Contagious diseases in competitive sport: what are the risks?

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.

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 author's major focus is on the ethical considerations.

PIP: Despite the fact that publicizing the availability of postcoital fertility control (PFC) has been advocated as a means of preventing many abortions, PFC has not been widely used. A study of the mechanism of action of the Yuzpe regimen led to the conclusion that ovulation is prevented in a third of the cases and implantation interrupted in the others. The risk of pregnancy, however, is only 17-26% if unprotected intercourse occurs 1 day before ovulation, which means that PFC is unnecessary in the majority of cases. Surveys performed in 1994-95 indicated that 1) 54% of a nationwide random sample of 2002 adults had heard of PFC, 36% were aware pregnancy could be prevented a few days after intercourse, and 61% had no ethical concerns about the procedure and 2) 56% of a random sample of 300 obstetrician/gynecologists objected to abortion, but 84% of the objectors had no objection to PFC and 48% had prescribed PFC in the past year. A potential obstacle to use of oral contraceptives for PFC is that they are not indicated for such use. While such use is still legal in the US, use of a product for an unlabeled purpose places liability with the physician rather than the manufacturer. The ethical barriers to PFC depend upon beliefs about the beginning of pregnancy and the value of a conceptus. A strict interpretation that life begins with conception would preclude the use of this method, but "gradualist" theory holds that PFC poses less of a moral problem than the abortion of a more highly developed embryo. With no easy ethical solutions at hand, women should be told the possible mechanisms of action, and women who are strongly against abortion should know that some authorities place PFC in that category. Such information will allow women to reach an informed decision.

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.

Positive pregnancy tests at Stanford: a follow up study, 1978-1980.

PIP: This follow-up study compares a 1978-80 survey of 195 patients with positive pregnancy tests to a previous study of a survey in 1973-75 in order to analyze the association of unplanned pregnancies and contraceptive practices among Stanford University students. Of the 195 patients, 105 (54%) filled out questionnaires and more information was retrieved from medical records of 69 other students. Comparison was made to a control population consisting of 100 sexually active women out of a total of 132 who were given the questionnaire. 55 (28.4%) of the pregnancies out of the total of 174 were planned while 119 were unplanned. This compares with 177 (40 planned (22.6%), 130 unplanned, 7 unknown) from 1978 and 95 (17 planned (17.8%), 63 unplanned, 15 unknown) from 1975. Those with planned pregnancies were generally married graduate students or student wives. Of the unplanned group, 24.4% were married and continued the pregnancy (7.6%), whereas the 90 single pregnant women elected to terminate (59.7%). The contraceptive methods that were used unsuccessfully to prevent pregnancy were "coitus dependent" methods such as the diaphragm (41.2%) and unreliable methods such as rhythm (16.8%). In the previous study, the diaphragm was only 15% relied upon. In the control populations, diaphragm use rose from 20% to 41% in 1979. These results confirm those of the earlier study in terms of the increased use of mechanical methods, e.g. the diaphragm, and an increasing number of unplanned pregnancies. This correlation prompts the need for student health services to develop ways to inform students better and for new approaches to be developed to combat the ultimate reliance upon abortion as a birth control method.^ieng

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.