Companion animal adoption and relinquishment during the COVID-19 pandemic: The experiences of animal rescue staff and volunteers.

There has been a paucity of research into the experiences of animal rescue staff and volunteers during COVID-19. The aim of this qualitative research was to explore the impact of the COVID-19 pandemic on companion animal rescue organisations and their staff and volunteers, and to develop a set of recommendations on how to reduce the risk to companion animal welfare during a crisis. Descriptive thematic analysis was used to explore the experiences of staff and volunteers from 28 animal rescue organisations, most of which were based in the UK. Other surveyed countries included Germany, the Republic of Ireland, France, Spain, the USA and Australia. We identify three key themes that reflect the challenges faced by pet rescue organisations during the pandemic: (1) impact on animals; (2) impact on identity; and (3) impact on organisational processes. Key recommendations include the promotion of co-operation and modifications within the sector, the need to understand, and change, detrimental pet-owner behaviours, and the need to clarify the identity of animal rescue organisations within the Government. Both positive and negative outcomes were experienced by animal rescue organisations during the COVID-19 pandemic. These findings should be considered for future crises and indeed the everyday operating procedures of companion animal rescue organisations.

A systematic review and meta-analysis of randomised controlled trials of surgical treatments for ingrown toenails part II: healing time, post-operative complications, pain, and participant satisfaction.

BACKGROUND: When performing nail surgery, clinicians must choose from a multitude of procedures and variations within each procedure. Much has been published to guide this decision making, but there are a lack of up to date robust systematic reviews to assess the totality of this evidence. METHODS: Five databases (MEDLINE, Embase, CINAHL, Web of Science and CENTRAL) and two registers (Clinicaltrials.gov and ISRCTN) were searched to January 2022 for randomised trials evaluating the effects of a surgical intervention(s) for ingrown toenails. Two independent reviewers screened records, extracted data, assessed risk of bias and certainty of evidence. Data on co-primary outcomes of symptom relief and symptomatic regrowth were presented in our first paper. This paper presents data for the secondary outcomes and further discussion. RESULTS: Of 3,928 records identified, 36 randomised trials were included in the systematic review. Healing time appears to be reduced with shorter application of phenol. A reduced healing time was also apparent was with the addition of curettage, although this may also increase the risk of post-operative bleeding and pain. Post operative bleeding was also reportedly lower in people who received local anaesthetic with epinephrine but no tourniquet. Use of phenol with nail bed excision may decrease the risk of infection. Lower pain scores were reported when using partial matrixectomy and surgical interventions with phenol. Shorter duration of pain was reported with phenolisation and wedge resection. Participant satisfaction was high overall. CONCLUSION: This second paper reports secondary outcomes from a robust systematic review of randomised trials on surgical treatment of ingrown toenails. Despite the large volume of clinical trials conducted on the topic, few clinical conclusions can be drawn due to the poor quality of these studies. Further high-quality clinical trials are needed to answer fundamental questions in the surgical treatment of ingrown toenails.

A systematic review and meta-analysis of randomised controlled trials on surgical treatments for ingrown toenails part I: recurrence and relief of symptoms.

BACKGROUND: Ingrown toenails are a common nail pathology. When conservative treatments are ineffective, a surgical approach is often utilised. Despite recent narrative reviews, there is a need for an up-to-date and rigorous systematic review of surgical methods for treating ingrown toenails. METHODS: Five databases (MEDLINE, Embase, CINAHL, Web of Science and CENTRAL) and two registers (Clinicaltrials.gov and ISRCTN) were searched to January 2022 for randomised trials evaluating the effects of a surgical intervention(s) for ingrown toenails with a follow-up of at least 1 month. Two independent reviewers screened records, extracted data, assessed risk of bias and certainty of evidence. RESULTS: Of 3,928 records identified, 36 (3,756 participants; 62.7% males) surgical interventions were included in the systematic review and 31 studies in the meta-analysis. There was very low quality evidence that using phenol with nail avulsion vs nail avulsion without phenol reduces the risk of recurrence (risk ratio [RR] 0.13 [95% CI 0.06 to 0.27], p < 0.001). No favourable effect was observed between chemical or surgical vs conservative management (0.55 [0.19 to 1.61], p = 0.280; 0.72 [0.33 to 1.56], p = 0.410), chemical or surgical vs other (e.g., CO2 laser, electrocautery) (1.61 [0.88 to 2.95], p = 0.120; 0.58 [0.25 to 1.37], p = 0.220), chemical vs surgical (0.75 [0.46 to 1.21], p = 0.230), surgical vs surgical (0.42 [0.21 to 0.85]), chemical vs chemical (0.19 [0.01 to 3.80], p = 0.280), surgical vs surgical + chemical (3.68 [0.20 to 67.35], p = 0.380), chemical vs surgical + chemical (1.92 [0.06 to 62.30], p = 0.710), local anaesthetic vs local anaesthetic + adrenaline (1.03 [0.22 to 4.86], p = 0.970), chemical timings 30 s vs 60 s (2.00 [0.19 to 21.41]) or antibiotics vs no antibiotics (0.54 [0.12 to 2.52], p = 0.430). Central toenail resection was the only procedure to significantly relieve symptoms (p = 0.001) but data were only available up to 8 weeks post-surgery. CONCLUSION: Despite the high number of publications, the quality of research was poor and the conclusions that can be inferred from existing trials is limited. Phenolisation of the nail matrix appears to reduce the risk of recurrence following nail ablation, and with less certainty 1 min appears to be the optimum time for application. Despite this being a widely performed procedure there remains a lack of good quality evidence to guide practice.

A scoping review of the outcome reporting following surgery for chronic osteomyelitis of the lower limb.

Chronic osteomyelitis (COM) of the lower limb in adults can be surgically managed by either limb reconstruction or amputation. This scoping review aims to map the outcomes used in studies surgically managing COM in order to aid future development of a core outcome set. A total of 11 databases were searched. A subset of studies published between 1 October 2020 and 1 January 2011 from a larger review mapping research on limb reconstruction and limb amputation for the management of lower limb COM were eligible. All outcomes were extracted and recorded verbatim. Outcomes were grouped and categorized as per the revised Williamson and Clarke taxonomy. A total of 3,303 records were screened, of which 99 studies were included. Most studies were case series (77/99; 78%) and assessed one method of reconstruction (68/99; 69%). A total of 511 outcomes were reported, which were grouped into 58 distinct outcomes. Overall, 143/511 of all outcomes (28%) were provided with a clear, in-text definition, and 231 outcomes (45%) had details reported of how and when they were measured. The most commonly reported outcome was 'recurrence of osteomyelitis' (62; 12%). The single-most patient-reported outcome measure was 'pain'. This study has highlighted significant inconsistencies in the defining, reporting, and measuring of outcomes across studies investigating surgical management for chronic osteomyelitis of the lower limb in adults. Future studies should clearly report complete details of how outcomes are defined and measured, including timing. The development of a standardized core outcome set would be of significant benefit in order to allow evidence synthesis and comparison across studies.

Reverse shoulder arthroplasty versus hemiarthroplasty versus non-surgical treatment for older adults with acute 3- or 4-part fractures of the proximal humerus: study protocol for a randomised controlled trial (PROFHER-2: PROximal Fracture of Humerus Evaluation by Randomisation - Trial Number 2).

BACKGROUND: Proximal humerus fractures (PHF) are common and painful injuries, with the majority resulting from falls from a standing height. As with other fragility fractures, its age-specific incidence is increasing. Surgical treatment with hemiarthroplasty (HA) and reverse shoulder arthroplasty (RSA) have been increasingly used for displaced 3- and 4-part fractures despite a lack of good quality evidence as to whether one type of arthroplasty is superior to the other, and whether surgery is better than non-surgical management. The PROFHER-2 trial has been designed as a pragmatic, multicentre randomised trial to compare the clinical and cost-effectiveness of RSA vs HA vs Non-Surgical (NS) treatment in patients with 3- and 4-part PHF. METHODS: Adults over 65 years of age presenting with acute radiographically confirmed 3- or 4-part fractures, with or without associated glenohumeral joint dislocation, who consent for trial participation will be recruited from around 40 National Health Service (NHS) Hospitals in the UK. Patients with polytrauma, open fractures, presence of axillary nerve palsy, pathological (other than osteoporotic) fractures, and those who are unable to adhere to trial procedures will be excluded. We will aim to recruit 380 participants (152 RSA, 152 HA, 76 NS) using 2:2:1 (HA:RSA:NS) randomisation for 3- or 4-part fractures without joint dislocation, and 1:1 (HA:RSA) randomisation for 3- or 4-part fracture dislocations. The primary outcome is the Oxford Shoulder Score at 24 months. Secondary outcomes include quality of life (EQ-5D-5L), pain, range of shoulder motion, fracture healing and implant position on X-rays, further procedures, and complications. Independent Trial Steering Committee and Data Monitoring Committee will oversee the trial conduct, including the reporting of adverse events and harms. DISCUSSION: The PROFHER-2 trial is designed to provide a robust answer to guide the treatment of patients aged 65 years or over who sustain 3- and 4-part proximal humeral fractures. The pragmatic design and recruitment from around 40 UK NHS hospitals will ensure immediate applicability and generalisability of the trial findings. The full trial results will be made available in a relevant open-access peer-reviewed journal. TRIAL REGISTRATION: ISRCTN76296703. Prospectively registered on 5th April 2018.

Companion animal adoption and relinquishment during the COVID-19 pandemic: Households with children at greatest risk of relinquishing a cat or dog.

Understanding the factors associated with companion animal relinquishment is key in safeguarding animal welfare and human well-being. The aims of this study were to assess the effect of demographic variables on risk of relinquishment of cats and dogs during the COVID-19 pandemic, and to report characteristics of those that relinquished a cat or dog, and the experience of said relinquishment process. A series of surveys were administered to pet owners (n = 3,945) across several countries including the UK, USA, Canada, Italy, Spain and France. In total, n = 1,324 reported having acquired their cat or dog via online means. There was no association between online source (search engines, breeder websites, rescue websites, online ad sites and social media) and relinquishment status (NCR1 [Never Considered Relinquishment] compared to CR_R [Considering Relinquishment or already Relinquished]. More participants from the USA considered or already had relinquished their cat or dog compared to the UK and Italy. Of those that have already given up their pet, 76.2% agreed that it was an emotionally difficult decision, while 100% agreed that it was, logically, the correct decision. Demographic characteristics in those that reported considering relinquishment or that had already relinquished (CR_R; n = 146) were compared to a comparison group that had never considered relinquishing their pet (NCR2; n = 193). Being a male-gendered pet-owner and a younger pet age increased the risk of relinquishment. Cats and dogs from households with children were 4.6 times more likely to consider or have already relinquished a cat or dog compared to those from households without children. Further research is needed to explore risk of relinquishment of cats and dogs when children are present in the home.

Borderline personality disorder traits and mentalising ability: The self-other social cognition paradox.

Objective: Borderline personality disorder (BPD) is a psychiatric condition characterised by a pervasive pattern of impulsivity, low self-image, and interpersonal conflicts. Previous findings indicate a mixed relationship between BPD and social cognition; little research as investigated whether BPD traits influence performance on specific elements of social cognitive tasks, i.e., positive/negative valence. Method: Community-based typical controls (n = 151; 51% female) were recruited through an online survey. Participants completed aspects of the Personality Assessment Inventory pertaining to BPD traits, the Interpersonal Reactivity Index, and measures of both emotion recognition and mentalising. Results: Following group stratification into high/low BPD traits, participants with high BPD traits were observed to perform significantly better when identifying negative valence stimuli. Furthermore, high levels of affect instability was found to significantly influence negative valence recognition. Conclusion: This research highlights previous research which shows a paradox between higher performance on measures of social cognition, with a group of individuals who report significant interpersonal and relational difficulties. This research supports the assessment of social cognitive processes for people with BPD and/or high BPD traits to support clinical formulation of strengths and difficulties.

Emotion Recognition and the Screening Instrument for Borderline Personality Disorder (SI-Bord): Outcomes and Community-Based Validation.

Background: Borderline Personality Disorder (BPD) is a psychiatric condition characterized by impulsivity, affect instability, dysregulation, low self-image, and interpersonal difficulties. There are many instruments to measure traits of BPD, however, few can be administered quickly. The Screening Instrument for Borderline Personality Disorder (SI-Bord) is an instrument offering a brief administration time with comparable psychometric properties to more comprehensive measures. The present study aimed to evaluate the psychometric properties of the SI-Bord in a healthy community-based sample and its relatedness to measures of social cognition. Methods: A community-based sample of participants completed an online survey consisting of measures of BPD traits and social cognition including: the Screening Instrument for Borderline Personality Disorder (SI-Bord), the Personality Assessment Inventory (PAI), the Florida Affect Battery (FAB), the Interpersonal Reactivity Index (IRI), and the Narcissistic Personality Inventory (NPI). Reliability was assessed using Cronbach's alpha and inter-item correlations. Validity was assessed using factor analysis, examining associations with other measures of BPD traits, and examining associations with measures not measuring BPD traits. Results: 151 participants were included in the study. Participants' age ranged from 20−76 (mean age of 38.79 ± 12.37) and comprised 76 females (50.33%) and 75 males (49.67%). Good internal consistency was found with a Cronbach's alpha of 0.71. Good inter-item reliability was found with a mean inter-item cross correlation of 0.25, with each item of the SI-Bord showing an inter-item correlation coefficient of >0.5. Factor analysis identified good construct validity with a strong singular dimension explaining a large proportion of variance (Question 1). The SI-Bord showed good concurrent validity with significantly strong positive correlations with the subscales of the PAI borderline scale measuring affect instability (r = 0.60; p < 0.001), identity problems (r = 0.67; p < 0.001), negative relationships (r = 0.61; p < 0.001), total score (r = 0.76; p < 0.001), and to a moderately strong positive correlation with self-harm (r = 0.39; p < 0.001). The SI-Bord was not correlated with the NPI-16 (r = 0.131; p = 0.11), showing good divergent validity. Conclusions: These findings support the SI-Bord as a quick and useful screening tool for traits associated with BPD. Further clinical validation is warranted.

Companion animal adoption and relinquishment during the COVID-19 pandemic: Peri-pandemic pets at greatest risk of relinquishment.

The COVID-19 pandemic has created a situation globally where companion animals may be at increased risk of relinquishment and abandonment due to multiple interrelated factors. The aims of this study were to establish the prevalence of self-reported adoption and relinquishment of cats and dogs during the pandemic, and to identify characteristics associated with relinquishment. A survey was distributed to 4,000 participants across several countries including the UK, USA, Canada, Italy, Spain and France. N = 3,945 responses were available for analysis. Three groups of participants were identified; Those that never considered relinquishment (NCR), those that have considered relinquishment (CR) and those that have already relinquished a cat or dog (R). Two follow-up surveys were sent to CR and R participants. Considering data from the three surveys, 4.06% of participants considered giving up their pet, 0.74% relinquished their pet, and 0.2% considered and then later give up their pet. Compared to pets given as a gift, there was a 38.7% decreased likelihood of relinquishment in pets sourced from a shelter (P < 0.001), 31.2% decrease in those sourced from a breeder, and a 24.4% decrease in those acquired directly from someone that needed to find a new home for their cat or dog. Compared to owners who acquired their pet > 6 months before COVID-19 was declared a pandemic, those acquired < 6 months before COVID-19 was declared a pandemic were three times more likely to be considered for, or be, given up (P < 0.001) and those acquired after COVID-19 was declared a pandemic were two times more likely to be considered for, or be, given up (P < 0.001). There was a trend for greater likelihood of CR or R of pets acquired online (P = 0.074). Of those that had already given up their pet, 14.3% relinquished to a shelter, 66.7% gave their pet to a new owner and 19% obtained temporary care from someone else. A total of 65.0% of CR participants were male, increasing to 72.2% of R participants. There was no effect of species (cat or dog) on risk of relinquishment. Financial constraints were the most mentioned reason for both giving up a pet and considering giving up a pet, followed by health concerns specific to COVID-19, and behavioral problems. The findings from this study should be used to inform interventions aimed at reducing companion animal relinquishment.

The Effect of Baby Schema in Cats on Length of Stay in an Irish Animal Shelter.

Several factors may influence cats' length of stay (LoS) within the shelter environment. The aim of this study was to investigate the potential influence that baby schema (characteristic facial features of infants, related to perceived 'cuteness') has on cats' length of stay (LoS) in an animal shelter. Other factors such as paired-homing requirements, adoption profile (adverts to encourage the adoption of a specific animal) wording, coat colour, sex and age were also explored. Objective 'cuteness' scores were created by measuring specific facial features of 165 shelter cats. Several proportions of the cats' faces were explored to identify the best objective measure of cuteness, including elements which have been found to associate with cuteness in cats and humans and new exploratory eye measurements. Subjective cuteness scores were developed by participants rating the 'cuteness' of the cat from '1-Not very cute' to '5-Extremely cute' through two online surveys; survey 1 investigated the cats' social nature as well as cuteness while the second only looked at cuteness. The subjective cuteness scores were used to validate the objective cuteness scores. The analysis found that subjective cuteness in survey 1 was the only variable of influence on LoS. A novel objective cuteness measurement was developed which reflects the eye shape associated with subjective cuteness scores. The current study found that cuteness may not be as influential on cats' LoS in shelters as hypothesised. This research looks to understand factors which influence LoS to help identify potential methods to reduce time spent in shelters and improve the welfare of cats within these environments.

Estimating the costs for implementing a maternity leave cash transfer program for women employed in the informal sector in Brazil and Ghana.

BACKGROUND: Maternity leave policies are designed to protect gender equality and the health of mothers in the workforce and their children. However, maternity leave schemes are often linked to jobs in the formal sector economy. In low- and middle-income countries a large share of women work in the informal sector, and are not eligible to such benefit. This is worrisome from a social justice and a policy perspective and suggests the need for intervening. Costing the implementation of potential interventions is needed for facilitating informed decisions by policy makers. METHODS: We developed and applied a costing methodology to assess the cost of a maternity leave cash transfer to be operated in the informal sector of the economy in Brazil and Ghana, two countries with very different employment structures and socioeconomic contexts. We conducted sensitivity analysis by modeling different numbers of weeks covered. RESULTS: In Brazil, the cost of the maternity cash transfer would be between 0.004% and 0.02% of the GDP, while in Ghana it would range between 0.076% and 0.28% of the GDP. The relative cost of rolling out a maternity intervention in Brazil is between 2.2 to 3.2 times the cost in Ghana depending on the benchmark used to assess the welfare measure. The differences in costs between countries was related to differences in labor market structure as well as demographic characteristics. CONCLUSIONS: Findings show how a standard methodology that relies on routinely available information is feasible and could assist policymakers in estimating the costs of supporting a maternity cash transfer for women employed in the informal sector, such intervention is expected to contribute to social justice, gender equity, and health trajectories.

Correlates of Social Cognition and Psychopathic Traits in a Community-Based Sample of Males.

Social cognition is the ability to identify, understand, and interpret mental states and emotions. Psychopathic traits are typically described in two ways; Primary: shallow affect, emotional detachment, and relationship difficulties, and Secondary Psychopathic Traits: antisocial traits, impulsiveness, and emotional dysregulation. People with high psychopathic traits tend to perform lower on measures of social cognition. This study investigated the relationship of social cognition (mentalising) to primary and secondary psychopathic traits in a non-clinical sample, and investigated the psychometric properties of the Reading the Mind in the Eyes Test (RMET) Short Forms (A and B). A community-based male sample (N = 1,000; age range 18-78) was recruited through an online platform. Psychopathic traits were measured using Levenson, Kiehl, and Fitzpatrick's Self-Report Psychopathy Scale, and stratified into Primary and Secondary Psychopathic traits. Secondary validation of the RMET Short Forms was completed investigating scale reliability, and validity. Findings suggest excellent psychometrics in a large community cohort for the RMET Short Forms (A and B), with significant negative correlations on social cognitive performance and high self-report psychopathy. The item valence within the social cognitive measure (positive, negative, and neutral affect stimuli) was also examined, and correlated significantly with both Primary and Secondary Psychopathic traits. This study provides further validation of the RMET Short Forms (A and B), and adds to the literature on the scale by investigating performance on short-form specific valence. This study further suggests that in a non-clinical community sample of males, that higher psychopathic traits correlated significantly, and negatively, with social cognitive performance.

A multicentre, randomized, parallel group, superiority study to compare the clinical effectiveness and cost-effectiveness of external frame versus internal locking plate for complete articular pilon fracture fixation in adults.

AIMS: A pilon fracture is a severe ankle joint injury caused by high-energy trauma, typically affecting men of working age. Although relatively uncommon (5% to 7% of all tibial fractures), this injury causes among the worst functional and health outcomes of any skeletal injury, with a high risk of serious complications and long-term disability, and with devastating consequences on patients' quality of life and financial prospects. Robust evidence to guide treatment is currently lacking. This study aims to evaluate the clinical and cost-effectiveness of two surgical interventions that are most commonly used to treat pilon fractures. METHODS: A randomized controlled trial (RCT) of 334 adult patients diagnosed with a closed type C pilon fracture will be conducted. Internal locking plate fixation will be compared with external frame fixation. The primary outcome and endpoint will be the Disability Rating Index (a patient self-reported assessment of physical disability) at 12 months. This will also be measured at baseline, three, six, and 24 months after randomization. Secondary outcomes include the Olerud and Molander Ankle Score (OMAS), the five-level EuroQol five-dimenison score (EQ-5D-5L), complications (including bone healing), resource use, work impact, and patient treatment preference. The acceptability of the treatments and study design to patients and health care professionals will be explored through qualitative methods. DISCUSSION: The two treatments being compared are the most commonly used for this injury, however there is uncertainty over which is most clinically and cost-effective. The Articular Pilon Fracture (ACTIVE) Trial is a sufficiently powered and rigorously designed study to inform clinical decisions for the treatment of adults with this injury. Cite this article: Bone Jt Open 2021;2(3):150-163.

The yearly financing need of providing paid maternity leave in the informal sector in Indonesia.

BACKGROUND: The economic cost of not breastfeeding in Indonesia is estimated at US$1.5-9.4 billion annually, the highest in South East Asia. Half of the 33.6 million working women of reproductive age (WRA) in Indonesia (15-49 years) are informal employees, meaning they are working as casual workers or they are self-employed (small scale business) and assisted by unpaid/family worker(s). No specific maternity protection entitlements are currently available for WRA working informally in Indonesia. This study aims to estimate the financing need of providing maternity leave cash transfer (MCT) for WRA working in the informal sector in Indonesia. METHOD: The costing methodology used is the adapted version of the World Bank methodology by Vilar-Compte et al, following pre-set steps to estimate costs using national secondary data. We used the 2018 Indonesian National Socio-Economic Survey to estimate the number of women working informally who gave birth within the last year. The population covered, potential cash transfer's unitary cost, the incremental coverage of the policy in terms of time and coverage, and the administrative costs were used to estimate the cost of MCT for the informal sector. RESULT: At 100% coverage for 13 weeks of leave, the yearly financing need of MCT ranged from US$175million (US$152/woman) to US$669million (US$583/woman). The share of the yearly financing need did not exceed 0.5% of Indonesian Gross Domestic Product (GDP). CONCLUSIONS: The yearly financing need of providing MCT for eligible WRA working in the informal sector is economically attractive as it amounts to less than 0.5% of GDP nominal of Indonesia. While such a program would be perceived as a marked increase from current public health spending at the onset, such an investment could substantially contribute to the success of breastfeeding and substantial corresponding public health savings given that more than half of working Indonesian WRA are employed in the informal sector. Such policies should be further explored while taking into consideration realistic budget constraints and implementation capacity.

The financing need for expanding paid maternity leave to support breastfeeding in the informal sector in the Philippines.

In low- and middle-income countries, almost three-fourths of women in the labour force lack maternity protection. In the Philippines, current laws do not guarantee paid maternity leave to workers in the informal economy. A non-contributory maternity cash transfer to informal sector workers could be used to promote social equity and economic productivity and could provide health benefits by helping mothers meet their breastfeeding goals. The objective of the study is to provide a realistic cost estimate and to assess the financial feasibility of implementing a publicly financed, non-contributory maternity cash transfer programme to the informal sector in the Philippines. Using a costing framework developed in Mexico, the study estimated the annual cost of a maternity cash transfer programme. The methodology estimated the unit cost of the programme, the incremental coverage of maternity leave and expected number of enrollees. Different unit and incremental costs assumptions were used to provide a range of scenarios. Administrative costs for running the programme were included in the analysis. The annual financing need of implementing maternity cash transfer programme in the Philippines ranges from a minimum scenario of USD42 million (14-week maternity cash transfer) to a more ideal scenario of USD309 million (26-week maternity cash transfer). The latter is financially feasible as it is equivalent to less than 0.1% of the country's gross domestic product substantially lower than the share cost of not breastfeeding (0.7%). The annual cost of the programme is only 10% of the total cost of the largest conditional cash transfer programme.

The effects of exercise to promote quality of life in individuals with traumatic brain injuries: a systematic review.

OBJECTIVE: To systematically review the effects of exercise interventions that may enhance quality of life (QOL) in individuals with traumatic brain injury (TBI). METHODS: A systematic search was conducted using five databases up to April 2018. Studies were included if QOL was quantified following an exercise programme for people with a TBI. Methodological quality was assessed using a validated scoring checklist. Two independent reviewers assessed study inclusion and methodological quality. RESULTS: Thirteen studies met the inclusion criteria (seven RCTs, six non-RCTs). The median total scores for the quality assessment tool were 26.1 (RCTs), and 21.3 (non-RCTs), out of 33. Eight out of the 13 studies reported improved QOL following an exercise programme. The duration of the interventions varied from 8-12 weeks. The most common programmes involved moderate to vigorous exercise; with a frequency and duration of 3-5 times/week for 30-60 minutes. CONCLUSION: Due to the diversity of the exercise training interventions, heterogeneity of patient characteristics, multitude of QOL instruments and outcome domains assessed, it was not possible to draw any definitive conclusion about the effectiveness of exercise interventions. However, this review identified positive trends to enhance various aspects of QOL measured using a range of assessment tools.

Development and Testing of Responsive Feeding Counseling Cards to Strengthen the UNICEF Infant and Young Child Feeding Counseling Package.

BACKGROUND: The UNICEF Community-based Infant and Young Child Feeding Counseling Package (C-IYCFCP) currently has limited responsive feeding (RF) content, thus limiting dissemination of RF messages within infant and young child feeding (IYCF) counseling. OBJECTIVES: This project 1) developed counseling cards based on existing evidence-based RF guidelines and 2) tested their feasibility in Ghana. METHODS: Five RF counseling cards were developed focusing on eating with family; introducing new foods; hunger/satiety cues; food texture; and calming a child. Four focus group discussions (FGDs) were conducted with adult mothers and fathers of children younger than 3 y of age to assess the cultural appropriateness of the cards and accompanying key messages. The feasibility of including cards as part of IYCF counseling was tested via 1) systematic observation of 8 group education sessions utilizing the cards with the same target audience and 2) in-depth interviews with health care providers involved in IYCF training and/or counseling. RESULTS: FGD findings guided changes to all cards to ensure comprehension and cultural appropriateness. The group education sessions suggested that the counseling cards provided important RF messages that are specific, clear, and feasible to implement. Health care providers strongly endorsed the need for and utility of the RF counseling cards and felt they were feasible and important to integrate into the C-IYCFCP currently being used to deliver IYCF training and counseling in Ghana. CONCLUSIONS: The counseling cards have a strong potential to add key RF dimensions to IYCF training and counseling in Ghana.

Costs of maternity leave to support breastfeeding; Brazil, Ghana and Mexico.

OBJECTIVE: To develop a method to assess the cost of extending the duration of maternity leave for formally-employed women at the national level and apply it in Brazil, Ghana and Mexico. METHODS: We adapted a World Bank costing method into a five-step method to estimate the costs of extending the length of maternity leave mandates. Our method used the unit cost of maternity leave based on working women's weekly wages; the number of additional weeks of maternity leave to be analysed for a given year; and the weighted population of women of reproductive and legal working age in a given country in that year. We weighted the population by the probability of having a baby that year among women in formal employment, according to individual characteristics. We applied nationally representative cross-sectional data from fertility, employment and population surveys to estimate the costs of maternity leave for mothers employed in the formal sector in Brazil, Ghana and Mexico for periods from 12 weeks up to 26 weeks, the WHO target for exclusive breastfeeding. FINDINGS: We estimated that 640 742 women in Brazil, 33 869 in Ghana and 288 655 in Mexico would require formal maternity leave annually. The median weekly cost of extending maternity leave for formally working women was purchasing power parity international dollars (PPP$) 195.07 per woman in Brazil, PPP$ 109.68 in Ghana and PPP$ 168.83 in Mexico. CONCLUSION: Our costing method could facilitate evidence-based policy decisions across countries to improve maternity protection benefits and support breastfeeding.

Individuals with Psychopathic Traits and Poor Attitudes towards Animals Can Recognise Infant Features But Give Them Reduced Attentional Priority.

Infant features are physical traits that are characteristic of human infants and include facial features such as large and low-lying eyes, and a small nose and mouth. Animals possessing high levels of infant features elicit care-giving responses in humans. Despite this, animal cruelty is a common occurrence. The aim of this research was to determine whether the ability to recognise and/or attend to infant features is linked to subclinical psychopathic traits and attitudes towards animals. Using a community sample, participants (n = 387) completed a cuteness forced-choice task. Self-reported psychopathy and attitude towards animals were not related to the participants' ability to detect cues of cuteness in human infants and animals. In a second study, participants (n = 142) were screened for low versus high primary psychopathy and low versus high animal attitude scores. A Psychopathy-Attitude Composite score was created and a subset of participants (n = 50) from the upper and lower quartiles completed a free-viewing eye-tracking task where 'Cute', 'Neutral, 'Monetary' and 'Control' images were presented in pairs. Higher levels of psychopathic traits and an anti-animal welfare attitude were associated with decreased attention to 'Cute' images in terms of decreased dwell time, mean fixation duration and mean fixation count, measures of voluntary attention. There were a number of interactions between Psychopathy-Attitude Composite classification and attention to each image category in terms of dwell time, first fixation duration, mean fixation duration and fixation count. These findings support the theory that individuals with psychopathic traits recognise facial cues of vulnerability but choose to give them reduced attentional priority. This may have implications for animal welfare.

A systematic review of costing studies for implementing and scaling-up breastfeeding interventions: what do we know and what are the gaps?

Despite the well-established evidence that breastfeeding improves maternal and child health outcomes, global rates of exclusive breastfeeding remain low. Cost estimates can inform stakeholders about the financial resources needed to scale up interventions to ultimately improve breastfeeding outcomes in low-, middle- and high-income countries. To inform the development of comprehensive costing frameworks, this systematic review aimed to (1) identify costing studies for implementing or scaling-up breastfeeding interventions, (2) assess the quality of identified costing studies and (3) examine the availability of cost data to identify gaps that need to be addressed through future research. Peer-reviewed and grey literature were systematically searched using a combination of index terms and relevant text words related to cost and the following breastfeeding interventions: breastfeeding counselling, maternity leave, the World Health Organization International Code of Marketing of Breastmilk Substitutes, the Baby-Friendly Hospital Initiative, media promotion, workplace support and pro-breastfeeding social policies. Data were extracted after having established inter-rater reliability among the first two authors. The quality of studies was assessed using an eight-item checklist for key costing study attributes. Forty-five studies met the inclusion criteria, with the majority including costs for breastfeeding counselling and paid maternity leave. Most cost analyses included key costing study attributes; however, major weaknesses among the studies were the lack of clarity on costing perspectives and not accounting for the uncertainty of reported cost estimates. Costing methodologies varied substantially, standardized costing frameworks are needed for reliably estimating the costs of implementing and scaling-up breastfeeding interventions at local-, national- or global-levels.