Shifting the paradigm - Applying universal standards of care to Ebola virus disease

As the Democratic Republic of Congo’s (DRC’s) 10th outbreak of Ebola virus disease (EVD) rages in this resource-limited, wartorn region, advances in the delivery of supportive care and the introduction of investigational therapies provide a glimmer of hope amid the mounting infections. In the absence of effective therapies or vaccines, EVD outbreak response has centered around the most basic of public health principles — identification and isolation of patients with suspected and confirmed EVD and tracking of all the contacts of the confirmed patients, who are then rapidly isolated if they show signs of disease. This strategy of “identify, isolate, and track” allows public health responders to curtail and eventually eliminate virus transmission in the community and has been the foundation of EVD outbreakcontrol efforts since the disease was first described in 1976

Child and family support policies across Europe: National reports from 27 countries

Il volume ricostruisce e analizza le politiche di supporto alla famiglia e alla genitorialità in 27 Paesi europe

Development of a Prediction Model for Ebola Virus Disease: A Retrospective Study in Nzérékoré Ebola Treatment Center, Guinea

The 2014 Ebola epidemic has shown the importance of accurate and rapid triage tools for patients with suspected Ebola virus disease (EVD). Our objective was to create a predictive score for EVD. We retrospectively reviewed all suspected cases admitted to the Ebola treatment center (ETC) in Nzérékoré, Guinea, between December 2, 2014, and February 23, 2015. We used a multivariate logistic regression model to identify clinical and epidemiological factors associated with EVD, which were used to create a predictive score. A bootstrap sampling method was applied to our sample to determine characteristics of the score to discriminate EVD. Among the 145 patients included in the study (48% male, median age 29 years), EVD was confirmed in 76 (52%) patients. One hundred and eleven (77%) patients had at least one epidemiological risk factor. Optimal cutoff value of fever to discriminate EVD was 38.5°C. After adjustment on presence of a risk factor, temperature higher than 38.5°C (odds ratio [OR] = 18.1, 95% confidence interval [CI] = 7.6-42.9), and anorexia (OR = 2.5, 95% CI = 1.1-6.1) were independently associated with EVD. The score had an area under curve of 0.85 (95% CI = 0.78-0.91) for the prediction of laboratory-confirmed EVD. Classification of patients in a high-risk group according to the score had a lower sensitivity (71% versus 86%) but higher specificity (85% versus 41%) than the existing World Health Organization algorithm. This score, which requires external validation, may be used in high-prevalence settings to identify different levels of risk in EVD suspected patients and thus allow a better orientation in different wards of ETC

Families - Private and Sacred: How to Raise the Curtain and Implement Family Support from a Public Health Perspective

Internationally, best practice in child abuse prevention is grounded in a public health approach – identifying risk factors (such as parental substance misuse, mental health problems, or family violence), and putting in place wide-reaching strategies to reduce the ‘burden of disease’ by altering the risk profile of the entire population (not just sub-groups identified as ‘at risk’). Families can play a crucial role in protecting children by providing a safe and supportive environment. Although family life and parenting activities are often framed as ‘private’ and ‘sacred’, and there is reluctance to tell parents what they should do (or for parents to seek help to improve their parenting capacity), there is considerable evidence that providing evidence-based supports at a population level can achieve significant benefits in reducing the likelihood of child maltreatment, while also enhancing the well-being of the greatest number of children. The greatest investment should be in primary prevention services, as they reach the largest number of families. If successfully implemented, primary prevention services will shift the “risk profile” positively for the entire population, which translates to fewer children and families in need of more intensive secondary or tertiary services. Policies that improve family access to services and supports that reduce stressors related to poverty, addiction and ill health will assist with prevention of child maltreatment. The broader availability of such whole-of-population strategies also helps with early identification of families ‘at risk’ or in need of additional supports. However, if strategies are only targeted to the most vulnerable families, the vast majority of parents experiencing difficulties with parenting will be ignored and it will be very difficult to impact on the prevalence of child maltreatment. Success should be measured by the engagement of universal service delivery platforms (which most children and their families encounter) in the task of protecting all children