The Campaign for Universal Free Lunch in New York City: Lessons Learned.

The New York City (NYC) Department of Education is the largest public school system in the United States, with an enrollment of >1.1 million students. Students who participate in school meal programs can have higher dietary quality than nonparticipating students. Historically, family income documentation qualifying students in the NYC Department of Education for free or reduced-price meals reimbursed by the National School Lunch Program perpetuated poverty stigma. Additionally, National School Lunch Program qualification paperwork was a deterrent to many vulnerable families to participate and impeded all eligible children's access to nutritious meals, potentially magnifying food insecurity. The Healthy, Hunger-Free Kids Act of 2010 provided a viable option for schools to serve free meals to all students, regardless of income status, as a universal free lunch (UFL) through a Community Eligibility Provision if ≥40% of students already participated in another means-based program, such as the Supplemental Nutrition Assistance Program. In this case study, we describe the processes of (1) strategic coalition building of the Lunch 4 Learning campaign (a coalition of students, parents, school-based unions, teachers, pediatricians, community leaders, and children's advocacy organizations) to bring UFL to all NYC public schools, (2) building political support, (3) developing a media strategy, and (4) using an evidence-based strategy to overcome political, administrative, and procedural challenges. The Lunch 4 Learning campaign successfully brought UFL to all NYC public schools in 2017. This case study informs further advocacy efforts to expand UFL in other school districts across the country and national UFL advocacy.

Child Health Behaviour and Parent Priorities for a School-Based Healthy Lifestyle Programme.

Objective: The purpose of this study was to characterise parents' concerns for their children's health behaviours and perceptions of motivators and barriers to positive child health behaviour change, and to determine associations between motivators and barriers and parents' priorities for a school-based healthy lifestyle programme. Design: Cross-sectional study of 46 parents who had completed an un-validated survey distributed during school-wide events. Setting: School for children aged 5-14 years in The Bronx, New York City, USA. Methods: Wilcoxon Rank Sum tests compared motivators and barriers to positive child health behaviour change by heath behaviour concern; Spearman's correlation measured associations between motivators and barriers and programme priorities. Results: Parents concerned about child weight significantly ranked keeping up with others and decreasing clothing size as motivators, while parents concerned about child food choices significantly ranked improving food choices and decreasing BMI and clothing size as motivators. Food-, play-, and self-esteem-related motivators were associated with nutrition education (rs ≥ .41, p ≤ .01), physical activity classes (rs ≥ .29, p ≤ .04) and child involvement in programme decision-making (rs ≥ .43, p ≤ .01) priorities. Consistency-, child resistance-, and home rules-related barriers were associated with nutrition education (rs ≥ .37, p=.02), physical activity classes (rs ≥ .32, p = .02), and child involvement (rs ≥ .40, p ≤ .02) priorities. Conclusions: Despite the study sample size, selection bias, and generalisability limitations, prioritising nutrition, physical activity and child involvement in programme decision-making may enhance parent support for school-based healthy lifestyle programmes.

Options for Teens with No Options: A Self-Managed Second Trimester Abortion.

BACKGROUND: Several states have deemed abortions as nonessential services, effectively calling for a halt to abortion care during the COVID-19 pandemic. In response, women might elect for self-managed abortions by obtaining abortion medications online. CASE: A 15-year-old girl presented with abdominal cramping and vaginal discharge after taking misoprostol obtained from an online retailer for a self-managed abortion in her second trimester during the COVID-19 pandemic. Her exam showed products of conception protruding from the vagina. The patient was emergently evaluated for an incomplete and possible septic abortion and underwent a dilation and evacuation procedure.

Effects of depression and exercise on health-related quality of life in patients with Parkinson's disease.

OBJECTIVES: There is limited literature describing the effect exercise may have on depression and an individual's health-related quality of life (HRQoL) in Parkinson's Disease (PD). We aim to quantify this effect. METHODS: A cross-sectional questionnaire was administered to 60 PD subjects. The Parkinson's Disease Questionnaire-39 (PDQ-39) summary index and the Geriatric Depression Scale-30 were used to quantify HRQoL and depression, respectively. Data were obtained on exercise habits. ANOVA and multivariate linear regression analysis were used to calculate mean differences in HRQoL. RESULTS: Depression was consistently related to HRQoL (p < 0.05). Of those who exercised as an adult before PD diagnosis, 49.02% (n = 25) reported depression as compared to 88.89% (n = 8) of those who did not report adult exercise (p = 0.03). Those who exercised frequently as an adult prior to PD diagnosis had a better PDQ-39 Cognitive Index (p = 0.03). Those who were not depressed and were currently exercising had a significantly higher HRQoL than those who were depressed and did not exercise (p < 0.01). DISCUSSION: Exercising and depression may interact to affect HRQoL. Thus, coordination of mental health evaluation and exercise regimens in persons with PD may improve HRQoL.

Acceptance of technology-based tools in a sample of Parkinson's patients.

Objectives Parkinson's disease is the second most common neurodegenerative movement disorder in the United States. Patients' opinions of technology-based tools for education and communication as related to Parkinson's disease are unclear with little documented research addressing the issue. The goal of this research was to investigate patient opinions about technology-based tools with a focus on differences between patients of different age groups. Methods A cross-sectional survey was used to assess views on using multiple different electronic methods for receiving instructions and communicating with healthcare providers in 109 Parkinson's disease patients. Results Approximately 28% (n = 28) of the subjects reported having unmet needs related to Parkinson's disease. Those 65 and over were less likely to believe that using technology to communicate with the healthcare center would result in themselves having a better understanding of their care (odds ratio = 0.36, 95% confidence interval: 0.14, 0.95). Those over 75 had a lower odds of being willing to use electronic methods (odds ratio = 0.33, 95% confidence interval: 0.14, 0.79), a lower odds of believing that technology would result in better self-understanding of medical needs (odds ratio = 0.27, 95% confidence interval: 0.12, 0.63) and a lower odds of believing that technology would result in their healthcare providers better understanding their needs (odds ratio = 0.32, 95% confidence interval: 0.14, 0.73). Discussion The results of this study indicate that older Parkinson's disease patients report a less favorable view regarding the role of technology in communicating with healthcare providers and for understanding their care.

Objective quantification of upper extremity motor functions in Unified Parkinson's Disease Rating Scale Test.

Two tri-axial accelerometers were placed on the wrists (one on each hand) of the patients with Parkinson's disease (PD) and a non-PD control group. Subjects were asked to perform three of the upper extremity motor function tasks from the Unified Parkinson's Disease Rating Scale (UPDRS) test. The tasks were: 1) finger tapping, 2) opening and closing of palms, and 3) pronation-supination movements of the forearms. The inertia signals were wirelessly received and stored on a computer for further off-line analysis. Various features such as range, standard deviation, entropy, time to accomplish the task, and maximum frequency present in the signal were extracted and compared. The results showed that among the studied population, "standard deviation", "range", "entropy", "time" and "max frequency" are the best to worst features, respectively, to distinguish between the non-PD and PD subjects. Furthermore, using the mentioned features, it is more probable to distinguish between the non-PD and PD subjects from tasks 2 and 3 as opposed to task 1.