A Process Description of Playing to Live! A Community Psychosocial Arts Program During Ebola

From 2014 to 2015, Liberia experienced the largest Ebola epidemic in world history. The impact of this disease was not only physical; it created fear, loss, and trauma throughout the country. This article will describe the process of three phases of a community-based psychosocial expressive arts program, which used theory from the fields of expressive arts therapy to build mental health capacity during and after the epidemic. This article will highlight the background of Ebola virus disease and the Ebola virus disease epidemic, provide an overview of current theory and research for expressive arts therapy and the impact of trauma, describe the process of how the program developed and was implemented, the process of partnering with the community, program components, the two pilot programs, and the large-scale community program. We performed a mixed-methods analysis of the large-scale program’s activity data to evaluate the impact. The results highlight a positive response from the participating children and facilitators. The authors discuss the findings from the results, best practices, and limitations. Additionally, the authors discuss implications and considerations for future programming

Objective Assessment of Adherence to Inhalers by COPD Patients.

RATIONALE: Objective adherence to inhaled therapy by patients with COPD has not been reported. OBJECTIVES: The aim of this study was to objectively quantify adherence to preventer DiskusTM inhaler therapy by patients with COPD with an electronic audio recording device (INCATM). METHODS: This was a prospective observational study. On discharge from hospital patients were given a salmeterol/fluticasone inhaler with an INCATM device attached. Analysis of this audio quantified the frequency and proficiency of inhaler use. MEASUREMENTS AND MAIN RESULTS: COPD patients (n=265) were recruited. The mean age 71 years, mean Forced Expiratory Volume in 1-second 1.3 Litres, and 80% had evidence of mild/moderate cognitive impairment. By combining time of use, interval between doses and critical technique errors, thus incorporating both intentional and unintentional non-adherence, a measure \u22Actual Adherence\u22 was calculated. Mean Actual Adherence was 22.9% of that expected if the doses were taken correctly and on time. Seven percent had an Actual Adherence\u3e80%. Hierarchical clustering found three equally sized well-separated clusters corresponding to distinct patterns: Cluster 1 (34%) had low inhaler use and high error rates, Cluster 2 (31%) had high inhaler use and high error rates, and Cluster 3 (30%) had overall good adherence. Lung function and co-morbidities were predictive of poor technique, while age and cognition with poor lung function distinguished those with poor adherence and frequent errors in technique. CONCLUSION: These data may inform clinicians both in understanding why a prescribed inhaler is not effective and to devise strategies to promote adherence in COPD