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Purpose: Although there are many studies that have examined substance use and mental health concerns in rural areas, there is a paucity of research related to the prevalence of substance use and mental well‐being in agriculturally based occupations. This study aimed to determine the prevalence of alcohol and opioid misuse and anxiety among adults in agriculturally based occupations in the rural Midwest and to determine the risk factors for alcohol misuse. Methods: Data were collected via mailed surveys with 1,791 surveys returned. Participants completed the Alcohol Use Disorder Identification Test, the Drug Abuse Screening Test‐1, the Generalized Anxiety Disorder Screener, and reported demographic data. Multivariable logistic regression was used to examine factors associated with alcohol misuse. Results: Younger age, male, not married, agriculturally based workers were significantly associated with alcohol misuse. For opioid use, the highest prevalence rate (10%) was found among direct agricultural workers who were not married and in the age group 19‐39. The highest anxiety prevalence rate was found in participants aged 19‐39 (15.5%) who also scored in the highest level of alcohol misuse with a prevalence rate of 27.9%. Conclusions: Future research is suggested in the areas of gender identity and anxiety in agricultural populations and agriculturally based occupations as protective factors for opioid misuse. [ABSTRACT FROM AUTHOR]

Objectives: ICU admission delays can negatively affect patient outcomes, but emergency department volume and boarding times may also affect these decisions and associated patient outcomes. We sought to investigate the effect of emergency department and ICU capacity strain on ICU admission decisions and to examine the effect of emergency department boarding time of critically ill patients on in-hospital mortality.Design: A retrospective cohort study.Setting: Single academic tertiary care hospital.Patients: Adult critically ill emergency department patients for whom a consult for medical ICU admission was requested, over a 21-month period.Interventions: None.Measurements and Main Results: Patient data, including severity of illness (Mortality Probability Model III on Admission), outcomes of mortality and persistent organ dysfunction, and hourly census reports for the emergency department, for all ICUs and all adult wards were compiled. A total of 854 emergency department requests for ICU admission were logged, with 455 (53.3%) as "accept" and 399 (46.7%) as "deny" cases, with median emergency department boarding times 4.2 hours (interquartile range, 2.8-6.3 hr) and 11.7 hours (3.2-20.3 hr) and similar rates of persistent organ dysfunction and/or death 41.5% and 44.6%, respectively. Those accepted were younger (mean ± SD, 61 ± 17 vs 65 ± 18 yr) and more severely ill (median Mortality Probability Model III on Admission score, 15.3% [7.0-29.5%] vs 13.4% [6.3-25.2%]) than those denied admission. In the multivariable model, a full medical ICU was the only hospital-level factor significantly associated with a lower probability of ICU acceptance (odds ratio, 0.55 [95% CI, 0.37-0.81]). Using propensity score analysis to account for imbalances in baseline characteristics between those accepted or denied for ICU admission, longer emergency department boarding time after consult was associated with higher odds of mortality and persistent organ dysfunction (odds ratio, 1.77 [1.07-2.95]/log10 hour increase).Conclusions: ICU admission decisions for critically ill emergency department patients are affected by medical ICU bed availability, though higher emergency department volume and other ICU occupancy did not play a role. Prolonged emergency department boarding times were associated with worse patient outcomes, suggesting a need for improved throughput and targeted care for patients awaiting ICU admission. [ABSTRACT FROM AUTHOR]