Understanding adherence to self-isolation in the first phase of the COVID-19 pandemic in England: a cross-sectional mixed-methods study.

BACKGROUND: During the early "containment" phase of the COVID-19 response in England (January-March 2020), contact tracing was managed by Public Health England (PHE). Adherence to self-isolation during this phase and how people were making those decisions has not previously been determined. The aim of this study was to gain a better understanding of decisions around adherence to self-isolation during the first phase of the COVID-19 response in England. METHODS: A mixed-methods cross sectional study was conducted, including an online survey and qualitative interviews. The overall pattern of adherence was described as never leaving home, leaving home for lower-contact reasons and leaving home for higher-contact reasons. Fisher's exact test was used to test associations between adherence and potentially predictive binary factors. Factors showing evidence of association overall were then considered in relation to the three aspects of adherence individually. Qualitative data were analysed using inductive thematic analysis. RESULTS: Of 250 respondents who were advised to self-isolate, 63% reported not leaving home at all during their isolation period, 20% reported leaving only for lower-contact activities (dog walking or exercise) and 16% reported leaving for higher-contact, and therefore higher-risk, reasons. Factors associated with adherence to never going out included: the belief that following isolation advice would save lives, experiencing COVID-19 symptoms, being advised to stay in their room, having help from outside and having regular contact by text message from PHE. Factors associated with non-adherence included being angry about the advice to isolate, being unable to get groceries delivered and concerns about losing touch with friends and family. Interviews highlighted that a sense of duty motivated people to adhere to isolation guidance and where people did leave their homes, these decisions were based on rational calculations of the risk of transmission - people would only leave their homes when they thought they were unlikely to come into contact with others. CONCLUSIONS: Understanding adherence to isolation and associated reasoning during the early stages of the pandemic is essential to pandemic preparedness for future emerging infectious disease outbreaks. Individuals make complex decisions around adherence by calibrating transmission risks, therefore treating adherence as binary should be avoided.

Exploring the impact of shielding advice on the wellbeing of individuals identified as clinically extremely vulnerable amid the COVID-19 pandemic: a mixed-methods evaluation.

BACKGROUND: The national shielding programme was introduced by UK Government at the beginning of the COVID-19 pandemic, with individuals identified as clinically extremely vulnerable (CEV) offered advice and support to stay at home and avoid all non-essential contact. This study aimed to explore the impact and responses of "shielding" on the health and wellbeing of CEV individuals in Southwest England during the first COVID-19 lockdown. METHODS: A two-stage mixed methods study, including a structured survey (7 August-23 October 2020) and semi-structured telephone interviews (26 August-30 September 2020) with a sample of individuals who had been identified as CEV and advised to "shield" by Bristol, North Somerset & South Gloucestershire (BNSSG) Clinical Commissioning Group (CCG). RESULTS: The survey was completed by 203 people (57% female, 54% > 69 years, 94% White British, 64% retired) in Southwest England identified as CEV by BNSSG CCG. Thirteen survey respondents participated in follow-up interviews (53% female, 40% > 69 years, 100% White British, 61% retired). Receipt of 'official' communication from NHS England or General Practitioner (GP) was considered by participants as the legitimate start of shielding. 80% of survey responders felt they received all relevant advice needed to shield, yet interviewees criticised the timing of advice and often sought supplementary information. Shielding behaviours were nuanced, adapted to suit personal circumstances, and waned over time. Few interviewees received community support, although food boxes and informal social support were obtained by some. Worrying about COVID-19 was common for survey responders (90%). Since shielding had begun, physical and mental health reportedly worsened for 35% and 42% of survey responders respectively. 21% of survey responders scored ≥ 10 on the PHQ-9 questionnaire indicating possible depression and 15% scored ≥ 10 on the GAD-7 questionnaire indicating possible anxiety. CONCLUSIONS: This research highlights the difficulties in providing generic messaging that is applicable and appropriate given the diversity of individuals identified as CEV and the importance of sharing tailored and timely advice to inform shielding decisions. Providing messages that reinforce self-determined action and assistance from support services could reduce the negative impact of shielding on mental health and feelings of social isolation.

Alleviation of Epiphora by Canaliculosinostomy into the Caudal Maxillary Sinus in the Horse.

OBJECTIVE: To describe a technique of canaliculosinostomy into the caudal maxillary sinus to alleviate epiphora secondary to nasolacrimal duct obstruction and to report the long-term outcome in 5 horses. STUDY DESIGN: Case series. ANIMALS: Five client-owned horses. METHODS: Case records of all horses presented for chronic epiphora to a single equine hospital that underwent surgical treatment were reviewed. All included horses had a Jones test or dacryocystography to confirm nasolacrimal duct obstruction. All horses were anesthetized and canaliculosinostomy was created from the medial canthus of the eye into the caudal maxillary sinus using a Steinmann pin and Jacob's chuck. A Foley catheter was placed normograde through the stoma. The inflated bulb held the Foley in place in the sinus, while the proximal end was pulled through the upper eyelid and sutured to the skin on the head. The Foley catheter was maintained in place for 3 weeks and then removed under sedation. RESULTS: Five horses were included. There were no intraoperative difficulties or complications. One horse dislodged the Foley catheter 3 days postoperatively. No other postoperative complications occurred. Followup was available for all horses. One horse was euthanatized for unrelated reasons 10 weeks postoperative at which time epiphora was resolved. The remaining 4 horses had resolution of epiphora at followup (24-46 months postoperative). CONCLUSION: This report describes a simple technique for canaliculosinostomy into the caudal maxillary sinus and long-term outcome in 4 of 5 horses, all of which had resolution of epiphora. This technique can be used to resolve epiphora of various etiologies.

A systematic review of the methods used to analyze the economic impact of endemic foot-and-mouth disease.

Foot-and-mouth disease (FMD) has large economic consequences in livestock systems, which must be robustly assessed to support disease control policy. This study described and assessed methods used within economic analyses of FMD and its control in endemic contexts. A systematic literature search was conducted in six academic search engines. Studies were included if they applied an economic analysis to a context with endemic FMD, producing a result articulated as a monetary figure. Data collected from each article included country of study, animal population, geographical level of analysis, time horizon and type of economic analysis. Each study was scored using a quality assessment tool containing a checklist of 42 reporting criteria. Sixty-four articles were included, from 12,087 identified in the searches, describing results for 26 countries. Over half of the articles (56%) described economic impact of FMD retrospectively, often only accounting for a selection of direct costs at farm or household level. Median quality score calculated was 41% (range 8%-86%). Methods were generally poorly reported, confirming previously described difficulties in using published data to evaluate economic impact of endemic FMD. Few studies included disaggregation of public and private costs, or benefits, of FMD control, or accounted for economic or social influences of scale in vaccination programmes. Many of the studies included had gaps in both premise and methodology. If these analyses are used when planning and budgeting FMD control programmes in endemic contexts, there is a risk of inefficient resource allocation.

Understanding what shapes disease control: An historical analysis of foot-and-mouth disease in Kenya.

Interpreting the interplay between politics, social demographics and epidemiology is essential for understanding how a disease's occurrence and control evolve over time. Foot-and-mouth disease (FMD) virus was first detected in Kenya in 1915 and serotyped in 1932. This review aims to describe and appraise initiatives to control FMD in Kenya since its independence from British rule in 1964, using information from the scientific literature. We describe the historical dynamics of FMD epidemiology in the country and determine socio-political factors that have shaped the control strategies used. PubMed, Scopus, CAB abstracts, Science Direct, Web of Science and Google Scholar were used to search and retrieve papers, using predetermined search criteria encompassing FMD, Kenya and disease control programme descriptors. In total 1234 papers were identified and screened for relevance using the World Health Organization's guidelines for rapid review. Ultimately 69 references from this search were included, and information extracted and consolidated. These papers highlight that following independence, there was a structured effort to control FMD consisting of a compulsory subsidised vaccination programme in the Rift Valley with movement controls and quarantine when outbreaks occurred. This programme led to an initial decrease in recorded FMD outbreaks. However, endemic circulation continued and this programme was discontinued due to multiple factors, including political deprioritisation and changes in the structure of veterinary services. Only low levels of active surveillance have been applied since 1964; most surveillance is passive and relies on outbreak reports. Currently control focuses on outbreak management and a mixture of public- and privately-funded vaccination. This review highlights critical drivers influencing disease control programme implementation including veterinary service structure, the active participation of stakeholders with farming systems and availability of affordable and matched FMD vaccine. Additionally, it appraises the availability of historical information and draws attention to gaps in the historical record.

The Role and Welfare of Cart Donkeys Used in Waste Management in Karachi, Pakistan.

Equine ownership is a common income-generating strategy in Pakistan. In Karachi, donkey carts are used to transport building materials, commercial produce and garbage. This study aimed to articulate the role and welfare of donkeys used in waste management. We conducted interviews with donkey owners (n = 200), households which use donkey carts for waste collection (n = 50) and key informants (n = 14). To assess the welfare of donkeys, the Standardised Equine-Based Welfare Assessment Tool (SEBWAT) was used (n = 204). Collection of waste was the primary source of income for 89% of owners interviewed. Of those directly involved in waste collection, 62% were found to be under 18 years of age. During interviews with donkey cart customers the majority reported that there would be a huge garbage build-up if donkey carts were not available. Welfare assessments demonstrated that 52.9% of donkeys had a body condition score of two. Muzzle mutilation was extremely high (78.4%) and 66.7% of donkeys had superficial knee lesions. This is the first study that has explored the role of donkey carts in waste management in Pakistan. The data demonstrate the sizable role that donkey-owning communities play in waste management and the important livelihood option this offers, as well as considerable animal welfare concerns.

Using Qualitative Methods to Explore Farrier-Related Barriers to Successful Farriery Interventions for Equine Welfare in India.

Farriery is a critical component of healthcare services for working equids. However, in India, an informal workforce, lack of structured training facilities and non-implementation of farriery regulations pose challenges for quality farriery. Brooke India, an equine welfare organisation, has undertaken many initiatives aiming to improve farriery services, including technical training and engagement with equid-owning communities. However, this has met with varying success. The study aimed to identify factors that prevent farriers providing quality farriery services. Focus-group discussions were conducted with farriers from two districts of Uttar Pradesh with varying programme outcomes. Within each area, farriers were grouped according to previous level of engagement with Brooke programmes. Demand for services, farrier status, the external environment and technical training and knowledge were identified as key elements that affected farriery work. These factors were very context specific: in areas where brick kilns provided the majority of customers, recent closures had resulted in an increase in those farriers' feeling of insecurity. A systems approach to improving farriery services, taking these factors into account, is advised. Mentoring-based capacity building, which is closely aligned to farrier needs and expectations, is expected to have positive results in terms of technical skill and farrier engagement.