Integrating Telepsychiatry Into Rural Primary Care for Upstream Prevention: Feasibility Case Study of the Faith Net Program.

INTRODUCTION: For decades, there has been a deficit of mental health services in rural areas of the United States. Beyond that longstanding need, the COVID-19 pandemic has reportedly increased the prevalence of unmet mental health needs among adults. Presently, many non-critical but urgent mental health concerns are first identified in rural emergency departments. This report describes the results of a 6-month feasibility case study of a program to integrate telepsychiatric triage "upstream" from emergency departments in rural primary care. METHODS: At routine primary care encounters in a single midwestern rural county, patients at risk for moderate-severe or severe depression, expressing thoughts of self-harm, or otherwise presenting in a way that raised clinical concern for mental or behavioral health, were referred to on-site telepsychiatric triage. Patients whose triage indicated further concern were provided six psychiatric and/or social work encounters for stabilization and treatment. RESULTS: 68 patients were referred to telepsychiatric triage during the pilot study (.85% of the estimated adult population in the county). Of those, only two had a documented mental/behavioral health diagnosis prior to triage, but 46 were diagnosed with at least one psychiatric disorder during the program. CONCLUSIONS: This model of telepsychiatric triage was feasible in rural primary care and may support identification and mitigation of unmet mental health needs.

Objectively measured association between air pollution and physical activity, sedentary behavior in college students in Beijing.

The purpose of this study is to examine the association between hourly air pollution on hourly physical activity (PA) and sedentary behavior (SB) among college students in Beijing, China. The secondary aim was to examine such associations varied at specific time. A total of 340 participants were recruited from the Tsinghua University, in Beijing, China. Accelerometers provided PA measures, including moderate-to-vigorous physical activity (MVPA), walking steps, energy expenditure and sedentary time for 7 consecutive days. Corresponding air pollution data by the Beijing Municipal Ecological Environment Bureau in the closed site (Wan Liu site) in Tsinghua University were collected including average hourly air quality index (AQI) and PM2.5 (µg/m³). Associations were estimated using linear individual fixed-effect regressions. We also conducted an air pollution risk perception survey among 2307 freshmen (76.6% males) who were enrolled in Tsinghua in 2016, and the survey was done in May 22-26, 2017. A one level increase in hourly air quality index (AQI) was associated with a reduction in 1-h PA by 0.083 (95% confidence interval [CI] = -0.137, -0.029) minutes of MVPA, 8.8 (95% CI = -15.0, -2.6) walking steps, 0.65 (95% CI = -1.03, -0.27) kcals of energy expenditure. A 10 µg/m³ increase in air pollution concentration in hourly PM2.5 was associated with a reduction in 1-h PA by 0.021 (95% confidence interval [CI] = -0.033, -0.010) minutes of MVPA, 2.2 (95% CI = -3.5, -0.9) walking steps, 0.170 (95% CI = -0.250, -0.089) kcals of energy expenditure an increase in 1-h sedentary behavior 0.045 (0.005, 0.0845). At specific time, stronger negative associations of AQI and PM2.5 air pollution with PA at 8 a.m., 4 p.m., 5 p.m. and 7 p.m. Similarly, stronger positive associations of 1 h AQI and PM2.5 air pollution with SB at 8 a.m., 9 a.m., 11 a.m., and 7 p.m. A total of 94.9% participants (n = 2235) responded "yes" to air pollution change activities in the survey, which may partially explain PA change. Air pollution may discourage physical activity and increases sedentary behavior among freshman students living in Beijing, China. This is preliminary study. The impact of air pollution on physical activity and sedentary behavior at a specific time may be different.

The Association between Air Pollution and Sleep Duration: A Cohort Study of Freshmen at a University in Beijing, China.

Background: Rising levels of air pollution in Beijing, China have become a serious environmental issue affecting human health, and young adults are experiencing high rates of insufficient sleep duration or a lack of sleep. Gaps in previous research remain regarding the relationship between air pollution and sleep duration among young adults. The purpose of this study is to assess the associations between air pollution and sleep duration among college students living in Beijing, China. Methods: We conducted follow-up health surveys on 16,889 freshman students enrolled at Tsinghua University over a five-year study period (2013-2018). Sleep duration was measured using the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI), which has been validated in China to measure sleep duration. Corresponding levels of the average hourly air quality index (AQI), PM2.5 (µg/m3), PM10 (µg/m3), and NO2 (µg/m3) were gathered from data provided by the Beijing Municipal Ecological Environment Bureau in a closed site at Tsinghua University. Multilevel mixed-effects linear regression models were used to analyze the data. Results: One standard deviation increase in air pollution concentration in AQI, PM2.5, PM10, and NO2 was associated with a reduction in daily hours of sleep by 0.68 (95% confidence interval (CI) = 0.63, 0.73), 0.55 (95% CI = 0.51, 0.59), 0.70 (95% CI = 0.64, 0.76), and 0.51 (95% CI = 0.47, 0.54), respectively. Conclusions: Air pollution was associated with a reduction in sleep duration among freshman students living in Beijing, China. Replication of this study is warranted among various populations within China.

Impact of Air Pollution on Sedentary Behavior: A Cohort Study of Freshmen at a University in Beijing, China.

Human populations worldwide have experienced substantial environmental issues in part due to air pollution, notably in China. Gaps in the scientific literature remain regarding the relationship between air pollution and sedentary behavior among young adults in China. The purpose of this study is to examine the effect of air pollution on sedentary behavior among college students living in Beijing, China. We conducted follow-up health surveys on 12,174 freshman students enrolled at Tsinghua University from 2013 to 2017. Sedentary behavior was measured using the short version of the International Physical Activity Questionnaire (IPAQ). Corresponding air pollution data measured by the Ministry of Environmental Protection of the People's Republic of China were collected to include the average hourly air quality index (AQI), PM2.5, PM10, and NO2 (µg/m³). The data were analyzed using linear individual fixed-effect regressions. An increase in air pollution concentration of one standard deviation in AQI, PM2.5, PM10, and NO2 was associated with an increase in weekly total hours of sedentary behavior by 7.35 (95% confidence interval (CI) = 5.89, 8.80), 6.24 (95% CI = 5.00, 7.49), 6.80 (95% CI = 5.46, 8.15), and 7.06 (95% CI = 5.65, 8.47), respectively. In the presence of air pollution, women students tended to increase their sedentary behavior more than men. Air pollution increases sedentary behavior among freshman students living in Beijing, China. Replication of this study is warranted among various populations within China.

The association between ambient fine particulate air pollution and physical activity: a cohort study of university students living in Beijing.

BACKGROUND: Air pollution has become a substantial environmental issue affecting human health and health-related behavior in China. Physical activity is widely accepted as a method to promote health and well-being and is potentially influenced by air pollution. Previous population-based studies have focused on the impact of air pollution on physical activity in the U.S. using a cross-sectional survey method; however, few have examined the impact on middle income countries such as China using follow-up data. The purpose of this study is to examine the impact of ambient fine particulate matter (PM2.5) air pollution on physical activity among freshmen students living in Beijing by use of follow-up data. METHODS: We conducted 4 follow-up health surveys on 3445 freshmen students from Tsinghua University from 2012 to 2013 and 2480 freshmen completed all 4 surveys. Linear individual fixed-effect regressions were performed based on repeated-measure physical activity-related health behaviors and ambient PM2.5 concentrations among the follow-up participants. RESULTS: An increase in ambient PM2.5 concentration by one standard deviation (44.72 µg/m3) was associated with a reduction in 22.32 weekly minutes of vigorous physical activity (95% confidence interval [CI] = 24.88-19.77), a reduction in 10.63 weekly minutes of moderate physical activity (95% CI = 14.61-6.64), a reduction in 32.45 weekly minutes of moderate to vigorous physical activity (MVPA) (95% CI = 37.63-27.28), and a reduction in 226.14 weekly physical activity MET-minute scores (95% CI = 256.06-196.21). The impact of ambient PM2.5 concentration on weekly total minutes of moderate physical activity tended to be greater among males than among females. CONCLUSIONS: Ambient PM2.5 air pollution significantly discouraged physical activity among Chinese freshmen students living in Beijing. Future studies are warranted to replicate study findings in other Chinese cities and universities, and policy interventions are urgently needed to reduce air pollution levels in China.