Current algorithms to determine eligibility for prenatal cytogenetic diagnostic services depend critically on the accuracy and precision of the underlying rates of cytogenetic abnormality used in the calculations. We examine the maternal age-specific rates of Down syndrome livebirths in eight studies of European-origin populations, pooled rates from which are widely used for baseline calculations in biochemical screening. These studies vary significantly in such factors as methods of ascertainment of cases, likelihood of complete ascertainment, and methods of correction, if any, for underascertainment. Restriction of analysis to those two studies among the eight whose methods suggest the greatest likelihood of complete ascertainment for Down syndrome generates rates significantly higher than those in widespread use. Confidence intervals about previously reported and currently derived rates indicate that even with large-scale data, there is considerable residual uncertainty in derived rates.
Objectives:
To explore best practices and challenges in providing school meals during COVID-19 in a low-income, predominantly Latino, urban-rural region.
Design:
Semi structured interviews with school district stakeholders and focus groups with parents were conducted to explore school meal provision during COVID-19 from June to August 2020. Data was coded and themes were identified to guide analysis. Community organizations were involved in all aspects of study design, recruitment, data collection, and analysis.
Setting:
Six school districts in California’s San Joaquin Valley.
Participants:
School district stakeholders (n=11) included food service directors, school superintendents, and community partners (e.g., funders, food co-operative). Focus groups (n=6) were comprised of parents (n=29) of children participating in school meal programs.
Results:
COVID-19-related challenges for districts included developing safe meal distribution systems, boosting low participation, covering COVID-19-related costs, and staying informed of policy changes. Barriers for families included transportation difficulties, safety concerns, and a lack of fresh foods. Innovative strategies to address obstacles included pandemic-EBT, bus-stop delivery, community pick-up locations, batched meals, and leveraging partner resources.
Conclusions:
A focus on fresher, more appealing meals and greater communication between school officials and parents could boost participation. Districts that leveraged external partnerships were better equipped to provide meals during pandemic conditions. In addition, policies increasing access to fresh foods and capitalizing on USDA waivers could boost school meal participation. Finally, partnering with community organizations and acting upon parent feedback could improve school meal systems, and in combination with pandemic-EBT, address childhood food insecurity.
Recent water quality crises in the United States, and recognition of the health importance of drinking water in lieu of sugar-sweetened beverages, have raised interest in water safety, access, and consumption. This review uses a socioecological lens to examine these topics across the life course. We review water intakes in the United States relative to requirements, including variation by age and race/ethnicity. We describe US regulations that seek to ensure that drinking water is safe to consume for most Americans and discuss strategies to reduce drinking water exposure to lead, a high-profile regulated drinking water contaminant. We discuss programs, policies, and environmental interventions that foster effective drinking water access, a concept that encompasses key elements needed to improve water intake. We conclude with recommendations for research, policies, regulations, and practices needed to ensure optimal water intake by all in the United States and elsewhere.
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