Book Review

Abstract

Uprooting and Health: Psycho-social Problems of Students from Abroad: Uprooting and Health: Psycho-social Problems of Students from Abroad, Charles A. A. Zwingmann and Alexander D. G. Gunn. Geneva, World Health Organization, 1983, 89pp.

“The Relationship of Dietary Calcium to the Maintenance of Skeletal Integrity in Man–-An Interface of Endocrinology and Nutrition,” Robert Marcus. Calcium restriction reliably produces osteoporosis in animals, but the impact of dietary calcium on age-related bone loss in man is controversial. The opinion that calcium intake is not clearly related to bone mass or to osteoporosis is well-entrenched in the nutrition literature, and has been influential in setting recommended intakes for the American public. This position rests on the poor correlation between habitual calcium intake and the incidence of osteoporosis in some non-Western countries, and on demonstrations that young men can achieve calcium balance on low intakes. However, such data neglect a variety of factors which determine calcium nutriture. These include the efficiency of mineral utilization, gonadal status, and the effect of dietary protein. It has recently been demonstrated that calcium requirements increase during adult life in women. This increase is attributable in large measure, but not completely, to estrogen deprivation associated with the menopause. In addition, the American diet is abundant in protein, a situation which may be deleterious to bone. Based on the evidence currently available, it is reasonable to propose that adolescent and young women consume one gram of calcium daily, and that this intake be increased to 1500 mg at the time of menopause. (Metabolism 1982 January;31(1):93)

“Campylobacter Enteritis: Early Diagnosis with Gram's Stain,” David D. Ho, Mark J. Ault, Mary A. Ault, Glen H. Murata. Campylobacter jejuni has become one of the most important causes of infectious diarrhea in the United States. We examined the utility of Gram's stain of stool for the rapid presumptive diagnosis of Campylobacter enteritis in a large, urban hospital and found that this test has a sensitivity of 43.5% and a specificity of 99.4%. We believe that Gram's stain of stool could be used to direct the early management of up to one half of patients infected with this pathogen. (Archives of Internal Medicine 1982;142:1858–1860)     

The Association Between Mental Health and Acute Infectious Illness Among a National Sample of 18- to 24-Year-Old College Students

Poor mental health is associated with physical illness, but this association is poorly characterized among college students. Objective and Participants: Using American College Health Association-National College Health Assessment data, the authors characterized poor mental health (depression, anxiety, negative affect) and examined the relationship between poor mental health and acute infectious illnesses (bronchitis, ear infection, sinusitis, strep throat) among 47,202 US college students. Methods: The authors used frequency and cross-tabulation analyses to characterize mental health and determine univariate associations among variables. They used binary logistic regression to determine the association between poor mental health and acute infectious illness, controlling for research-derived covariates. Results: The prevalence of acute infectious illness ranged from 8% to 29%. The prevalence of anxiety and depression ranged from 12% to 20%, respectively. Depression, anxiety, and exhaustion were associated with acute infectious illness across all dependent measures, with odds ratios ranging from .56 to .91. Conclusions: Poor mental health is associated with acute infectious illness among college students.     

Some obstacles to the effective investigation and registration of children at risk—issues gleaned from a worker's perspective

Abstract

This paper describes a woman who is both damaged and damaging. The mental disorder/disturbance felt by this woman generates levels of anxiety that she cannot contain, and this anxiety is passed onto the others who constitute her community. For community care to work it must be possible within the community system to identify, think about and manage the anxieties generated by such mental disturbance. The new legislation of community care may encourage us to ignore the reality of mental illness and issues of power, conflict and pain, and their underlying anxieties. Current examples are given of the acute anxieties felt by many workers in the field which, if uncontained, lead to defensive anti-task strategies. When disturbance is projected and disowned it is put out of mind and may then be passed between parts of the system. Even though it may no longer be possible, except as a short term measure, to put the mentally ill out of sight in mental hospitals, the mental disturbance and those in whom it is located may still be marginalised. The paper proposes a model of community care which encompasses mental illness, professional workers and the community. These three elements are seen as the corners of a triangular space which theoretically becomes the container of mentally disturbing anxieties and within which these anxieties can be addressed, thought about and managed

It is argued that this model could enable workers to foresee some difficulties and to address others in a manner that would lead to greater containment and more effective management of mental illness in the community     

Illness uncertainty and illness intrusiveness as predictors of depressive and anxious symptomology in college students with chronic illnesses

Objective: To examine predictors of psychological functioning in college students with chronic illnesses. Participants: Participants (N = 1413) included 364 students with self-reported diagnoses of asthma or allergies, 148 students with other chronic illnesses (eg, epilepsy, type 1 diabetes), and 901 healthy students. Data were collected between November 2013 and May 2015. Methods: Participants completed online measures of psychosocial functioning, including illness uncertainty, illness intrusiveness, depression, and anxiety. Results: Students with chronic illnesses other than asthma or allergies evidenced the greatest levels of anxious (p <. 05), but not depressive symptomology. Additionally, this group reported greater illness uncertainty and intrusiveness (p <. 05) compared to their peers. Uncertainty and intrusiveness independently predicted depressive and anxious symptoms for students in both illness groups. Conclusions: Compared to peers with asthma or allergies, college students with other chronic illnesses reported higher levels of anxious symptoms. Illness uncertainty and intrusiveness appear to be predictors of psychological distress, regardless of illness.     

Mental illness as metaphor in Hua-ling Nieh and Li-hua Yu's Chinese-language American novels

Abstract

This article focuses on two fictional immigrant characters who appear in the Chinese-language American novels Sang Ching Yu Tau Hong (Mulberry and Peach) by Hua-ling Nieh and You Jian Zong Lu, You Jian Zong Lu (Palm Trees Again, Palm Trees Again) by Li-hua Yu respectively. Both protagonists suffer from identity crises that lead to mental disorders. These disorders, resulting partly from their immigrant experience, should be read as a metaphor for the damage that can be caused by discrimination and cultural dislocation, not as a statement that immigrants are somehow inherently unbalanced. A character's slip into mental illness may occur because of the character's mistreatment and subsequent inability to adjust, but the character's mental illness may also be seen as an active resistance to assimilation and as a reaffirmation of the character's 'Chineseness'.     

Prevalence of Sufficient Physical Activity Among Parents Attending a University

Objective: The benefits of regular physical activity are well documented. However, approximately half of all university students are insufficiently active, and no research to date exists on the activity behavior of university students who are also parents. Participants and Methods: Using an adapted version of the Godin Leisure Time Exercise Questionnaire (ie, the Physical Activity Prevalence Questionnaire), the authors examined the prevalence of sufficient physical activity among 245 parent students from 6 faculties and 12 programs. Results: Half (49.5%) of the students who were not parents (n = 90) were sufficiently physically active, compared with 16% of students who were parents (n = 3, p < .002). The authors found that 33.3% of parents and 13% of nonparents limited their activity level as a result of illness or injury (p < .05). Conclusions: Most parent students in this study were insufficiently active and at potential risk for the negative health consequences of inactivity. This is a grossly understudied population, and researchers must conduct further studies to understand what can be done to facilitate physical activity among this potentially vulnerable group of students.     

Importance of Macro Social Structures and Personality Hardiness to the Stress-Illness Relationship in Low-Income Women

Abstract

Individuals confronted with poverty are at increased risk for disease and death due, in part, to the influence of macro social structures on differential exposure and heightened responsiveness to stress (Williams, 1990). For this reason, the influence of personality hardiness in moderating the stress-illness relationship in a biracial sample (African-American and European-American) of low-income women was examined. The effect of differential perceptions of the community on illness also was studied. Participants (100) completed rating scales, including Social Readjustment, Dispositional Resilience, Community Stress, and Seriousness of Illness. Hierarchical regression indicated that hardiness moderated the stress-illness relationship (p < .01), with high stress, low hardy women having higher levels of illness. In addition, race moderated the effect of stress, with high stress, Caucasian women having higher levels of illness. Group mean differences on community stress scores for low and high hardy women were obtained (p < .0001), but community stress was not associated with illness. Stress is linked to illness in low-income women; furthermore, both personality hardiness and being African-American buffer the effect of stress.     

Epidemic Mycoplasma Pneumoniae Infection at a College for the Deaf

Abstract

An outbreak of Mycoplasma pneumoniae infection affected up to 110 students and employees at a college for deaf students (Gallaudet). After the introduction of M. pneumoniae onto the campus in late August 1977, the disease spread slowly among the students; the last documented case occurred in mid-December. A thorough review of chart records, mail surveys, a dormitory survey, and a three-month surveillance of the student health service provided an intensive look at the epidemiology and clinical spectrum of a mild to moderately severe disease in the epidemic setting. A matched-pair analysis demonstrated a more serious clinical illness among patients with M. pneumoniae than other patients presenting with febrile respiratory illness. Appropriate antimicrobial therapy appeared to suppress a high antibody response to M. pnuemoniae. A follow-up serosurvey one year after this outbreak demonstrated diagnostic titers to M. pneumoniae in 11 of 30 patients with confirmed infection in the original epidemic.     

A response to 'factitious disorders by proxy: A trap for the unwary' Parent induced illness,factitious illness by proxy (Munchausen by proxy)

Abstract

Introduction This form of child abuse is quite rare but perhaps not as unusual as the figures imply. The name itself and the recent changes confirm that there is increasing awareness of its significance; Munchausen Syndrome by proxy has been changed to factitious illness by proxy or parent induced illness. Roy Meadow (1977, 1982, 1990), first drew attention to this form of abuse where parents present their child with an organic illness. Bools et al (1994) has developed the work and there has been a recent important article from Gray and Bentovim (1996), based on work at Great Ormond Street Hospital. The complexity and diversity of these cases and the range of presentations seem to be part of the problem in recognition. An outline of the emergence of awareness of this form of child abuse and a review of the literature is well covered in the article 'Factitious disorders by proxy' (Randall & Parker, 1997). While drawing this difficult and complex form of abuse to the attention of professionals, what we would suggest is also needed is both an outline of the various forms of presentations and some thoughts about the processes that are present both within the professional system, intrafamilially, and intraphysically.     

Actual Versus Perceived Risk of Cervical Cancer Among College Women Smokers

Cervical cancer is a well-established smoking-related illness, but many at-risk women are unaware of this link. Objective: The authors designed this study to (1) investigate the relationship of smoking behavior with the history of abnormal Pap test results, sexual history, and perceived risk of cervical cancer and (2) determine whether self-classified smoking status (and hence perceived risk) corresponds with actual smoking behavior in a college student population. Participants and Method Summary: College women students (N = 135) completed a survey assessing smoking history, health history, sexual risk behavior, and risk awareness. Results: Relative to those who had not smoked in the past month, current smokers (n = 36, or 27% of the total sample) perceived themselves to be at higher risk for developing cervical cancer, but did not demonstrate increased awareness of specific cervical cancer risk factors, including smoking. Twenty-eight percent (10 of 36) of past-month smokers did not define themselves as current smokers. Conclusion: The authors conclude that antismoking and health-related messages targeting smokers may misfire for individuals who do not define themselves as smokers but are nonetheless at risk for smoking-related consequences and escalating use.     

Index for Volume 32

Abstract

College students with insulin-dependent diabetes mellitus often ignore the care of their illness. Faced with managing this illness independently for the first time, they lack the knowledge and experience to do so effectively. Their need to establish autonomy often prevents them from seeking the advice of health professionals. In view of this, the author undertook a pilot study to investigate the role of a peer support group on a college campus as a means of improving the diabetic students' management of their illness.

Three closed-membership groups met for 10 weekly sessions. Hemoglobin A_1c (the measure of average blood sugar over the preceding 3-month interval) determinations prior to participation in the group ranged from 4.0 to 11.7, with a mean of 8.16; after participation in the group, the mean hemoglobin A_1c levels of group members dropped to 6.10 (p < .001). (Hemoglobin A_1c measures lower than 6.2 reflect physiologic blood sugar measures of someone without diabetes.)

These results suggest that the peer-group approach may be a viable way to improve the metabolic control of young adults with diabetes at the time in their lives when they are learning to manage their illness independently.     

A Comparative Study of Campus Experiences of College Students With Mental Illnesses Versus a General College Sample

Abstract

Objective: Examine campus experiences and relationships of college students with mental illnesses compared to general student norms using the College Student Experiences Questionnaire to understand potential sources of distress and retention issues. Participants: Responses were obtained from 449 former and current students with mental illnesses from more than 300 colleges and universities around the country. Methods: Participants completed an online survey available from July 2005 to July 2006. Results: Multivariate analysis of variance and t test results indicate that college students with mental illnesses report less engagement on campus and poorer relationships, and that these factors were associated with lower graduation rates. Students reporting they were treated differently “most of the time” because of a mental illness had the lowest levels of engagement and poorest relationships. Conclusions: More attention is needed to developing interventions that enhance social functioning and engagement and address stigma on campus in order to reduce distress and enhance retention.     

Literary clinical practice: desire,depression and toxic masculinity in Hamlet

ABSTRACT

This essay introduces the notion of a literary clinical practice for which it remains essential to continue to consider those texts that open up a place for a readership, or audience, or even a civilization to consider the endlessly generative failure of its literature to write mental health. Concerned with mental illness that is an effect of language on the subject, the body, and of the enigma of the truth as cause, psychoanalysis is the crucial interlocutor for any literary clinical concern with the maladies of literature and society. In order to re-assess the utility of Shakespeare’s Hamlet to contemporary problems such as depression – perhaps the dominant symptom of our time – this essay attempts a reconsideration of Jacques Lacan’s famous seminar on Hamlet from the perspective of the contemporary clinic of the Lacanian orientation in psychoanalysis led by Jacques-Alain Miller.     

The Effect of Mixing Events on the Dynamics of pH1N1 Outbreaks at Small Residential Colleges

Abstract

Objective: The authors examine the dynamics and the impact of all-campus events on pH1N1 spread at Bates College in fall 2009, with comparisons to 3 other campuses. Participants: Students (N = 285) presented or called in to the Bates Health Center with symptoms consistent with influenza-like illness. Methods: Health Center staff at Bates collected data on the outbreak; data from other colleges are from Web sites and journal articles. Data were analyzed using a mathematical model for influenza. Results: Bates held 2 vaccine clinics mid-outbreak. The data are consistent with the hypothesis that the vaccine clinics may have altered routine student interactions, facilitating transmission of pH1N1 among students who otherwise might not have encountered each other. Conclusion: The vaccine clinics, held when vaccine became available, were too late to halt transmission. The disruptions to campus rhythms due to the vaccine clinics may instead have contributed to pH1N1 spread.     

High in the Cold,Thin Air: Risks and Benefits

Abstract

The purpose of this paper is to familiarize health professionals with the clinical manifestations of illness encountered by healthy subjects upon acute exposure to high altitude. Acute mountain sickness (AMS) consists of mild (headache, lethargy, anorexia) and severe (pulmonary and cerebral edema) forms which are probably a continuum of the adverse effects of hypoxia. The former occurs usually at more than 6000 feet, and is self-limited with rest and analgesia; the latter occurs at more than 12,000 feet, can be rapidly fatal, and must be treated with descent and/or oxygen. Acetazolamide may provide prophylaxis for mild symptoms; Lasix and morphine should not be used for severe AMS unless close monitoring is available. The etiology of AMS is not clear but may be related to one's ventilatory response or the response of the pulmonary and cerebral vasculature to hypoxia.     

Comorbid Substance Abuse and Mental Illness

Abstract

Literature concerning assessment and treatment of comorbid substance abuse and mental illness is reviewed. Currently, comorbidity is under-diagnosed and dually diagnosed clients are under-served. Those clients, who are so diagnosed, are most often offered dichotomous parallel or serial interventions. However, research suggests that an integrated approach is preferable. Enhanced training of mental health and substance abuse professionals is urgently needed as is further research concerning the efficacy of various treatment modalities. Improved identification and treatment of comorbidity may reduce the revolving door effect among these individuals and thereby lower health care costs.     

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.     

An Evaluation of a Community Collaboration Approach to Psychosocial Rehabilitation

ABSTRACT

This article reports on the results of a multiagency collaboration demonstration project that was designed to replicate the salient features of an exemplary practice, single-agency program of psychosocial rehabilitation for persons with serious mental illness (SMI). The community collaboration extended over two phases for 2 years and involved over 20 mental health service providers. The demonstration project itself was designed to be a replication of the Village Integrated Services Agency (Village ISA) of Long Beach, California. Additionally, this article reports the results of a rigorous evaluation of the project. The treatment group outcomes were substantially superior to all control group measures at or beyond the 0.05 level of significance. With due regard for limitations imposed by a small sample size (n = 50), the project demonstrates that the replicated model of intervention can be effectively implemented through a collaborative organizational structure involving a coalition of agency service providers.     

Mental Health Consumer and Carer Participation in Professional Education: ‘Getting There Together’ for Children of Parents with Mental Illness and Their Families

Abstract

‘Getting There Together’ is a professional education seminar developed as a collaborative project by professionals, mental health consumers and carers aimed at service providers who work with children of parents with mental illness and their families. The need for such professional education concerning this group is well recognised and the project reported herein was initiated by a reference group of professionals, consumers and carers focusing on children of parents with mental illness in the Eastern region of Melbourne (Victoria, Australia). The project began and continued as a collaborative effort during development and implementation, which ensured the experience, point of view and voice of consumers and carers was central to the material prepared, and at the time of seminar presentations. Seminar participants were from the family welfare, child care and supported housing sectors. Seminar participants found the first person accounts of consumers and carers the most helpful aspects of the seminars because they gave new insights into the experiences of carers and of mental health consumers as parents, as well as an understanding of ‘… the whole family, and how the child fits into the picture’.