How Can Young Adults Keep Themselves Safe at College?

Patient Presentation
A 18-year-old male came to clinic for his health supervision visit. He was going to college in a city several hours away and wanted to make sure he had enough of his medication before leaving. The past medical history was positive for attention deficit disorder primarily inattentive type, that was diagnosed in early elementary school. He had good relief of symptoms with a consistent dose of Concerta® for several years. His immunizations, including human papilloma virus and meningococcal meningitis vaccines, were current.

The pertinent physical exam showed a healthy male with normal vital signs. The diagnosis of a healthy male with ADD was made. His physician recommended that he have a local health and mental health provider identified to help with any mental health or health care issues he might have at school. Additionally, the physician discussed some general safety recommendations such as having a carbon monoxide detector and fire extinguisher in his dorm room. He also discussed party and date safety.

Discussion
Going away to college or moving away from home brings new challenges for adolescent and young adults. New surroundings, situations, responsibilities and fewer trusted adults to help advise combine to provide new challenges for young adults. Simple things like not taking your keys with you or locking a door having different potential consequences in a new dorm or apartment. Using common sense and trusting one’s instinct and planning ahead usually keeps most young adults safe in many situations.

Learning Point
Tips for student going off to college include:

    Get yourself ready
    • Trust your instincts – if it feels wrong or seems wrong, then something probably is. Don’t make things worse by ignoring your instinct. Make a good choice – avoid or leave a situation.
    • Your cellphone is a tool. Keep it fully charged and take it with you. Have contacts entered into speed dial including police, fire, hospital, friends and family.
    • If you have specific health problems or take medicines, put that information in your cellphone too so people can help you if needed.

    • Identify help at school before you need it – student health service, mental health professional, pharmacy and a hospital. Keep a list of your hometown doctors, hospital etc. too.
    • Get a supply of your medications and know where you can get refills. You may or may not be considering having sex. Have, or know where to obtain, contraceptives to protect you, your partner or a friend.
    • You will be living in close quarters and infections travel fast. Wash your hands often or use hand sanitizers.
    • Make sure your immunizations are up to date especially meningococcal vaccine and yearly influenza vaccine. If you are traveling internationally, plan ahead w.ith enough time to get all additional vaccines and medicines.
    • Get a lanyard for your ID/keys and emergency cash. Keep a whistle with it for safety. Don’t mark your keys with your name, address, phone, license number etc. As if they are found they can provide access to your home or car. Only give a parking attendant the keys to your car, never your dorm/apartment.
    • Get insurance for your personal articles and car.

    Watch out for the other guy/gal

    • There is safety in numbers. Develop some friends (buddy system) you can trust – people who know where you are going, when you will return, people who will look out for you and people you can call anytime. Remember that people have to earn your trust. Don’t assume someone you just met will look out for you.
    • Do the same for your friends. Be the good friend even if it is an inconvenience for you. If it is a bad situation, don’t compound the problem. Do what is right for everyone’s safety and health and call the police, ambulance, etc.. Better to talk to them than to explain things to the coroner, funeral home and your friend’s family.
    • Keep people informed – your don’t have to tell everyone everything, but letting people know where you are going, when you will return and whom you are going out with is polite and can keep you safe.
    • Have a code word so that if you are in a situation you can communicate your discomfort without the person you are with knowing.

    General Safety

    • Know your way around campus. Walk around the buildings during the day and at night to make sure they are well lit, secured and patrolled. Avoid shortcuts.
    • Know where the emergency telephones are located.
    • Know several routes to use. Stick to well-lit and busy areas.
    • If you think someone is following you, go in another direction that is better lit, has more activity etc.
    • When walking:
      • Be aware of your surroundings. Don’t talk on the phone or listen to your music while walking – you are easy prey then.
      • Walk like you are calm, confident and know where you are going even if you don’t.
      • Keep your keys out and ready to use for your dorm, apartment, car or bike.
      • Keep your hands otherwise free.
      • Keep your whistle or have pepper spray handy.
      • Walk on the street side of the sidewalk away from shrubs, doorways etc. where people could be hiding.
    • At night: NEVER walk alone. If your friend is leaving, leave with them.
      Use the campus escort service or call a taxi.

    • Use your trusted friends and buddy system.
    • Be aware of your people and don’t be afraid to report suspicious activity.
    • If you need to:
      • Lie – Make up a reason to go or to stay.
      • Do something to bring attention and bring help.
      • Make a lot of noise – blow your whistle, pull the fire alarm, shout.
      • Stand in the middle of the road where there are brighter lights and you can see what is happening around you.

    Dorm/Apartment

    • Never give your keys to someone else. They now have access to everything you did.
    • Always lock your room, even for a minute. Remember, your dorm room/apartment is open. Only your actual room is locked and kept locked by you all the time.
    • Lock first and second story windows when not in the room and at night
    • Use the central dorm/apartment entrance to come and go. It is usually monitored and there are more people there. It also makes it safer for everyone, because other people can easily sneak into other entrances.
    • Don’t prop doors open or allow people access.
    • Rekey your locks if your key is lost or stolen
    • Don’t leave valuables in plain sight
    • Follow your dorms rules about cooking and electronic items and extension cords. Don’t use candles and incense.
    • Have portable fir and carbon monoxide alarms and a fire extinguisher in your room.
    • Be aware of your neighbors and don’t be afraid to report suspicious activity.

    Valuables

    • Don’t bring them to campus.
    • Don’t leave them or any other personal property unattended
    • Keep them locked up if possible.
    • Register them with local law enforcement – cars, bikes etc.
    • Engrave them with identification so they can be more easily tracked and returned
    • ATMs – use ATMs located inside a building and never count cash there. Count cash when you are in a secure location.

    Transportation

    • Have your keys ready to unlock before you get to the car.
    • Always look in the backseat before getting in
    • Always lock your car as soon as you are inside and when you leave the car
    • Don’t leave valuables in plain sight or in the glove box.
    • Park your car in well-lit places, close to activity
    • If you think someone is following you, go to a police or fire station, gas or convenience store or other open place to get help.
    • Always keep more than 1/4 tank of gasoline, so you don’t run out of gas. Keep your spare tire inflated, a set of jumper cables handy.
    • If your car breaks down, roll up all the windows, turn on the emergency flashers, and stay in the car until help arrives. Don’t open the car unless trusted assistance arrives like police, or a wrecker service that you have called.
    • Enroll in a motorist assistance program like AAA
    • Don’t mark your keys with your name, address, phone, license number etc. If they are found they can provide access to your home or car. Only give a parking attendant the keys to your car, never your dorm/apartment.
    • Never pick up hitchhikers. Consider your safety before agreeing to share a ride with someone.

    Parties and Activities

    • Before going out to a party or activity, always have a friend with you and decide in advance when you will leave. Always leave together. Do not stay somewhere alone. Check in with your friends during the party/activity to make sure they are safe.
    • Plan in advance how you are going to get home.
    • Take a cellphone and emergency cash with you.
    • Don’t accept drinks from someone you don’t trust. Always pour your own drinks and always keep control of your drinks, so someone cannot tamper with them. If you put it down, do not drink it, get another. Rape drugs can easily be put into drinks without you knowing.

    Drinking and Drugs

    • Don’t do illegal activities.
    • Drugs and alcohol decrease your ability to care for yourself and make good decisions.
    • Don’t drink if you are under aged. Don’t put yourself in situations where people can think you are drinking under aged.
    • Don’t do drugs.
    • If you do drink, drink responsibly.
    • If someone has drunk too much, make sure they get home and are okay. Stay with them if needed or get medical help. Remember to do what is right for everyone’s safety and health. Call the police, ambulance or other help.

    Dating

    • Use common sense. If your instincts say something is not right, get out of the situation.
    • Going out in a group is safer, especially for first, blind dates or people you have met online. Meet in public places.
    • Always tell your trusted friends where you are going and when you will return.
    • Plan in advance how you are going to get home.
    • Take a cellphone and emergency cash with you.
    • Don’t leave a party/activity with someone you have just met.
    • Plan ahead to protect yourself and your partner from pregnancy and sexually transmitted infections. Remember, contraceptives do not work if they are left in your wallet, purse, etc..

      For any person, male or female, saying “No” means No. Period. No discussion. The person does not want to have sex.

    • Never have sex with anyone who is inebriated or passed out. This is sexual assault.
    • Just because someone dresses in a certain way, agrees to go home with you, is kissing you or performing other sexual intimacies, previously had sex with you, or anything else, DOES NOT MEAN THEY AGREE TO HAVE SEXUAL INTERCOURSE WITH YOU.
    • Never force or coerce someone into have sex. If you see someone who appears to be pressuring or forcing someone into a sexual or other situation, do not be afraid to intervene or call for help.
    • Always check with your partner, several times to see if they still are consenting to have sex.
    • If sexual violence occurs, get help right away by calling the police, or crisis phone numbers, or going to the hospital.

    Online

    • Set up virus protection and firewalls on your laptop.
    • Don’t use public Wi-Fi, when transmitting personal or financial information
    • Use pseudonyms online and don’t give out personal information like your address, phone etc. If you call someone you met online, use phone number ID blockers
    • Check your privacy settings on social media monthly
    • Be careful of your “away” messages as this can tell people of your activities.

Questions for Further Discussion
1. What other safety equipment should a college student have available?
2. What other tips do you recommend to college students?

Related Cases

To Learn More
To view pediatric review articles on this topic from the past year check PubMed.

Evidence-based medicine information on this topic can be found at SearchingPediatrics.com, the National Guideline Clearinghouse and the Cochrane Database of Systematic Reviews.

Information prescriptions for patients can be found at MedlinePlus for this topic: College Health.

To view current news articles on this topic check Google News.

To view images related to this topic check Google Images.

To view videos related to this topic check YouTube Videos.

Sarkis S. 50 Tips for College Students.
Available from the Internet at https://www.psychologytoday.com/blog/here-there-and-everywhere/201008/50-tips-college-students (rev. 8/23/10, cited 3/3/15).

Campus Safety Magazine. Back-to-School Safety Tips. 9/7/2011
Available from the Internet at http://www.campussafetymagazine.com/article/Back-to-School-Safety-Tips (rev. 9/7/11, cited 3/3/15).

State Farm Insurance. 15 Safety Tips for College Students.
Available from the Internet at http://learningcenter.statefarm.com/safety-2/family-1/15-safety-tips-for-college-students/ (rev. 7/18/13, cited 3/3/15).

Hoyt E. Top 10 Safety Tips for College Students.
Available from the Internet at http://www.fastweb.com/student-life/articles/top-10-safety-tips-for-college-students (rev. 6/27/14, cited 3/3/15).

Loyola University. Safety Tips For Students While at College.
Available from the Internet at http://finance.loyno.edu/police/safety-tips-students-while-college (rev. 2015, cited 3/3/15).


Author

Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa Children’s Hospital

When Do Feet Have Arches?

Patient Presentation
A 3.5-year-old female came to clinic with a history of intermittently saying that her feet hurt. Her father said that it started recently but could not say for how long. The child only said her feet hurt but it did not stop her from playing or other activities. He was also unable to say when it occurred throughout the day or how many times per week. He was certain that it never bothered her sleep nor did she have limping, falling, or redness or stiffness of any body parts. The father was worried because he had flat feet that bothered him doing his job which required him to walk or stand for long periods of time on a hard surface. He had gotten relief with orthotically fitted shoes. He thought that his daughter should have some special shoes also because she had flat feet also. The past medical history showed a healthy child. The family history showed no orthopaedic, rheumatological or neurological problems in the family. The review of systems was negative for fevers, rashes, eye problems, excessive fatigue or lethargy.

The pertinent physical exam showed a well-appearing female with normal vital signs and growth parameters in the 10-25%. HEENT showed no obvious eye abnormalities. She had no rashes, or changes in her nails. Neurologically she had good tone and strength with normal DTRs. Her lower extremities including her hips showed no erythema or edema and had normal range of motion. No pain could be elicited with movement or pressure. She had a normal gait. When standing, her feet were flat with a minimal medial arch. When on her tiptoes or when sitting her arch became curved. Alignment of the lower leg with the foot was normal. Her shoes did not appear to have excessive or abnormal wear, and appeared to fit well.

The diagnosis of a flexible flat foot that appeared to be normal for age was made. As the child did not appear to be bothered by the flat feet and the history was somewhat vague, the pediatrician counseled to monitor the child and keep a symptom diary. She pointed out how the feet did have an arch but when standing the arch became flat and the flatness by itself was not a reason to intervene. The father agreed to followup at her next well child appointment in a couple months if the symptoms did not change or worsen before then.

Discussion
Pes planus or flat foot is a common presentation in children and is defined as the absent or diminished longitudinal medial foot arch. Parents usually become more concerned if the child appears to have problems with walking, tripping or falling, problems with alignment (i.e. feet turning outward or inward) or if there is perceived discomfort. Some parents of older children will become concerned when they notice excessive or abnormal shoe wear.

The differential diagnosis in rare cases also includes rheumatologic, neurologic, neoplastic and genetic syndromes such as Ehler-Danlos and Marfan syndrome. The differential diagnosis of leg pain can be found here, and the differential diagnosis for intoeing and outtoeing can be found here.

A history of chronic pain and/or rheumatological or neurological origins makes other diagnoses more likely. A history of trauma, gait abnormalities or refusal to bear weight should be gathered.

Examination of the entire extremity is important checking for decreased range of motion, joint swelling or specific areas of pain. Feet should be examined with barefeet on a flat surface about shoulder width apart. The foot’s longitudinal arch may be absent or minimal with the heel in slight valgus. When asked to raise on toes or when seated, the arch returns. With weight bearing the heal swings varus also. When these arch changes are accompanied by no changes in range of motion, it is called a flexible flatfoot. The legs should also examined for possible torsion, and ligamentous laxity should be assessed throughout the body. Gait should also be examined. Any decrease in motion of the foot joint should be of concern for other disease processes. However, there are many patients who also have rigid flat feet who do not have other problems or need treatment.

For most patients no testing is necessary. If a child has a significant abnormality such as severe flat feet, real pain, rigidity or other concerns for alternative diagnoses then plain radiographs are a first step. Additional imaging or blood work depends on the clinical scenario. The majority of flexible flat feet do not require any treatment. Orthotics or other specially fitted shoes are sometimes prescribed and may be helpful in truly painful flexible flat feet.

Learning Point
The natural arch in infants is flat and because of normal ligamentous laxity continues throughout early childhood. Most children < 6 years old have flexible flat feet. The arch usually fully develops by age 10 but 15-23% of adults have flat feet.

Questions for Further Discussion
1. What are indications for referral to a podiatrist?
2. How often do children outgrow their shoes?

Related Cases

To Learn More
To view pediatric review articles on this topic from the past year check PubMed.

Evidence-based medicine information on this topic can be found at SearchingPediatrics.com, the National Guideline Clearinghouse and the Cochrane Database of Systematic Reviews.

Information prescriptions for patients can be found at MedlinePlus for this topic: Foot Injuries and Disorders

To view current news articles on this topic check Google News.

To view images related to this topic check Google Images.

To view videos related to this topic check YouTube Videos.

Jane MacKenzie A, Rome K, Evans AM. The efficacy of nonsurgical interventions for pediatric flexible flat foot: a critical review. J Pediatr Orthop. 2012 Dec;32(8):830-4.

Graham ME. Congenital talotarsal joint displacement and pes planovalgus: evaluation, conservative management, and surgical management. Clin Podiatr Med Surg. 2013 Oct;30(4):567-81.

Dare DM, Dodwell ER. Pediatric flatfoot: cause, epidemiology, assessment, and treatment. Curr Opin Pediatr. 2014 Feb;26(1):93-100.

Author

Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa Children’s Hospital

What Temperature Should Food Be Cooked To for Botulism Prevention?

Patient Presentation
The mother of an 11-month-old infant telephoned as she was cooking dinner and realized that she had put honey into the family’s stew. The food was being cooked in a home slow-cooker and would be cooked for several hours. She wanted to know if the infant could still eat the food since it would otherwise be appropriate for her. The nurse was not sure and asked the pediatrician who checked several reliable sources on the Internet. The pediatrician felt that although it was unlikely that a small amount of honey in the food would cause problems, the C. botulinum spores would not be killed at this temperature and advised not to feed the stew to the infant. He recommended other age-appropriate foods be offered instead.

Discussion
Clostridium botulinum is a gram-positive, motile, anaerobic rod. C. botulinum produces spores which themselves produce a toxin that causes paralytic disease which may be fatal. About 145 cases per year are reported in the US.

  • Foodborne botulism is caused by eating food contaminated with the spores or toxin. 15% of US cases yearly.
  • Wound botulism is caused by a wound that is infected with the spores which produces toxin causing botulism. 20% of cases yearly.
  • Infantile botulism is considered separate from foodborne botulism and is caused by consuming the spores and the toxin is produced in the infant’s gut causing the disease. Adults can have the same problem but it is extremely rare. 65% of US cases yearly.
  • Iatrogenic – caused by an overdose of botulinum toxin.
  • Inhalation botulism is very rare.

Classic symptoms includes visual changes (e.g. blurred or double vision, ptosis), speech and swallowing difficulties, dry mouth and muscle weakness. Infants have a weak cry, poor tone and weakness, poor feeding and lethargy. If untreated symptoms can progress to paralysis of the extremities, trunk and respiratory muscles. With foodborne disease, symptoms can occur at 6 hours – 10 days after eating the contaminated food but generally within 18-26 hours.

The differential diagnosis for infantile botulism commonly includes meningitis/sepsis, electrolyte abnormalities, congenital myopathy and Werdnig-Hoffman disease.

Learning Point
There is no vaccine for C. botulinum, and anti-toxin is not useful for prevention. Heating to high temperatures will kill the spores. Temperature greater than boiling (212°F) is needed to kill spores so pressure cookers are recommended for home canning (reaching at least 250-250°F). The toxin is heat-labile though and can be destroyed at > 185°F after five minutes or longer, or at > 176°F for 10 minutes or longer. Boiling homecanned foods for 10 minutes or longer is recommended.

Home canned foods should follow strict hygienic practices to reduce contamination, especially low acidic foods such as asparagus, green beans, beets and corn. But any food has the potential to be contaminated. Boiling home-canned foods for 10 minutes is recommended to ensure safety.

Potatoes baked in aluminum foil do not kill spores and may actually help spores germinate and produce toxin if held at room temperature. Potatoes in foil must be kept hot before consumption or refrigerated. Oils that are infused with herbs or garlic should be refrigerated.

Honey can contain spores of C. botulinum and has been a source of infection for infants. Children less than 12 months old should not be fed honey. For persons older than 1 year it is safe.

All leftover food should be refrigerated within 2 hours after cooking and within 1 hour if the ambient temperature is > 90°F.

If ever in doubt about potential safety the food should not be consumed.

Questions for Further Discussion
1. What food sources are potentially contaminated with C. botulinum?
2. How is botulism treated?
3. What other cultural practices can put an infant at risk for C. botulinum?
4. Why is Botox® safe?

Related Cases

To Learn More
To view pediatric review articles on this topic from the past year check PubMed.

Evidence-based medicine information on this topic can be found at SearchingPediatrics.com, the National Guideline Clearinghouse and the Cochrane Database of Systematic Reviews.

Information prescriptions for patients can be found at MedlinePlus for this topic: Botulism

To view current news articles on this topic check Google News.

To view images related to this topic check Google Images.

To view videos related to this topic check YouTube Videos.

Schneider KR, Silverberg R, Chang A, Goodrich Schneider RM. Preventing Foodborne Illness: Clostridium botulinum. University of Florida IFAS Extension. Available from the Internet at http://edis.ifas.ufl.edu/fs104 (cited 2/17/15).

UCSB Science Line. What Kills Botulism?. University of California Santa Barbara. Available from the Internet at
http://scienceline.ucsb.edu/getkey.php?key=1307
(cited 2/17/15).

Centers for Disease Control. Botulism Facts for HealthCare Providers. Available from the Internet at http://emergency.cdc.gov/agent/botulism/hcpfacts.asp (rev. 4/19/2006, cited 2/17/15).

Centers for Disease Control. Botulism Overview for Clinicians: Prevention. Available from the Internet at http://emergency.cdc.gov/agent/Botulism/clinicians/prevention.asp (rev. 10/06/2006, cited 2/17/15).

World Health Organization. Botulism. Available from the Internet at http://www.who.int/mediacentre/factsheets/fs270/en/ (rev. 8/13, cited 2/17/15).

Centers for Disease Control. Botulism. Available from the Internet at http://www.cdc.gov/nczved/divisions/dfbmd/diseases/botulism/ (rev. 4/25/14, cited 2/17/15).

Author

Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa Children’s Hospital