Assessing the Efficacy of a Brief Universal Family Skills Programme on Violence and Substance-Use Indicators in Youth in Trentino and Parma, Italy: Study Protocol for a Multi-Centre, Non-Blinded, Cluster-Randomised Controlled Trial (cRCT) of Family UNited.

Homes in which families are experiencing stressful and challenging circumstances can foster a social space that engenders violent behaviours in parents, inadequate childcare, and the exposure of children to criminal and antisocial behaviours at an early age in addition to many other negative social and health consequences throughout their development. Family Skills Training offers a combination of parenting knowledge, skill building, competency enhancement, and support to strengthen family protective factors, such as communication, trust, problem-solving skills, and conflict resolution. Through over a decade-long experience piloting evidence-based family skills packages globally, we developed a universal open-source family skills package, "Family UNited" (FU), designed for families with children aged 8 to 15 years living in low- and middle-income countries (LMIC). The current study aims to explore the efficacy, fidelity, and acceptability of FU in Trentino and Parma, Italy. We plan to conduct a multi-site, non-blinded, two-armed, cluster-randomised controlled trial to assess efficacy in 160 families: the intervention group receiving FU and the waitlist/control group only receiving FU after the completion of all data collection points. We will prospectively collect outcome data, assessing changes in parenting skills and family adjustment in caregivers, children's behaviour, resilience capacities, and attitudes towards peer violence. To assess programme delivery, fidelity, feasibility, and acceptability we will include an embedded process evaluation. This study aims to evaluate the improvement in parenting skills, child well-being, and family mental health after participation in FU, compared to no intervention. Even though this trial is to be conducted in a high-income country, such results complement the existing piloting experience in LMIC. with impact-related measures encouraging the adoption of such approaches globally and beyond the EU borders.

Audience effect on domestic dogs' behavioural displays and facial expressions.

In the present study we investigated the influence of positive and negative arousal situations and the presence of an audience on dogs' behavioural displays and facial expressions. We exposed dogs to positive anticipation, non-social frustration and social frustration evoking test sessions and measured pre and post-test salivary cortisol concentrations. Cortisol concentration did not increase during the tests and there was no difference in pre or post-test concentrations in the different test conditions, excluding a different level of arousal. Displacement behaviours of "looking away" and "sniffing the environment" occurred more in the frustration-evoking situations compared to the positive anticipation and were correlated with cortisol concentrations. "Ears forward" occurred more in the positive anticipation condition compared to the frustration-evoking conditions, was positively influenced by the presence of an audience, and negatively correlated to the pre-test cortisol concentrations, suggesting it may be a good indicator of dogs' level of attention. "Ears flattener", "blink", "nose lick", "tail wagging" and "whining" were associated with the presence of an audience but were not correlated to cortisol concentrations, suggesting a communicative component of these visual displays. These findings are a first step to systematically test which subtle cues could be considered communicative signals in domestic dogs.

Safety Compliance in a Sample of Italian Mechanical Companies: The Role of Knowledge and Safety Climate.

The accident rate in the Italian mechanical sector is still too high, and evidence-based interventions to improve safety performance are essential. To better address this, our study contributes to the understanding of how to promote safety compliance through safe behaviours by using a sample of Italian mechanical workers (n = 109). Before and after scheduled safety training, intervention data on organizational factors, as well as on individual factors affecting safety-related behaviours, were collected. Particularly, data were collected using multiple sources, including self-perception questionnaires (to measure the safety climate among the management and colleagues and the safety attitude), paper and pencil tests (to measure safety knowledge), and observations by personnel with experience in observation tasks (to measure safety behaviours objectively). A model class of competing general linear models was built to determine which of the models was best suited for predicting safety-related behaviours. The results showed that both knowledge and the management's safety climate effectively promoted safety compliance. Crucial implications for the effectiveness of active teaching methods, along with the need for continuous training and the prominent role of the management team members in giving, through their actions, further relevance to the need to respect rules and procedures, were revealed. Finally, practical implications for researchers, corporate decision makers, government agencies, and international bodies are discussed.

A promising novel judgement bias test to evaluate affective states in dogs (Canis familiaris).

The judgement bias test represents one of the most applied tools to evaluate animals' optimistic/pessimistic attitude and to infer their emotional and welfare state accordingly. The judgement bias test (JBT) has been used several times with dogs (Canis familiaris), in most cases using a spatial test that evaluates the dog's attitude towards a bowl placed in ambiguous positions (located between two unambiguous trained positions associated with opposite outcomes). Results are contrasting and methodological and statistical caveats emerged: dogs struggled to learn the association between unambiguous positions and their outcomes, they hardly discriminated between adjacent locations and they might be influenced by researchers. Therefore, we propose a novel paradigm, aimed at easing the learning process and at achieving more reliable measures. Improvements of the novel paradigm are the increased difference between payoffs of trained locations, the reduction of the number of trials and of their length and the removal of the potential influence of researchers. Results showed that 98% of dogs reached the learning criterion and that their learning appeared more stable: dogs behaved differently between the two trained stimuli and the variability of responses towards these stimuli was lower than the one towards ambiguous stimuli. Behavioural analyses confirmed that dogs fully learned outcomes associated with trained stimuli and that they were hesitant towards ambiguous stimuli. Furthermore, dogs managed to successfully discriminate between each pair of adjacent locations. These results suggest that this protocol is a promising tool to assess judgement biases in dogs and to evaluate their affective state.

Personal health budget in patients with first episode psychosis: A new rehabilitation model based on a community care system in Italy.

AIM: Recently, there has been increasing interest in providing Personal Health Budgets (PHBs) to patients with severe mental illness. However, information on implementing PHB initiatives is still limited. Aim of this observational study was to evaluate the applicability of a PHB intervention model in a sample of Italian adults with first-episode psychosis (FEP) across a 2-year follow-up period. METHODS: Participants (n = 104; 18-50 years) were recruited within the 'Parma-Early Psychosis' program and completed the brief psychiatric rating scale (BPRS), the health of nation outcome scale (HoNOS) and the global assessment of functioning (GAF). Mixed-design analysis of variance (ANOVA) and Kaplan-Maier survival analysis (as drop-out measure) were performed. RESULTS: A significant effect of time on all BPRS, HoNOS and GAF scores along the follow-up was observed in both the FEP subgroups (i.e., with [n = 49] and without [n = 55] PHB intervention). Mixed-design ANOVA results showed a significant 'time x group' interaction effects on BPRS 'Disorganization', HoNOS 'Psychiatric Symptoms' and GAF scores in FEP participants with PHB. Kaplan-Meyer survival analysis showed a longer survival mean for FEP patients with PHB. CONCLUSIONS: Our results support the applicability of a PHB model within an 'Early Intervention in Psychosis' program in public community mental health services.

Affective Contagion: How Attitudes Expressed by Others Influence Our Perception of Actions.

Vitality forms represent a fundamental aspect of social interactions by characterizing how actions are performed and how words are pronounced on the basis of the attitude of the agent. Same action, such as a handshake, may have a different impact on the receiver when it is performed kindly or vigorously, and similarly, a gentle or rude tone of voice may have a different impact on the listener. In the present study, we carried out two experiments that aimed to investigate whether and how vocal requests conveying different vitality forms can influence the perception of goal-directed actions and to measure the duration of this effect over time. More specifically, participants were asked to listen to the voice of an actor pronouncing "give me" in a rude or gentle way. Then, they were asked to observe the initial part of a rude or a gentle passing action, continue it mentally, and estimate the time of its completion. Results showed that the perception of different vitality forms expressed by vocal requests influenced the estimation of action duration. Moreover, we found that this effect was limited to a certain time interval (800 ms), after which it started to decay.

Burnout and Oncology: an irreparable paradigm or a manageable condition? Prevention strategies to reduce Burnout in Oncology Health Care Professionals.

BACKGROUND: Burnout is a stress-induced occupational related syndrome, characterized by Emotional Exhaustion (EE), feeling of depersonalization (DP) and low sense of professional accomplishment (PA). The aim of this study is to analyse the effectiveness of interventions in decreasing health professionals Burnout as well as work and life-style risk factors.  Methods: A survey in Medical Oncology Department in the University Hospital of Parma was conducted using the validated Maslach Burnout Inventory (MBI) and two additional questionnaires exploring lifestyle and work factors. An 8-months intervention involved fortnight meetings by facilitators, incorporated elements of reflection, shared experiences and managing emotions. Six months after the end of the intervention a second survey was performed among the participants using MBI and the same questionnaires mentioned above.  Results: EE resulted the most problematic score in Day Hospital: after the 8-month intervention we described a significant decreasing in EE score especially for Day Hospital operators (from 16.7 to 10.9) and a considerable reduction in DP score. In the Oncology Ward a correlation between lack of collaboration among different health categories and DE score was detected; in the Day Hospital the absence of solid working teams was related to higher EE scores.  Conclusion: The Oncology professional health care personnel are at the greatest risk of Burnout. Our study in Oncology Department shows that specific intervention should be used to prevent and reduce Burnout. Effective personal health care strategies should be incorporated into routine oncology care to prevent and treat Burnout.

Post-Traumatic Outcomes among Survivors of the Earthquake in Central Italy of August 24, 2016. A Study on PTSD Risk and Vulnerability Factors.

Central Italy suffered from the earthquake of 2016 resulting in great damage to the community. The purpose of the present study was to determine the long-term traumatic outcomes among the population. A preliminary study aimed at obtaining the Italian translation of the first 16 item of HTQ IV part [1] which was administered, 20 months after the disaster, at 281 survivors. In backward stepwise logistic regressions models, we estimated among the respondent's characteristics and event-related variables the best predictors of Post-Traumatic Stress Disorder (PTSD).A Confirmatory Factor Analysis (CFA) revealed a HTQ five-factors solution as best model, with satisfactory indexes of fit. HTQ held a positive correlation with both the SQD-P (r = .65, p < .05) and SQD-D subscales (r = .47, p < .05). ROC analysis suggested an area of .951 (95% CI = .917-.985) for the PTSD prediction. Basing on sensibility (.963) and specificity (.189), the best cut-off of 2.0 allowed discriminating for PTSD positive cases. After 20 months of the earthquake, the estimate prevalence of PTSD among the survivors is of 21.71% with a consistent and graded association between exposure variables and vulnerability factors (gender, age, exposure to death and home damage) and PTSD symptoms.

Using judgment bias test in pet and shelter dogs (Canis familiaris): Methodological and statistical caveats.

It is now widely agreed that a positive affective state is a crucial component of animal well-being. The judgment bias test represents a widespread tool used to assess animals' optimistic/pessimistic attitude and to evaluate their emotional state and welfare. Judgment bias tests have been used several times with dogs (Canis familiaris), in most cases using a spatial test with a bowl placed in ambiguous positions located between a relatively positive trained location (P) which contains a baited bowl and a relatively negative trained location (N) which contains an empty bowl. The latency to approach the bowl in the ambiguous locations is an indicator of the dog's expectation of a positive/negative outcome. However, results from such tests are often inconclusive. For the present study, the judgment bias test performance of 51 shelter dogs and 40 pet dogs was thoroughly analysed. A pattern emerged with shelter dogs behaving in a more pessimistic-like way than pet dogs. However, this difference between the two populations was detected only when analysing the raw latencies to reach the locations and not the more commonly applied adjusted score (i.e. average latency values). Furthermore, several methodological caveats were found. First of all, a non-negligible percentage of dogs did not pass the training phase, possibly due to the experimental paradigm not being fully suited for this species. Second, results showed a high intra-dog variability in response to the trained locations, i.e. the dogs' responses were not consistent throughout the test, suggesting that animals may not have fully learned the association between locations and their outcomes. Third, dogs did not always behave differently towards adjacent locations, raising doubts about the animals' ability to discriminate between locations. Finally, a potential influence of the researcher's presence on dogs' performance emerged from analyses. The implications of these findings and potential solutions are discussed.

Emotional exhaustion among healthcare professionals: the effects of role ambiguity, work engagement and professional commitment.

BACKGROUND AND AIM: The study aims at identifying the antecedents and consequences of emotional exhaustion in health professionals and, particularly, examining the process that leads from a hindrance demand, like role ambiguity, to exhaustion and job satisfaction. Emotional exhaustion is a phenomenon that affect health professionals with negative consequence on job satisfaction, and literature has underlined that job demands could be may be a cause of this chronic stress. However, the relationship among job demands, work engagement and exhaustion has produced results not always converging. METHOD: A self-report questionnaire was administered to 66 health professionals. RESULTS: The results showed that the effect of role ambiguity on emotional exhaustion was mediated by work engagement and the emotional exhaustion impairs job satisfaction when workers are not committed to their profession. CONCLUSIONS: Role ambiguity represents a psychosocial risk factor that influence workers' wellbeing diminishing the level of motivation and this process leads to emotional exhaustion. However, professional commitment appears to be a resource that can protect professionals preventing a decrease in satisfaction. These findings suggest that human resource management should remove hindrance stressors and enhance the mission of Healthcare Professionals in order to increase employees' work engagement and prevent exhaustion.

Effects of breed group and development on dogs' willingness to follow a human misleading advice.

The aim of this work was to investigate the effect of dog breed groups, i.e., primitive, hunting/herding and Mastiff like (Study 1) and development, i.e., 4-month-old puppies vs adults (Study 2) on a quantity discrimination task. The task consisted of three conditions: C1-dogs were asked to choose between a large and a small amount of food; C2-the same choice was presented and dogs could choose after having witnessed the experimenter favouring the small quantity. C3-similar to C2 but the plates had two equally small food quantities. Study 1 revealed that dogs in the hunting/herding group were significantly more likely than Mastiff-like group to choose the small quantity indicated by the person over the large one, although all dog groups chose the large quantity over the small when they had a free choice. These results are consistent with the hypothesis that hunting/herding breeds have been selected for working in cooperation with humans and thus may be more sensitive to human social communicative cues than other breeds. In Study 2, results showed that 4-month-old puppies performed at chance level in C1, whereas in C2 both adults and puppies conformed to the experimenter's choice. In C3, adults followed the experimenter significantly more than puppies, although puppies still followed the experimenter above chance. Overall, domestic dogs seem to rely heavily on social communicative cues from humans, even when the information contradicts their own perception. This tendency to respond to human social cues is present, although at a lesser extent already at 4 months.

Pet dogs' behavior when the owner and an unfamiliar person attend to a faux rival.

While dog owners ascribe different emotions to their pets, including jealousy, research on secondary emotions in nonhuman animals is very limited and, so far, only one study has investigated jealousy in dogs (Canis familiaris). This work explores jealousy in dogs one step further. We conducted two studies adapting a procedure devised to assess jealousy in human infants. In each study 36 adult dogs were exposed to a situation in which their owner and a stranger ignored them while directing positive attention towards three different objects: a book, a puppet and a fake dog (Study 1: furry; Study 2: plastic). Overall, the results of both studies do not provide evidence that the behavioral responses of our dogs were triggered by jealousy: we did not find a clear indication that the fake dogs were perceived as real social rivals, neither the furry nor the plastic one. Indeed, dogs exhibited a higher interest (i.e. look at, interact with) towards the fake dogs, but differences in the behavior towards the fake dog and the puppet only emerged in Study 2. In addition, many of the behaviors (protest, stress, attention seeking, aggression) that are considered distinctive features of jealousy were not expressed or were expressed to a limited extent, revealing that dogs did not actively try to regain their owner's attention or interfere with the interaction between the owner and the faux rival. Finally, a differentiated response towards the attachment figure (the owner) and the unfamiliar person (the stranger) did not emerge. Differently from what reported in human infants, dogs' behavior towards the attachment figure and the stranger interacting with the potential competitor (in this case, the fake dog) did not significantly differ: in both studies dogs paid attention to the owner and the stranger manipulating the fake dog to the same extent. In conclusion, we do not exclude that dogs could possess a rudimentary form of jealousy, but we suggest that research on this topic should require the use of a real social interloper (conspecific or human) and more naturalistic procedures.

Differences in Action Style Recognition in Children with Autism Spectrum Disorders.

Vitality form is a term, originally introduced by Stern (2010), to describe "how" an action is performed. The capacity to perceive the vitality form of others' actions is a fundamental element of social interactions and a basic way of relating to and understanding others' behaviors. Although vitality forms characterize all human interactions, few studies have addressed their role in social and communicative disorders such as autism. The aim of the present study is to evaluate the ability to recognize different vitality forms during the observation of different motor actions in a group of children with autism spectrum disorders (ASD) compared to typically developing controls (TD). Results show a significant difference between children with ASD and TD in vitality forms recognition. This finding sheds new light on how children with ASD understand others' actions providing new ideas on overall social understanding as well as useful insights for professionals and caregivers alike.

Breed, sex, and litter effects in 2-month old puppies' behaviour in a standardised open-field test.

A considerable number of studies have reported differences among dog breeds with respect to their genetic profile, cognitive abilities or personality traits. Each dog breed is normally treated as a homogeneous group, however, researchers have recently questioned whether the behavioural profile of modern breeds still reflects their historical function or if the intense divergent selective pressures and geographical barriers have created a more fragmented picture. The majority of studies attempting to assess and compare modern breeds' personality focused on the evaluation of adult dogs where the potential effects of environmental/human factors on the dogs' behaviour are hard to discern from their genetic heritage. In the following study, we aimed at investigating between- and within-breed differences in the personality of two-months-old puppies by direct behavioural observation of 377 puppies from 12 breeds. Results showed that there was no effect of sex, however both breed and litter, significantly affected all personality traits. Breed on average explained 10% of the variance, whereas the effect of litter was noticeably higher, explaining on average 23% of the variance. Taken together, our results suggest that breed does have some influence on personality traits, but they also highlight the importance of taking litter effects into account.

The Progression of Alzheimer's Disease: Are Fast Decliners Really Fast? A Four-Year Follow-Up.

BACKGROUND: The rate of cognitive and functional decline in Alzheimer's disease (AD) changes across individuals. OBJECTIVES: Our purpose was to assess whether the concept of "fast decline" really fits its definition and whether cognitive and functional variables at onset can predict the progression of AD. METHODS: 324 AD patients were included. We retrospectively examined their Mini-Mental State Examination (MMSE) total score and sub-items, Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL) at baseline and every six months for a 4-year follow-up. Patients were divided into "fast decliners" (n = 62), defined by a loss ≥5 points on the MMSE score within the first year from the baseline; "intermediate decliners" (n = 37), by a loss ≥5 points after the first year and before the 18th month; or "slow decliners" (n = 225), composed of the remaining patients. RESULTS: At baseline, the groups did not differ on demographic, clinical, and cognitive variables. The decline at the end of the 4-year follow-up period seems to be similar among the different decline clusters. Predictors of disease progression have not been identified; only the MMSE total score at 12 months <14/30 was indicative of a poor prognosis. CONCLUSIONS: Even with the limitation due to the small sample size, the lack of differences in the disease progression in time in the different clusters suggest the inconsistency of the so-called "fast decliners". This study was unable to show any significant difference among clusters of AD progression within a 4-year time interval. Further studies should better clarify whether a more consistent distinction exists between slow and fast decliners.

Phenobarbital for Neonatal Seizures: Response Rate and Predictors of Refractoriness.

Background Phenobarbital is the first-line choice for neonatal seizures treatment, despite a response rate of approximately 45%. Failure to respond to acute anticonvulsants is associated with poor neurodevelopmental outcome, but knowledge on predictors of refractoriness is limited. Objective To quantify response rate to phenobarbital and to establish variables predictive of its lack of efficacy. Methods We retrospectively evaluated newborns with electrographically confirmed neonatal seizures admitted between January 1999 and December 2012 to the neonatal intensive care unit of Parma University Hospital (Italy), excluding neonates with status epilepticus. Response was categorized as complete (cessation of clinical and electrographic seizures after phenobarbital administration), partial (reduction but not cessation of electrographic seizures with the first bolus, response to the second bolus), or absent (no response after the second bolus). Multivariate analysis was used to identify independent predictors of refractoriness. Results Out of 91 newborns receiving phenobarbital, 57 (62.6%) responded completely, 15 (16.5%) partially, and 19 (20.9%) did not respond. Seizure type (p = 0.02), background electroencephalogram (EEG; p ≤ 0.005), and neurologic examination (p ≤ 0.005) correlated with response to phenobarbital. However, EEG (p ≤ 0.02) and seizure type (p ≤ 0.001) were the only independent predictors. Conclusion Our results suggest a prominent role of neurophysiological variables (background EEG and electrographic-only seizure type) in predicting the absence of response to phenobarbital in high-risk newborns.

How good is this food? A study on dogs' emotional responses to a potentially pleasant event using infrared thermography.

Understanding how animals express positive emotions is becoming an interesting and promising area of research in the study of animal emotions and affective experiences. In the present study, we used infrared thermography in combination with behavioral measures, heart rate (HR) and heart rate variability (HRV), to investigate dogs' emotional responses to a potentially pleasant event: receiving palatable food from the owner. Nineteen adult pet dogs, 8 females and 11 males, were tested and their eye temperature, HR, HRV and behavior were recorded during a 30-minutestestconsisting of three 10-minute consecutive phases: Baseline (Phase 1), positive stimulation through the administration of palatable treats (Feeding, Phase 2) and Post-feeding condition following the positive stimulation (Phase 3). Dogs' eye temperature and mean HR significantly increased during the positive stimulation phase compared with both Baseline and Post-feeding phases. During the positive stimulation with food (Phase 2), dogs engaged in behaviors indicating a positive emotional state and a high arousal, being focused on food treats and increasing tail wagging. However, there was no evidence of an increase in HRV during Phase 2 compared to the Phase 1, with SDNN significantly increasing only in Phase 3, after the positive stimulation occurred. Overall results point out that IRT may be a useful tool in assessing emotional states in dogs in terms of arousal but fails to discriminate emotional valence, whose interpretation cannot disregard behavioral indexes.

Does Subjective Rating Reflect Behavioural Coding? Personality in 2 Month-Old Dog Puppies: An Open-Field Test and Adjective-Based Questionnaire.

A number of studies have recently investigated personality traits in non-human species, with the dog gaining popularity as a subject species for research in this area. Recent research has shown the consistency of personality traits across both context and time for adult dogs, both when using questionnaire based methods of investigation and behavioural analyses of the dogs' behaviour. However, only a few studies have assessed the correspondence between these two methods, with results varying considerably across studies. Furthermore, most studies have focused on adult dogs, despite the fact that an understanding of personality traits in young puppies may be important for research focusing on the genetic basis of personality traits. In the current study, we sought to evaluate the correspondence between a questionnaire based method and the in depth analyses of the behaviour of 2-month old puppies in an open-field test in which a number of both social and non-social stimuli were presented to the subjects. We further evaluated consistency of traits over time by re-testing a subset of puppies. The correspondence between methods was high and test- retest consistency (for the main trait) was also good using both evaluation methods. Results showed clear factors referring to the two main personality traits 'extroversion,' (i.e. the enthusiastic, exuberant approach to the stimuli) and 'neuroticism,' (i.e. the more cautious and fearful approach to the stimuli), potentially similar to the shyness-boldness dimension found in previous studies. Furthermore, both methods identified an 'amicability' dimension, expressing the positive interactions the pups directed at the humans stranger, and a 'reservedness' dimension which identified pups who largely chose not to interact with the stimuli, and were defined as quiet and not nosey in the questionnaire.

Neonatal seizures in preterm newborns: A predictive model for outcome.

BACKGROUND: With a reported prevalence of 22.2%, seizures in preterm newborns represent an emergent challenge, because they are often related to adverse outcome. The electroclinical features of preterm infants with neonatal seizures were evaluated in order to predict outcome. METHODS: From 154 newborns with video-EEG confirmed neonatal seizures admitted to Parma University Hospital between January 1999 and December 2012, we collected 76 preterm newborns with neonatal seizures. Outcome was assessed at least at one year. Student t-test for unpaired data was used to compare means of continuous variables. We applied the χ(2) test to compare nominal data between preterm newborns with favorable versus adverse outcome, and between those with seizures versus those with status epilepticus. Then we determined the independent risk factors for adverse outcome with multivariate logistic regression analysis. RESULTS: Birth weight, Apgar at 1st minute, neurologic examination, EEG, US brain scans and the presence of neonatal status epilepticus were different between preterm newborns with favorable and adverse outcome (p ≤ .049). Furthermore, birth weight, seizure onset, neurologic examination and EEG were different between the group with or without status (p ≤ .031). None of the infants with status epilepticus had a favorable outcome compared to 22.3% of those with neonatal seizures (p = .004). We also identified a predictive model that correctly classified outcome in 85.5% of subjects, with a high sensitivity for adverse outcome (>91.5%). CONCLUSION: The presence of neonatal seizures in preterm newborns is highly related to an adverse outcome that can be predicted since the first days of life.