The Development and Implementation of a Nursing Clinic on a College Campus

Abstract

“Usefulness of Screening Chest Roentgenograms in Preoperative Patients,” Lloyd Rucker, Elizabeth B. Frye, Myrlene A. Staten. We proposed that clinical criteria could define a group of patients very unlikely to have abnormal preoperative chest roentgenograms. Nine hundred five surgical admissions were screened for the presence of clinical factors we thought would make those patients more likely to have abnormal preoperative chest roentgenograms. Of these, 368 had no risk factors. One patient (0.3%) of the 368 had an abnormal x-ray film, which did not affect the surgery. No material abnormalities were found in the remainder of the group without risk factors. Five hundred four patients had identifiable risk factors. Of these, 114 (22%) were found to have serious abnormalities on preoperative chest roentgenograms. (Journal of the American Medical Association 1983;250:3209–3211)

“Effect of Treatment Regimens for Neisseria Gonorrhoeae on Simultaneous Infection With Chlamydia Trachomatis,” Walter E. Stamm, et al. We evaluated the effect of treatment for gonorrhea on simultaneous Chlamydia trachomatis infection by randomly assigning 293 heterosexual men and 246 heterosexual women with gonorrhea to receive one of the following treatment regimens: (1) 4.8 million units of aqueous procaine penicillin plus 1 g of probenecid, (2) nine tablets of trimethoprim-sulfamethoxazole daily for three days, or (3) 500 mg of tetracycline four times a day for five days. Among the men, gonococcal infection was cured in 99 per cent given penicillin plus probenecid, 96 per cent given trimethoprim-sulfamethoxazole, and 98 per cent given tetracycline. Among the women, only 90 per cent given tetracycline were cured, in contrast to 97 per cent given penicillin plus probenecid and 99 per cent given trimethoprim-sulfamethoxazole.     

Antimicrobial Resistance of Urinary Tract Isolates in Acute Uncomplicated Cystitis Among College-Aged Women: Choosing a First-Line Therapy

Objective and Participants The authors of this retrospective case study focused on antimicrobial susceptibility of urinary tract isolates in cases of acute uncomplicated cystitis in college-aged women, aged 18 to 24 years, diagnosed at a major south-central university student health center. Methods The authors obtained pertinent data from patient medical and laboratory records, including, diagnoses, urine culture, and susceptibility results. Results Of 179 isolates, 161 (90%) were Escherichia coli (E. Coli) isolates, of which 23% were resistant to trimethoprimsulfamethoxazole, < 1% were resistant to Ciprofloxacin, and < 1% were resistant to nitrofurantoin. Sixty-eight (42%) E. Coli isolates were multidrug resistant. There were 18 isolates cultured in the study group that were significant organisms other than E. coli. For all organisms in the study group, there was a combined resistance rate of 22% to trimethoprim-sulfamethoxazole, < 1.0% for Ciprofloxacin, and 7% for nitrofurantoin. Conclusions The findings suggest that both Ciprofloxacin and Nitrofurantoin are acceptable choices for empiric therapy of acute uncomplicated urinary tract infection in this study population, keeping in mind the potential for rising resistance rates to Ciprofloxacin in the community setting.     

Antibiotic resistance in urinary tract infections in college students

Abstract Objective: To determine resistance to antibiotics of Escherichia coli in uncomplicated urinary tract infections (uUTIs) in female college students. Participants: Symptomatic patients presenting to a student health service from September 2008 to December 2009. Methods: Clean catch midstream urine samples were tested for urinalysis (UA) and culture and sensitivity. Results: Of 168 students enrolled in the study, 138 had positive UA, and 94 of these grew >100,000 colonies/mL of E. coli. Ampicillin resistance was 31.9%, trimethoprim-sulfamethoxazole (TMP-SMX) resistance 16.0%, ciprofloxacin resistance 4.3%, amoxicillin/clavulanate resistance 3.2%, and nitrofurantoin resistance 1.1%. The sensitivity of UA was 95.4% and the positive predictive value was 87.0% (p ≤ .001). Specificity was 77.5% and negative predictive value 92.9%. Conclusions: In healthy college women with uUTI symptoms, TMP-SMX should not be universally used for empirical therapy, whereas use of ciprofloxacin, amoxicillin/clavulanate, and nitrofurantoin are appropriate.     

Antimicrobial resistance of urinary tract isolates in acute uncomplicated cystitis among college-aged women: choosing a first-line therapy

OBJECTIVE AND PARTICIPANTS: The authors of this retrospective case study focused on antimicrobial susceptibility of urinary tract isolates in cases of acute uncomplicated cystitis in college-aged women, aged 18 to 24 years, diagnosed at a major south-central university student health center. METHODS: The authors obtained pertinent data from patient medical and laboratory records, including, diagnoses, urine culture, and susceptibility results. RESULTS: Of 179 isolates, 161 (90%) were Escherichia coli (E. Coli) isolates, of which 23% were resistant to trimethoprimsulfamethoxazole, <1% were resistant to Ciprofloxacin, and <1% were resistant to nitrofurantoin. Sixty-eight (42%) E. Coli isolates were multidrug resistant. There were 18 isolates cultured in the study group that were significant organisms other than E. coli. For all organisms in the study group, there was a combined resistance rate of 22% to trimethoprim-sulfamethoxazole, <1.0% for Ciprofloxacin, and 7% for nitrofurantoin. CONCLUSIONS: The findings suggest that both Ciprofloxacin and Nitrofurantoin are acceptable choices for empiric therapy of acute uncomplicated urinary tract infection in this study population, keeping in mind the potential for rising resistance rates to Ciprofloxacin in the community setting.     

Antibiotic Resistance in Urinary Tract Infections in College Students

Abstract

Objective: To determine resistance to antibiotics of Escherichia coli in uncomplicated urinary tract infections (uUTIs) in female college students. Participants: Symptomatic patients presenting to a student health service from September 2008 to December 2009. Methods: Clean catch midstream urine samples were tested for urinalysis (UA) and culture and sensitivity. Results: Of 168 students enrolled in the study, 138 had positive UA, and 94 of these grew >100,000 colonies/mL of E. coli. Ampicillin resistance was 31.9%, trimethoprim-sulfamethoxazole (TMP-SMX) resistance 16.0%, ciprofloxacin resistance 4.3%, amoxicillin/clavulanate resistance 3.2%, and nitrofurantoin resistance 1.1%. The sensitivity of UA was 95.4% and the positive predictive value was 87.0% (p ≤ .001). Specificity was 77.5% and negative predictive value 92.9%. Conclusions: In healthy college women with uUTI symptoms, TMP-SMX should not be universally used for empirical therapy, whereas use of ciprofloxacin, amoxicillin/clavulanate, and nitrofurantoin are appropriate.     

Combined physical and psychosexual therapy for provoked vestibulodynia-an evaluation of a multidisciplinary treatment model

Our objective is to standardize and evaluate a combined physical and psychosexual therapy for women with provoked vestibulodynia. Twenty-four patients underwent the treatment program. Sessions with a psychosexual counselor included issues on sexual functioning, psychological adjustments, and stress elimination. Exercises for mucosal desensitization and reestablishment of pelvic floor function were supervised by a midwife. A questionnaire was used for evaluation at a minimum of 6 months after the treatment. The mean number of appointments to the counselor was 12 (4-24) and 15 (9-26) to the midwife during a mean period of 53 weeks (19-92). Nineteen women (79%) considered themselves to be cured or having greatly improved. Intercourse frequency was increased (p = 0.001) and coital pain was reduced (p = 0.02) after completing the treatment. Improvements in sexual functioning and coping strategies for psychological impairment and stress were reported. Women with provoked vestibulodynia benefit from a multidisciplinary treatment model including desensitization of the vestibular mucosa, rehabilitation of the pelvic floor, and psychosexual adjustments.     

The Infirmary as a Short-Term Psychiatric Facility

Abstract

The purpose of this study was to describe the role of the Oregon State University Infirmary (inpatient unit) in the provision of crisis intervention services for students with emotional problems. The focus was on the working assumptions of the infirmary program, the patient population which utilized the infirmary, the dimensions of treatment, and treatment outcomes.

Data were collected for a three year span on all patients who had contact with the infirmary for problems of an emotional nature. Records were reviewed for demographic variables, presenting symptomatology, diagnosis, treatment, disposition, and outcomes. Comparisons were made between these patients and those who received outpatient services through the Oregon State University Mental Health Clinic.

Demographic data indicated that patients who were treated in the infirmary differed only slightly from either the general student population of the university or from students receiving outpatient services. Presenting symptoms reflected a wide range of emotional problems. The severity of psychopathology was demonstrated by the finding that one-quarter of the patients manifested symptoms of acute psychosis, suicidal preoccupation, acute drug reaction, or toxic alcohol reaction. Consistent with the working assumptions of the program, the focus of treatment was short-term, intensive, and symptom directed. Treatment outcomes as determined by followup data were generally positive.

It was concluded that the infirmary provided an important treatment option which extended rather than duplicated outpatient services. The need for such an option was clearly demonstrated. The study was supportive of the concept that a university infirmary has the potential for utilization as a multipurpose facility.     

Vaginal Douching Among University Women in the Southeastern United States

Objective: The authors assessed the knowledge, beliefs about, and practices of vaginal douching among women attending 2 universities in the southeastern United States. Participants: There were 416 participants in this study; 46.9% were black and 44.5% were white. Methods: The authors administered a 30-item questionnaire to women enrolled in health-related and social science courses at 2 southeastern universities. Results: Approximately 38% of participants reported vaginal douching, mostly for hygienic reasons (70.7%). Most women first learned about douching from their mother. Douching was more common and more frequent among black women (48%) than among white women (27%). Age of first douche correlated positively with age of first sexual intercourse and age of first period. Conclusion: Women who had been informed not to douche by a healthcare professional were less likely to have douched within the past 6 months than were women who were not given this information. Misconceptions about douching are common and should be addressed by healthcare professionals.     

Effect of a Web-Based Sexual Health Enhancement Program for Women with Gynecologic Cancer and Their Husbands

Objectives: This study examined the effects of a web-based sexual health enhancement program on of women with gynecologic cancer and their husbands. Methods: Twenty-one couples attended the program for 4 weeks and 22 couples were assigned to a control group. Results: The experimental group reported significant improvements in the sexual function of the women with gynecologic cancer (effect size [ES] = .75; p?p?=?.015). Conclusions: Therefore, our results can help provide interventions for patients and their husbands to identify and resolve sexual problems after gynecologic cancer treatment.     

Randomized controlled trial of the Marriage Checkup: Stress outcomes

Several couple interventions targeting relationship distress also show beneficial effects on individual mental health. Yet, strikingly few studies report effects on perceived stress. This study examined the effects of a brief couple intervention, the Marriage Checkup (MC), on perceived stress. We randomly assigned 231 couples to receive two MCs (Weeks 7 and 51) or to a waitlist control. Survey data were collected at seven time points over 2 years and analyzed using multilevel models. We found no significant between-group treatment effects on average stress at any time point. However, women, but not men, in the intervention group experienced decreased stress after the second MC (d = −0.23) and more women in the intervention group (26.5%) compared with the control group (14.9%) experienced reliable improvements in stress after the second MC. Overall, the MC did not result in main effects on stress but caused temporary reliable change in terms of stress relief for women.     

Needs and Perceptions of LGBTQ Caregivers: The Challenges of Services and Support

Increasing attention has been paid to the lack of services and support afforded older lesbian, gay, bisexual, transgender, and queer (LGBTQ) women in same-sex relationships, including caregivers. This study was designed to investigate the needs and perceptions of LGBTQ women from ages 35 to 91, including informal caregivers and older adults regarding services and support from health care providers. Questionnaires were completed by older LGBTQ women (N = 76), and follow-up interviews were conducted with 25% of caregiver respondents. The majority of subjects indicated a fear of future challenges and discrimination. Four main themes emerged when analyzing the open-ended responses: the need for health care workers who were both supportive and knowledgeable about LGBTQ issues; better and consistent recognition of same-sex partners and their rights to make decisions as primary caregivers; increased sensitivity training regarding the needs of LGBTQ patients and caregivers; and more open and accepting environments where LGBTQ patients and caregivers could feel comfortable discussing issues with the staff.     

THE EFFECT OF ABORTION LEGALIZATION ON CHILDBEARING BY UNWED TEENAGERS IN FUTURE COHORTS

This article examines the long‐term impact of legalized abortion on childbearing by unwed teenagers in the United States. I find that the 1970 legalization of abortion in the repeal states led to about a 6% reduction in unwed childbearing rates for white women aged 15–20 who were born in these states immediately after abortion became legal. I find a larger long‐term impact for African‐American women of the same ages: a 7.5%–13% reduction in unwed childbearing. My estimates are smaller and not as precise for the effect of Roe v. Wade. This outcome is not surprising given that I am able to estimate only a potential lower bound of the effect on unwed childbearing rates. On the other hand, when I estimated a Difference‐in‐Difference regression for the non‐repeal states assuming that there was no national trend that affected the childbearing behavior of the treatment age groups and their respective control age groups separately, I found that the true effect of Roe v. Wade on childbearing by unwed teenagers was about an 11% and 3% reductions for white and African‐American teenagers, respectively. (JEL J13, I18)     

Togetherness—The Health Care Team

Abstract

In order to evaluate the progress of a health service, certain criteria (indices) should be established and monitored. If any health center wishes to compare its situation with others, a valid instrument for measuring morbidity is required, and the criteria must be in conformity with national and/or international standards. This paper details methods of producing health indices from medical diagnoses. It is based on experience in a health service for students. Three systems are offered to cover centers with and without computer facilities: 1) a minimum for student health services; 2) the “minima” requested by the World Health Organization; 3) a classification of conditions of special interest in student health. It is strongly recommended that the International Classification of Diseases (ICD-9) of the World Health Organization be accepted as the local and international basis for these diagnostic categories.

“Epidemic Non-A, Non-B Hepatitis in Nepal: Recovery of a Possible Etiologic Agent and Transmission Studies in Marmosets,” MARK A. KANE, et al. An epidemic of non-A, non-B hepatitis occurred in Kathmandu Valley, Nepal, during 1981–1982, with approximately 7.6% of households and 1.4% of individuals affected. Cases occurred preponderantly in the 15- to 34-year-old age group (70%), with most cases (75%) occurring in males. A high mortality rate (21%) occurred in pregnant women admitted to the hospital. No single water source was implicated, but epidemic peaks occurred during monsoon rains, and multiple opportunities for enteric transmission existed. One of eight patient stools examined by immune electron microscopy revealed aggregated, antibody-coated, 27-nm viruslike particles when convalescent serum samples were used as sources of antibody. Inoculation of two chimpanzees and four marmosets with a suspension of this stool resulted in elevated liver enzyme activity in three marmosets. Fecal excretion of 27-nm particles during the acute phase of disease (with temporally coincident antigen activity by radioimmunoassay) was observed in one marmoset, which also developed convalescent antibody against the particles in the original inoculum. (Journal of the American Medical Association 1984;252:3140–3145.)

“High-dose Vitamin C Versus Placebo in the Treatment of Patients with Advanced Cancer who Have Had No Prior Chemotherapy; A Randomized Double-Blind Comparison,” CHARLES G. MOERTEL, et al. It has been claimed that high-dose vitamin C is beneficial in the treatment of patients with advanced cancer, especially patients who have had no prior chemotherapy. In a double-blind study 100 patients with advanced colorectal cancer were randomly assigned to treatment with either high-dose vitamin C (10 g daily) or placebo. Overall, these patients were in very good general condition, with minimal symptoms. None had received any previous treatment with cytotoxic drugs. Vitamin C therapy showed no advantage over placebo therapy with regard to either the interval between the beginning of treatment and disease progression or patient survival. Among patients with measurable disease, none had objective improvement. On the basis of this and our previous randomized study, it can be concluded that high-dose vitamin C therapy is not effective against advanced malignant disease regardless of whether the patient has had any prior chemotherapy. (New England Journal of Medicine 1985;312:137–41.)     

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

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 treated with acyclovir twice daily (P < 0.001 for both groups compared with placebo). While receiving therapy, 86 of 96 acyclovir-treated patients had over a 50 per cent reduction in their pretreatment recurrence rate. Breakthrough recurrences in acyclovir recipients were of shorter duration and associated with a lower frequency of viral shedding than recurrences in placebo recipients. After medication was discontinued, the subsequent recurrence rate returned to pretreatment frequencies. Daily oral acyclovir was well tolerated. We conclude that oral acyclovir given for four months markedly reduces but does not completely prevent recurrences of genital herpes and does not influence the long-term natural history of the disease. (New England Journal of Medicine 1984 July;310:1551–6.)     

Change in cytokine levels after administration of saikokaryuukotsuboreito or testosterone in patients with symptoms of late-onset hypogonadism

The purpose of this study was to evaluate plasma cytokine levels after treatment with saikokaryukotsuboreito (SKRBT), which is a herbal medicine, or androgen replacement treatment (ART), for patients with late-onset hypogonadism (LOH)-related symptoms. Thirty-one patients over 40 years of age with LOH-related symptoms were included in this study. SKRBT was given orally three times daily to a total of 7.5 g/day for 15 eugonadal patients and ART was give to 16 hypogonadal patients by intramuscular injection of testosterone enanthate at 125?mg each time every 2 weeks. Plasma levels of testosterone and 18 cytokines, as well as LOH-related symptoms scored according to the Aging Males' Symptoms (AMS) scale, were compared before and more than 2 months after treatment. In the ART group, the total AMS score was decreased and testosterone was increased significantly after treatment. No cytokine variables were altered significantly after the treatment. In the SKRBT group, although the total AMS score was significantly decreased, testosterone did not change. From the evaluation of cytokines, a significant increase was found in interleukin (IL)- 8, IL-13, interferon-γ and tumour necrosis factor-α. We conclude that SKRBT might improve LOH-related symptoms in eugonadal patients through the beneficial effect of cytokines, a mechanism that is quite different from ART.     

Healthy Dating: A Mixed-Gender Date Rape Workshop

Abstract

College communities are increasingly being called upon to institute date rape prevention programs. This article describes a mixed-gender workshop sponsored by a university's Program for Rape Education and Prevention that was given to more than 1,400 undergraduate students in more than 80 presentations. In order to guide modifications of the workshop, formative evaluation data collected from 330 male (mean age 20.3 years) and 314 female (mean age 20.5 years) university students were collected. Results were largely positive. Despite the sensitive nature of the topic, only 10.2% of the men and 8.2% of the women reported being uncomfortable discussing date rape in mixed-gender groups. Furthermore, students were virtually unanimous in their agreement that date rape is a topic worthy of a workshop.     

Ethnicity and Health Service Use in a Women's Prison

ABSTRACT

This paper highlights the findings in relation to health need, ethnicity, and health service use among a sample of women in prison. Medical records review for 129 women and interviews with 15 women were conducted to determine factors associated with differential service use. Statistical analyses reveal that ethnicity and an interaction between ethnicity and whether one is on medication at prison admission (a health need variable) significantly predict extent of service use. Women of color use fewer services overall, with the exception of those on medication. Qualitative analyses reveal that women of color view the quality of medical care and the ways they are treated less positively than White women. Implications for equitable service provision are explored.