COVID-19 in one region of New Zealand: a descriptive epidemiological study.

OBJECTIVE: To describe the epidemiology of COVID-19 in one region of New Zealand in the context of the national lockdown and provide a reference for comparing infection dynamics and control measures between SARS-Cov-2 strains.  Methods: Epidemiological linking and analysis of COVID-19 cases and their close contacts residing in the geographical area served by the Southern District Health Board (SDHB).  Results: From 13 March to 5 April 5 2020, 186 cases were laboratory-confirmed with wild-type Sars-Cov-2 in SDHB. Overall, 35·1% of cases were attributable to household transmission, 27·0% to non-household, 25·4% to overseas travel and 12·4% had no known epidemiological links. The highest secondary attack rate was observed in households during lockdown (15·3%, 95%CI 10·4-21·5). The mean serial interval in 50 exclusive infector-infectee pairs was 4·0 days (95%CI 3·2-4·7days), and the mean incubation period was 3.4 days (95%CI 2·7-4·2). CONCLUSIONS: The SARS-CoV-2 incubation period may be shorter than early estimates that were limited by uncertainties in exposure history or small sample sizes. IMPLICATIONS FOR PUBLIC HEALTH: The continuation of household transmission during lockdown highlights the need for effective home-based quarantine guidance. Our findings of a short incubation period highlight the need to contact trace and isolate as rapidly as possible.

Acute respiratory infection risk associated with exposure to outdoor PM{{10}} emissions from domestic heating.

AIM: Woodsmoke exposure has known adverse respiratory health effects. However, most studies are based on exposure in developing countries or developed cities. Woodburners are commonly used for domestic heating in New Zealand, and in some areas they impact air quality. We investigated whether woodsmoke exposure at levels encountered in a mid-size township has health effects. METHOD: We performed a time-stratified case crossover analysis of 1,870 general practitioner (GP) visits for acute respiratory infections (ARI) over five consecutive winters (May-August 2014-2018). Daily air concentrations of particulate matter less than 10 µm (PM{{10}}) were obtained from a fixed-site monitoring station. Conditional logistic regression was used to estimate OR and 95% CI after adjusting for the effects of temperature. RESULTS: A 10 µg/m[[3]] increase in PM{{10}} concentration was associated with 8% (95% CI 1%-15%) and 20% (95% CI 4%-38%) increases in the odds of a GP visit for an ARI within 24 hours for women and girls, and Maori of both sexes, respectively. CONCLUSION: Woodsmoke pollution may negatively affect the respiratory health of residents in mid-size towns. However, those most affected by woodsmoke are also likely to be most affected by woodburner phase-out policies. Air quality and housing policies must be integrated to meet a mutual goal of improved health.

Achieving Consensus in the Measurement of Psychological Adjustment to Cleft Lip and/or Palate at Age 8+ Years.

BACKGROUND: Consensus regarding optimal outcome measurement has been identified as one of the most important, yet most challenging developments for the future of cleft lip and/or palate (CL/P) services. In 2011, a process began to adopt a shared conceptual framework and to identify a set of core outcome measures for the comprehensive assessment of psychological adjustment. OBJECTIVES: The aim of the current article is to outline the collaborative process used to achieve consensus in the academic and clinical measurement of psychological adjustment to CL/P from the age of 8 years onward. RESULTS: A conceptual framework and corresponding parent- and self-reported outcome measures for use at ages 8, 10, 12, 15, 18, 20, and 25 years have been agreed upon by clinicians, researchers, and patient and parent representatives. All measures have been evaluated according to their psychometric properties, clinical utility, ability to produce meaningful longitudinal data, and a range of pragmatic considerations. CONCLUSIONS: Although the collaborative process has been challenging and has required ongoing dedication from multiple stakeholders, consistency in data collection over time will allow for key research questions in CL/P to be addressed, both in the United Kingdom (UK) and internationally. The process has also demonstrated the clinical utility of the measures and the potential for the gradual integration of the measures into clinical practice. UK progress has sparked global interest, and the adaptation of the framework and its corresponding measures for worldwide use is now a prominent focus.

Promoting Psychosocial Adjustment in Individuals Born With Cleft Lip and/or Palate and Their Families: Current Clinical Practice in the United Kingdom.

OBJECTIVES: The importance of psychosocial aspects of care has received growing recognition in recent years. However, the evidence base for psychosocial intervention remains limited. Specialist clinicians working in cleft lip and/or palate (CL/P) services hold a wealth of knowledge and experience yet to be elicited. The aims of this study were to identify common psychosocial challenges and potential risk and/or protective factors for psychosocial distress from the perspective of specialist clinicians and to establish the types of interventions currently being delivered in practice. DESIGN: Individual interviews with 17 clinical nurse specialists and 19 specialist clinical psychologists, representing all 16 UK CL/P surgical sites. Data were analyzed using inductive content analysis. RESULTS: Numerous psychosocial challenges affecting individuals with CL/P and their families were identified across the life span. Risk factors were predominantly contextual in nature, while protective factors appeared amenable to intervention. Participants drew upon a range of therapeutic models and approaches to guide formulation and intervention, while acknowledging the lack of evidence to support these approaches in CL/P populations specifically. CONCLUSIONS: Findings have important implications for the way in which psychosocial support for CL/P and related conditions is delivered and evaluated. A framework for the standardized assessment of holistic individual and familial well-being is proposed. Suggestions for increasing the evidence base for specific psychosocial interventions are made, including enhanced family functioning; social, emotional, and appearance concerns; treatment decision-making; and screening for psychosocial and developmental issues.

Achieving Consensus in the Measurement of Psychological Adjustment to Cleft Lip and/or Palate.

BACKGROUND: Psychological adjustment to cleft lip/palate is multifaceted and can fluctuate over time and across different situations. Consequently, a comprehensive understanding of adjustment is difficult to capture, and the challenge of achieving consensus among researchers and clinicians regarding key constructs and processes is considerable. Numerous measures have been used in research and clinical audit, resulting in conflicting findings and difficulties in evidencing the value of psychological intervention. The launch of the world's largest cleft lip/palate cohort study has provided an opportunity to standardize data collection across the United Kingdom. OBJECTIVE: To describe the collaborative process used to achieve consensus in the academic and clinical measurement of psychological adjustment to cleft lip/palate. RESULTS: Extensive work based on existing literature and clinical experience has resulted in a conceptual framework comprising six domains of adjustment and corresponding risk/protective factors that are measureable across key developmental time points. Driven by this framework, a core pack of standardized measures has been selected according to psychometric properties, clinical utility, and pragmatic considerations. CONCLUSIONS: To date, these measures have been implemented within a UK-wide longitudinal cohort study (at diagnosis, 18 months, 3 years, 5 years, and 8 years) and adopted into the national routine clinical audit protocol for cleft lip/palate at age 5. Further data collection points will follow as the cohorts age. Over time, consistency in data collection will allow researchers to address some of the key unanswered questions in relation to psychological adjustment to cleft lip/palate.

The Effectiveness of Psychosocial Intervention for Individuals With Cleft Lip and/or Palate.

OBJECTIVE: The aim of this review was to assess the effectiveness of different psychological interventions for children and adults with cleft lip and/or palate and their parents. DESIGN: We searched six databases including MEDLINE and EMBASE to June 2013 and checked bibliographies. We included research that evaluated any psychological intervention in studies in which at least 90% of the participants had cleft lip and/or palate or were parents of those with cleft lip and/or palate. Studies containing less than 90% were excluded unless they reported results separately for those with cleft lip and/or palate, or raw data were available upon request from the authors. Inclusion assessment, data extraction, and risk of bias assessment were carried out independently by two reviewers. RESULTS: Seven studies were identified as inclusions, with only two studies being included in the full data analysis (one of which failed to meet the full inclusion criteria). The five remaining studies were included only in a narrative synthesis because data were available for people or parents of those with cleft lip and/or palate only. This highlights a distinct dearth of research into psychological intervention within the field of cleft lip and/or palate. CONCLUSIONS: The review found no evidence to support any specific intervention. Key uncertainties need to be identified and addressed. Adequately powered, methodologically rigorous randomized controlled trials are needed to provide a secure evidence base for psychological intervention techniques in participants with cleft lip and/or palate and their parents.

Validity and reliability of the munsell soil color charts for assessing human skin color.

BACKGROUND: Skin pigmentation is a key factor for ultraviolet radiation exposure-related cancers and can make a significant contribution to the patterns of other diseases. For surveys, and to appropriately target cancer control activities, valid and reliable measures of skin color are required. METHODS: Validity and reliability of the Munsell Soil Color Charts were investigated for skin color assessment. The unexposed skin color of 280 university students was measured by spectrophotometer to calculate an Individual Typology Angle (ITA) value, and categorized by two independent raters according to the Munsell system (the latter was repeated after a 7-day interval). RESULTS: Interrater and intrarater reliability for the Munsell charts was found to be acceptable [intraclass correlation coefficients (ICC) of 0.85 and 0.86, respectively]. When ITA values were converted to the six Del Bino skin color categories, weighted κ for agreement between raters, within rater, and between Munsell chip and spectrophotometer were 0.63, 0.60, and 0.61, respectively. A tendency toward overestimation of the extremes of skin pigmentation was evident, particularly for the "brown" and "dark" skin types. CONCLUSIONS: Study findings suggest that the Munsell Soil Color Charts represent a reliable and valid measurement strategy when assessing skin type. IMPACT: The Munsell Year 2000 Soil Color Charts may provide a useful instrument for fieldwork contexts. Subsequent classification of individuals into skin cancer risk categories, rather than the use of precise ITA values, may be sufficient for targeting public health messages for skin cancer prevention and other health risks.

Questionnaire items to assess skin color and erythemal sensitivity: reliability, validity, and "the dark shift".

BACKGROUND: Skin pigmentation is a key factor for UV radiation exposure related cancers. To appropriately target cancer control activities related to this exposure and for better representation in epidemiologic studies, a valid and reliable assessment of skin color is required. METHODS: The validity and reliability of two self-report measures were assessed: skin color and erythemal sensitivity. A sample of 289 university students categorized their unexposed skin color and photosensitivity via a questionnaire. Skin color was also measured by spectrophotometer. After 7 days, participants repeated the self-report assessment. RESULTS: Significant correlations were found for both self-report items with objective measures, indicating that these items may be valid assessment tools (color: Spearman's rho=-0.75, P<0.001; photosensitivity: Spearman's rho=-0.64, P<0.001). No sex differences in validity were evident. Stronger correlations were found among those of European than those of non-European ethnicity (color: Spearman's rho=-0.78 versus -0.59, bootstrap P=0.007; photosensitivity: Spearman's rho=-0.63 versus -0.28, bootstrap P=0.001). Strong biases toward overestimation of skin pigmentation were evident, ranging from 36% in the self-identified fair skin group to 77% in the medium skin color group. Intrarater reliability of the questionnaire items was high (color: k=0.78, P<0.001; photosensitivity: k=0.77, P<0.001). CONCLUSIONS: Study findings suggest that self-report may be a valid measurement strategy when assessing skin type, but there is a bias toward overestimation of skin color and, potentially, UV radiation resilience. IMPACT: This bias has the potential to undermine the effectiveness of skin cancer prevention efforts and needs to be addressed in health promotion programs.

Preliminary assessment of Apache hopefulness: Relationships with hopelessness and with collective as well as personal self-esteem.

Hopelessness is central to prominent mental health problems within American Indian (AI) communities. Apaches living on a reservation in Arizona responded to diverse expressions of hope along with Hopelessness, Personal Self-Esteem, and Collective Self-Esteem scales. An Apache Hopefulness Scale expressed five themes of hope and correlated negatively with Hopelessness and positively with both Collective and Personal Self-Esteem. These data confirmed the potential of conducting more extensive analyses of hope within AI tribal life.

Are workers or their workplaces the key to occupational sun protection?

ISSUE ADDRESSED: High levels of sun exposure and skin cancer are experienced by outdoor workers. To develop effective preventive strategies it is important to understand which factors predict sun protection use. METHODS: Outdoor workers (n=74) in Central Otago, New Zealand, completed a questionnaire and recorded sun protection practices for five consecutive working days, January-March 2007. RESULTS: Sun protection was predicted by beliefs of personal susceptibility to skin cancer, suntan attitudes, and perceived workplace support, but not knowledge. CONCLUSIONS: Both individual and workplace factors influence outdoor workers' sun protection.