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OBJECTIVE: Our goal was to assess whether integration of behavioral and medical services in college settings is associated with decreased use of primary care by patients with mental health diagnoses (MHDs). METHOD: The cohort consisted of 80,219 patients with at least 1 MHD in 21 universities. Two levels of service integration were defined: "standard"-universities with separate electronic health records (EHR) systems and minimal clinical collaboration between services, and "enhanced"-universities with shared EHR and collaborative patient care. Frequency, the total number of primary care visits, and complexity, the total visit length for primary care per unit time, were compared by using multilevel models. RESULTS: Nine schools met the criteria of enhanced clinical integration; a tenth school shifted to enhanced service during the study period. Student and patient demographics and clinical diagnoses were similar between the 2 categories. When controlling for variance in age, sex, and total time in school, patients with MHDs in standard systems had 15.72% (95% confidence interval [CI]: 10.77%-20.44%) more primary care visits and 22.88% (95% CI: 21.42%-24.38%) more time than patients in enhanced systems. CONCLUSIONS: Students with MHDs have significantly lower utilization of primary care services in integrated health care systems, but only a minority of institutions nationally have adopted this model of care. Although further research is needed to specifically assess differences in health outcomes and perceived suffering, it is possible that reduced primary care visits in enhanced integrative service settings with robust mental health support indicates overall reduction in perceived suffering for patients/clients. (PsycINFO Database Record

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OBJECTIVE: This description of the College Health Surveillance Network (CHSN) includes methodology, demography, epidemiology, and health care utilization. PARTICIPANTS: Twenty-three universities representing approximately 730,000 enrolled students contributed data from January 1, 2011, through May 31, 2014. METHODS: Participating schools uploaded de-identified electronic health records from student health services monthly. RESULTS: During this study, just over 800,000 individuals used the health centers, comprising 4.17 million patient encounters. Sixty percent of visits included primary care, 13% mental health, 9% vaccination, and 31% other miscellaneous services. The 5 most common specific diagnostic categories (with annual rates per 100 enrolled students) were preventive (16); respiratory (12); skin, hair, and nails; infectious non-sexually transmitted infection (5 each); and mental health (4). Utilization and epidemiologic trends are identified among subpopulations of students. CONCLUSIONS: CHSN data establish trends in utilization and epidemiologic patterns by college students and the importance of primary and behavioral health care services on campuses.

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Transcranial direct current stimulation (tDCS) continues to demonstrate success as a medical intervention for neurodegenerative diseases, psychological conditions, and traumatic brain injury recovery. One aspect of tDCS still not fully comprehended is the influence of the tDCS electric field on neural functionality. To address this issue, we present a mathematical, multiscale model that couples tDCS administration to neuron electrodynamics. We demonstrate the model's validity and medical applicability with computational simulations using an idealized two-dimensional domain and then an MRI-derived, three-dimensional human head geometry possessing inhomogeneous and anisotropic tissue conductivities. We exemplify the capabilities of these simulations with real-world tDCS electrode configurations and treatment parameters and compare the model's predictions to those attained from medical research studies. The model is implemented using efficient numerical strategies and solution techniques to allow the use of fine computational grids needed by the medical community.

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This pilot study from self-selected institutions of higher education provides an estimate of the causes and rates of mortality among college students between the ages of 18 and 24 years old. One hundred fifty-seven 4-year colleges participated in an online survey of student deaths during one academic year. A total of 254 deaths were reported. The mortality rates (per 100,000) were as follows: total accidental injuries, 10.80; suicide, 6.17; cancer, 1.94; and homicide, 0.53. Within the accident and injury category, alcohol-related vehicular deaths (per 100,000) were 3.37 and alcohol-related nontraffic injuries were 1.49. Men had significantly higher rates of suicide (10.46) than women (2.34). Suggestions for future research and implications of these findings are discussed.

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BACKGROUND: The 2009 novel H1N1 influenza epidemic generated interest in regional and national influenza surveillance methods. Some systems revamped traditional syndromic and laboratory surveillance techniques, whereas others tracked influenza by Internet-based searches or other unique methods. We hypothesized that an influenza-like illness (ILI) surveillance system at a single university hospital would be accurate and useful for monitoring local influenza activity and impact. METHODS: We developed a system of ILI surveillance at 8 sentinel sites associated with a university health care system before the pandemic 2009-10 influenza season. Most sentinel sites used a symptom-based definition of ILI, whereas others used electronic medical records-based definitions. RESULTS: Results of the local ILI surveillance network correlated well with the onset and peak of the influenza season compared with state and regional ILI data, closely approximated cases of microbiologically confirmed influenza, demonstrated early onset of illness in one site in the sentinel site network, and were available several days sooner than data from existing surveillance systems. CONCLUSIONS: Local influenza surveillance at a single-institution level provided timely, useful, and accurate information, which helped guide resource utilization during the pandemic influenza season. The system was an important supplement to state and regional influenza surveillance.

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Heavy drinking and associated negative consequences remain a serious problem among college students. In a secondary analysis of data from two published study, the authors examine the correlation between minimum legal age to purchase and/or consume alcohol and rates of heavy drinking among college students in 22 countries. The published studies use identical definitions of heavy drinking and similar methodologies. In the study of 20 European countries and the United States, there is a positive correlation between prevalence of heavy drinking and both minimum legal purchase age (r =.34) and minimum legal drinking age (r =.19); in the study of Canada and the United States, there is a perfect positive correlation (r = 1.0). Examination of this evidence does not support the conclusion that a lower minimum legal age for purchase and/or consumption of alcoholic beverages is a protective factor for decreasing heavy drinking among college students.

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The United States experienced a shortage of influenza vaccine for the 2004--2005 influenza season. The authors surveyed college health programs to determine whether they had targeted vaccine to priority groups and knew how to reallocate remaining vaccine. They used an electronic message to distribute a Web-based survey to the members of 3 college-affiliated organizations--the Association of American Colleges and Universities, American Association of Community Colleges, American College Health Association--and to subscribers of the Student Health Service Listserv. They received 434 completed surveys. Sixty percent (259) of the respondents stated they had received vaccine and planned to vaccinate their high-risk students, staff, and faculty members; 77% (198) planned to reallocate leftover vaccine. Given the potential for future disruptions of the influenza vaccine supply, the authors recommend that college health programs establish policies to identify members of their high-risk population and also consider providing the live attenuated influenza virus vaccine.

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OBJECTIVE: Heavy episodic alcohol use has been associated with numerous consequences among college students. However, neither the incidence nor the demographic and clinical characteristics of serious health consequences have been clearly defined in this population. This study is conducted to better understand clinical outcomes associated with alcohol use in college students. METHOD: In a prospective observational study, medical records of students presenting to a large university medical center emergency department were examined. Demographic and clinical features of alcohol-related visits were gathered on patients who were enrolled as undergraduates at a 4-year public institution during 2 academic years from July 2000 through June 2002. Enrollment was approximately 12,500 undergraduates per year. RESULTS: Of all emergency visits, 13% were alcohol related; and of all undergraduate students, 0.7% presented with alcohol-related medical conditions each year. Injuries accounted for 53% of all visits, and acute intoxication accounted for 34%. Nine of 185 patients were hospitalized. Men aged 21 years and older had the highest odds of visiting the emergency department. Trauma occurred more frequently among men, students > 18 years of age and white students. Accidents (84%) and fights (16%) were the sources of injuries. Acute intoxication occurred more frequently among women, students < or = 18 years of age and nonwhite students. CONCLUSIONS: Alcohol use contributes to a small yet significant proportion of emergency room visits for college students. Distinctive subgroups of college students, including legal-age drinkers, experience patterns of serious health consequences as a result of problem use of alcohol.

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OBJECTIVE: The estimated blood alcohol concentration (eBAC) is a potentially useful index of alcohol-induced intoxication and impairment. This study investigates the association of the eBAC with negative consequences associated with alcohol use. METHOD: Self-reported negative consequences were assessed using a stratified random sampling of 4,708 undergraduate students at a public university with a total enrollment of 12,550. Survey questions permitted the calculation of the "typical" eBAC for each respondent. The eBACs were correlated with demographic characteristics and self-reported negative consequences. The effectiveness of eBAC in predicting negative consequences was compared with drinks per week and consumption at or above the heavy episodic drinking level by calculating receiver operator characteristic values and incremental validity through multiple logistic regressions. RESULTS: The odds of reporting a higher eBAC were significantly elevated for men, underage underclassmen and members of Greek organizations. The odds of reporting a negative consequence were highly associated with each incremental increase in the eBAC. In correlating with negative consequences, the performance of the eBAC index was not significantly different from drinks per week and the heavy episodic drinking index. CONCLUSIONS: As an index of alcohol consumption, the "typical" eBAC is correlated with 17 self-reported social and health consequences. There are potential advantages in using the eBAC index for assessing alcohol use among college drinkers.

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