Mental health services for medical students: perceptions of students, student affairs deans, and mental health providers

PURPOSE

To examine (1) whether there is any consistency among medical schools in mental health services provided and (2) how these services are perceived by student affairs deans, mental health service providers, and the students themselves.

METHOD

Questionnaires were sent in October 1991 to the student affairs dean (or director), the individual responsible for student mental health services, and a student representative in each of the 126 U.S. and Canadian medical schools. Data were sought regarding personnel, individuals served, location, hours, administration, funding, confidentiality, administrative referrals, and respondents' suggestions for improvement. Possible differences among the three groups of respondents were tested by chi-square.

RESULTS

Responses were received from 75 student affairs deans, 53 mental health providers, and 30 students. There was much diversity among schools in services provided, especially in the areas of administration and funding. Although perceptions of the three respondent groups were often the same, they differed significantly in a number of areas. Suggestions for improvement of services involved funding, personnel, hours, confidentiality and privacy, specialty services, preventive and support programs, and visibility. The suggestion most frequently made by the students was for increased information and visibility.

CONCLUSION

The differences among schools coupled with the differing perceptions within schools indicate a need for a comprehensive consideration of what kinds of mental health services are needed and how they can best be made accessible to a diverse body of students experiencing a variety of academic and personal challenges.

ELISA tests for antibodies in experimental bovine tuberculosis

It was shown that 10(4) cfu of a field isolate of Mycobacterium bovis caused illness in five experimentally infected calves; one of these died. One of three contact calves also became clinically infected. Considerable variation in the humoral response of the affected animals was demonstrated by ELISAs using purified protein derivative (PPD) and phosphatide antigens. The inoculation of antigens used in the comparative tuberculin skin test significantly enhanced the level of PPD antibodies in the affected animals whereas that of the apparently non-infected contact animals remained unchanged.

Proteins of Crustacean Exoskeletons: I. Similarities and Differences among Proteins of the Four Exoskeletal Layers of Four Brachyurans

Most of the proteins extracted from exocuticle, endocuticle, and membranous layer of four species of anecdysial (intermolt) crabs (the Bermuda land crab Gecarcinus lateralis, the rock crab Cancer antennarius, the shield-backed kelp crab Pugettia producta, and the southern shield-backed kelp crab Taliepus nuttalli) were 31 kDa or smaller; proteins of similar Mr were common to all three layers. Proteins from the membranous layer were qualitatively indistinguishable in all four species. More proteins 31 kDa or smaller were similar in size and pI to proteins from other exoskeletal layers than were proteins larger than 31 kDa. Proteins extracted from the epicuticle of G. lateralis included a group of five ranging from 54 to 42 kDa that bound 45Ca++ in vitro. The group was not seen in other layers of the exoskeleton of G. lateralis or, with the exception of 44 and 42 kDa protein bands that were in the epicuticle of C. antennarius, in any layers of the exoskeletons of the other three species. During proecdysis, the membranous layer is completely degraded, and proteins 31 kDa or smaller are preferentially degraded from the exocuticle and endocuticle of the old exoskeleton of G. lateralis, which is cast as an exuvia at ecdysis. The relative amounts of proteins in extracts of epicuticle from (1) anecdysial exoskeletons and (2) exuviae were very similar, suggesting that there was little degradation of epicuticle during proecdysis. Some of the proteins of the three inner layers of the exoskeleton of G. lateralis have characteristics similar to those of flexible cuticles of insects; they have acidic pIs and they form "charge trains," i.e., proteins of the same size separated by differences in charge during isoelectric focusing.

Use of azathioprine or 6-mercaptopurine in the treatment of Crohn's disease

The efficacy and safety of therapy with azathioprine/6-mercaptopurine was studied in 78 patients with Crohn's disease. Mean duration of therapy was 1.6 years; 52 patients were treated greater than or equal to 6 months. All patients were also on other antiinflammatory medications. Evaluations included self-assessment and physician's assessment of well-being, functional capacity, general clinical response, clinical activities indices (National Foundation for Ileitis and Colitis/International Organization for the Study of Inflammatory Bowel Disease and Harvey-Bradshaw), and achievement of specific therapeutic goals. General clinical condition improved in 70% of the patients. Median response time was 3 months. The average Harvey-Bradshaw score decreased 37% with therapy, and a decrease of greater than or equal to 30% occurred in 66% of the subjects. An overall 72% achievement rate for specified therapeutic goals included controlling refractory disease, 73%; corticosteroid "sparing," 76%; and lessening fistulization, 63%. Nine patients got worse despite therapy. Adverse effects requiring discontinuation of therapy occurred in 10%, whereas dosages were briefly lowered for mild side effects in another 10%. This study demonstrates the effectiveness and safety of azathioprine/6-mercaptopurine in the majority of selected patients with chronic, unremitting, or steroid-requiring Crohn's disease.

A mathematical model for Mycobacterium bovis excretion from tuberculous cattle

An analysis was carried out of available information from a series of experiments on the excretion of M. bovis from infected cattle. The analysis indicated that an inverse exponential relationship exists between 'dose' of organisms given and the delay before excretion commences. This relationship was represented mathematically. Available field data supported the relationship and indicated that in natural bovine tuberculosis excretion of M. bovis begins around 87 days after infection occurs. It is also suggested that the data supports the concept of single nuclei infections in cattle.

Effect of creep feeding on the incidence, duration and severity of post-weaning diarrhoea in pigs

The effect of creep feeding on the response of pigs weaned at two or three weeks old to infection with an enteropathogenic strain of Escherichia coli (O149; K91[B], K88 a, c [L]) was studied in two separate experiments. Gastric intubation was adopted to regulate the intake of creep feed during the sucking period. Animals were given the enteropathogenic strain either before weaning or at weaning and the course and outcome of the infection followed bacteriologically and clinically. The response of the animals to the infection varied considerably in accord with recent reports of multiple phenotypes (to K88 +ve organisms) among pigs but consumption of creep feed before weaning did not significantly affect the prevalence, duration or severity of the diarrhoea induced experimentally by the organism. Hence reputed immunological responses mounted against dietary antigens did not predispose to or protect against this infection.

Computed tomography evaluation of the sacroiliac joints in Crohn disease. Radiologic/clinical correlation

Computed tomography (CT) was used in a prospective study of the sacroiliac joints in 86 patients with Crohn disease to determine the type and frequency of sacroiliac joint abnormalities present in this population. The CT findings were correlated with review of the clinical history in 64 patients. Computed tomography demonstrated changes of sacroiliitis in 29% of the study group. This high prevalence of sacroiliac joint abnormality was found even in those under 30 years of age. It exceeds the 11-19% previously reported from plain film examination, reflecting the greater sensitivity of CT. In the subgroup of 64 patients studied clinically, 19 (30%) had abnormal sacroiliac joints on CT, but only 2 (3%) reported symptoms related to the sacroiliac joints.

Control, prevention and eradication of Salmonella enteritidis infection in broiler and broiler breeder flocks

Salmonella enteritidis was identified by serological and bacteriological techniques in two clinically normal breeder flocks in an integrated broiler organisation in Northern Ireland. The organism was transmitted vertically to clinically affected progeny flocks. The infected breeder flocks were slaughtered and the infection throughout the organisation controlled and subsequently eradicated. A working group, consisting of the senior management of the broiler organisation and veterinary staff from the Veterinary Research Laboratories at Stormont, was formed to establish procedures to minimise the risk of the reintroduction of salmonella infection, by preventing vertical transmission from grandparent flocks, or lateral transmission from personnel, other animal species and fomites, or transmission through the feed. All feed was heated to a minimum of 70 degrees C for 12 minutes immediately before it was pelleted and subsequently transported to the flocks through a dedicated system of conveyor belts, bins and lorries. A comprehensive system for monitoring the efficacy of the preventive procedures was established and is now used throughout the poultry industry of Northern Ireland.

Dezocine. A preliminary review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy

Dezocine is an analgesic agent with opioid agonist and antagonist activity. After parenteral administration of therapeutic doses it is approximately equipotent with morphine, and has proved at least as effective an analgesic as morphine, pethidine (meperidine) and butorphanol in moderate to severe postoperative pain. However, preliminary pharmacodynamic data indicate that the ceiling of analgesic activity of dezocine occurs at a higher level of analgesia than that of reference agonist/antagonist agents. Also, the drug exhibited a morphine-like degree of anaesthetic-sparing activity in animals. Although long term data are very limited, single doses of dezocine are well tolerated, with mild and transient sedation and gastrointestinal upset the principal adverse effects. As with some other agonist/antagonist analgesics, a 'ceiling' effect to dezocine-induced respiratory depression occurs with increasing dosage, beyond which further depression has not been observed. In single analgesic doses, however, dezocine is a slightly more potent respiratory depressant than morphine. Clinically important haemodynamic changes have not been observed with usual analgesic doses of dezocine. As an agonist/antagonist opioid, the dependence liability of dezocine would be expected to be lower than that of pure agonist opioids, but extended clinical use is required before more definitive conclusions can be drawn in this regard. Unlike older drugs of its type, dezocine produced opiate-like subjective effects and was identified as morphine-like by drug abusers. Thus, provided the promising conclusions of currently available clinical studies are confirmed with its wider use, dezocine should be a useful additional agent for the treatment of moderate to severe postoperative pain.

Use of PPD and phosphatide antigens in an ELISA to detect the serological response in experimental bovine tuberculosis

Five calves from tuberculosis free herds were each inoculated intranasally with 10(6) viable organisms of a field isolate of Mycobacterium bovis. Four of the calves developed acute tuberculosis. ELISAs employing protein and phosphatide extracts of M bovis as antigens were used to monitor the humoral response of the infected calves. Fourteen days after infection there was a dramatic increase in the level of antibodies demonstrated by the phosphatide antigen. This increase coincided with the first appearance of signs of the disease. The results suggest that the phosphatide antigen may be of potential value in detecting a humoral response, if present, in cattle infected with M bovis. The tests employing the protein antigen demonstrated a humoral response in only one of the infected calves and emphasises the importance of antigen selection to detect antibodies in tuberculous animals.

Transmission of tuberculosis from experimentally infected cattle to in-contact calves

Five of a group of six calves were inoculated with Mycobacterium bovis. Two more uninoculated calves were introduced to the group 84 days later. All the inoculated calves were subsequently shown to be excreting M bovis in nasal mucus. The uninoculated calf in the initial group of six became infected and subsequently excreted M bovis. The two uninoculated calves which were introduced later did not become infected. It was concluded that contact with nasal mucus from the infected cattle resulted in infection of the uninoculated calf and that the density of accommodation of animals excreting M bovis was an important factor in transmission of the disease.

Acyclovir. An updated review of its antiviral activity, pharmacokinetic properties and therapeutic efficacy

Acyclovir (aciclovir) is a nucleoside antiviral drug with antiviral activity in vitro against members of the herpes group of DNA viruses. As an established treatment of herpes simplex infection, intravenous, oral and to a lesser extent topical formulations of acyclovir provide significant therapeutic benefit in genital herpes simplex and recurrent orofacial herpes simplex. The effect of acyclovir therapy is maximised by early initiation of treatment, especially in non-primary infection which tends to have a less protracted course than the primary episode. Long term prophylactic oral acyclovir, in patients with frequent episodes of genital herpes simplex, totally suppresses recurrences in the majority of subjects; as with other infections responding to acyclovir, viral latency is not eradicated and pretreatment frequencies of recurrence return after discontinuation of treatment. Caution should accompany the prophylactic use of acyclovir in the general population, due to the theoretical risk of the emergence of viral strains resistant to acyclovir and other agents whose mechanism of action is dependent on viral thymidine kinase. Intravenous acyclovir is the treatment of choice in biopsy-proven herpes simplex encephalitis in adults, and has also been successful in the treatment of disseminated herpes simplex in pregnancy and herpes neonatorium. Intravenous and oral acyclovir protect against dissemination and progression of varicella zoster virus infection, but do not protect against post-herpetic neuralgia. In immunocompromised patients, intravenous, oral and topical acyclovir shorten the clinical course of herpes simplex infections while prophylaxis with oral or intravenous dosage forms suppresses reactivation of infection during the period of drug administration. Ophthalmic application of 3% acyclovir ointment rapidly heals herpetic dendritic corneal ulcers and superficial herpetic keratitis. Thus, despite an inability to eradicate latent virus, acyclovir administered in therapeutic or prophylactic fashion is now the standard antiviral therapy in several manifestations of herpes simplex virus infection, and indeed represents a major advance in this regard. With the exception of varicella zoster virus infections, early optimism concerning the use of the drug in diseases due to other herpes viruses has generally not been supported in clinical investigations.

Excretion of Mycobacterium bovis by experimentally infected cattle

Three groups, each of five calves, four to seven months old, were inoculated intranasally with different numbers of Mycobacterium bovis. Infection was established readily in the calves which received an inoculum containing either 10(6) or 10(4) colony forming units (cfu). After every infection there was a lag period during which the organisms could not be isolated from specimens of nasal mucus. All the animals excreted M bovis and the time of commencement, quantity and duration of excretion appeared to be related to the inoculation dose. Excretion continued for many weeks, and for two calves excretion became intermittent over many months. All the calves which were given inocula of 92 cfu failed to develop the disease and no immunological responses were detected; however, M bovis was isolated from nasal secretions from one of these animals 100 days after inoculation.

Mycobacterium bovis in the anterior respiratory tracts in the heads of tuberculin-reacting cattle

Twenty-five of 50 randomly selected tuberculin-reacting cattle were confirmed as tuberculous in the laboratory. All 25 cattle had macroscopic lesions in lymph nodes associated with the respiratory tracts but only one had lung lesions. M bovis was isolated from the anterior respiratory tracts in the heads of four of the 25 tuberculous animals and from a nostril lesion found in a fifth. For at least three of these five animals, the intervals between the final tuberculin test and their previously negative tests indicated that infection had established relatively rapidly. Four of them had been tuberculin tested solely because they were animals in contiguous 'at risk' herds. It would appear that although M bovis can be isolated from the anterior respiratory tracts in the heads of tuberculin-reacting cattle, it is unlikely that primary foci of infection exist in regions other than the lungs or associated tissues. The study demonstrates the potential for reactors with lesions to excrete M bovis and the continued importance of infected cattle in the epidemiology and eradication of the disease.