Fieldwork for public health responses during pandemics: lessons from the New South Wales Health experience with COVID-19.

Problem: Fieldwork is a vital component of public health emergency response, yet little has been published on undertaking fieldwork safely. Safety is of particular importance with emerging pandemic viruses, which can pose additional risks to public health fieldwork staff. Context: During a pandemic, surge health staff may be drawn from diverse professional backgrounds; they may have limited experience in fieldwork or be unfamiliar with the risks posed by a novel virus. Novel pathogens pose dangers to fieldwork staff, particularly when there are global or local shortages of personal protective equipment. Action: During the coronavirus disease 2019 (COVID-19) pandemic, New South Wales (NSW) Health's Public Health Emergency Operations Centre (PHEOC) deployed staff for fieldwork in a range of settings. The PHEOC developed a protocol to systematize planning, risk assessment and management for COVID-19 fieldwork. The protocol was accompanied by training, discussion exercises and debriefs to support PHEOC fieldwork staff. Lessons learned: Effective fieldwork is an essential component of outbreak investigation and management, including stakeholder management. Here, we share and discuss key elements of the NSW Health protocol to support fieldwork during outbreak responses for emerging communicable diseases across various resource contexts. Limited understanding of novel viruses, particularly in the early phases of a pandemic, must be considered in decisions to deploy fieldwork staff and implement precautionary risk mitigation approaches. Planning is essential to protect staff and ensure ethical allocation of resources. Through appropriate selection of teams and training, surge staff can be supported to effectively conduct fieldwork.

Food Co-Operatives: A Potential Community-Based Strategy to Improve Fruit and Vegetable Intake in Australia.

Only 5% of Australian children and adults eat enough fruit and vegetables. Two common barriers are high cost and limited access. Food co-operatives ('co-ops') may have the potential to reduce these barriers. We conducted a scoping analysis of food co-ops in the Sydney region to describe their characteristics and objectives. We also conducted a survey of members and non-members of co-ops to assess their fruit and vegetable intake using validated questions. Fifteen food co-ops were identified in the Sydney region and the most common objective was to provide cheap affordable produce. Most co-ops (61%) were in areas of high socio-economic status (SES). Members of food co-ops had a higher vegetable intake than non-members [mean difference (MD) = 0.54 serves/daily; 95% confidence interval (CI) of 0.15 to 0.93] and were also more likely to meet the recommendations for fruit and vegetable intake [odds ratio (OR) = 4.77 (95% CI = 1.15, 19.86)]. Implications of this study are that if food co-ops can be implemented on a wider scale, they hold potential for improving fruit and vegetable intakes.

Associations of vigorous physical activity with all-cause, cardiovascular and cancer mortality among 64 913 adults.

BACKGROUND: Physical activity recommendations state that for the same energy expenditure, moderate-to-vigorous physical activities (MVPAs) produce similar health benefits. However, few epidemiological studies have tested this hypothesis. DESIGN: We examined whether, compared with moderate, vigorous activity was associated with larger mortality risk reductions. METHODS: Data from 11 cohorts of the Health Survey for England and the Scottish Health Survey, collected from 1994 to 2011 (mean (SD) follow-up, 9.0 (3.6) years). Adults aged ≥30 years reported MVPA and linkage to mortality records. Exposure was the proportion of self-reported weighted MVPA through vigorous activity. Outcomes were all-cause, cardiovascular disease (CVD) and cancer mortality. RESULTS: Among 64 913 adult respondents (44% men, 56% women, mean (SD) age, 49.8 (13.6) years), there were 5064 deaths from all-causes, 1393 from CVD and 1602 from cancer during 435 743 person-years of follow-up. Compared with those who reported no vigorous physical activity, and holding constant the volume of weighted MVPA, vigorous activity was associated with additional reductions in mortality risk. For all-cause mortality, the adjusted HR was HR=0.84 (95% CI 0.71, 0.99) and HR=0.84 (95% CI 0.76, 0.94) among those who reported between >0% and<30%, or ≥30% of their activity as vigorous, respectively. For CVD and cancer mortality, point estimates showed similar beneficial associations yet CIs were wider and crossed unity. CONCLUSION: Vigorous activities were associated with larger reductions in mortality risk than activities of moderate intensity, but no evidence of dose-response effects was found.

Reproductive Outcomes After a Childhood and Adolescent Young Adult Cancer Diagnosis in Female Cancer Survivors: A Systematic Review and Meta-analysis.

Improvements in cancer therapy for childhood and adolescent and young adult (AYA) survivors have increased in excess of 80% among pediatric patients and in excess of 85% among AYA cancer patients. Our research group explored the late effects consequences of cancer treatment on pregnancy and birth outcomes subsequent to a childhood (0-14 years) or AYA (15-25 years) diagnosis of cancer in female cancer survivors. Embase and Medline databases were searched. There were 17 review (n = 10 matched and n = 7 unmatched) studies that met the inclusion criteria. Subanalyses were conducted on 10 matched studies. The median age for all studies for patients at diagnosis and birth was 11 and 27 years, respectively. In matched cohort studies, female childhood and AYA cancer patients, who received chemotherapy alone, had a pooled estimated rate of 18% of experiencing a live birth compared with 10% of females who received radiotherapy alone and subsequently had a live birth. Females who received surgery alone reported higher pooled estimated rates of 44% for a live birth. For matched retrospective review studies, 79% (n = 973) of women experienced a live birth, of which 22% of these babies were born preterm. This meta-analysis found lower birth rates for survivors. Access to fertility-related information and discussions around fertility preservation options and oncofertility psychosocial support should be offered to all cancer patients and their families before starting cancer treatment.

Expectations for dog ownership: Perceived physical, mental and psychosocial health consequences among prospective adopters.

Dog ownership is popular worldwide, with most human-dog dyads forming successful attachment bonds. However, millions of dogs are surrendered to animal shelters annually, possibly due to mismatches between owner expectations and the realities of dog ownership. The aim of the current study was to explore the benefits and challenges people expect from dog ownership and how these expectations vary with previous ownership history. An Australian-wide sample of 3465 prospective adopters completed a self-administered online questionnaire about the physical, mental and psychosocial health benefits and challenges they associated with dog ownership. Among the potential benefits, respondents expected increased walking (89%), happiness (89%) and companionship (61%) and decreased stress (74%) and loneliness (61%). Among the challenges, they expected increased responsibility (64%) and dog training (62%). Ownership history influenced respondents' expectations, with previous/current dog owners having consistently greater odds of expecting benefits and reduced odds of expecting challenges than non-owners. A possible explanation is that previous/current dog owners' exhibit bias when considering dog ownership by selectively recalling positive experiences from previous ownership. Our findings support the need for education of prospective dog owners to ensure their expectations align with the reality of ownership, based on current scientific evidence.

Sociodemographic correlates of prospective dog owners' intentions to participate in controlled trials of dog ownership and human health.

OBJECTIVE: Dog ownership is popular, with research suggesting improvements in physical and psychological health of dog owners. However, majority of these studies were not investigator-controlled. Ethical and practical implications arising from the intervention exposure (dog ownership) result in recruitment difficulties. A fit-for-purpose design, such as delaying dog adoption until after data collection, could alleviate such issues. The purpose of this study was to explore intentions and possible incentives for participation in investigator-controlled trials examining the effects of dog ownership on human physical and psychological health. RESULTS: Female (OR 1.64, 95% CI 1.31-2.04) and older (OR 65+ years 1.49, 95% CI 1.06-2.10) participants were more likely to be interested in taking part in a study investigating the health benefits of dog ownership. Majority reported no incentive was necessary for participation (57%), while others preferred pet food supplies (37%), or vouchers for veterinary care (32%). Over half of participants (53%) were willing postpone adoption for up to 3 months to participate in an investigator-controlled trial. The results of the study, showing majority of participants interested in participating in future studies examining the health benefits of dog ownership and without incentives, provides insight to methodical directions for future studies.