Management Of Illness Research Articles

Cost-effectiveness of village health worker-led integrated community case management (iCCM) versus health facility based management for childhood illnesses in rural southwestern Uganda

BackgroundIn Uganda, village health workers (VHWs) manage childhood illness under the integrated community case management (iCCM) strategy. Care is provided for malaria, pneumonia, and diarrhoea in a community setting. Currently, there is limited evidence on the cost-effectiveness of iCCM in comparison to health facility-based management for childhood illnesses. This study examined the cost-effectiveness of the management of childhood illness using the VHW-led iCCM against health facility-based services in rural south-western Uganda.MethodsData on the costs and effectiveness of VHW-led iCCM versus health facility-based services for the management of childhood illness was collected in one sub-county in rural southwestern Uganda. Costing was performed using the ingredients approach. Effectiveness was measured as the number of under-five children appropriately treated. The Incremental Cost-Effectiveness Ratio (ICER) was calculated from the provider perspective.ResultsBased on the decision model for this study, the cost for 100 children treated was US$628.27 under the VHW led iCCM and US$87.19 for the health facility based services, while the effectiveness was 77 and 71 children treated for VHW led iCCM and health facility-based services, respectively. An ICER of US$6.67 per under five-year child treated appropriately for malaria, pneumonia and diarrhoea was derived for the provider perspective.ConclusionThe health facility based services are less costly when compared to the VHW led iCCM per child treated appropriately. The VHW led iCCM was however more effective with regard to the number of children treated appropriately for malaria, pneumonia and diarrhoea. Considering the public health expenditure per capita for Uganda as the willingness to pay threshold, VHW led iCCM is a cost-effective strategy. VHW led iCCM should, therefore, be enhanced and sustained as an option to complement the health facility-based services for treatment of childhood illness in rural contexts.

AN OVERVIEW OF SOME HERBAL ANTIDEPRESSANT PLANTS

There are numerous ways to categorize and treat depression, which is a diverse mood disease. The illness is caused by factors such as 5-HT, NA, and MAO-A inhibition and stimulation. Reduced curiosity about pleasure, feelings of inappropriate guilt or worthlessness, a drop in hunger and sexual desire, sleeplessness, and persistent suicidal thoughts are some of the symptoms. There are several synthetic medications used to treat depression, but not all of them make patients happy, and some of them may have negative side effects. Many have turned to well-liked traditional herbal remedies to avoid the negative effects of allopathic therapy. Due to their broad application, therapeutic efficacy, and little to negligible adverse effects, herbal medications are currently used worldwide. Several medicinal plants and medicines derived from these plants have shown antidepressant properties by the combined effect of their medicinal constituents. We discuss promising novel medicinal products targets for the management of major depressive illness in this review. We address the potential antidepressant benefits of selectively targeting receptors, including opioid, G-protein-coupled, and metabotropic glutamate receptors. Since they may also have therapeutic value, we also talk about substances that target biological processes, including inflammation, the gut microbiota, the cholesterol biosynthesis pathway, and the hypothalamic-pituitary-adrenal axis. Lastly, we offer a synopsis of all the plants displayed in graphical format, together with an overview of the antidepressant plants which currently are widely accessible.

Impact of timing of antimicrobial therapy on outcome and mortality in severe sepsis and septic shock

Even though new antimicrobial treatments have been available for over 60 years, the fatality rate from septic shock has not decreased. Evolutionary pressure on microbial pathogens has, as expected, led to selection towards resistant species as a consequence of the creation of ever more broad-spectrum and strong antimicrobials. The ineffectiveness of antibiotic treatment of septic shock un the decades that followed may have been a result of this phenomena. The treatment of septic shock has traditionally focused on resuscitative measures. The management of these serious illnesses has not prioritised the prompt provision of effective antibiotic treatment.

Health Profile of Workers at Gas Station X Maulafa District Kupang City

Gas stations are areas that operate in the petroleum sector where repeated exposure to the products produced (butane, pentane, isopentane, benzene, alkylbenzene, toluene, and xylene) can have an impact in the form of health problems. The individuals with the greatest exposure to gas station products are the workers. According to data, during the period from 2016 to 2018 there were 120 cases of work accidents around gas stations. The use of Personal Protective Equipment (PPE) and training regarding the prevention for the worker and management of accidents and illnesses resulting from working at gas stations are important in ensuring worker safety. According to research that has been conducted, it was found that the use of Personal Protective Equipment (PPE) is still very low among Gas Station X workers, Maulafa District, Kupang City. Training and equipment that support Occupational Safety and Health programs are also not available to the majority of workers. This is the cause of health problems among Gas Station X workers, Maulafa District, Kupang City. Method: This research is a quantitative study with a cross sectional approach and involved 12 respondents. This study data collection techniques by interview dan physical examination directly to the samples at Gas Station X Maulafa District, Kupang City. Result: Based on the research results, it was found that the majority of Gas Station The health problems found were Peripheral Vertigo (16%), Tension Type Headache (TTH) (8%), Allergic Rhinitis (8%) and Irritant Contact Dermatitis (8%). Conclusion: An occupational risk factor that can affect the occupational safety and health of employees at GAS STATION X is exposure to fuel oil which contains volatile substances. It was found that 4 out of 12 workers at the gas station in Maulafa District, Kupang City experienced health problems, the health problems they experienced were Peripheral Vertigo, Tension Type Headache, Allergic Rhinitis and Irritant ...........

Unveiling the potential of chitosan-coated lipid nanoparticles in drug delivery for management of critical illness: a review.

Chitosan (CT), a natural, cationic, chemically stable molecule, biocompatible, biodegradable, nontoxic, polysaccharide derived from the deacetylation of chitin, has very uniquely surfaced as a material of promise for drug delivery and biomedical applications. For the oral, ocular, cutaneous, pulmonary, and nose-to-brain routes, CT-coated nanoparticles (CTCNPs) have numerous advantages, consisting of improved controlled drug release, physicochemical stability, improved cell and tissue interactions, and increased bioavailability and efficacy of the active ingredient. CTCNPs have a broad range of therapeutic properties including anticancer, antiviral, antifungal, anti-inflammatory, antibacterial properties, treating neurological disorders, and other diseases. This has led to substantial research into the many potential uses of CT as a drug delivery vehicle. CT has also been employed in a wide range of biomedical processes, including bone and cartilage tissue regeneration, ocular tissue regeneration, periodontal tissue regeneration, heart tissue regeneration, and wound healing. Additionally, CT has been used in cosmeceutical, bioimaging, immunization, and gene transfer applications. CT exhibits a number of biological activities, which are the basis for its remarkable potential for use as a drug delivery vehicle, and these activities are covered in detail in this article. The alterations applied to CT to obtain the necessary properties have been described.

Evaluation of integrated community case management of the common childhood illness program in Gondar city, northwest Ethiopia: a case study evaluation design

BackgroundIntegrated Community Case Management (ICCM) of common childhood illness is one of the global initiatives to reduce mortality among under-five children by two-thirds. It is also implemented in Ethiopia to improve community access and coverage of health services. However, as per our best knowledge the implementation status of integrated community case management in the study area is not well evaluated. Therefore, this study aimed to evaluate the implementation status of the integrated community case management program in Gondar City, Northwest Ethiopia.MethodsA single case study design with mixed methods was employed to evaluate the process of integrated community case management for common childhood illness in Gondar town from March 17 to April 17, 2022. The availability, compliance, and acceptability dimensions of the program implementation were evaluated using 49 indicators. In this evaluation, 484 mothers or caregivers participated in exit interviews; 230 records were reviewed, 21 key informants were interviewed; and 42 observations were included. To identify the predictor variables associated with acceptability, we used a multivariable logistic regression analysis. Statistically significant variables were identified based on the adjusted odds ratio (AOR) with a 95% confidence interval (CI) and p-value. The qualitative data was recorded, transcribed, and translated into English, and thematic analysis was carried out.ResultsThe overall implementation of integrated community case management was 81.5%, of which availability (84.2%), compliance (83.1%), and acceptability (75.3%) contributed. Some drugs and medical equipment, like Cotrimoxazole, vitamin K, a timer, and a resuscitation bag, were stocked out. Health care providers complained that lack of refreshment training and continuous supportive supervision was the common challenges that led to a skill gap for effective program delivery. Educational status (primary AOR = 0.27, 95% CI:0.11–0.52), secondary AOR = 0.16, 95% CI:0.07–0.39), and college and above AOR = 0.08, 95% CI:0.07–0.39), prescribed drug availability (AOR = 2.17, 95% CI:1.14–4.10), travel time to the to the ICCM site (AOR = 3.8, 95% CI:1.99–7.35), and waiting time (AOR = 2.80, 95% CI:1.16–6.79) were factors associated with the acceptability of the program by caregivers.Conclusion and recommendationThe overall implementation status of the integrated community case management program was judged as good. However, there were gaps observed in the assessment, classification, and treatment of diseases. Educational status, availability of the prescribed drugs, waiting time and travel time to integrated community case management sites were factors associated with the program acceptability. Continuous supportive supervision for health facilities, refreshment training for HEW’s to maximize compliance, construction clean water sources for HPs, and conducting longitudinal studies for the future are the forwarded recommendation.

Differences between parents' and paediatricians' perceptions of mild respiratory infections in childhood: contrast study.

Mild respiratory infections are a common reason for consultation in paediatrics, both in the emergency department and in primary care clinics. These conditions, mostly viral and self-limiting, have a significant impact on the healthcare system, school and work absenteeism, and family routines. Despite being common and banal illnesses from a medical perspective, they involve a significant concern in families. The main objective of the contrast study was to compare the perceptions of parents and paediatricians regarding mild respiratory infections in childhood and their impact on family conciliation. Two online, cross-sectional surveys were conducted among Spanish paediatricians and parents with children aged 6 months to 12 years, involving 504 paediatricians and 1,447 families, with questions on attitudes towards visits to the paediatric consultation, care burden of minor pathologies, work, and family conciliation, and treatment and prevention of these illnesses. Results showed significant differences in paediatricians' and parents' perceptions in many aspects. According to 34.5% of paediatricians and 27% of parents, families regularly go to the paediatrician without a scheduled visit. Only 4% of parents report having self-medicated their child, while paediatricians raise this percentage significantly to 48%. Regarding the question: "it is normal for a child to have an average of 4 colds a year," only 25.5% of the surveyed families "strongly agree" unlike to 70.2% of paediatricians. 72.8% of paediatricians "strongly agree" with: "in my opinion, it is good for children to get sick to improve their immune system" reduced to 45.9% of parents. Consultations for minor pathologies represent a "high workload" for 60.9% of paediatricians, while this opinion is agreed by only 18.9% of the parents. Mild respiratory infections in childhood are perceived differently by paediatricians and parents. While paediatricians perceive them as a common and manageable phenomenon, parents tend to show higher concern and demand for medical attention. This study underlines the need to improve communication between paediatricians and parents to align perceptions, optimise the use of the health system resources, and improve the efficiency in the management of these common paediatric illnesses.

Role of Artificial Intelligence in Endoscopic Intervention: A Clinical Review.

Gastrointestinal diseases are increasing in global prevalence. As a result, the contribution to both mortality and healthcare costs is increasing. While interventions utilizing scoping techniques or ultrasound are crucial to both the timely diagnosis and management of illness, a few limitations are associated with these techniques. Artificial intelligence, using computerized diagnoses, deep learning systems, or neural networks, is increasingly being employed in multiple aspects of medicine to improve the characteristics and outcomes of these tools. Therefore, this review aims to discuss applications of artificial intelligence in endoscopy, colonoscopy, and endoscopic ultrasound.

Typhus Fever- A Diagnosis Often Missed as A Cause of Fever.

Background: In tropical countries epidemic and endemic typhus are sometimes missdiagnosed as typhoid fever. Typhus infection is emerging in the subcontinent and clinically presents as nonspecific febrile illness. So high index of clinical suspicion is essential and the objective of the study was to detect typhus infection as a cause of febrile illness. Materials &Method: This is a prospective observational study done from January to December 2019. A total 50 patients of different age groups were taken randomly who were suffering from fever for more than 7 days. All relevant investigations including CBC, Dengue serological test, Widal test, urine routine examination and C/S, blood C/S, chest x-ray were done. Patients not responding to conventional antibiotic therapy and having persistent fever were further investigated for typhus fever with Weil-Felix test. Results: Out of 50 patients 35 were male; age range was 2 to 12 years. Mean duration of fever was 10 days. Blood for CBC showed nonspecific findings, Blood culture and urine for c/s were negative for bacterial growth, dengue serological tests were negative, chest x-ray were normal (except 2 patients had pneumonia). Weil-Felix tests were positive in all cases. 12 cases were positive for both Widal test and Weil-Felix test and in 8 cases blood c/s were also positive with Weil-Felix test. Treatment changed to Doxycycline or Azithromycin in cases of typhus fever. Conclusion: Typhus fever should be taken into account in the management of febrile illness who were admitted without a confirmed cause of fever. BANGLADESH J CHILD HEALTH 2022; VOL 46 (2) : 54-57

AI-Enabled Smart Jacket : Revolutionizing Healthcare Monitoring and Environmental Control

The AI smart jacket represents a groundbreaking innovation in healthcare monitoring, merging wearable technology, advanced sensors, and machine learning algorithms. This wearable device integrates GPS and biometric sensors for real-time data capture, facilitating remote access to health metrics via wireless networking. With a focus on user comfort and privacy, the jacket features machine-washable fabrics and robust security measures. Its array of functionalities includes temperature adjustment, SOS capability, oximeter, ECG monitoring, pulse rate tracking, and a fan with massage functions. The jacket's versatility extends from chronic illness management to elderly care, promising to enhance overall well-being and quality of life. By seamlessly integrating technology into daily life, the AI smart jacket stands as a pioneering solution at the forefront of healthcare innovation.

Infant Mortality Decline in Zambia: To What Extent Did Maternal Education Influence Infant Mortality Rate Decline for the Period 1992 to 2018?

Purpose: In Zambia, infant mortality has reduced from 107 per 1000 live births in 1992, to 42 per 1000 live births during the 2018 period. Across the Globe, it is argued that maternal education (ME) contributes to the reduction in infant mortality (IM). However, the extent to which maternal education influenced the decline in infant mortality in Zambia for the period 1992 to 2018 was not clear. Therefore, this study sought to investigate the extent to which ME influenced the decline in IM in Zambia from 1992 to 2018. Materials and Methods: This study was a secondary data analysis (Trend Analysis). Zambia Demographic and Health Survey (ZDHS) data sets: 1992 to 2018 were used in the analyses. The unit of analysis was IM with sample sizes: 6169, 7066, 6526, 6025,12916 and 9959 respective to the ZDHS years. All analyses were done using SPSS version 25.0. Univariate analysis was done for descriptive statistics. Bivariate analysis, Chi-square was used at 5% level of significance for associations. Point Bi-serial Correction was done between ME and IM at 1% and/or 5% levels of significance. Binary logistic regression at 5% level of significance was used to determine the influence of predictors on IM. Findings: It was found that ME was (negatively) related to IM from 1992 to 2001-2. The correlation coefficients were smaller negatives indicating a very weak negative relationship between ME and IM. In multivariate analysis ME was found to be negatively associated with IM, from 1992 to 2001-2 only. Among the interactions, only the interactions between ME and contraceptive use; ME and preceding birth interval; ME and breast feeding; and ME and antenatal care (visits) significantly influenced the decline in IM from 1992 to 2018. Singularly, ME influenced the decline in IM rate to a lesser extent (only marginally). When interacted with contraceptive use, preceding birth interval, breast feeding and antenatal care, ME influenced the decline in IM to a larger extent. Implications to Theory, Practice and Policy: in order to come up with more robust interventions to further reduce IM in the country, these interactions should be considered in the planning and implementation of child health programs such as the child health nutrition, national partnership for maternal, new-born and child health, child health week, Integrated Community Case Management of Childhood Illnesses (ICCM), and the Support to Safe motherhood and New-born Health among others.

Assessment of factors related to caregivers and children on the IMCI program outcomes in Baghdad City in 2021

Background: The implementation of the Integrated Management of Childhood Illness (IMCI) program has led to enhancement in outcomes for many treatable childhood diseases. This study aims to assess how implementing IMCI affects child mortality and morbidity in Iraq. Methods: A cross-sectional study spanning from January to December 2021 was carried out at primary healthcare centers (PHCCs) with IMCI units in Baghdad, Iraq. Using a lottery sampling method, 40 PHCCs were randomly chosen from a total of 235 centers across both sides of the city. A universal sampling technique was adopted to select all children attending these PHCCs regularly. With a p-value below 5%, multiple logistic regression analyses were performed to identify the significant independent predictors at a 95% confidence interval. Results: The majority of caregivers were mothers (97.8%), aged 20 to 30 years (75.8%), and housewives (59.2%). Sixty percent of children (6 to 35 months) had normal anthropometric measurements. Bottle feeding was common (44.2%), and most children had a normal neonatal history (82.9%). In bivariate analysis, the severity of illness, severe cases of diarrhea, and acute respiratory infection (ARI) showed significant associations with worsened or not improved outcomes (χ2 = 18.900, p < 0.001; χ2 = 6.265, p= 0.016; and χ2 = 7.549, p= 0.003, respectively). However, multiple logistic regression analysis indicated that mild and moderate illness severity (OR = 10.634, 95% CI: 6.985 to 16.192, p < 0.001), strict breastfeeding (OR = 3.307, 95% CI: 1.703 to 6.421, p < 0.001), and completing treatment at home (OR = 6.190, 95% CI: 4.115 to 9.311, p < 0.001) significantly improved outcomes through IMCI services. Conclusion: Severe illness, especially in diarrhea and ARI, correlates with poorer outcomes. Conversely, exclusive breastfeeding, prompt medical attention within a day of illness onset, and completing home treatment are associated with improved outcomes.

Measuring Vital Signs such as Temperature, BPM, Humidity using different IOT Sensors and Designing a Mobile Application using Firebase

Abstract: This research describes the creation of an Internet of Things-based smart health surveillance system that allows for the real-time data tracking of a person's vital signs. An ESP8266 Node MCU microcontroller is integrated with temperature, humidity, and heart rate sensors in the system to gather information on the user's body temperature, ambient humidity, and heart rate. A specially created Android mobile application shows the gathered data, which is wirelessly sent to a Firebase cloud database. With the use of the mobile app, users can easily create individualized profiles, view vital sign data, and get warnings. Early health issue diagnosis and proactive illness management are aided by successful implementation, which shows that lowcost IoT devices, cloud computing, and mobile technologies may all be used for effective remote health monitoring

Telehealth Monitoring System for Chronic Disease Management

Telehealth Monitoring System for Chronic Disease Management

The Tools for Integrated Management of Childhood Illness (TIMCI) study protocol: a multi-country mixed-method evaluation of pulse oximetry and clinical decision support algorithms.

Effective and sustainable strategies are needed to address the burden of preventable deaths among children under-five in resource-constrained settings. The Tools for Integrated Management of Childhood Illness (TIMCI) project aims to support healthcare providers to identify and manage severe illness, whilst promoting resource stewardship, by introducing pulse oximetry and clinical decision support algorithms (CDSAs) to primary care facilities in India, Kenya, Senegal and Tanzania. Health impact is assessed through: a pragmatic parallel group, superiority cluster randomised controlled trial (RCT), with primary care facilities randomly allocated (1:1) in India to pulse oximetry or control, and (1:1:1) in Tanzania to pulse oximetry plus CDSA, pulse oximetry, or control; and through a quasi-experimental pre-post study in Kenya and Senegal. Devices are implemented with guidance and training, mentorship, and community engagement. Sociodemographic and clinical data are collected from caregivers and records of enrolled sick children aged 0-59 months at study facilities, with phone follow-up on Day 7 (and Day 28 in the RCT). The primary outcomes assessed for the RCT are severe complications (mortality and secondary hospitalisations) by Day 7 and primary hospitalisations (within 24 hours and with referral); and, for the pre-post study, referrals and antibiotic. Secondary outcomes on other aspects of health status, hypoxaemia, referral, follow-up and antimicrobial prescription are also evaluated. In all countries, embedded mixed-method studies further evaluate the effects of the intervention on care and care processes, implementation, cost and cost-effectiveness. Pilot and baseline studies started mid-2021, RCT and post-intervention mid-2022, with anticipated completion mid-2023 and first results late-2023. Study approval has been granted by all relevant institutional review boards, national and WHO ethical review committees. Findings will be shared with communities, healthcare providers, Ministries of Health and other local, national and international stakeholders to facilitate evidence-based decision-making on scale-up.Study registration: NCT04910750 and NCT05065320.

Integrated Care in Neurology: The Current Landscape and Future Directions.

The rising burden of neurological disorders poses significant challenges to healthcare systems worldwide. There has been an increasing momentum to apply integrated approaches to the management of several chronic illnesses in order to address systemic healthcare challenges and improve the quality of care for patients. The aim of this paper is to provide a narrative review of the current landscape of integrated care in neurology. We identified a growing body of research from countries around the world applying a variety of integrated care models to the treatment of common neurological conditions. Based on our findings, we discuss opportunities for further study in this area. Finally, we discuss the future of integrated care in Canada, including unique geographic, historical, and economic considerations, and the role that integrated care may play in addressing challenges we face in our current healthcare system.

An examination of wearable technology in the field biomedical engineering: A review

A wearable device is a piece of technology that can be worn on the body, designed to be portable, lightweight and equipped with various sensors or features for specific functions. As a game-changer in the field of biomedical engineering, wearable technology provides innovative approaches to illness management, individualized healthcare and health monitoring. This review looks at wearable technology as it stands in the field of biomedical engineering, emphasizing its uses, difficulties and potential. The research examines a wide variety of wearable wireless biosensors, sensor patches, wristwatches, wearable face masks and multi-sensor smart clothing, emphasizing their potential to measure physiological parameters, including blood pressure, heart rate and sleep patterns. This study demonstrates the need for intelligent wearable devices for high-quality signal capture, processing and continuous monitoring of critical parameters. The creation of smart wearables that meet the specified design standards enables the creator of a wearable with reduced power consumption that can be used to monitor the health of patients. This study offers a thorough analysis of wearable technology's present state, obstacles and potential applications in the field of biomedical engineering. It will be of great use to investigators, medical professionals and developers of technology.

Phytochemicals, Herbal Extracts, and Dietary Supplements for Metabolic Disease Management.

Comprehensive and effective care techniques have become essential due to the global epidemic dimensions of metabolic disorders, including diabetes, obesity, and cardiovascular ailments. Recent research highlights the potential of dietary supplements, herbal extracts, and phytochemicals in treating metabolic diseases. This abstract conveys the current state of the science in this field by highlighting these findings' underlying mechanisms and potential therapeutic applications. Plant-based diets contain naturally occurring bioactive molecules termed phytochemicals, which have shown promise in treating various metabolic illnesses. Examples include curcumin, flavonoids, and polyphenols' insulin-sensitizing, antioxidant, and antiinflammatory properties. Herbal extracts, derived from ancient medicinal herbs, have been used by people for years to treat a wide range of ailments. Recent studies have shown the efficacy of these strategies in improving lipid profiles, glucose metabolism, and overall cardiovascular health. Omega-3 fatty acids, vitamins, and minerals are just a few of the numerous nutritional supplements that are critical to metabolic health. These vitamins improve insulin sensitivity, regulate blood sugar, and decrease inflammation. Probiotics and prebiotics also affect the gut flora, which significantly affects metabolic function. These natural medicines' ability to treat metabolic diseases either by themselves or in combination with conventional medical interventions. However, when using it therapeutically, one must consider the differences in doses, individual responses, and bioavailability. The article concludes that phytochemicals, plant extracts, and food supplements offer a promising avenue for the management of metabolic illnesses. Comprehensive research, including clinical studies, is needed to ascertain their safety and efficacy characteristics. When added to treatment strategies, these natural therapies could be helpful supplements that improve overall health and the quality of life among individuals with metabolic diseases. Naringenin, a citrus flavonoid, can potentially prevent kidney injury in hyperuricemia by reducing uric acid, inflammation, apoptosis, DNA damage, and activating antioxidants. Further research and professional consultation are essential. Factors contributing to metabolic diseases, current approaches to management nutritional approaches for managing obesityassociated metabolic impairments in the liver and small intestine, and nutritional approaches for managing obesity-associated metabolic dysregulation are also explained briefly.

Telehealth Utilization and Associations in the United States During the Third Year of the COVID-19 Pandemic: Population-Based Survey Study in 2022.

The COVID-19 pandemic rapidly changed the landscape of clinical practice in the United States; telehealth became an essential mode of health care delivery, yet many components of telehealth use remain unknown years after the disease's emergence. We aim to comprehensively assess telehealth use and its associated factors in the United States. This cross-sectional study used a nationally representative survey (Health Information National Trends Survey) administered to US adults (≥18 years) from March 2022 through November 2022. To assess telehealth adoption, perceptions of telehealth, satisfaction with telehealth, and the telehealth care purpose, we conducted weighted descriptive analyses. To identify the subpopulations with low adoption of telehealth, we developed a weighted multivariable logistic regression model. Among a total of 6252 survey participants, 39.3% (2517/6252) reported telehealth use in the past 12 months (video: 1110/6252, 17.8%; audio: 876/6252, 11.6%). The most prominent reason for not using telehealth was due to telehealth providers failing to offer this option (2200/3529, 63%). The most common reason for respondents not using offered telehealth services was a preference for in-person care (527/578, 84.4%). Primary motivations to use telehealth were providers' recommendations (1716/2517, 72.7%) and convenience (1516/2517, 65.6%), mainly for acute minor illness (600/2397, 29.7%) and chronic condition management (583/2397, 21.4%), yet care purposes differed by age, race/ethnicity, and income. The satisfaction rate was predominately high, with no technical problems (1829/2517, 80.5%), comparable care quality to that of in-person care (1779/2517, 75%), and no privacy concerns (1958/2517, 83.7%). Younger individuals (odd ratios [ORs] 1.48-2.23; 18-64 years vs ≥75 years), women (OR 1.33, 95% CI 1.09-1.61), Hispanic individuals (OR 1.37, 95% CI 1.05-1.80; vs non-Hispanic White), those with more education (OR 1.72, 95% CI 1.03-2.87; at least a college graduate vs less than high school), unemployed individuals (OR 1.25, 95% CI 1.02-1.54), insured individuals (OR 1.83, 95% CI 1.25-2.69), or those with poor general health status (OR 1.66, 95% CI 1.30-2.13) had higher odds of using telehealth. To our best knowledge, this is among the first studies to examine patient factors around telehealth use, including motivations to use, perceptions of, satisfaction with, and care purpose of telehealth, as well as sociodemographic factors associated with telehealth adoption using a nationally representative survey. The wide array of descriptive findings and identified associations will help providers and health systems understand the factors that drive patients toward or away from telehealth visits as the technology becomes more routinely available across the United States, providing future directions for telehealth use and telehealth research.

"A Feeling of Safeness and Freedom": The Promotion of Mental Health Recovery Through Co-Production in an Italian Community Organization.

In mental health promotion, recovery is a process that leads to personal strengthening, control over crucial life decisions, and participation in communities through relevant professional, educational, or family social roles. Co-production, a key aspect of the recovery-oriented approach, emphasizes collaboration and active participation of people with mental health first-hand experience, family members, and citizens. Even though studies on co-production are limited and fragmented, there is evidence that co-production leads to positive outcomes, including improved well-being, empowerment, social connectedness, inclusion, and personal competencies. This study aimed to contribute to the limited literature on co-production in mental health by evaluating the co-production process in a non-profit mental health organization and its impact on empowerment processes and personal recovery outcomes. The research team adopted a collaborative approach and conducted qualitative research, including 13 individual semi-structured interviews and four focus groups. Results showed how the different dimensions of empowerment are promoted in and by the organization: (a) co-production processes supported empowered outcomes on an individual level, such as self-awareness; (b) the organization was perceived to promote empowering processes, such as a sense of safeness and protection; (c) co-production was a mean to build and maintain a network with mental health services that acknowledges the dignity and value of each subjectivity and promotes participation and recovery. Peer support workers were seen as facilitators of mental illness management, and the organization as a place for sharing mental health experiences and fostering individual recovery journeys.