US college and university student health screening requirements for tuberculosis and vaccine-preventable diseases, 2012.

OBJECTIVE: Colleges are at risk for communicable disease outbreaks because of the high degree of person-to-person interactions and relatively crowded dormitory settings. This report describes the US college student health screening requirements among US resident and international students for tuberculosis (TB) and vaccine-preventable diseases (VPDs) as they relate to the American College Health Association (ACHA) guidelines. Methods/Participants: In April 2012, US college health administrators (N = 2,858) were sent online surveys to assess their respective school's TB screening and immunization requirements. RESULTS: Surveys were completed by 308 (11%) schools. Most schools were aware of the ACHA immunization (78%) and TB screening (76%) guidelines. Schools reported having policies related to immunization screening (80.4%), immunization compliance (93%), TB screening (55%), and TB compliance (87%). CONCLUSION: Most colleges were following ACHA guidelines. However, there are opportunities for improvement to fully utilize the recommendations and prevent outbreaks of communicable diseases among students in colleges.

Use of Expedited Partner Therapy for Sexually Transmitted Diseases in College and University Health Centers in the United States, 2011-2012.

We examined expedited partner therapy for chlamydia and gonorrhea in college and university health centers by institutional and policy characteristics. Expedited partner therapy awareness and use was low (44.1% used), did not differ by institutional characteristics, and differed by policy environment. Our findings suggest missed opportunities for sexually transmitted disease prevention in college and university health centers.

Waterpipe smoking among U.S. university students.

INTRODUCTION: While cigarette use is declining, smoking tobacco with a waterpipe is an emerging trend. We aimed to determine the prevalence of waterpipe use in a large diverse sample of U.S. university students and to assess the association of waterpipe use with individual and institution-related characteristics. METHODS: We assessed students from 152 U.S. universities participating in the National College Health Assessment during 2008-2009. We used multivariable regression models to determine independent associations between individual and institutional characteristics and waterpipe tobacco use in the past 30 days and ever. RESULTS: Of 105,012 respondents included in the analysis, most were female (65.7%), White (71.2%), and attending public (59.7%) nonreligious (83.1%) institutions. Mean age was 22.1 years. A total of 32,013 (30.5%) reported ever using a waterpipe to smoke tobacco. Rates for current tobacco use were 8.4% for waterpipes, 16.8% for cigarettes, 7.4% for cigars (including cigarillos), and 3.5% for smokeless tobacco. Of current waterpipe users, 51.4% were not current cigarette smokers. Although current waterpipe use was reported across all individual and institutional characteristics, fully adjusted multivariable models showed that it was most strongly associated with younger age, male gender, White race, fraternity/sorority membership, and nonreligious institutions in large cities in the western United States. CONCLUSIONS: After cigarettes, waterpipe use was the most common form of tobacco use among university students. Because waterpipe use affects groups with a wide variety of individual and institutional characteristics, it should be included with other forms of tobacco in efforts related to tobacco surveillance and intervention.

Aspects of suicidal behavior, depression, and treatment in college students: results from the spring 2000 national college health assessment survey.

The National College Health Assessment Survey (NCHA), sponsored by the American College Health Association, measured depression, suicidal ideation, and suicide attempts among 15,977 college students in the academic year 1999-2000. Similar to the National College Health Risk Behavior Survey, conducted by the Centers for Disease Control and Prevention in 1995, 9.5% of students reported that they had seriously considered attempting suicide and 1.5% of students reported that they had attempted suicide within the last school year. The NCHA findings show a relationship between suicidal behavior and depressed mood. Depressed mood, difficulties of sexual identity, and problematic relationships all increase the likelihood of vulnerability to suicidal behavior. Less than 20% of students reporting suicidal ideation or attempts were receiving treatment.

Usefulness of prodromal unstable angina pectoris in predicting better survival and smaller infarct size in acute myocardial infarction (The InTIME-II Prodromal Symptoms Substudy).

Prodromal unstable angina on presentation is a significant predictor of smaller infarct size, reflected by smaller creatine kinase-MB and creatine kinase total measurements and lower 30-day, 6-month, and 5-year mortality. These findings suggest that prodromal unstable angina is an important physiologic marker that should be routinely collected for risk stratification.

Whiplash injuries in Finland: a prospective 1-year follow-up study.

OBJECTIVES: The aim of the study was to define how many whiplash injuries occur in Finland in traffic accidents and the degree of severity of these injuries using the whiplash-associated disorders (WAD) classification presented by the Quebec Task Force, and to define possible long-term health effects caused by whiplash injury as well as the duration of whiplash-associated sick-leaves. METHODS: This was a prospective one-year-follow-up study. Fourteen insurance companies paving compensations for traffic accidents in Finland sent the accident reports and medical certificates of all neck injuries attributable to traffic accidents to the research team. The material was collected from neck injuries that had occurred in traffic accidents during the year 1998. RESULTS: The majority of those suffering a whiplash injury were women. On the basis of the WAD classification, most whiplash injuries were mild, belonging to grades WAD I and II. At one year from the accident nearly 10% considered that their health had been impaired significantly as a result of their neck injury. Over 10% of those questioned had been on sick-leave for over a month but only 1.5% had been on sick-leave associated with the injury for more than 6 months. The most common symptom after one year was neck pain or neck pain combined with headache and symptoms in the upper extremities. No major changes related to the seasons of the year were found. CONCLUSIONS: The number of reported neck injuries in proportion to all traffic accidents involving physical injuries is small, even in proportion to rear-end collisions. In a considerable proportion of collision patients, whiplash injury does result in significant impairment which can last as long as a year after the accident. The WAD classification predicts the duration of work disability and the long-term health damage caused by the injury. Since the appearance of symptoms and the individual need for rehabilitation due to impaired functional capacity do not depend solely on the tissue damage and biomechanical forces involved in the collision, in the future it will be important to determine which factors are responsible for the differences in coping after a collision.

Prodromal unstable angina in acute myocardial infarction: prognostic value of short- and long-term outcome and predictor of infarct size.

BACKGROUND: An estimated 50% of patients with myocardial infarction have prodromal unstable angina. There is controversy over whether prodromal unstable angina identifies a group of patients at lower risk of short- and long-term death and the clinical importance of recording this event. METHODS: Of 207 patients enrolled at a single Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO-I) site, 196 survived the 24 hours after presentation, achieved peak creatine kinase MB concentrations, and were classified as having either abrupt symptom onset or prodromal unstable angina in the 2 weeks before myocardial infarction. Creatine kinase MB peak was used to categorize infarct size as aborted myocardial infarction, minor myocardial damage, or extensive myocardial injury. Follow-up was performed at 24 hours, 30 days, 1 year, and 5 years. Multiple variables, including prodromal unstable angina, time to treatment, age, sex, previous infarction and infarct location, were analyzed for predicting infarct size. Also, these variables plus peak creatine kinase MB level and a combined variable of prodromal unstable angina and peak creatine kinase MB level were examined for predicting survival. RESULTS: Mortality rate was 2.5% within 24 hours, 9.0% at 30 days, 13.5% at 1 year, and 27.1% at 5 years. Patients categorized as either aborted infarction or minor myocardial damage were significantly more likely to have prodromal unstable symptoms (81.3% vs 51.2%, P <.001) and better survival at each follow-up period. Prodromal presentation was the most significant predictor of infarct size category (P =.001). Five-year survival was predicted by age (P <.0001), peak creatine kinase MB level (P =.007), infarct location (P =.009), the combined variables (P =.029), and prodromal unstable angina (P =.017). Prodromal unstable angina had the highest odds ratio for 5-year survival at 3.83 (95% confidence interval 1.27-11.47). CONCLUSIONS: Prodromal unstable angina is a strong predictor of infarct size and survival. Recognizing prodromal unstable angina is important for clinically assessing prognosis.

Alcohol consumption and mortality. I. Characteristics of drinking groups.

AIMS: This is the first of a set of three papers evaluating drinking status and mortality risk. Analyses of multiple studies describe associations of drinking patterns with characteristics hypothesized to confound the relationships between drinking status and mortality. Characteristics which both significantly differentiate drinking groups and are consistent across studies would suggest that mortality studies not controlling for them may be compromised. DESIGN AND PARTICIPANTS: Associations are evaluated from the raw data of 10 general population studies which contained mortality data. Long-term abstainers are compared to former drinkers, long-term abstainers and former drinkers are compared to light drinkers (by quantity, frequency and volume in separate analyses) and moderate to heavy drinkers are compared to light drinkers. Tetrachoric correlation coefficients assess statistical significance; meta-analysis determines if associations are homogeneous across studies. MEASUREMENTS: Measures of alcohol consumption are quantity, frequency and volume; long-term abstainers are differentiated from former drinkers. Multiple measures of health, social position, social integration and mental health characteristics are evaluated. FINDINGS: Across studies, adult male former drinkers are consistently more likely to be heavier smokers, depressed, unemployed, lower SES and to have used marijuana than long-term abstainers. Adult female former drinkers are consistently more likely to be heavier smokers, in poorer health, not religious, and unmarried than long-term abstainers. Both types of abstainers tend to be of lower SES than light drinkers and report poorer health (not consistent). Female abstainers are more likely to be of normal or overweight than light drinkers. CONCLUSIONS: Characteristics of two groups of abstainers, other than their non-use of alcohol, may confound the associations found between drinking and mortality risk.

Alcohol consumption and mortality. II. Studies of male populations.

AIMS: This is the second of a set of three papers evaluating drinking status and mortality risk. Analysis of eight general population surveys of men evaluated all-cause mortality rates by drinking pattern. DESIGN AND PARTICIPANTS: Raw data from three studies of youth and five studies of adults were evaluated. Logistic regression models controlled for confounding characteristics. Meta-analysis combined study results. MEASUREMENTS: Drinking pattern was alternatively defined by quantity, frequency and volume of drinking. Final models included drinking pattern (as well as abstinence in the youth models and long-term abstainers and former drinkers in adult models), age and other confounding variables. Models also evaluated interactions of age and, respectively, long-term abstinence and former drinking. FINDINGS: No evidence was found for the hypothesis that abstinence is associated with greater mortality risk than light drinking. In the youth samples, abstainers had a lower risk of dying than those drinking less than 15 times per month. One study of the adult samples showed a significant age by former drinker interaction; this did not alter the lack of association of former drinking with mortality risk or the homogeneity of results across studies for this finding. The most consistent finding was the association of heavy drinking with mortality among youth. Among adults, drinking 43 or more drinks per month and drinking 21 or more times per month were associated with increased mortality risk. Quantity per occasion was not significantly associated with mortality risk among adults. CONCLUSIONS: That frequent drinking was related to mortality risk, whereas heavier quantity was unrelated, is inconsistent with the belief that daily consumption of a few glasses of wine has salutary effects. Empirically, however, this pattern tends to be unusual. Findings were homogeneous across studies lending generalizability to results.

Alcohol consumption and mortality. III. Studies of female populations.

AIMS: This is the third of a set of three papers evaluating drinking status and mortality risk. Analysis of three general population surveys of women evaluated all-cause mortality rates by drinking pattern. DESIGN AND PARTICIPANTS: Raw data from three studies of adult women were evaluated. Logistic regression models controlled for confounding characteristics. Meta-analysis combined study results. MEASUREMENTS: Drinking pattern was alternatively defined by quantity, frequency and volume of drinking. Final models included drinking pattern (including long-term abstainers and former drinkers) as well as age and other confounding variables. Models also evaluated interactions of age and, respectively, long-term abstinence and former drinking. FINDINGS: In models in which age was controlled, odds of death for long-term abstainers and former drinkers (defined by volume or quantity) were greater than those for light drinkers; odds of death for moderate and heavy drinkers (defined by quantity) were greater than those for light drinkers. When other psychosocial attributes were controlled, odds of death were similar for abstainers and light drinkers. When other psychosocial attributes were controlled, odds of death for heavy drinkers (defined by volume and quantity) were greater than those for light drinkers. When interactions of age and the two forms of abstinence were introduced, one study showed a significant effect of age and former drinking. CONCLUSIONS: Results were consistent with the hypothesis that characteristics of abstainers other than their non-use of alcohol may account for their higher mortality risk. With the exception of former drinkers compared to light drinkers, when interactions were introduced into models (for measures of quantity and frequency) findings were homogeneous across studies, lending generalizability to results.

Clinical predictors of transvenous defibrillation energy requirements.

Nonthoracotomy and, more recently, transvenous lead systems have become routine for initial implantable cardioverter-defibrillator (ICD) placement. Previous studies of clinical predictors of nonthoracotomy defibrillation energy requirements evaluated multiple complex lead systems that included subcutaneous patches. However, the predictors of an adequate transvenous defibrillation threshold (DFT) have not been assessed previously. Accordingly, the present study is a prospective evaluation of DFT using a uniform testing protocol in 119 consecutive patients undergoing ICD implantation with a single transvenous lead. For each patient, 38 parameters were assessed including standard clinical, echocardiographic, and radiographic measures. An adequate monophasic DFT (< or =20 J) was achieved in 76% of patients. Multivariable analysis revealed 3 independent factors predictive of a high threshold: preoperative amiodarone use (odds ratio = 5.8, p < or =0.002), echocardiographic measures of left ventricular dilation (odds ratio = 0.47, p < or =0.005) and body size (odds ratio = 0.51, p < or =0.006). Patients receiving amiodarone who also had left ventricular dilation constitute a group at considerable (69%) risk for having a high DFT. In contrast, patients with neither of these risk factors have only an 11% chance of having a high threshold. We conclude that an adequate transvenous DFT can be predicted from simple clinical parameters.

Determinants of life-course variation in the frequency of alcohol consumption: meta-analysis of studies from the collaborative alcohol-related longitudinal project.

OBJECTIVE: This report evaluates the relative contribution of predictors of change in the frequency of alcohol consumption among drinkers, based on the quantitative synthesis of data from 27 longitudinal studies of the general population. The analysis has two objectives: (1) to evaluate the impact of selected demographic characteristics on the magnitude and trajectory of change in drinking across multiple samples, and (2) to assess the influence of methodological characteristics on the consistency of results across studies. METHOD: Raw data from studies including two serial measures of the frequency of alcohol consumption are analyzed. Fixed, random and mixed effects models for meta-analysis are used to pool measures across observations and model the influence of predictors on variability between results. RESULTS: Gender-based variation in the patterning of change is present across all observations, but concentrated in early periods of the life course. Age displays significant predictive effects across all observations, but statistically uniform results are obtained for subjects aged 30 and over. The national origin of study predicts larger amounts of variation than do other demographic predictors in the models. Significant effects are observed for several methodological characteristics of studies. Variation among effect estimates is associated with differences between samples in the interval between first and final measurements, the date of first measurement (a proxy for the historical context of the sample), the percentage retention of subjects between measurements and the time frame of the original alcohol measure. CONCLUSIONS: Based on the synthesis of data from multiple longitudinal samples, this study (1) characterizes normative developmental patterning in the frequency of alcohol consumption and demonstrates the varying effects of demographic factors across the life-course: (2) indicates the key influence of cultural and historical context on the establishment of drinking patterns; and (3) confirms the impact of methodological differences on variation in the results of studies.

Aggregate-level predictors of the prevalence of selected drinking patterns in multiple studies: a research synthesis from the Collaborative Alcohol-Related Longitudinal Project.

This paper examines the prevalence of two "at-risk" alcohol drinking patterns (infrequent heavy drinking and frequent heavy drinking) within age/gender groups in multiple general population studies. When heterogeneity in findings across studies is found, we test the hypotheses that suicide, divorce, unemployment rates, and the per capita consumption of alcohol in each country are associated with the prevalence of these drinking patterns. These analyses should inform the literature on the relationships between societal factors and the prevalence of persons in different societies and periods in history that drink at these levels.

Dorsal ramus irritation associated with recurrent low back pain and its relief with local anesthetic or training therapy.

Nerves leave the spinal cord as mainly motor primary rootlets and sensory rootlets. These join to nerve root before leaving the spinal canal. After the root canal, the nerve root branches into the ventral root, which contains sensory and motor fibers innervating the extremities, and the dorsal root, that is, the dorsal ramus, which innervates the posterior structures, for example, back muscles: the dorsal ramus itself may become irritated (dorsal ramus syndrome). Especially predisposed to entrapment is the medial branch of the dorsal ramus, which innervates the multifidus muscle and also contains pain fibers. Here we describe the influence of local anesthesia and back-muscle-training therapy on subjective and objective pain parameters in 21 low-back-pain patients who had similar clinical status and neurophysiologic findings and whose recurrent low back pain was most apparently associated with dorsal ramus neuropathy, without any radiologic or neurophysiologic evidence of more proximal ventral nerve root damage in the spinal cord or at the nerve root origin. After treatment, all were pain free and back muscle activity during lumbar-pelvic rhythm was normalized.

Gender differences for the risk of alcohol-related problems in multiple national contexts.

The primary research question asked is: After holding alcohol consumption constant, will men and women be at equal risk for a variety of alcohol-related problems? Since women are actually at a higher blood alcohol content at the same consumption levels, a physiological argument would suggest that women are at equal or greater risk for alcohol problems than men. However, variation in societal norms surrounding gender roles and/or societal-level stress may mediate the experience of men and women, regardless of the differences in physiology. Ten cross-sectional general population studies are used. Analyses control for individual-level variables (age, quantity, and frequency of drinking) and societal-level variables (proportion of women in the work force and female suicide rate) that might confound these relationships; cross-study homogeneity is examined.

Relationships of measures of alcohol consumption with alcohol-related problems in multiple studies: a research synthesis from the collaborative alcohol-related longitudinal project.

Two measures of alcohol consumption were used to predict groups of alcohol problems in 21 general population studies from 11 countries to determine (a) if quantity of drinking per occasion or frequency of drinking per month constituted significant "risk" for alcohol problems, having controlled for each as well as individual-level and aggregate-level variables which might confound these relationships and (b) if these associations were homogeneous across studies. A two-tiered analysis assessed these relationships within each study by modeling age, sex, quantity per occasion and frequency per month as predictors of alcohol problems. Meta-analysis combined test statistics to determine if they were homogeneous across studies. The meta-analysis was repeated, blocking for per capita consumption of alcohol (a trait of nations thought to measure drinking norms) and the female rate of suicide (a trait of nations thought to measure societal-level stress). When only individual-level variables were controlled (age and sex), both quantity and frequency were risk factors for each drinking problem. However, except in the case of the association of quantity with alcohol treatment, the magnitude of these risks were heterogeneous across studies. When blocking for the societal-level traits, each had more relevance for some, but not all, of the relationships between consumption and problems. Particularly striking was the well-documented finding that per capita consumption of alcohol significantly distinguished the relationships of frequency of drinking and health problems (while the female suicide rate did not) and the previously undocumented finding that the female suicide rate significantly distinguished the relationships of both quantity and frequency with treatment (while the per capita consumption of alcohol did not). These findings suggest that the impact of norms and the impact of societal stress in groups have different but significant consequences for the relationships of consumption to problems.

Societal-level predictors of groups' drinking patterns: a research synthesis from the Collaborative Alcohol-Related Longitudinal Project.

OBJECTIVES: Period effects of per capita consumption of alcohol and divorce rates are assessed for change in quantity and frequency among age/sex groups in multiple longitudinal studies. METHODS: Twenty-five studies of quantity and 29 studies of frequency are used. Studies are from 15 nations and cover periods of 1 to 21 years. Models predict the standardized mean difference for quantity and frequency based on period effects and group-level and methodological variables. RESULTS: When both the period effects of per capita consumption and the divorce rate are considered, the divorce rate significantly predicts change in quantity and frequency. An increase in the divorce rate is associated with a stronger decrease in frequency among younger people; men are more likely than women to decrease their frequency of drinking when divorce rates rise. CONCLUSIONS: Multiple societal-level factors should be considered critical in influencing the drinking patterns of groups. These results suggest that an increase in the divorce rate is associated with more "dry" social contexts, characterized possibly by drinking patterns of a more "volitive" nature (i.e., heavier quantity per occasion and less frequent drinking).

Exercise therapy effects on functional radiographic findings and segmental electromyographic activity in lumbar spine instability.

Flexion-extension and traction-compression radiographs as well as functional electromyographic (EMG) analysis were used to assess nine patients with chronic low back pain and segmental instability symptoms. After a treatment program, at which time most of the patients were asymptomatic and their physical status normalized, the patients were reexamined using EMG and radiographs. No significant change was found in the functional radiographic examination, whereas the myographic findings were significantly improved. Although the number of subjects was small, the results suggest that radiographic findings correlate poorly with clinical findings. Because of the improvement of the physical and myographic findings, the term "segmental dysfunction" may better describe the disability and symptoms than does the term "segmental instability."

A cross-study contextual analysis of effects from individual-level drinking and group-level drinking factors: a meta-analysis of multiple longitudinal studies from the collaborative alcohol-related longitudinal project.

In contextual (cross-level) analysis within multiple longitudinal general population studies, individual-level drinking behaviors (quantity per typical occasion, frequency of drinking per month and total volume of drinks per month) at final measurement are assessed by three models that simultaneously enter individual- and group-level measures. Two age groups (15-20 and 21-30) are independently assessed. In each model, the Time 1 individual-level drinking behavior and one of three group-level factors are entered. The group-level factors are (1) the percentage of abstainers at Time 1 for each age/sex cohort, (2) the Time 1 group mean for the drinking measure for the age/sex cohort and (3) the mean difference of the age/sex cohort's change in the drinking measure over time. All variables in the model are controlled by variations to exposure in per capita consumption of alcohol during the age/sex cohort's formative years and at Time 2. Meta-analysis assesses the homogeneity of the findings across studies. Models were proposed with the rationale that (1) understanding of individual drinking behavior can be advanced if individual-level data and group-level data are considered in the same models, and (2) integration of these two levels of analyses are, to date, rare. The rationale for using meta-analysis is that findings from the models can be assessed across social contexts with respect to their generalizability. The mean difference model, controlling for individual drinking at Time 1, is the most influential of the group-level models for the younger age group: the degree to which the group changes its drinking pattern is positively related to individual-level drinking behavior at final measurement, over and above the individual's drinking behavior at Time 1, for individual-level frequency of drinking among males (homogeneous among drinkers only). Younger females show more significant relationships for the mean difference females show more significant relationships for the mean difference model. Findings are significant for all relationships examined for the mean difference of the drinking of the group and the individual drinking among the older males and females. Measures of individual-level drinking for all measures at Time 1, controlling for the group-level effects, are significantly related to individual-level drinking at final measurement. The results are homogeneous for quantity (drinkers only) and volume among the young. Findings indicate that characterizations of the drinking for both the individual and the group to which the individual belongs predict measures of drinking practices on the individual level over time.

The influence of health on family contacts and family feelings in advanced old age: a longitudinal study.

This study provides a longitudinal analysis of the influences of health, age, gender, and socioeconomic status on family contacts and family feelings in a sample of 62 members of the Berkeley Older Generation Study. Stability in family contacts and in family feelings was observed over 14 years of advanced old age. Of the four predictor variables, health and socioeconomic status accounted for the largest proportion of observed variance. Contrary to our hypotheses, study participants in better health had greater amounts of contact with family than did those in poorer health. The former also had more feelings of closeness to family members, a finding that may reflect greater possibilities for reciprocity between elders in good health and their family members.