Health Services and Infrastructure Recovery of a Major Public Hospital in Liberia During the 2014-2016 Ebola Epidemic.

During the 2014-2016 Ebola outbreak, health services in Liberia collapsed. Health care facilities could not support effective infection prevention and control (IPC) practices to prevent Ebola virus disease (EVD) transmission necessitating their closure. This report describes the process by which health services and infrastructure were recovered in the public hospital in Monrovia, Liberia. The authors conducted an assessment of the existing capacity for health care provision, including qualitative interviews with community members, record reviews in Ebola treatment units, and phone calls to health facilities. Assessment information was used to determine necessary actions to re-establish services, including building and environmental renovations, acquiring IPC supplies, changing health care practices, hiring additional staff, developing and using an EVD screening tool, and implementing psychosocial supports. On-site monitoring was continued for 2 years to assess what changes were sustained. Described in the report are 2 cases that highlight the challenge of safely re-establishing services with only a symptom-based screening tool and no laboratory tests available on-site. Despite fears among the public, health workers, and the international community, the actions taken enabled basic health care services to be provided during EVD transmission and led to sustainable improvements. This experience suggests that providing routine medical needs helps limit the morbidity and mortality during times of disease outbreak. (Disaster Med Public Health Preparedness. 2018;13:767-773).

Facilitators and barriers to enrolling in falls prevention programming among community dwelling older adults.

The purpose of this cross-sectional survey study was to identify factors that increase the likelihood of enrolling in falls prevention programming among community dwelling older adults. A convenience sample of 369 participants completed a written, selfadministered questionnaire on history and beliefs related to falls, and facilitators and barriers associated with enrollment. History of falling, fear of falling, self-efficacy, and recognition of program benefits were all associated with a greatly likelihood to enroll in falls prevention programming. Additionally, seven facilitators were associated with greater likelihood to enroll, including offered close to home (OR = 6.75(3.829-11.898); p = 0.000), free vision screen (OR = 4.816 (1.442-16.084); p = 0.005), friendly leader (OR = 3.930 (2.049-7.538); p = 0.000), coffee hour to socialize (OR = 3.789 (1.309-10.971); p = 0.009), no cost (OR = 3.653 (2.125-6.253); p = 0.000), group exercise (OR = 2.584 (1.341-4.980); p = 0.004), and safe place (OR = 2.378 (1.181-4.789); p = 0.013). Physician advice to attend a program, however, was not associated with likelihood to register (p = 0.99), supporting the need for a paradigm shift from physicians serving as the key change-agent in falls prevention to multiple partnerships. In addition, although 72% of participants were likely to register for a falls prevention program, only 28% knew if a program was being offered in their community. These findings highlight a critical need to disseminate information about falls prevention programming through social marketing in locations where older adults go in their everyday lives.