Background: The Ebola virus, a highly infectious and deadly pathogen, has posed a significant public health threat in West Africa for several decades. Liberia is one of the most severely affected countries. Healthcare personnel, including nurses, are on the front lines of patient care, and their perspectives are invaluable in understanding the challenges that arise during outbreaks, especially in implementing prevention measures. Objective: This study aimed to explore the potential risk components and prevention measures of the Ebola virus disease (EVD). Methods: This study used an exploratory descriptive qualitative design. Five stakeholders, ten doctors and five nurses who had suffered from EVD during the outbreak in Liberia participated in semi-structured interviews to provide their experience and comprehensive perspectives on EVD. Data were collected from February 2022-August 2023. NVivo 12 plus was used for inductive thematic analysis. Results: Six themes and several subthemes emerged: 1) transmission modes (body contact, body fluid, sexual intercourse, traditional burial), 2) funeral attendance (traditional practices and crowded gatherings), 3) community-led prevention (promoting good hygiene practices, increasing awareness, contact tracing, and surveillance), 4) Ebola virus vaccine (false sense of security, potential side effects, and limited data), 5) challenges in implementing prevention measures (inadequate health infrastructures, difficulty of tracing infected people, lack of resources, and cultural-social barriers), 6) Liberia's health systems (a weak, underfunded, fragile health infrastructure, lack of health facilities and shortage of health workers). Conclusion: Several potential risk components contributing to the EVD outbreak should be a public concern. Strengthening the current healthcare system supported by local community and international aid providers (multidisciplinary teams) is needed to anticipate behavioral problems and to improve the efficacy of the prevention measures appropriate to the conditions in Liberia. Accordingly, the nurses' compliance with the recommended prevention practices is necessary.

The Need for Palliative Care Education and Training in Liberia and Indonesia: A Literature Review

Background: Palliative care is an integral approach to enhancing patients’ overall quality of life by taking into account their entire lives and addressing any suffering they may be experiencing. Thus, palliative care education and training should be advanced. However, palliative care training and education in Liberia have just started, and their development warrants further investigation. Objective: This research aimed to explore the state of palliative care education in Liberia and highlight its barriers and challenges. Methods: A descriptive qualitative exploratory study design was adopted in this study. Semi-structured interviews were conducted with ten male lecturers and four female nurses to gain in‐depth insight into their perspectives on palliative care education. Thematic analysis with NVivo 12 plus was used for data analysis. Results: Four themes emerged from the data: 1) the need for palliative education (lack of healthcare professionals, government support, regular workshops, integration, and interprofessional education on palliative care), 2) palliative care barriers (lack of curriculum implementation, lack of experience, lack of government actions, and poor infrastructures), 3) the level of student knowledge (senior and junior level, same educational level, and regular teaching materials), and 4) the roles of health care professionals (attention on palliative care, providing education on pain, and public awareness). Conclusion: The study findings may serve as input to develop palliative care education and training in Liberia. The identified gaps must be filled, and critical barriers must be overcome if the area of palliative care needs to be advanced. However, the comprehensive knowledge gathered in this study can be used by nurses, lecturers, and multidisciplinary teams to achieve the effectiveness of palliative care for patients.

Introduction: ADHD is a common neurodevelopmental condition often managed with stimulant medications such as methylphenidate. While pharmacotherapy remains effective for symptom controlgrowing attention has focused on the role of nutrition in modulating treatment outcomes and overall management of ADHD. However, concerns remain regarding long-term outcomes, adverse effects, and dependence on medication. In recent years, research has increasingly emphasized a more integrative perspective beyond pharmacotherapy, incorporating environmental and nutritional factors to a more comprehensive understanding, including the role of environmental factors, diet, and nutrition. Methods: This case report discusses a 20-year-old female college student with a history of ADHD who presented with behavioral disturbances and sleep deprivation. She had previously shown improvement in focus and academic performance with methylphenidate (CONCERTA), but experienced weight gain as a side effect, motivating her to study nutritional science. Nutritional factors and food–drug interactions appeared to influence both the expression of ADHD symptoms and the tolerability of pharmacotherapy. Discussion: This case highlights individual variability in response to methylphenidate, particularly concerning metabolic effects. The effectiveness and adverse reactions to ADHD medications may be influenced by dietary interactions, suggesting the importance of a personalized treatment approach. A well-balanced diet may enhance cognitive performance and improve pharmacologic tolerability, especially when it includes adequate intake of protein, unsaturated fats, and essential micronutrients. Conclusion: The management of ADHD should consider both pharmacological and nutritional factors. Integrating dietary support into treatment plans may enhance outcomes and reduce side effects, offering a more holistic and individualized model of care.

Background: Palliative care education is still in infancy in some countries, including Liberia and Indonesia. Palliative care education resources for health care professionals in Liberia and Indonesia have not emerged in the tutorial curriculum for advancement.Aims: This review aimed to identify the availability of palliative care education and the factors that influence palliative care education in Liberia and Indonesia.Methods: In this study, the researcher reviewed the literature of articles found in Scopus, PubMed, Google Scholar, and Science Direct, published until December 2021. The eligible studies investigating the need for palliative care education and training in Liberia and Indonesia were included. The quality of the studies was evaluated using a critical evaluation tool from the Joanna Briggs Institute, and PRISMA was used to analyze the data findings.Results: After a comprehensive review, this review included fourteen eligible articles. After intensive study, the article concluded that three unique common factors affect palliative care education in developing countries. Those factors included poor infrastructure, lack of government support, and the inaccessibility of a palliative care curriculum. Likewise, those articles show the slow development of PC education in Liberia.Conclusions: This literature review shows the lack of palliative care education in Liberia and Indonesia. As identified, there is a gap in palliative care education and training. Therefore, there is a need to invest in human resources and palliative care education resources due to its slow improvement.

Traditional funeral practices were a significant factor in the transmission of Ebola virus disease (EVD) during the West African outbreak of 2014–2016. In Liberia, these practices often conflict with public health directives, resulting in noncompliance and secret burials. Understanding the barriers to and facilitators of adopting safe burial practices is critical for informing future epidemic responses. This mixed-methods study was conducted in Vai and Clara Towns, Monrovia, Liberia. Data collection included surveys (n = 200), in-depth interviews (n = 40), and four focus groups (n = 40) with family members and community leaders. The quantitative data was analyzed via descriptive statistics. Thematic analysis was applied to the qualitative data to identify major themes. The survey demonstrated high levels of EVD-related knowledge and perceived risk in 2024; however, these descriptive findings do not establish an association between knowledge and burial behavior. Qualitative findings identified cultural, emotional, social, informational, and logistical factors that influenced the adoption of safe burial practices during the outbreak. Qualitative analysis revealed seven major themes: cultural and traditional resistance, mistrust and stigma, misinformation, emotional and psychological distress, communication and logistical challenges, socioeconomic constraints, and facilitators of safe practices. Knowledge measured in 2024 cannot establish outbreak-era knowledge. Retrospective accounts identified cultural norms, mistrust, and systemic barriers to safe burials. Future responses should prioritize early community engagement, the involvement of traditional and religious leaders, culturally sensitive adaptations of protocols, and adequate psychosocial and logistical support.