies of American colleges and universities; (2) the disease occurrence on campuses for 1979–1981; and (3) the validity of self-report of immune status. Ninety-three institutions completed a questionnaire distributed at the 1981 American College Health Association meeting. Sixty-two percent of the respondents stated that they require a preadmission immunization record. Of those who require a record, 86% require it for tetanus, 72% require it for diphtheria, and 70% for polio. Only 40% require it for measles and 56% for rubella. Reports of disease incidence at the same colleges and universities, however, revealed that there were no cases of tetanus and only one case of diphtheria in the preceding two years. In contrast, the diseases reported with greater frequency on those campuses during this time were measles and rubella. Serologic titers in a group of 46 medical and nursing students indicated that 59% were immune t...

Screening and chemoprophylaxis for tuberculosis infection in college populations.

Active tuberculosis and the potential for widespread disease exist on college campuses. To maximize the benefit and minimize the potential harm of a screening program, health service clinicians should administer tuberculin skin tests to high-risk students only. Those found to be infected should be considered for prophylactic treatment. The criteria that identify students as being at high risk need to be clearly appreciated, especially the issue of birth outside the United States. Certain countries of origin pose a high risk; others do not. By understanding the fundamentals of the current pandemic and employing a consistent approach, college health professionals can make the correct screening decisions, thereby reducing the risk to their campus communities and assisting in the eradication of this preventable disease.