Clinical features of suspected Ebola cases referred to the Moyamba ETC, Sierra Leone: challenges in the later stages of the 2014 outbreak.

BACKGROUND: The last ebola virus disease (EVD) outbreak has been the most important since 1976. EVD cases decreased drastically in Sierra Leone at the beginning of 2015. We aim to determine the clinical findings and evolution of patients admitted to an Ebola treatment center (ETC) during the epidemic's late phase. METHODS: We analyze retrospectively data of patients admitted to the Moyamba ETC (December 2014-March 2015). Patients were classified in EVD or non-EVD patients according to the results of Ebola virus real-time reverse transcription polymerase chain reaction (ZAIRE-RT-PCR). RESULTS: Seventy-five patients were included, 41.3 % were positive for ZAIRE-RT-PCR. More women (68 % vs 28 %, p = 0.001) were EVD-positive. More EVD patients had previous contact with an Ebola patient (74.2 % vs 36.3 %, p < 0.001). At admission, EVD patients were more likely to have fatigue (96.7 %, p < 0.001), diarrhea (67.7 %, p = 0.002), and muscle pain (61.3 %, p = 0.009); but only objective fevers in 35.5 % of EVD patients. The most reliable criteria for diagnosis were: contact with an Ebola patient plus three WHO symptoms (LR + =3.7, 95 % CI = 1.9-7.3), and positive contact (LR + =2.3, 95 % CI = 1.15-4.20). Only 45.2 % of EVD patients developed fevers during stay, but 75 % developed gastrointestinal symptoms. Non-EVD patients had gastrointestinal problems (33 %), respiratory conditions (26.6 %), and others such as malaria, HIV or tuberculosis with a mortality rate of 11.4 %. vs 58 % in EVD group (p < 0.001). CONCLUSIONS: More non-EVD patients were admitted in the outbreak's late phases. The low percentage of initial fever highlights the need to emphasize the epidemiological information. EVD patients presented new symptoms getting worse and requiring closer follow-up. Diagnoses of non-EVD patients were diverse with a remarkable mortality, presenting a challenge for the health system.

Clinical Features of and Risk Factors for Fatal Ebola Virus Disease, Moyamba District, Sierra Leone, December 2014-February 2015.

The 2013-2016 outbreak of Ebola virus disease (EVD) in West Africa infected >28,000 people, including >11,000 who died, and disrupted social life in the region. We retrospectively studied clinical signs and symptoms and risk factors for fatal outcome among 31 Ebola virus-positive patients admitted to the Ebola Treatment Center in Moyamba District, Sierra Leone. We found a higher rate of bleeding manifestations than reported elsewhere during the outbreak. Significant predictors for death were shorter time from symptom onset to admission, male sex, high viral load on initial laboratory testing, severe pain, diarrhea, bloody feces, and development of other bleeding manifestations during hospitalization. These risk factors for death could be used to identify patients in need of more intensive medical support. The lack of fever in as many as one third of EVD cases may have implications for temperature-screening practices and case definitions.

Should patients who use illicit drugs be offered a second heart-valve replacement?

Intravenous drug users (IVDUs) have an elevated risk of contracting infectious endocarditis. Most of them have good effect from medical treatment, but some will need valve replacement. Until a few years ago, our hospital withheld valve surgery if patients with intravenous drug dependency and infectious endocarditis came to need a second valve replacement. However, there are no consensus guidelines for treatment of this group of patients, and a dearth of data on the effects and benefits of interventions. Using a method of ethical analysis, we here discuss whether it is appropriate to offer valve surgery to drug users for a second time.

Adolescent smoking behavior and outcome expectancies.

Adolescent smoking behavior is assumed to be associated with smoking outcome expectancies. Results in this paper are based on data from the control group of two data collections among Norwegian secondary school students taken approximately 30 months apart (T1 and T2). The dimensionality of smoking outcome expectancies was the same at both time points, revealing three components ("Addicted", "Not harmful" and "Social"). After correction for attenuation, the Pearson's correlation between T1 and T2 was 0.41 for the total sumscore, indicating low to moderate relative stability. When examining smoking expectancy sumscore means by smoking habits at T1 and T2, never smokers were different from smokers on both occasions. Never smokers scored low on "Social" and "Not harmful", and high on "Addictive". All associations were statistically significant (p < 0.001). The "Social" dimension was the strongest predictor of smoking behavior at T1 and T2. One of the outcome expectancy sumscores ("Addictive") at T1 predicted smoking habits at T2 after controlling for smoking habits at T1 (p < 0.01). This predictor was significant also after entering outcome expectancy sumscores at T2 into the model (p < 0.05). These results indicate that outcome expectations other than the health-related ones should be paid attention to when planning new prevention programs.

Anabolic steroid use in high school students.

A total of 1351 high school students (52.3% males, 47.7% females) with mean age 17.5 years (SD = 2.2) from randomized school classes in Hordaland County, Norway, participated in an Internet survey conducted in 2004 about the lifetime use of anabolic steroids and personal acquaintance with at least one user of anabolic steroids. In addition to questions about anabolic steroids the participants completed the Hospital Anxiety and Depression Scale and the Alcohol Use Disorders Identification Test. They also answered questions about demography, smoking, and narcotic use. The lifetime prevalence for use of anabolic steroids was 3.6% for males and 0.6% for females. In all, 27.9% of the respondents reported having at least one acquaintance that used or had used anabolic steroids. Use of anabolic steroids and having acquaintances using such drugs were strongly related to use of other drugs such as alcohol, nicotine, and narcotics. Implications for prevention are discussed and the study's limitations are noted.

Evaluation of the school-based smoking-prevention program "BE smokeFREE".

This article examines the impact of the school-based smoking-prevention program "BE smokeFREE" on adolescent smoking. A national representative sample of 99 schools (195 classes, 4,441 students) was used when the intervention started in November 1994. Schools were allocated to one of four groups: a comparison group (A) and three intervention groups (B, C, and D). Group B received the most comprehensive intervention. A baseline (autumn 1994) and three follow-up data collections (1995, 1996, and 1997) were conducted. There were no significant differences in smoking habits among the four groups at baseline. The smoking habits in the group that was involved in the most comprehensive intervention (group B) changed more favourably than those of students in the comparison schools over the three follow-up data collections. At the third follow-up, the proportion of students smoking weekly or more in the comparison group was 29.2%, compared with 19.6% in the model intervention group. The two less comprehensive interventions (no teacher in-service courses in group C, and no involvement of parents in group D) appeared to be less effective than the model intervention. Multilevel multiple logistic regression analyses, comparing changes in smoking habits between students in group B with those among students in the comparison schools, confirm the conclusion that the comprehensive intervention was the most effective. This school-based intervention, based on a social influence approach, proved to be effective at reducing smoking rates among participants.

[Activities performed by general practitioners before and after the introduction of an inter-municipal emergency service and the list patient system]. / Legevaktaktivitet før og etter innføring av interkommunal legevakt og fastlegeordning.

BACKGROUND: Over a span of four years we studied the number and type of patient contacts with the off-hour emergency service in a municipality in Western Norway. At the start of the period, the service was organised by each municipality, later more municipalities formed a regional service. At the end of the period, a list patient system was introduced. MATERIAL AND METHODS: All contacts from patients as well as activities performed by general practitioners on off-hour emergency duty were registered in four separate periods, from 1999 to 2002. RESULTS: Simultaneously with shift from a local to a regional system, the proportion of home calls fell from 18% to less than 1%. The implementation of a list patient system combined with a regional system reduced the total number of contacts by 30%. Public expenditure was reduced by 66%. INTERPRETATION: The combination of a regional off-hour service and a list patient system gives an efficient organisation. The total work-load for doctors is significantly reduced and the quality of medical services improve; financial considerations also support a shift in off-hour emergency service towards regional organisation.

[BE smokeFREE--evaluation of an intervention program for smoke-free schools]. / VAER røykFRI--evaluering av et tiltak for røykfrie skoler.

BACKGROUND: We present an evaluation of school-based intervention aiming at smoke-free schools (BE smokeFREE). The intervention programme was developed by the Norwegian Cancer Society. MATERIAL AND METHODS: A large-scale field experiment (initial n = 4,215) was carried out among lower secondary school students, starting in 8th (age 15) grade during the school year 1994/95. Schools were allocated to four groups: Control (A), a model intervention which included involvement of parents as well as courses for teachers (B), intervention identical to B but with no courses for teachers (C), and intervention identical to B but with no involvement of parents (D). Questionnaire surveys were administered four times (baseline and three follow-up surveys). A total of 19 school hours were used for the intervention, which took place in grades 8, 9, and 10. RESULTS: Changes in smoking frequency (daily, weekly, more seldom, non-smoker) and number of cigarettes smoked per week were used as end-point measures. Changes in smoking habits were markedly more favourable among students in model intervention schools than among students in control schools. INTERPRETATION: Carefully planned school-based intervention contributes to reduced smoking among adolescents.

[BE smokeFREE--from trials to national implementation]. / VAER røykFRI--fra forsøk til nasjonal implementering.

BACKGROUND: After small-scale trials, BE smokeFREE, a tobacco education programme covering the three years of lower secondary school was offered to all Norwegian schools in 1997. We have studied the effects of the programme, comparing them with results from the pilot project (1994-97). MATERIAL AND METHODS: A representative sample of 3,691 students filled in a questionnaire on their smoking habits and attitude to smoking (response rate 75%). Students enrolled in the BE smokeFREE programme were compared with a group of non-enrolled students, and with a third group that reported not knowing whether they were enrolled or not. Information on implementation of the programme was obtained from the first cohort of teachers using the programme who were followed up over three years. The response rate varied from 62% to 65%. RESULTS: From 1997 to 2000, the proportion of Norwegian lower secondary classes enrolled increased from 42% to 62%. Over this period, a total of 110,000 students were enrolled in the programme, receiving on average four periods more of tobacco-related information than students outside the programme. Compared to other tobacco education programmes, BE smokeFREE has been shown to have a significant effect on maintenance of a non-smoking lifestyle, number of cigarettes smoked, experiments with chewed tobacco, expectations as to future smoking status and smoke-free behaviour in the school area. For 8th and 9th grade, maintenance of smoke-free status seems to be the same as in the pilot project; for the 10th grade, the results seem to be better. INTERPRETATION: The large-scale implementation of BE smokeFREE has been successful and should be continued.